Stress, Exercise, and Immobility NU 206 PDF

 Chapter 4 Stress, Exercise, and Immobility Copyright ©2024 F.A. Davis Company Overview Eustress – Stress that stimulates a person positively Distre...

 Chapter 4 Stress, Exercise, and Immobility Copyright ©2024 F.A. Davis Company Overview Eustress – Stress that stimulates a person positively Distress – Stress that stimulates a person negatively Stress induces a physical response – Human mind-body connection plays a role Emotional and psychological conditions affect the body Physiological disorders influence one’s state of mind Physical Responses to Stress Acute stress – Response to intermittent stimuli – Intensity varies in response to stimuli – Ends after threat avoided Chronic stress – Prolonged activation of stress response – Does not abate rapidly – Linked to disease states  Selye’s Stress Response Theory Adaptability to stressor – Maintain homeostasis General Adaptation Syndrome – Neural, endocrine, immune Stages of stress response – Alarm, resistance, exhaustion  Nervous System Response: Activation of SNS Norepinephrine—Fight or Flight Increases Decreases – Alertness – Blood flow to: – Heart rate GI tract Genitourinary system – Respiratory rate – Vasoconstriction – Pupil dilation – Bronchodilation – Blood flow to muscles – Sweating  Endocrine Response: Adrenal Cortex Hypothalamus—Release CRF Anterior Pituitary—Release ACTH Adrenal Cortex—Release Cortisol Cortisol – Increase blood glucose – Short-term: immune activation – Long-term: immune suppression  Endocrine Response: Adrenal Medulla Release epinephrine Release norepinephrine  Endocrine Response: Posterior Pituitary Release anti-diuretic hormone (ADH) ADH – Decreased urine output Increase blood volume Stress Response: Resistance Stage Stress response continues Time-limited stage – Stress abates: PSNS (parasympathetic nervous system) induces relaxation – Stress does not abate: Body’s ability to respond lessens over time Stress Response: Exhaustion Stage Stress response cannot be maintained – Stress overwhelms the body – Rundown, overwhelmed, and unable to cope Chronic stress – Adversely impacts overall health – Long-term cortisol: suppresses the immune system Increased risk for infection Response to Stressor McEwen’s Stress Response Theory Developed by McEwen in the 1990s Allostasis – Dynamic state of balance Theory – Frequent stressors change physiological balance – Create new setpoint – Example: Chronic stress leading to hypertension (a new, higher setpoint for blood pressure) Allostatic Load Wear and tear on body systems by stress – Due both to the stressor AND the individual’s ability to respond Accumulation – Repeated stressful experiences – Inability to adapt – Prolonged reaction – Inadequate response  Allostatic Overload Stress exceeds ability to adapt – Pathophysiological disorders may manifest Lifestyle choices – Role in the adaptive capacities Allostatic Overload and Societal Pressures Structural Racism – Totality of ways societies foster racial discrimination – Mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice Influence of these societal-level stressors – Health disparities Common Stress-Related Disorders Asthma Hypertension Atherosclerosis Irritable bowel syndrome Autoimmune disease Migraine headache Cardiac rhythm disturbances Peptic ulcer disease Coronary artery disease Skin disorders such as urticaria (hives) Cerebrovascular disease General anxiety disorder Diabetes Treatment of Stress: Lifestyle Practices Reduce caffeine intake Exercise Restorative sleep Psychotherapy – Polysomnography Meditation Examine sleep patterns Yoga Work/leisure balance Stress management Social support programs Use humor Role of Serotonin and Tryptophan Serotonin – Neurotransmitter in brain and GI tract – Levels depleted in stress – GI upset and indigestion – Lack of feeling calm and relaxed Tryptophan – Amino acid, precursor to serotonin – Carbohydrate ingestion Helps facilitate tryptophan uptake by brain Pharmacological Treatments to Reduce Stress Sedatives – Depress CNS resulting in relaxation AKA: tranquilizers, “downers” – Alcohol is a sedating substance Antidepressants – Modulate the neurotransmitters in brain – Serotonin, dopamine – At least 3 weeks to reach therapeutic levels  Benefits of Exercise Typical recommendation is 40 minutes 3 to 4 days per week – Those with underlying health issues (cardiovascular disease, diabetes, etc.) should consult a physician  Epigenetics and Exercise Epigenetic modifications occur with continual aerobic and resistance exercise – Cells of brain, blood, skeletal and cardiac muscle, and adipose tissue Mechanism by which exercise confers a healthier phenotype Exercise vs Inactivity Body System Exercise Inactivity Cardiovascular Lower blood pressure Decondition of heart Reduced CVD risk muscle Pulmonary Increased oxygenation Increased risk Increased depth/rate of atelectasis breathing Decreased pulmonary function Gastrointestinal Reduced colon cancer Diminished risk peristalsis Increased peristalsis Increased constipation Skeletal/ Increased muscle Loss of bone mineral Muscular strength density Increased bone mineral Loss of muscle mass density Psychological Increased endorphins Depression, fear, effects Stimulate mood swings neurotransmitter Inactivity: Circulatory System Venous stasis – Increased risk for edema and blood clots – DVT: deep vein thrombosis – Pulmonary embolism: venous clot from legs travels to lungs Orthostatic hypotension Natriuresis – ADH and aldosterone inhibited – Increased water loss from body Inactivity: Joints and Muscles Without activity, joints assume flexion contractures Assume fetal position Clinicians need to: – Ensure proper body alignment – Turn immobile patients – Passive daily range of motion work Inactivity: Additional Systems Renal system Metabolic and endocrine – If supine, urinary stasis and – Increased muscle protein UTIs ’ breakdown GI system – Negative nitrogen balance – Decreased intestinal – Glucose intolerance increases absorption – Increased risk for Gastroesophageal reflux  Harmful Effects of Immobility: Integumentary System Bedrest pressure sores may develop Decubitus ulcers – Stage I: Persistent skin redness – Stage II: Loss of epidermal or dermal layers – Stage III: Deterioration of layers deep to dermis – Stage IV: Loss of full thickness of tissue, down to muscle and bone Decubitus Ulcers  Harmful Effects of Immobility: Integumentary System Frequent repositioning – At least every 2 hours – Provide padding for areas – Use TED stockings to facilitate venous return If ulcer forms, wound care is necessary If ulcer becomes infected, may extend into bloodstream resulting in septicemia Clinical Concept Examples Clinical Example Concept Surgery Physical/psychological stressor Cortisone prescription Suppress ACTH signaling May reduce ability to respond to stressor Anti-depressants May require 3 weeks to reach therapeutic levels Breathing More energy to breathe in supine position Upright, seated better position Urinary infection Immobility predisposes to urinary stasis, increasing risk for infection  Alerts! Diabetes mellitus – Be vigilant against hypoglycemia with intense exercise Orthostatic hypotension – Older individuals at increased risk Pressure injuries – Vulnerable to bacterial contamination and infection