Module 2 NUR 529

Stress and Adaptation

• The traumatic stress response is a change in the biochemical stress response system that occurs in people who have experienced mistreatment as a child, making it difficult for them to respond effectively to stressors in the future.
• Early intervention can help individuals develop new and effective coping mechanisms to manage stress.
• Caregiver stress can contribute to burnout, leading to decreased patient satisfaction and increased safety risks.
• A study conducted during the COVID-19 pandemic showed that caregivers reported higher levels of caregiver stress and had poorer self-perceived global health ratings due to reduced home and community resources and limited contact with friends and family.

Geriatric Considerations

• Using an interpreter can be helpful when bilingual people use their home language when stressed.
• Caregiver stress contributes to abuse of older adults, highlighting the importance of educating about available resources and support systems.
• Role fulfillment is key to stress management in the aging adult, and sharing the need to allow the person to perform roles within limitations is encouraged.
• Stress is twice as common in people aged 50 to 65 than those aged 65 to 80 years.

Pediatric Considerations

• Chronicity and excessive activation of the stress response can result from chronic illnesses and contribute to the development of long-term health problems.
• Chronic activation of the stress response is an important public health issue from both a health and a cost perspective.
• Stress is linked to various health disorders, including diseases of the cardiovascular, gastrointestinal, immune, and neurologic systems, as well as depression, substance use disorder, eating disorders, accidents, and suicide.
• Allostatic load describes the cumulative effects of chronic stress on one's health, leading to negative effects on the immune, cardiovascular, and metabolic processes.

Hormonal Stress

• Neuroendocrine responses and effects on the body are important aspects of hormonal stress.

Compartmental Distribution of Body Fluids

• Edema can be defined as palpable swelling produced by expansion of the interstitial fluid volume.
• Assessment of edema involves daily weight, visual assessment, measurement of the affected part, and application of finger pressure to assess for pitting edema.
• Treatment of edema is directed towards maintaining life when the swelling involves vital structures, correcting or controlling the cause, and preventing tissue injury.
• Edema of the lower extremities may respond to simple measures such as elevating the feet.

Mechanisms of Acid-Base Regulation

• The lungs play a role in acid-base regulation through the control of extracellular CO2.
• The kidneys are the third line of defense in acid-base disturbances and play three major roles: excretion of H+ from fixed acids, reabsorption of HCO3, and production of new HCO3.

Infectious Diseases

• Diagnosis of an infectious disease requires the recovery of a probable pathogen or evidence of its presence from the infected sites of a diseased host, and accurate documentation of clinical signs and symptoms compatible with an infectious process.
• Culture refers to the growth of a microorganism outside of the body, usually on or in artificial growth media.
• Diagnosis types include culture, microscopy, and biochemical reactions.

Treatment of Infectious Diseases

• Antimicrobial agents can be bactericidal or bacteriostatic, depending on whether they cause irreversible and lethal damage to the bacterial pathogen or inhibit bacterial growth.
• Antiviral agents interrupt viral replication and can interfere with host cell production.
• Antifungal agents target the cytoplasmic membranes of yeasts or molds.
• Antiparasitic agents target essential components of the parasite's metabolism or cellular anatomy that are not shared by the host.
• Immunotherapy involves supplementing or stimulating the host's immune response to limit or reverse the spread of a pathogen.
• Surgical intervention may be necessary to remove infected tissues, organs, or limbs.

Innate and Adaptive Immunity

• Epithelial barriers, such as intact skin, provide a physical barrier against infection.
• Anaphylaxis is a catastrophic, systemic, life-threatening IgE-mediated hypersensitivity reaction that requires immediate management, including withdrawal of the offending allergen, maintenance of a patent airway, and administration of epinephrine.

Innate Immunity Barriers

• Innate barriers, such as the respiratory tract, help protect humans against pulmonary infections.

Chronic Stress and Health

• Chronic stress can lead to chronic illnesses and contribute to the development of long-term health problems.
• Chronic activation of the stress response is a significant public health issue, affecting both health and economic costs.
• Stress is linked to various health disorders, including cardiovascular, gastrointestinal, immune, and neurologic system diseases, as well as depression, substance use disorder, eating disorders, accidents, and suicide.
• Allostatic load describes the cumulative effects of chronic stress on one's health, leading to negative effects on the immune, cardiovascular, and metabolic processes, resulting in inflammation, hypertension, hyperglycemia, and other health problems.
• Increased allostatic load contributes to health disparities in marginalized communities.

Hormonal Stress

• Neuroendocrine responses and effects on the body

Compartmental Distribution of Body Fluids

• Edema is defined as palpable swelling produced by expansion of the interstitial fluid volume.
• Assessment: daily weight, visual assessment, measurement of the affected part, and application of finger pressure to assess for pitting edema.
• Treatment: directed towards maintaining life when the swelling involves vital structures, correcting or controlling the cause, and preventing tissue injury.
• Edema of the lower extremities may respond to simple measures such as elevating the feet.
• Diuretic therapy is commonly used for an increase in ECF volume.
• Albumin may be administered to raise the plasma colloidal osmotic pressure when the cause of the edema is hypoalbuminemia.
• Elastic support stockings and sleeves increase interstitial fluid pressure and resistance to outward movement of fluid from the capillary into the tissue spaces.

Mechanisms of Acid-Base Regulation

• Respiratory: Control of extracellular CO2 by the lungs, which comes into play when chemical buffers do not minimize H+ changes.
• The lungs respond rapidly, preventing large changes in pH from occurring while waiting for the kidneys to respond.
• Kidneys: The third line of defense in acid-base disturbances, playing three major roles:
  • Excretion of H+ from fixed acids that result from protein and lipid metabolism.
  • Reabsorption of HCO3 that is filtered through the glomerulus, so it's not lost in the urine.
  • Production of new HCO3 that is released back into the blood.

Infectious Diseases

• Diagnosis and treatment of infectious diseases require the recovery of a probable pathogen or evidence of its presence from the infected sites of a diseased host, and accurate documentation of clinical signs and symptoms compatible with an infectious process.
• Diagnosis types:
  • Culture: Growth of a microorganism outside of the body, usually on or in artificial growth media.
  • Serology: Indirect means of identifying infectious agents by measuring serum antibodies in the diseased host.
  • Antigen detection: Incorporates features of culture and serology, reducing the time required for diagnosis.
  • DNA and RNA sequencing: Methods such as DNA probe hybridization and polymerase chain reaction (PCR).
• General intervention methods used in treatment of infectious diseases:
  • Antimicrobial agents: Can be categorized according to mechanism of anti-infective activity, chemical structure, and target pathogen.
  • Antimicrobial agents: Antibacterial agents, antiviral agents, antifungal agents, and antiparasitic agents.
  • Immunotherapy: Involves supplementing or stimulating the host's immune response.
  • Surgical intervention: Surgical removal of infected tissues, organs, or limbs, usually only needed when the infective agent is resistant to all treatments.

Innate and Adaptive Immunity

• Epithelial barriers: The intact skin is a formidable physical barrier available to infection.
• Anaphylaxis: A catastrophic, systemic, life-threatening IgE-mediated hypersensitivity reaction associated with the widespread release of histamine into the systemic circulation.
• Clinical manifestations of anaphylaxis occur along a continuum in severity and can be graded on a scale of I to IV.
• Prevention of anaphylaxis is essential, and initial management should focus on withdrawal of the offending allergen, maintenance of a patent airway, establishment of appropriate intravenous access, volume resuscitation, and administration of epinephrine.

Innate Immunity Barriers

• Innate barriers that help protect humans against pulmonary infections:
  • Epithelial barriers

Chemical Defenses

• Mucus-trapped microorganisms are subjected to various chemical defenses throughout the body.
• Lysozyme is a hydrolytic enzyme found in tears, saliva, and human milk that breaks down bacterial cell walls.
• Lysozyme is capable of breaking down bacterial cell walls.

The Complement System

• The complement system is found in the blood and is essential for the activity of antibodies.
• The complement system is composed of 20 different enzyme precursors.
• Activation of the complement system by antigen-antibody complexes causes bacteria to clump together.
• Clumped bacteria are more susceptible to phagocytic immune cells.

Bridging Innate-Adaptive Immune Responses

• The complement system plays a key role in bridging the innate-adaptive immune responses through the release of C3 complement protein.
• Research by Thurman (2020) supports the role of complement in bridging innate-adaptive immune responses.

Defense Mechanisms in the Stomach and Intestines

• Death of microbes in the stomach and intestines results from the action of digestive enzymes, acidic conditions, and the secretion of defensins.
• Defensins are small, positively charged peptides that quickly kill both gram-positive and gram-negative microorganisms.
• Defensins disrupt the microbial membrane, leading to the death of microorganisms.
• Research by Lin et al. (2020) supports the role of defensins in killing microorganisms.

Chemical Defenses

• Mucus-trapped microorganisms are subjected to various chemical defenses throughout the body.
• Lysozyme is a hydrolytic enzyme found in tears, saliva, and human milk that breaks down bacterial cell walls.
• Lysozyme is capable of breaking down bacterial cell walls.

The Complement System

• The complement system is found in the blood and is essential for the activity of antibodies.
• The complement system is composed of 20 different enzyme precursors.
• Activation of the complement system by antigen-antibody complexes causes bacteria to clump together.
• Clumped bacteria are more susceptible to phagocytic immune cells.

Bridging Innate-Adaptive Immune Responses

• The complement system plays a key role in bridging the innate-adaptive immune responses through the release of C3 complement protein.
• Research by Thurman (2020) supports the role of complement in bridging innate-adaptive immune responses.

Defense Mechanisms in the Stomach and Intestines

• Death of microbes in the stomach and intestines results from the action of digestive enzymes, acidic conditions, and the secretion of defensins.
• Defensins are small, positively charged peptides that quickly kill both gram-positive and gram-negative microorganisms.
• Defensins disrupt the microbial membrane, leading to the death of microorganisms.
• Research by Lin et al. (2020) supports the role of defensins in killing microorganisms.