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General Adaptation Syndrome (GAS)
Coined by Hans Selye (1950s); model explains the body’s physiological response to prolonged stress.
3 sequential stages:
Alarm (Fight-or-Flight)
Triggered by an acute stressor (e.g., seeing a bear).
Release of adrenal hormones:
\text{Epinephrine (Adrenaline)} → ↑ HR, ↑ BP, ↑ RR, ↑ blood glucose (hepatic glycogenolysis), ↑ muscular strength.
\text{Cortisol} → ↓ pain, ↓ inflammation, temporary immunosuppression, mobilization of energy stores.
Observable clinical signs:
\text{Tachycardia} (HR > 100 bpm).
\text{Hypertension} (BP > 140/90 mm Hg).
Hyperventilation.
Resistance (Adaptation)
Stressor persists (e.g., “bear outside the window” analogy).
Body attempts homeostasis: vital signs may trend toward baseline, but cortisol/epinephrine remain elevated.
Consequences of chronic exposure: sustained ↑ BP, ↑ HR, ↑ muscle tension, irregular blood sugar, suppressed immunity.
Behavioral manifestations: irritability, poor concentration, fatigue.
Exhaustion (Burnout)
Adaptive capacity overwhelmed → organ-system impairment.
Outcomes: anxiety, depression, burnout, decreased stress tolerance, onset/exacerbation of disease (CAD, stroke, diabetes, infections, cancer).
“Stress can kill you” – prolonged elevation of \text{cortisol}/\text{epinephrine} directly damages cardiovascular, endocrine, musculoskeletal, and immune systems.
Illness–Wellness Continuum
Dynamic model: individuals constantly move between high-level wellness and premature death.
Central Comfort Zone
No overt symptoms, but also no active health-promoting behaviors; potential “false wellness.”
Right (Wellness) Side
Progression: awareness → education → growth → Optimal Health.
Behaviors: balanced nutrition, exercise, screening programs, preventive classes.
Typically minimal or no pharmacologic/surgical interventions required.
Left (Illness/Disease) Side
Early ↓ health: first symptoms, single med.
Progressive ↓: polypharmacy, procedures, functional decline, limited ADLs.
End-stage: loss of body functions → premature death.
Stress-Reduction & Mindfulness
Mindfulness = deliberate, non-judgmental awareness of present moment (body, thoughts, environment).
Reduces overwhelm; encourages “one-thing-at-a-time” focus.
Often begins with body scan → progressive relaxation.
Outcomes: ↓ stress response, ↓ cortisol, improved concentration.
Complementary techniques: guided imagery, progressive muscle relaxation, breathing exercises.
Professional & Regulatory Bodies
Healthy People 2030 (ODPHP)
Federal blueprint (updated q10 yrs since 1979) for population-level prevention strategies.
ANA (American Nurses Association)
Sets Standards of Practice (e.g., frequency of assessments in Med-Surg vs ICU).
Publishes Code of Ethics – key provisions:
Autonomy: respect pts’ right to choose (e.g., refuse chemo).
Human dignity, confidentiality (HIPAA).
Professional boundaries (no dating patients until >1 yr post-care).
Duty to report unsafe colleagues (substance use, impairment).
State Boards of Nursing (BON)
Protect the public via licensure, discipline, monitoring programs (e.g., for DUIs, narcotic diversion).
Penalties range: remediation ↔ suspension/revocation.
Healthcare Economics & Quality Initiatives
Cost Drivers
Skipped preventive care due to \uparrow price.
Technological innovations ⇒ \uparrow equipment costs → passed to consumers.
Affordable Care Act (ACA)
Links reimbursement to:
Patient satisfaction surveys.
Hospital-Acquired Infections (HAIs).
30-day readmission rates (bundled payments).
Nursing-Sensitive Quality Indicators
Oral care for ventilated pts (↓ VAP).
Turning schedules & skin assessments (↓ pressure injuries).
Documentation critical: “If it isn’t charted, it didn’t happen.”
Failure → hospital absorbs 100 % of treatment cost (e.g., Stage IV pressure ulcer ⇒ sepsis, ICU stay).
Chain reaction: ↓ reimbursement → ↓ staffing, equipment, raises → potential compromise of patient care.
Key Ethical Terms & NCLEX “Favorites”
\textbf{Autonomy} – self-determination; competent pts may accept/refuse treatment.
\textbf{Beneficence} – act for pt’s good.
\textbf{Non-maleficence} – do no harm.
\textbf{Justice} – fairness in resource allocation.
Confidentiality (HIPAA), veracity (truth-telling), fidelity (keeping commitments).
Delegation Preview (Full lecture later)
Safety prioritized; follow Right Task, Circumstance, Person, Communication, Supervision.
Numerical / Statistical References & Concepts
\text{Tachycardia} = \text{HR} > 100\ \text{bpm}
\text{Hypertension} = \text{BP} > 140/90\ \text{mmHg} (some guidelines \geq130/80).
30-day readmission ⇒ \downarrow reimbursement (bundled payment penalty).
Zero-tolerance goals for certain HAIs (CLABSI, CAUTI) – target incidence =0.
Practical / Real-World Links
Chronic workplace stress in nursing mirrors prolonged Resistance → Exhaustion phases; emphasizes need for self-care, mindfulness, adequate staffing.
Ethical scenario: intoxicated off-duty nurse must self-report to BON; honesty can qualify for monitoring programs.
Documentation of pt refusal (e.g., turning, oral care) protects institution from financial & legal risk.
Quick-Recall Summary
GAS: Alarm → Resistance → Exhaustion (cortisol & epinephrine central).
Illness-Wellness continuum: comfort zone midpoint; aim toward optimal health via preventive behaviors.
Mindfulness dampens physiological stress cascade.
ANA sets practice/ethical standards; BON enforces licensure & discipline.
ACA ties $$ to quality: satisfaction, HAIs, readmissions.
Ethical must-knows: autonomy, confidentiality, professional boundaries.