Study Notes on Stress and Disease (NURS 309)
Stress and Disease Overview
Course Information
Course Title: NURS 309 Patho-Pharm I
Chapter: 10 Patho
Instructor: S. Tullos, EdD, MNSC, RN
Objectives of the Study
Define stress and provide examples.
List the three stages of General Adaptation Syndrome (GAS) and explain each stage's processes.
Explain the two types of psychological stressors and their characteristics.
Describe the prolonged impact of stress including associated effects.
Understand and explain concepts of allostasis and allostatic overload.
Identify and explain the components of the Stress System.
Discuss cortisol's role and activity during stress events.
Define sterile inflammation and provide a comparison of acute vs. chronic stress.
Discuss stress outcomes across various age groups: maternal, fetal, infant/child/adolescent, and older adult.
Analyze continuous childhood stressors and their long-term impact.
Provide examples of positive coping strategies vs. maladaptive coping strategies.
Identify categories of medications for managing psychological stress outcomes.
Clarify the immune system components targeted by these medications, such as benzodiazepines.
Patient education on benzodiazepines, fluoxetine, and MAOIs, including associated risks.
Definition of Stress
Stress Characterization:
Sensed or anticipated threat (detectable stimulus).
Positively or negatively affect an individual's normal activities and overall well-being.
Potentially surpasses the individual's coping abilities, thereby altering homeostasis.
Impacts security and stability.
Physiological and Psychological Tension:
The term was popularized by Cannon through "Fight or Flight" response, indicating both physiological and psychological aspects of stress.
Stressors
Types of Stressors:
Can be internal (psychological) or external (environmental).
Examples include:
Loss: Loss of family members, friends, job, home, or during a divorce.
Work-related Stress: Includes high workload or extended hours.
Health Diagnoses: Such as cancer or chronic diseases.
Abuse: Categories include physical, mental, or emotional abuse.
Educational Pressures: Multiple courses, assignment overloads, exams, sleep deprivation.
Neuroendocrine Response to Stress
National Institute of Mental Health Definition:
Stress is defined by how the brain responds through activation of (1) neuroendocrine systems, (2) the autonomic nervous system (ANS), and (3) the immune system.
Important to note: Chronic activation of these systems might compromise recovery and lead individuals to engage in unhealthy habits, resulting in issues like hypertension, depression, and obesity.
General Adaptation Syndrome (GAS)
Concept Originator: Hans Selye.
Overview of GAS Stages:
Alarm Stage:
Triggers activation in the hypothalamic-pituitary-adrenal (HPA) axis and activates the sympathetic nervous system (SNS).
Increases volume and glucose levels in the blood along with secretion of hormones, e.g., epinephrine.
Results in increased heart rate, oxygen intake, and mental alertness while boosting immune functions.
Resistance Stage:
Characterized by decreased hormone levels, heart rate, and cardiac output as the body attempts to return to equilibrium.
Exhaustion Stage (Allostatic Load):
The body reaches a point where it cannot effectively defend against stress.
Continuing stress leads to health risks and exhaustion of resources.
The Stress Response Mechanism
Central Model of Stress Response
Involves communication between the central nervous system and various hormone regulations:
Hypothalamus Activation
Release of Corticotropin-Releasing Hormone (CRH) to anterior pituitary
Production of Adrenocorticotropic hormone (ACTH)
Adrenal Cortex Response: Release of cortisol
Other hormones and compounds activated include:
Antidiuretic hormone (ADH)/vasopressin – Increases water retention.
Epinephrine and Norepinephrine – Affect blood pressure and heart rate.
Neuropeptide Y (NPY) – May also cause dilation of blood vessels and stimulation of appetite.
Effects of Cortisol during Stress
Cortisol Effects:
Stimulates gluconeogenesis, thus elevating blood sugar levels.
Has a powerful anti-inflammatory and immunosuppressive role.
Chronic dysregulation may lead to obesity, hypertension, metabolic syndrome, cognitive impairment, emotional disorders like chronic depression, and various physical ailments (gastric ulcers, DM, atherosclerosis).
Psychological Stressors
Types:
Reactive Stressors: Physiological responses (e.g., increased heart rate) without a physical trigger.
Anticipatory Stressors: Related to past trauma or future outcomes, e.g., PTSD, associating with adverse events.
Long-term Effects of Stress
Physiological Changes:
Rising hormone levels can disrupt normal processes.
Unhealthy coping strategies may emerge like neglecting health schedules or substance use (tobacco, alcohol).
Specific Outcomes of Prolonged Stress:
Elevated blood pressure and body temperature.
Impaired sleep.
Increased susceptibility to infections.
Allostasis and Allostatic Overload
Allostasis:
A dynamic response strategy where the brain continuously monitors the body's need for homeostasis and adapts accordingly.
Helps in anticipating and preparing for challenges which may ultimately lead to wear-and-tear if adaptive systems are overactivated.
Allostatic Overload:
Occurs when there is excessive activation of these adaptive systems, resulting in increased disease susceptibility and clinical issues.
Stress Systems
Components of the Stress Systems
Hypothalamus-Pituitary-Axis (HPA): Central stress response system.
Sympathetic-Adreno-Medullary (SAM) Axis: Quick response involving release of norepinephrine from sympathetic nerves and epinephrine from the adrenal medulla.
Resulting physiological responses include increased blood pressure, heart rate, cardiac output, and blood sugar levels.
Immune System Reaction:
Stress influences immune functions and levels of inflammatory cytokines.
Health Impact Across Lifespan
Stress Outcomes: Different age groups are affected in specific ways due to stress. Notably:
Maternal stress can impact fetal development.
Early childhood adversity can lead to long-lasting psychological issues.
Telomere Length and Aging:
Prolonged stress can decrease the length of telomeres, associated with heightened infection risk and accelerated aging effects due to increased oxidative stress.
Coping and Management Strategies
Positive vs. Maladaptive Coping Strategies
Positive Strategies Include:
Regular physical activity, healthy nutrition, adequate sleep, and mental activities like meditation.
Seeking social support has positive effects on coping.
Maladaptive Strategies Include:
Poor dietary choices, substance abuse (smoking, alcohol), and avoidance behaviors (e.g., neglecting health).
Medications for Stress Management
Commonly Used Medications
Benzodiazepines:
Action Mechanism: Enhance the effects of GABA, an inhibitory neurotransmitter; used for anxiety and insomnia management.
Risks: Dependence, respiratory distress with long-term use, and potential withdrawal symptoms.
Examples Include:
Diazepam (Valium) – Long half-life; caution for use in various conditions such as respiratory diseases.
Lorazepam (Ativan) – Caution with narrow-angle glaucoma.
Selective Serotonin Reuptake Inhibitors (SSRIs):
Used primarily for major depressive disorders; effective for anxiety too.
Potentially adverse effects include sexual dysfunction.
Examples Include:
Fluoxetine (Prozac), Sertraline (Zoloft), and others.
Monoamine Oxidase Inhibitors (MAOIs):
Require dietary restrictions due to interaction with tyramine in food.
Examples Include:
Phenelzine (Nardil).
Importance of Patient Education
Patients must be informed about the risks of medications and withdrawal symptoms induced by abrupt cessation.
Attention to social connections and mental health needs is crucial for overall well-being.
Note: Reference for advanced understanding: Huether, S. E., McCance, K. L., & Brashears, V. L. (2026). Understanding Pathophysiology (8th ed.). St. Louis: Elsevier.