Stress and Adaptation (PDF)

Module 3: Inflammatory Response Lesson 1: Stress and Adaptation Stress is a natural feeling of not being able to cope with specific demands and events. However, stress can become a chronic condition if a person does not take steps to manage it. These demands can come from work, relationships, finan...

Module 3: Inflammatory Response Lesson 1: Stress and Adaptation Stress is a natural feeling of not being able to cope with specific demands and events. However, stress can become a chronic condition if a person does not take steps to manage it. These demands can come from work, relationships, financial pressures, and other situations, but anything that poses a real or perceived challenge or threat to a person’s well-being can cause stress. Stress can be a motivator, and it can even be essential to survival. The body’s fight-or-flight mechanism tells a person when and how to respond to danger. However, when the body becomes triggered too easily, or there are too many stressors at one time, it can undermine a person’s mental and physical health and become harmful. When the body is threatened or suffers an injury, its response may involve functional and structural changes; these changes may be adaptive (having a positive effect) or maladaptive (having a negative effect). The defense mechanisms that the body uses determine the difference between adaptation and maladaptation—health and disease. This module discusses homeostasis, stress, adaptation, health problems associated with maladaptation, and ways nurses can intervene to reduce stress and its health-related effects. Unit I. Introductory Concepts Homeostasis-Stress & Adaptation Homeostasis- Stress and Adaptation 1.Definitions Stress and Stressors Homeostasis and Adaptation 2.Models of Stress Stimulus Based Model Response Based Model Transaction Based Model 3.Physiological Adaptation Pathway 4. Psychological Adaptation Anxiety Level of Anxiety 5. Stress Management Promoting Healthy Lifestyle Enhancing Coping Strategies Teaching Relaxation Techniques Educating About Stress Management Enhancing Social Support Stress: is a state produced by a change in the environment that is perceived as challenging, threatening or damaging to a person’s dynamic balance or equilibrium. TYPE of STRESSORS: Physical stressors Cold Heat Chemical agents Physiologic stressors Pain Fatigue Psychosocial stressors Fear of failing an examination Losing a job Waiting for a diagnostic test result Let’s Differentiate: Adaptation a change or alteration designed to assist in adapting to a new situation or environment This is the process of coping with the stress, a compensatory process that has physiologic and psychological components Adaptation is a constant, ongoing process that requires a change in structure, function, or behavior so that a person is better suited to the environment; it involves an interaction between the person and the environment. Homeostasis a steady state within the body; the stability of the internal environment When a change or stress occurs that causes a body function to deviate from its stable range, processes are initiated to restore and maintain dynamic balance. When these adjustment processes or compensatory mechanisms are not adequate, steady state is threatened, function becomes disordered, and dysfunctional responses occur The goal of the interaction of the body’s subsystems is to produce a dynamic balance or steady state (even in the presence of change), so that all subsystems are in harmony with each other. Four concepts—constancy, homeostasis, stress, and adaptation— are key to the understanding of steady state Models of Stress Stimulus Based Model Response Based Model Transaction Based Model Stimulus-Based Model of Stress It proposed that life changes (LIFE EVENTS) or (STRESSORS), either positive or negative, are stressors that tax the adaptation capacity of an individual, causing physiological and psychological strains that lead to health problems. They developed the Social Readjustment Rating Scale (SRRS). They hypothesized that people with higher scores in the SRRS, -that is major life changes-are more likely to experience physical or mental illness. Holmes and Rahes advanced this theory Sample of the Social Readjustment Rating Scale (SRRS). Response Based Model of Stress It is represented in the well-known theory of Hans Selye It is similar to the “Fight or Flight” response, which occurs in situation that perceived as very threatening. The response is a physiological one in which arousal of the sympathetic nervous system results in many physiological and somatic changes and finally disruption of homeostasis. A. Psychological Response to Stress B. Physiologic Response to Stress RESPONSE BASED MODEL GENERAL ADAPTATION SYNDROME (GAS) RESPONSE BASED MODEL: LOCAL ADAPTATION SYNDROME Local Adaptation Syndrome (LAS) – Response of a body tissue, organ or part to the stress of trauma, illness or other physiological change Characteristics 1.The response is localized, it does not involve entire body systems 2.The response is adaptive, meaning that a stressor is necessary to stimulate it 3.The response is short term. It does not persist indefinitely 4.The response is restorative, meaning that the LAS assists in restoring homeostasis to the body region or part Two Localized Responses 1. Reflex Pain Response – is a localized response of the central Nervous system to pain. It is an adaptive response and protects tissue from further damage. The response involves a sensory receptor, a sensory nerve from the spinal cord, and an effector muscle. 2. Inflammatory Response – is stimulated by trauma or infection. This response localizes the inflammation, thus revenging its spread and promotes healing. The inflammatory response may produce localized pain, swelling, heat, redness and changes in functioning. The Transactional Model of Stress Lazarus& Folkman They believe that people have the capacity to think, evaluate, and then react. Thinking can make stress either better or worse. Lazarus developed an interaction theory that proposed TWO- STAGE PROCESS of appraisal: A Primary Appraisal Process: Determine whether the event represents a threat to the individual. It has three outcomes: 1.Events regarded as irrelevant. 2.Events regarded as positive to well being. 3.Events regarded as negative to well being. This negative appraisal leads to: A Secondary Appraisal Process: Here the individuals assess their COPING RESOURCES. These resources include environmental factors, social support or help, knowledge, and skills to reduce this threat. Physiological Adaptation How does the brain interpret Stressful Stimuli? Interpretation of Stressful Stimuli by the Brain Limbic System – contains amygdala, hippocampus and septal nuclei eg. Eating, drinking,temperature control,reproduction, defense, aggression) Cerebral hemisphere – concern with cognitive functions Reticular Activating System (RAS) – network of cells that forms a two-way communication system Psychological Adaptation Mediating Process – after recognizing a stressor, a person consciously or unconsciously reacts to manage the situation. Psychological Adaptation COPING with the Stressful Event consists of the cognitive and behavioral efforts made to manage the specific external or internal demands that tax a person’s resources and may be emotion-focused or problem-focused. Adaptation to ANXIETY. How does this happen? ANXIETY Level of Anxiety I. Mild anxiety II. Moderate Anxiety III.Severe anxiety IV.Panic Stress Management 1. Promoting Healthy Lifestyle 2. Enhancing Coping Strategies 3. Teaching Relaxation Techniques 4. Educating About Stress Management 5. Enhancing Social Support Lesson 2: Inflammatory Process Disease and Illness Definition of Terms Disease an alteration in body function resulting in reduction of capacities or a shortening of the lifespan. Illness a highly personal state in which the person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is thought to be diminished ILLNESS Types of illness/disease acc. to duration: Acute- abrupt onset and short duration, may not require intervention Ex. Common colds Chronic – insidious onset and usually last for an extended period of time usually characterized by remissions and exacerbations Illness Behavior ways people describe monitor and interpret thei symptoms, take remedial actions and use the health care system Illness Behavior Affected by: Age Sex Occupation socioeconomic status Religion ethnic origin psychological stability Personality education modes of coping. 4 aspects of the sick role: 1. Clients are not held responsible for their condition 2. Clients are excused from certain social roles and tasks 3. Clients are obliged to get well as quickly as possible 4. Clients or their families are obliged to seek competent help 5 Stages of Illness according to Suchman: 1. Symptom experience person comes to believe that something is wrong consults others about the symptoms may self medicate 3 Aspects: a. Physical experience of symptoms b. Cognitive aspect c. Emotional response 2. Assumption of the sick role person accepts the sick role and seeks confirmation from family members and friends often continue self treatment and delay consultation as long as possible may have anxiety, fear or depression may be excused from normal roles or duties : 3. Medical care contact seeking medical help either by own initiative or at the urging of others Information usually sought by patients: Validation of real illness Explanation of the symptoms in understandable terms Reassurance or prediction of condition 4. Dependent Client Role acceptance of the client role may vary from one client to another 5. Recovery or Rehabilitation the client is expected to relinquish the dependent role and resume former roles and responsibilities Effects of Illness/Disease: Impact on the Client Behavioral or emotional changes Change in body image Vulnerability for loss of autonomy Changes in lifestyle Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death Cellular Responses to Stress Introduction to Pathology Pathology is the study (logos) of disease (pathos). It is devoted to the study of the structural, biochemical, and functional changes in cells, tissues, and organs that underlie disease Four aspects of a disease process 1. cause (etiology), 2. the mechanisms of its development (pathogenesis), 3. the biochemical and structural alterations induced in the cells and organs of the body (molecular and morphologic changes) 4. the functional consequences of these changes (clinical manifestations). Stages of the cellular response to stress and injurious stimuli Adaptations of Cellular Growth & Differentiation Hypertrophy refers to an increase in the size of cells, resulting in an increase in the size of the organ. can be physiologic or pathologic and is caused by increased functional demand or by stimulation by hormones and growth factors Compensatory hypertrophy is the result of an enlarged muscle mass and commonly occurs in skeletal and cardiac muscle that experiences a prolonged, increased workload. One example is the bulging muscles of an athlete. Atrophy can be the consequence of disease, decreased use, decreased blood supply, loss of nerve supply, or inadequate nutrition. Disuse of a body part is often associated with the aging process and immobilization. Cell size and organ size decrease, and the structures principally affected are the skeletal muscles, the secondary sex organs, the heart, and the brain. Hyperplasia is an increase in the number of new cells in an organ or tissue. As cells multiply and are subjected to increased stimulation, the tissue mass enlarges. This mitotic response (a change occurring with mitosis) is reversible when the stimulus is removed.This distinguishes hyperplasia from neoplasia or malignant growth, which continues after the stimulus is removed. may be hormonally induced. An the thyroid gland caused by thyroid stimulating hormone (secreted from the pituitary gland) when a deficit in thyroid hormone occurs. Dysplasia is bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same tissue type. Dysplastic cells have a tendency to become malignant; dysplasia is seen commonly in epithelial cells in the bronchi of people who smoke Metaplasia is a cell transformation in which one type of mature cell is converted into another type of cell. This serves a protective function, because less-transformed cells are more resistant to the stress that stimulated the change. Cellular Injury Injury is defined as a disorder in steady-state regulation. Any stressor that alters the ability of the cell or system to maintain optimal balance of its adjustment processes leads to injury. Causes of disorder and injury in the system (cell, tissue, organ, body): 1. Hypoxia - Inadequate cellular oxygenation (hypoxia) interferes with the cell’s ability to transform energy. Causes: 1. decrease in blood supply to an area, 2.decrease in the oxygen-carrying capacity of the blood (decreased hemoglobin), 3. a ventilation–perfusion or respiratory problem that reduces the amount of arterial oxygen available, 4. a problem in the cell’s enzyme system that makes it unable to use oxygen. The usual cause of hypoxia is ischemia or deficient blood supply. Ischemia is commonly seen in myocardial cell injury in which arterial blood flow is decreased because of atherosclerotic narrowing of blood vessels. Ischemia also results from intravascular clots (thrombi or emboli) that may form and interfere with blood supply 2. Nutritional imbalance refers to a relative or absolute deficiency or excess of one or more essential nutrients. This may be manifested as undernutrition (inadequate consumption of food or calories) or overnutrition (caloric excess) Protein deficiencies and avitaminosis (deficiency of vitamins) are typical examples. An energy deficit leading to cell injury can occur if there is insufficient glucose or insufficient oxygen to transform the glucose into energy. 3. Physical agents Physical agents, including temperature extremes, radiation, electrical shock, and mechanical trauma, can cause injury to the cells or to the entire body. The duration of exposure and the intensity of the stressor determine the severity of damage. 4. Chemical agents Chemical injuries are caused by poisons, such as lye, that have a corrosive action on epithelial tissue, or by heavy metals, such as mercury, arsenic, and lead, each of which has its own specific destructive action. Drugs, including prescribed medications, can also cause chemical poisoning. Some people are less tolerant of medications than others and manifest toxic reactions at the usual or customary dosages Alcohol (ethanol) is also a chemical irritant. 5. Infectious agents Biologic agents known to cause disease in humans are viruses, bacteria, rickettsiae, mycoplasmas, fungi, protozoa, and nematodes. The severity of the infectious disease depends on the number of microorganisms entering the body, their virulence, and the host’s defenses (e.g., health, age, immune responses). 6. Immune mechanisms The immune response detects foreign bodies by distinguishing non self substances from self substances and destroying the non self entities. The entrance of an antigen (foreign substance) into the body evokes the production of antibodies that attack and destroy the antigen (antigen– antibody reaction). The immune system may function normally, or it may be hypoactive or hyperactive. When it is hypoactive, immunodeficiency diseases occur; when it is hyperactive, hypersensitivity disorders occur. 7. Genetic defects Many of these defects produce mutations that have no recognizable effect, such as lack of a single enzyme; others contribute to more obvious congenital abnormalities, such as Down syndrome Morphologic Alterations in Cell Injury It is useful to describe the basic alterations that occur in damaged cells before we discuss the biochemical mechanisms that bring about these changes. All stresses and noxious influences exert their effects first at the molecular or biochemical level. There is a time lag between the stress and the morphologic changes of cell injury or death; the duration of this delay may vary with the sensitivity of the methods used to detect these changes