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Chapter 6

Homeostasis, Stress,
and Adaptation

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Steady State

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Steady State (contd)


Internal constancy
Homeostasis
Stress
Adaptation

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Types of Stressors
Physical
Examples: cold, heat, chemical agents
Physiologic
Examples: pain, fatigue
Psychosocial
Examples: developmental tasks/changes, anxietyproducing events (losing job)

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stress as a Stimulus for Disease


Links between stress, illness
Life-event scales
Holmes and Rahe (1967)
Recent Life Changes Questionnaire (1982)
Each persons appraisal, response to event or stressor
will vary

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Stress as a Stimulus for Disease (contd)


Refer to fig. 6-2

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stress as a Stimulus for Disease (contd)

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stress as a Stimulus for Disease (contd)

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Selyes General Adaptation Syndrome


Theory of adaptation to biologic stress
Three phases:
Alarm: SNS fight or flight response; catecholamines
released onset of ACTH response, self-limiting
Resistance: adaptation occurs to stressor; cortisol
activity still increased
Exhaustion: endocrine activity continues, body will
fail if exposure to stressor is prolonged

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Tell whether the following statement is true or false:
The neural and hormonal activities that respond to stress
and maintain homeostasis are located in the cerebral
cortex.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
False.
Rationale: The neural and hormonal activities that
respond to stress and maintain homeostasis are located
in the hypothalamus.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Adaptive Processes
Hypertrophy
Atrophy
Hyperplasia
Dysplasia
Metaplasia

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Local Adaptation Syndrome


Local response to injury
Includes inflammatory, tissues-repair process
If injury is severe enough, general adaptation syndrome
will be activated

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Local Adaptation Syndrome (contd)

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Tell whether the following statement is true or false:
The five cardinal signs of inflammation are redness, heat,
swelling, pain, and loss of function.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
True.
Rationale: The five cardinal signs of inflammation are
redness, heat, swelling, pain, and loss of function.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assessment
Subjective symptoms
Objective symptoms
Include indicators of stress response such as anxiety,
increased pulse, increased respirations
Consider potential indicators for stress (life events,
developmental tasks, health risk appraisal)

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Implications
Are heart rate, respiratory rate, temperature normal?
What emotional distress may be contributing to patients
health problems?
Are there other indicators of steady-state deviation?
What are patients blood pressure, height, weight?
Are there problems in movement or sensation?
Are there problems with affect, behavior, speech,
cognitive ability, orientation, or memory?
Are there obvious impairments, lesions, or deformities?
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Diagnosis
Anxiety
Impaired adjustment
Ineffective coping
Social isolation
Risk for powerlessness
Risk for spiritual distress
Decisional conflict
Situational low self-esteem
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stress Management: Nursing


Interventions
Promoting healthy lifestyle
Enhancing coping strategies
Teaching relaxation techniques
Progressive muscle relaxation
Bensons relaxation response

Relaxation with guided imagery

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Stress Management: Nursing


Interventions (contd)
Educating about stress management
Enhancing social support
Recommending support, therapy groups

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
A nursing student is getting ready to take a final exam.
Based on the understanding of the sympathetic nervous
systems response to stress, which assessment finding
will be noted?
A.Hot, sweaty skin
B.Rapid respirations
C.Decreased heart rate
D.Skeletal muscle relaxation

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
B. Rapid respirations
Rationale: Common assessment findings with the
sympathetic nervous systems response to stress are
cold, clammy skin; increased heart rate; rapid
respirations; and skeletal muscle tension.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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