Stress Response: SAMR and GAS

Stress Response/SMR/GAS

• Stress responses encompass the Sympatho-Medullary Response (SAMR, or sympatho-adreno-medullary response) and the General Adaptation Response (GAS).
• Diaphoresis, or excessive sweating, occurs.
• Blood pressure and pulse rate elevate.
• The respiratory rate and depth increase.
• Skin exhibits pallor and feels cold and clammy.
• Weight loss, weakness, and anorexia (loss of appetite) manifest.
• Changes in bowel habits include diarrhea or constipation.
• There is an increased frequency of urination, potentially leading to oliguria (reduced urine output) or anuria (absence of urine output).
• Transient hyperglycemia, or high blood sugar, is observed.
• Visual acuity may improve temporarily.
• The hypothalamus initiates these responses.

Hypothalamus & Adrenal Glands

• The hypothalamus stimulates the sympatho-adrenal medullary system as well as the adreno-cortical system.
• The adrenal glands are located on top of the kidneys and consist of the adrenal medulla and adreno-cortical areas.

Adrenal Medulla

• The inner portion of the adrenal glands secrets catecholamines like epinephrine and norepinephrine.
• Epinephrine and Norepinephrine act on the body
• Epinephrine/Adrenaline functions as a vasodilator in coronary, cerebral, and peripheral blood vessels.
• Epinephrine/Adrenaline functions as a vasoconstrictor in peripheral arterioles.
• It promotes glycogenolysis, the breakdown of glycogen in the liver.
• Norepinephrine/Noradrenaline primarily functions as a vasoconstrictor.

Adrenal Medulla Effects

• Coronary arteries dilating leads to improved myocardial perfusion, increased myocardial contraction, and a higher pulse rate.
• Dilation of peripheral blood vessels occurs alongside the relaxation of smooth muscular bronchioles.
• Bronchodilation leads to increased respiratory rate and depth.
• Constriction of peripheral arterioles increases peripheral resistance and blood pressure.
• Skin arteries constricting results in pallor due to reduced blood supply.
• Glycogenolysis increases, and the sweat glands are stimulated.
• The gastrointestinal tract experiences decreased gastric secretion and motility.
• The urinary bladder muscle relaxes while the urinary sphincter closes, resulting in reduced urine production or its absence.
• Pupils dilate, improving visual acuity.

Adrenal Cortex & Neurohypophyseal

• Within the adrenal cortex, glucocorticoids promote gluconeogenesis, increasing CHON catabolism and nitrogen loss.
• Glucocorticoids/Steroids: nitrogen balance can switch to positive with more protein anabolism over catabolism.
• Mineralocorticoids/Aldosterone: retain sodium & fluid while excreting potassium and potentially leading to oliguria (<400 ml in 24 hours) or anuria (<100 ml in 24 hours).
• The neurohypophyseal area, comprised of the anterior (adenohypophysis) and posterior (neurohypophysis) areas, controls hormone secretion.
• Anterior neurohypophyseal hormones: TSH, ACTH, FSH, LH, MSH (Melanocyte-Stimulating Hormone), SH (Somatotrophic Hormone) and GH
• the hormones in the posterior neurohypophyseal area are ADH and Oxytocin.

Endocrine Activity

• Hypoactivity in endocrine glands can stem from congenital absence of glands, surgical removal, or idiopathic atrophy.
• Hyperactivity: results from tumors or failure of kidneys to secrete hormones and failure of liver to deactivate of hormones
• Decreased Anterior Pituitary Gland (APG) Activity results in pituitary dwarfism.
• Frohlicks Syndrome, marked by dwarfism with doubled infant size, obesity, intellectual disability, and genital atrophy.
• Simmonds disease/ Pituitary Cachexia: causes a wizened appearance, mental lethargy, loss of teeth, and amenorrhea.

Increased APG Activity

• Gigantism occurs prior to the closure of epiphyseal lines.
• Gigantism rapid growth of long bones resulting in their prolongation or elongation.
• Acromegaly: bone thickness & hypertrophy of soft tissues after closure of epiphyseal line
• Acromegaly can cause enlargement of cartilages in the nose, ears, and larynx, causing a deepened voice.
• Acromegaly causes prognathism (protrusion of the jaw) and teeth separation.
• Also causes thickening of oral mucous membranes, lengthening of the chin, and broad, spade-like fingers.
• It can lead to the enlargement of visceral organs.

Endocrine Management + Diabetes Insipidus

• Management with Cobalt therapy, surgical removal, or inhibit production of growth (Somatostatin or Octreotide).
• Diabetes Insipidus: water metabolism disorder stems from decreased ADH. It prevents renal tubules from water reabsorption, leading to polyuria (5-29 L/24 hours) and polydipsia.
• Electrolyte tests used to diagnose Diabetes Insipidus
• Dilated urine (decreased specific gravity = 1.010-1.025) increases sodium count (135-145 mEq/L)

Treating Diabetes Insipidus, SIADH

• Oily adh preparations require deep IM administration rotate
• Treatment with vasopressin as a vasoconstrictor may cause HPN
• Nasal sprays with desmopressin acetate or lypressin increase ADH hormone
• Anti-lipidemic treatment with Clofibrate/Atromid S/Clo 5 combats excessive lipind in blood
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - increased ADH causes fluid retention.
• Electrolyte dilution, or dilutional hyponatremia, results in fluid moving into the cell and causing cerebral edema increased ICP.
• Increased IV volume (hypervolemia) and Renal perfusion enhances (GFR), increasing UO which causes hyponatremia
• Treat by restricting fluids

SIADH, Parathormone, Hypoparathyroidism, Tetany treatment

• Treat ADH overproduction through Demeclocyline/Declomycin PO
• Parathormone promotes Calcium reabsorption, Potassium excretion, and regulates cardiac rhythm and blood coagulation.
• Hypoparathyroidism causing hypocalcemia (hyperphosphatemia) treats: 4.5-5.5 mEq/L with 8-11 mg/dL High calcium diet.
• Treatment with (+) Chvostek - by tapping the Facial, will cause twitching of face.
• Treatment with Trousseau will cause carpopedal spasm

Conn's Hyperaldosteronism

• Leads to tumor on the adrenal cortex, a gland superior of the Kidneys
• Tumors being benign leads to hyperactivity
• Glucocorticoid/steroid: fat turns lipolysis (fat distribution), abnormal wasting
• CHON:Increased CHON catabolism resulting to tissue starvation & muscle wasting Mineralocorticoid/aldosterone causes Na retention

Cushing's, Addison's + Treatment

• Cushing's includes increased, Sugar + Salt + sex hormones all increased:

• Hyperglycemia

• Moon facies + Buffalo hump + truncal obesity.

• Increased BP + Hypernatremia + Hypokalemia

• Virilism + Masculinization + Hirsutism

• Treat with Cobalt therapy, or adrenalectomy

• Addison's includes decreased Sugar + Salt + Sex

• Hypoglycemia

• Low BP + Hyponatremia

• Myocardial irritability + altered electrical conduction + dysrhythmias + heart arrest

Adrenal Cortex, Pheochromocytoma

• Adenoma of adrenal cortex (benign) leads to hyperactivity
• Pheochromocytoma: Adenoma of adrenal medulla (benign) leads to hyperactivity with increased hypertension, hyperglycemia, hypermetabolism, and hyperhidrosis.
• Treat with cobalt or adrenalectomy, radiation etc
• Diagnose high catecholamine levels with blood and urine tests

Thyroid Gland, S/S, RAIU

• The thyroid gland consists of the isthmus that connects the two lobes.
• The thyroid produces hormones:T3 and T4 regulate TSH and thyrocalcitonin.
• Diagnonistic tests for thyroid conditions
• Levels of hormones use feedback mechanisms to control the anterior pituitary
• Inversely proportional to urine; directly proportional to uptake
• Evaluate radioactive iodine 131 levels in the thyroid gland and kidneys
• No intake of iodine

Hyper/Hypothyroidisim, Treatmenr Options

• Hyperthyroidism has elevated T3 and T4. Treat with ant-thyroids to prevent symptoms and synthesis.

• Grave's disease will occur with increased amounts of T3 TO T4

• Hypothyroidism is a failure of thyroid gland to secrete T3 TO T4 causing sever deficienceis • RAIU - evaluate RAI 131 to determine the location of thyroid gland

• For a high-anxious level of thyroid gland, start anit-thyroid prep three months prior and end in a normal T3 T4

• For surgeries that invole the gland treat as with other conditions with these examples

  • Sistrunk's - thyroglossal cyst
  • Partial/Subtotal thyroidectomy - takes 5/6 of 2 lobes
  • Radical/Total thyroidectomy - a collar like incision on the sternum

Thyroid Surgeries Complications + DM

• To avoid Tetany during thyroid surgery: avoid excising too much tissue for an easy removal of parathyroid glands

• Bleding + Airway complications require vigilance, support for recovery including diet

• Blood test include • FPG, RBS, PPBS, OGTT, Hgt • HHNK Coma/HHNS

  • Hyperglycemia over 1.5x diuresis
  • Lipolysis/ oxidation creates Ketone bodies
  • Normal Blood sugar

• Treatment Options include • Exercise as need, limit and monitor for glucose needs • Alert for low glucose

Neurologic Conditions: Lesions, Tumors

• Brain has many different functions: each has its own condition for awareness
  • Pareital deals with sensation
  • Occipital deals with vision • Causes stemming from lesions lead or result tumors and hematomas
  • May have metabolic depression and may present toxins as part of the causes

• Assessment for patients under these conditions - Glasgow Coma Scale and check pupillary dilation with a Ophthalmoscope

GCS, Refelxes

• GCS checks for - Eye opening - Verbal Response - Motor Response - Can assess to a spinal level (Decorticate and motor functions)

Refelx Conditions include many levels within the extremities and joints such as

• Knee, and bicep
• Babinski fanning (a defeciency)
• Spinal Lesions (Kernig or Gordon)

FAST MEDICAL SURGICAL NURSING

Decerebrate is diencephalon and brain stem affectation (medulla - respiratory paralysis) Disease of pons and midbrain decorticate and decerebrate at the same time Pain is mid-epigastric, burning, gnawing Gastric ulcer - Radiate to left epigastric (2-4 hrs. p.c. with Food that worsens condition and Vomiting that relieves) Duodenal ulcer- Radiate to right epigastric Food - improve (30 min. 2 hrs. p.c.)

• weight loss - with Decrease HCI

PUD Treatment

• Patients should receive buffers - food and antacid (an hour after meal, in between meals, at bedtime) Decrease CHON (potent secretagogue → HCI) - Increase CHO
• Encourage fat intake (polyunsaturated) Administer H2-receptor antagonist (block release of histamine by parietal cell) Antacid and H2 blocker- can be both given

PUD Complications

• Complingations include perforation (infection and abdominal rigidity
• May even trigger bleeding and pyloric obstruction
• Treat these complications via different surgeries O Billroth I, remove distal third → anastomose to duodenum O Billroth II/Polya/Hoffmeister • Gastrorrhaphy - Suture-up perforations

Management, IBD

Management is based on the specific conditions present and based on individual needs Remove antrur for Pyloric and peptic relief via Anastomies: A) gastrorrhaphy to duodenum B) antrectomy to jejunum O Vargotomy requires large opening in the area

Dumping Syndrome may also result in the development Causes:

• Rapid passage of hyperosmolar solution into a) Local: leads to local extention b) Extreme effect triggers shock c) food intake and chons should be in proper order

Bowel Inflammations

Cohns and Ulcerative Colitis a) crohn's are transmursla (all layers) with Ulcerative being limited to a segment: small and terminal b) Ulcerative includes the entire length of the colon with descending effects

Pathology of said conditions A ) hereditary conditions leading the a subnucosal B) ascending bacterial conditions leading to more conditions

Diarrhea is also expected from these conditions, but may manifest as loose or more water like

Colon Manifications

Includes mechanicisms relating to Tumors and Polips

• The colon (Ascendin and Descending) are responsible for Solds, Chrome, and Ulcerating

1. If one is high in one they will be lower in another
2. Most Colon issues relate to dietary effects and consumption • With symptoms ranging low - and - high with: A) R and L Melena B) Absences C) Decompressions

Hepto-biliary Disorders

Liver Cirrhosis a condtion based on bile acid production

• may be based on Laennec's or cardiac defects
• Early S/S include Hepatomegaly
• Late include: - Small conracted, atrophic and shorted liver - Alcholism All which lead to:

1. Portal Hypertension -> Early sign of Ascites or Esophogial Varicies
2. Splenomegaly
3. Edema
4. hemorrhoids

• This requires shunts on the patient
• PV lVC
• SvlRv
• Msc-IVC
• HassaBs

AH + BT Management + Pancreatits

• Failure to detox happens then AMonia (happen) causing hepatic or Encepelaputhy

• Hepateucs can only be treated with:

• High then low proten - regeneration

• Anti- coma regins

  • Enema to clean colon
  • Enema Neomyocin "
  • Diactulose

• Pancreatits is due to alc abuse to drug intake and must be monitoed, to avoid the deadly causes of death

• Treatment is non-existant

Biliary Contions

• Most common condition, to avoid and check when it occurs (post operation)
• Metabolic issues, from obesity, cause gallstones
• Nicotine effects should also be moniterend
  • A) vasoconsitricts
  • B) decreases Alkinity Symptoms include Jaundic from either hemolysis or structure damages (cholocitits)

Burn Management

• The process of identifying a burn comes in 4 ways:

1. thermal- caused by touch with heat
2. chemical- related to interactions of the cells wth their structures
3. electrical with current
4. chemical based off of damage

• Injuries related to skin, with flud repsonise and high damage to cells
• Treatment has a acute care focus, for support and healing

Burns Classification + Manifiestations

Burns are diagnosed related to zone and how they are present depending on the degree

1. Thermal A) location for easy id B) color of skin
2. electrical A) voltage B) Amperag

1* In relation to thermal A) causes and problems may show:

• Fluid restrictions to treat damage,
• Hyper, then hypo natreimia
• electrolyte imbalance causing hypermia
• Manifestations A) pain and aniexity B) Shock and fluid Loss

Burn Phases + Treatments

• Requires more information for blood pressure and function Phase 1: (hypo)volemic shock, until fluid and diuretiion - greates threat is from Hypovolemic to decrease osmotic for better function

Phase 2: treatmemt - Check for wound infection - Antibiotics • General info:

• Never add tape
• Maintain a safe and clean environment
• • Monitor Labs and values to determine best functions (Electrolytes)

Musculosketetal + Neurological + GI System Complications

• May trigger Musculosketetal systems
• Deacreased Rom, leads to contractures
• Muscle weakness, GI and neuro as well General info:
• Most problems can be corrected with early diagnosis
• With proper information and function you can improve life quality
• with an emphasis on healing

Genitourinary Systems

• All related to kidney function, the ureters, bladder
• UO is crucial, all of the parts related to it is a problem
• UTI and kidney functions are critical and must be prevented
• Cancer, or damage and infection in this area is critical and a life threatening issue

Treatments

Medical Treatment + Complications

• Medical treatments for various genitourinary conditions
• • TURP (Tamsyosin, Cialis)
• • Palametto
• General concepts: • Never be afraid to check on wounds and patients • The goal is to create or maintain the patients standard of life • Patient will need support and help to get their.
• Common in conditions
• ** Negligence with actions

End of notes

Hopefully this help all information with it. The data is extensive so it is expected that you use this information as reference and look up some other data I have attempted to include to the best of abilities what is needed and required, while keeping the details to the minimal Good luck