NUR 252: stress, coping, pain, thermoregulation

thermoeffectors for heat loss

sweaating, vasodilation

thermoeffectors for heat production

vasoconstriciton, shivering, thermogenesis

what happens to the body during heat production

created by metabolic activity through chemical reactions occuring in cells, muscles and liver have greatest amount of activity, basal metabolic activity decreases

hypothermia number

below 36.2 C or 95 F

hypothermia definition

excessive heat loss, insuffiient production of heat, disfunction of hypothalamus

targeted temperature managment (TTM)

induced set to reduce metabolism and preserve tissue by preventing ischemia

hyperthermia definition

excessive heat production, inadequate ability to cool, hypothalamic regulator dysfunction

excessive sweating

sodium loss and dehydration leads to hypotension, tachycardia, reduced perfusion

heat exhaustion

milder, can lead to heat stroke, fatigue, headache, nausea

heat stroke

alteration in mental status, hot and dry skin, nausea, bradycardia, weakness, leads to destruction of cell mitochrondria

fever

temporary elevation in temperature, caused by exogenous and endogenous pyrogens

exogenous pyrogens

bacteria, viruses

endogenous pyrogens

produced by WBCs, triggers hypothalamus in brain to increase temperature

risk factors for newborn regulation of heat

do not have the ability to shiver, greater risk of hypothermia, blood vessels closer to skin, thin layer of subcutaneous fat/brown fat

nociceptors

cells of free nerve endings in the skin and peripheral organs that are receptors for the sensation of pain (all tissues except CNS)

chemical mediators are released from damaged cells

attach to nociceptor, opening sodium channels causing action potential

what do fibers do

carry impulse to spinal cord

a delta fibers

sharp stabbing pain in one area

b beta fibers

transmit vibration and touch sensations

C fibers

dull aching pain general area

what inhibits pain impulses

release of endorphins, serotonin, other substances

neuromatrix pain theory

pain interpretation, brain produces patterns of impulses drawn from inputs like genetic, psych, and cogntive

gate control theory

pain control, nonpainful input closes pain gates to painful input in dorsal horn, prevents transmission to CNS

nociceptive pain

normal pain transmission, can be somatic or visceral

somatic pain

sharp, aching, throbbing, localized to a specific area

visceral pain

within body cavity, response to stretching, swelling, oxygen deprivation

neuropathic pain

from diseased pain receptors, results from pathology of somatosensory system, can include phantom pain

phantom pain

burning, sharp, shooting

paresthesias

numbness, tingling, buring sensation

phantom sensations

sensation of movement

telescoping

distal part of missing limb is approaching limb stump

why does phantom limb pain occur

nociceptors damaged during amputation, lower threshold for activation of nociceptors

acute pain

hours to weeks, could be somatic or visceral, expectation is pain will stop when healing is done

chronic pain

longer period of time, can increase in intensity over time, interrelated with chronic illness

chronic recurrent pain

due to a condition with no pain and then the pain comes back (like headaches)

why do migranes occur

episodic exacerbation of unilateral throbbing pain and other neuologic symptoms

sickle cell pain

genetic condition, gene damaged, hemoglobin releases oxygen, collapses into sickle shape

chronic progressive pain

includes cancer pain and osteoarthritis

cancer pain

nociceptors stimulated by tissue/organs experiencing pressure from tumors

osteoarthritis

most common form of arthritis- 50% of world population, can be idiopathic or secondary, cartilage breakdown allows bones to rub against each other

chronic intractable benign pain

very severe and unrelenting but not cancerous

neck/back/sciatic pain

poor posture, decreased fitness levels poor body meachanics, includes intervertebral disk degeneration

intervertebrak disk degeneration

decrease in cushion in disks, nerves can be compressed and swell

herniated disk

disk ruptures and fluid leaks

sciatica

low back pain along the distrubution of lumbar nerve root

fibromyalgia

musculoskeletal pain, longer than three months, may have abnormal nocicpetive pathways, exacerbated by physical or emtoional trauma

stress

physical or psychological tension that threatens homeostatis

coping

psychologic and behavioral measures aimed at handling stress demands

adaptation

physiologic and psychologic process used in response to stress

acute stress

most common, occurs for a short period of time, in reaction to threat and disseapears quickly

episodic acute stress

self inflicted, controlled by the person

chronic stress

represents a perpetural or sustained therat, lats a long time

psychological and emotional response

anxious, angry, depressed

physiological response

physical sign and symptoms (high blood pressure)

behavioral response

linked to coping mechanisms

General adaption syndrome (GAS)

alarm stage, stage of resistance, stage of exhaustion

alarm stage in GAS

reaction, central nervous system is aroused and body mobalizes defenses (fight or flight)

triggering of alarm GAS

stressor activates hypothealamus and sympathertic nervous sytem, increases secretion of glucocorticoids and epinephrine and norepinephrine

stage of resistance in GAS

adaptation, mobilization contributes to fight or flight

triggering of resistance stage

begins with actions of adernal hormones cortisol, norephineprhine, and epinephrine

stage of exhaustion in GAS

continuous stress causes progressive breakdown of compensatory mechansims and homeostasis

triggering of exhaustion

occurs if stress contintues and adaptiation is unsuccessful, will cause imapriment of immune system and organ failure

stress as a stimulus

if seen as a threat, then a stressor, how event is interpreted leads to response

stress as a transaction

indiviaul appraisal of event, response depends on how situation interacts with coping

Hypothalamic pituitary adrenal (HPA) axis

hypothalamus secretes CRH that binds to pituitary cells, ACTH goes to adrenal glands, cortisol is released

cortisol

regulate functions of CNS, effects protein metabolism

LC/NE system- catecholamines

stimulate sympathetic nervous system (epinephrine and norepinephrine), stimulates a1, a2, b1, b2 receptors

norepinephrine

regulate bp, arousal, anxiety, binds with a receptors

epinephrine

cardiac action, dilates blood vessels, decrease insulin release, binds with a and b receptors

homeostasis

presence of an internal state of balance

allostasis

describes the contrinual state of flucutaiton our body is in

stress age syndrome

neurohormonal and immune alerations, homeostasis is changed, (catecholamines, ADH, ACTH, cortisol are all increased), depression and chronic inflammation

risk factors for coping

inability to assess stressor, lack of control, deniance or avoidance, lack of knowledge