Chapter 5: Stress and Inflammatory Responses

What is the General Adaptation Syndrome (GAS)?

The general adaptation syndrome (GAS) is a nonspecific physiologic response to a stressor. The process occurs through the neuroendocrine and autonomic nervous systems.

What are the stages of the General Adaptation Syndrome

Alarm Reaction Stage 

• What it is: The initial response to a stressor, activating the body's fight-or-flight mechanism. 

• Physiological response: Heart rate, blood pressure, and cortisol levels increase. 

• Body's state: The body is unprepared for the stressor but has not yet adjusted. 

Resistance Stage

• What it is: The body's attempt to adapt and cope with a persistent stressor. 

• Physiological response: The body's vital signs begin to normalize, but it remains in a state of high alert. 

• Symptoms: May include irritability, frustration, and poor concentration. 

Exhaustion Stage

• What it is: Occurs when stress continues for an extended period, depleting the body's resources. 

• Physiological response: The body's ability to fight stress breaks down, weakening the immune system. 

• Symptoms: Fatigue, depression, anxiety, and increased susceptibility to illness. 

Which nervous system response is most helpful in an emergency situation?

A response by the sympathetic nervous system is most helpful in an emergency situation.

The most common pathway for the stress response is through the sympathetic nervous system, which uses norepinephrine to stimulate body systems, arousal, and anxiety in response to stress.

How does sympathetic nervous system response work in emergencies?

This response overrides the control of the parasympathetic nervous system, which slows metabolic processes.

The cardiovascular system and musculoskeletal system respond because of sympathetic stimulation.

What are the sympathetic nervous system responses to stress?

The sympathetic nervous system is activated in response to stress but is short-lived.

It is caused by norepinephrine being released at nerve endings that are in direct contact with end organs that cause an increase in function of the organs and general body arousal.

What are the sympathetic nervous system responses to stress? (Part 2 - Pupils & Heart)

Symptoms include dilated pupils to increase awareness. The heart rate and blood pressure are increased to increase perfusion of vital organs.

What are the sympathetic nervous system responses to stress? (Glucose & Respiratory

Blood glucose is increased to supply the needed additional energy. The respiratory rate is rapid and shallow to increase the amount of oxygen needed for energy.

What are physical signs and symptoms of stress?

Indicators of stress include both subjective and objective measures.

Signs and symptoms may be observed directly or reported.

Over time, a client tends to develop a characteristic pattern of behavior during stress to warn that the system is out of balance. Examples include teeth grinding (bruxism) and excessive sweating.

What symptoms should the nurse assess for when evaluating stress?

Symptoms of stress include decreased energy level and fatigue, dry mouth (oral mucosa), changes in the menstrual cycle, and substance use/substance use disorder.

What symptoms should the nurse assess for when evaluating stress? (Part 2)

Additional symptoms include gastrointestinal, genitourinary, cardiovascular, neuromuscular, and psychosocial changes, including feeling weak or dizzy, hyperactivity, difficulty sleeping, palpitations and anxiety, increased urination, nausea, and decreased appetite.

What are the manifestations of anxiety?

Anxiety is manifested by physiologic, emotional, and behavioral signs and symptoms. These include palpitations, inability to concentrate (e.g., feeling like one's mind is all over the place), and irritability (e.g., feeling like everything is annoying).

What additional indicators suggest anxiety?

Low productivity would suggest anxiety. Social isolation (not interacting with friends to go out to the movies) would be an indicator.

What is spiritual distress and how is it manifested?

Spiritual distress is typically manifested by despair, discouragement, ambivalence, detachment, anger, resentment, or fear. A statement about God punishing the client suggests spiritual distress.

How does spiritual distress differ from other diagnoses?

Anxiety would reflect client statements about feelings of discomfort, apprehension, or dread.

Readiness for enhanced coping would be reflected by statements about being able to manage stressors or use appropriate coping strategies.

Ineffective coping would be reflected by statements related to difficulty in meeting their own needs, solving problems, or dealing with stressors.

What is primary appraisal?

Primary appraisal evaluates a situation with respect to what is at stake.

What is secondary appraisal?

Secondary appraisal is an evaluation of what might and can be done about a situation. It occurs when a person thinks about whether it is possible to do something about a situation.

What is reappraisal?

Reappraisal is a change of opinion based on new information.

What is hardiness?

Hardiness is the name given to a general quality that comes from having rich, varied, and rewarding experiences.

What does norepinephrine normally do in the body?

Norepinephrine affects attention and concentration, raises energy level, and heightens arousal

How do the immune system and brain communicate

The immune system and the brain communicate with each other through the chemical messenger system using neurotransmitters and immunopeptides.

How does stress impact the immune system?

Stress can lower the number of white blood cells, the immune system's disease fighters.

What activities enhance coping skills?

Activities to enhance coping include exploring the coping strategies the client has found helpful in the past and encouraging their continued use.

What activities enhance coping skills?

Additional activities include encouraging clients to reestablish priorities and to strike a healthy balance between work and play.

What activities enhance coping skills?

Also suggest cultivating relationships with family and friends who are supportive

What is the most useful trait for family coping under stress?

Communication skills and spirituality have been identified as the most useful traits that enhance family members' coping.

What interventions reduce stress levels? (External resources)

broad social network is considered an external resource to help reduce stress.

What interventions reduce stress levels? (Internal resources)

Internal resources to help reduce stress include healthy eating habits and relaxation techniques.

How should progressive muscle relaxation be performed?

Progressive muscle relaxation involves guiding the client through a sequence of tensing and relaxing individual muscle groups in a quiet, calm environment. The most effective approach is to have the client lie down in a comfortable position, such as supine or prone, in a quiet room while the nurse reads the instructions in a slow, relaxed manner.

What difficulties do individuals with substance use disorder have?

Individuals with substance use disorder often have difficulty identifying and implementing adaptive behaviors. Substance use disorder occurs in all settings. Individuals with substance use disorder are unable to make healthy decisions and to solve problems effectively.

What are the symptoms of PTSD?

Symptoms include intrusive thoughts and dreams (e.g., nightmares), avoidance of activities that arouse recollection of the traumatic event (e.g., being at home if assaulted at home), heightened vigilance, and exaggerated startle reaction.

What statements support a PTSD diagnosis?

"I keep having nightmares about the incident," "I can't feel safe in my own house after what happened there," "Being around other people takes too much energy," and "I jump when I hear any loud noise, like a bang" support PTSD diagnosis.

What physiologic responses are associated with PTSD?

The physiologic responses associated with PTSD result from increased activity of the sympathetic nervous system, increased plasma catecholamine levels, and increased urinary epinephrine and norepinephrine levels.

What is the priority when caring for a client with PTSD?

The priority when caring for a client with PTSD is establishing a trusting nurse-client relationshipWhich cells are unable to regenerate?

Which cells are unable to regenerate?

Brain cells are not able to regenerate

How quickly can brain cell death occur?

 Brain cells may succumb in 3 to 6 minutes without oxygen, depending on the situation.

What is inflammation?

Inflammation is a defensive reaction intended to neutralize, control, or eliminate an offending agent and to prepare the site for repair. A general sequence of events occurs in the local inflammatory response

What are the five cardinal signs of inflammation?

erythema (redness), warmth, edema (swelling), pain, and loss of function.

What body responses occur with a deep vein thrombosis (DVT)?

A deep vein thrombosis (DVT) results in vascular vasodilation (heat and redness), local tissue congestion, and increased capillary permeability (swelling). The nurse would expect to see erythema and pain.

What should the nurse expect at a surgical incision site?

The nurse should anticipate that the wound edges are approximated.