Learning Module 2A: Protection & Comfort PDF

Learning Module 2A: Protection & Comfort NUR 370 Rebecca Young, MS, RN, CCRN  Learning Objectives 1. Describe the sequence of events in the immune and inflammatory responses 2. Discuss the role of anti-inflammatory agents and immunizations in...

Learning Module 2A: Protection & Comfort NUR 370 Rebecca Young, MS, RN, CCRN  Learning Objectives 1. Describe the sequence of events in the immune and inflammatory responses 2. Discuss the role of anti-inflammatory agents and immunizations in mitigating the inflammatory response and prevention of diseases 3. Differentiate between normal and abnormal anatomy and physiology of the autonomic nervous system 4. Determine the mechanism of action, indication(s) and expected/unexpected outcomes of medications impacting protection and comfort 2  Autonomic Nervous System Regulates homeostasis of the body’s normal functions through CNS, PNS, and endocrine responses Nerve impulses in PNS are sent to thalamus, medulla, & spinal cord (CNS) From the CNS, impulses are sent out to stimulate organs, glands, muscles Blood pressure, heart rate, respiratory rate, temperature, fluid status, urinary output, digestion Parasympathetic vs. Sympathetic 3  Sympathetic Nervous System “Fight-or-flight”: response to a stressor CNS cells in thoracic and lumbar areas of spinal cord stimulate nerve ganglia Neurotransmitters released: primarily norepinephrine and epinephrine Because the body is attempting to survive, it picks organ systems that are most beneficial: heart rate, blood pressure, respiratory rate, bronchodilation, pupil dilation, breakdown of glucose Elimination, digestion, reproduction all slow 4 Fight or Flight Response Figure 29.3 Tucker/Karch 5  Adrenergic/Sympathetic Receptors Alpha and Beta receptors that respond to circulating epinephrine and norepinephrine Alpha1, Alpha2, Beta1, Beta2 Respond differently based on concentrations of neurotransmitters Some drugs may be specific to receptor type, others stimulate all receptors More specific drugs result in less systemic side effects 6  Adrenergic Agonists Contraindications: Alpha and Beta Adrenergic Pheochromocytoma Tachyarrhythmias, VF Agonist: dopamine, epinephrine Hypovolemia (give fluids) Mechanism of Action: dopamine: Increased HR, increased BP; preserves Adverse effects: blood flow to kidneys Effects on the heart/CV Treats shock Arrhythmias, hypertension, palpitations, angina, dyspnea epinephrine: Vasoconstriction, increased HR, Depressant effects on the GI tract increased BP, bronchodilation Nausea, vomiting, constipation Treats shock, severe bronchospasm (asthma), anaphylaxis Sympathetic stimulation effects Pharmacokinetics: IV or IM Headache, sweating, feelings of tension or anxiety, and piloerection 7 Physiological effects of adrenergic stimulation: Adrenergic Agonists cause stimulation of adrenergic receptors, producing physiological effects associated with sympathetic stimulation. 8  Nonselective Adrenergic Blocking Agents Nonselective adrenergic blocking agents: labetalol Mechanism of action: blocks the effects Adverse effects: bradycardia, of norepinephrine at alpha and beta-receptors hypotension, bronchospasm, cough throughout the SNS, decreasing BP, HR and improving renal perfusion. Client/Therapy Management Treats hypertension and tachycardia Monitor HR, BP, & blood glucose Pharmacokinetics: Oral or IV Contraindications: Bradycardia, heart block, asthma Caution with clients diagnosed with diabetes (masks symptoms of hypo/hyperglycemia) 9 Effects of Nonselective Adrenergic Blockers Block the effects of the sympathetic nervous system; results in lack of SNS stimulation 10  Parasympathetic Nervous System “Rest and digest”: slows metabolism/function to conserve energy CNS cells in cranium and sacral areas of spinal cord stimulate nerve ganglia Neurotransmitters released: acetylcholine Conserve energy, build up proteins and nutrients, increase digestion: motility/secretions in GI tract, heart rate, bronchoconstriction, relaxation of sphincters, contraction of urinary bladder, pupil constriction 11  Cholinergic/Parasympathetic Receptors Receptors found in muscle or organs Muscarinic or nicotinic Respond differently based on concentrations of neurotransmitters Drugs tend to stimulate all cholinergic receptors, so see systemic effects throughout the body Some drugs are specific to muscarinic vs. nicotinic receptors 12  Direct-Acting Cholinergic Agonists Direct-Acting Cholinergic Agonists: bethanechol Adverse effects: Mechanism of action: Systemic effects of mimics acetylcholine and parasympathetic stimulation parasympathetic Treats urinary retention, stimulation: bradycardia, atonic bladder; glaucoma hypotension, heart block Bladder spasm Pharmacokinetics: Oral Contraindications: bradycardia, hypotension, and coronary artery disease 13 Effects of Direct-Acting Cholinergic Agonists Parasympathetic system activation 14  Anticholinergic Agents/Parasympatholytic Anticholinergic Agents: atropine Adverse effects: blocking of cholinergic receptors so see Mechanism of action: block more sympathetic effects acetylcholine receptors, no CNS- blurred vision, photophobia, parasympathetic stimulation dizziness, insomnia, confusion Treats bradycardia, secretions CV- tachycardia GI- dry mouth, altered taste, Pharmacokinetics: PO, IM, IV, constipation, bloating subcutaneous, and ophthalmic routes GU- hesitancy, urinary retention Gen- decreased sweating, heat Contraindications: intolerance Obstruction risks: glaucoma, paralytic ileus, GI obstruction, benign prostatic Client/Therapy Management: Monitor heart rate & blood pressure hypertrophy, bladder obstruction Monitor neuro status Cardiac impairment: cardiac arrhythmias, tachycardia, MI 15 Effects of Anticholinergic Agents Block the effects of acetylcholine, parasympathetic system is blocked 16  Stress Response Homeostasis: maintenance of stable internal environment Threatened during a stress response Ideally, stress responses should be acute. If chronic, issues result with a suppressed immune system and increased energy demands; body begins to break down Stress response is designed to protect the body but if overwhelmed, can cause damage to the body Control systems and feedback mechanisms in place to regulate cell function 17  Control Systems/Feedback Mechanisms Control systems integrate the body’s responses to stressors (physical, emotional, behavioral) and create a stress response Sensor: detects the change Integrator: assesses incoming information and compares it to “normal” Effector: attempts to reverse the change Negative feedback system: decrease occurs of substance, body stimulated to increase it// increase occurs of substance, body stimulated to decrease it 18  General Adaptation Syndrome (GAS) HPA axis plays a large role in stress response (hypothalamus- pituitary-adrenal) Regulates ANS and neurotransmitter release 3 stages: alarm, resistance, fatigue Alarm: stimulation of sympathetic nervous system HPA axis stimulated: epinephrine, norepinephrine, dopamine, cortisol release Resistance: most efficient defenses are initiated Cortisol decreases 19  General Adaptation Syndrome (GAS) Fatigue: stressor is prolonged or overwhelms the body Resources are depleted Systemic damage to the body occurs Conditioning factors: how do different people respond and adapt to stress? Age, genetics, sex, life experience, nutrition, social support Body reserve, health status, circadian rhythm, hardiness (control over environment + purpose in life), psychosocial factors 20  Acute Stress Should be an acute and time-limited trigger Fight-or-flight response (SNS): pounding headache, increased vital signs, increased alertness, blood diverted away from less essential organs Client with limited coping may develop stress-induced disease processes: anxiety, depression, eating disorders, sleep disorders, high blood pressure (hypertension), pain, infection, migraine 21  Chronic Stress Chronic intermittent: stressor exposed to many times, over time Chronic sustained: stressor exposed to constantly, does not dissipate HPA axis becomes overactive or underactive: Failure in neural or hormonal connections Stressor stimulus is prolonged Stressor stimulus is so great it overwhelms the system Impacts cardiac, immune, neurological gastrointestinal, substance use, mental health 22 23