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Medical surgical nursing; pathophysiology

Medical surgical nursing; pathophysiology

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Published by marc joseph

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Published by: marc joseph on Dec 25, 2009
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04/25/2013

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Medical-Surgical Nursing(Stress, Inflammation and Pain)
Dynamic Balance: Steady Balance
Claude Bernard: “Fixity of internal milieu”
Walter Cannon: “ Homeostasis”
Rene Jules Dubos: “Homeostasis and Adaptation”
o
Homeostasis- stead state within the body.
Stress and AdaptationStress
A disruptive condition that occurs in response to adverseinfluences from the internal or external environments.
It is a state produced by a change in the environment that isperceived as challenging, threatening, or damaging to aperson’s dynamic balance or equilibrium.Adaptation
It is a constant, ongoing process that requires change instructure, function, or behavior so that a person is bettersuited to the environment.
A change or alteration designed to assist in adapting to anew situation or environment. Types of Stressors
Physical Stressors- cold, heat, chemical agents.
Biological/ Physiological- pain and fatigue.
Psychosocial- fear of failing exams, loss of job and waitingfor the result of a diagnostic exam.
Day to day frustration/hassles- caught in traffic jam,experiencing computer down time, having argument with aroommate/spouse.
Major complex occurrence involving large group- terrorism,war
Stressors that occur less frequently and involving fewerpeople- death, birth, marriage, divorce and retirement.
 
Acute, time-limited stressors- studying foe final exam.
Stressor sequence- series of stressful events
Chronic intermittent stressors- daily hassles.
Chronic enduring stressors that persistent over time- chronicillness, disability, poverty.Psychological Response to Stress (LAZARUS)
Appraisal of the Stressful Event
o
Cognitive appraisal- is a process by which an event isevaluated with respect to what is at stake (primaryappraisal) and what might and can be done (secondaryappraisal).
o
Primary Appraisal- results in the situation beingidentified as either nonstressful or stressful.
o
Secondary Appraisal- is an evaluation of what mightand can be done about the situation.
o
Reappraisal- a change of opinion based on newinformation, also occurs.
Coping With the Stressful Event
o
Emotion Focus Coping- seeks t make the person fellbetter by lessening the emotional distress.
o
Problem-focus coping- aims to make direct changes inthe environment so that the situation can be managedmore effectively.Physiologic Response to Stress
Selye’s Theory of Adaptation
o
General Adaptation Syndrome
Alarm- is defensive and anti-inflammatory but self-limiting
 
Resistance- adaptation to the noxious stressoroccurs, and cortisol activity is still increased.
Exhaustion- endocrine activity increases and thishas negative effects on the body systems that canlead to death.
o
Local Adaptation Syndrome
Inflammatory Response and repair.Sympathetic-Adrenal-Medullary Response to Stress
EffectsPurposeMechanismIncreased heartrate and bloodpressure
Better perfusion of vital organsIncreased cardiacoutput due toincreasedmyocardialcontractility andheart rate; increasedvenous return.
Increased bloodglucose level
Increased availableenergyIncreased liver andmuscle glycogenbreakdown;increasedbreakdown oadipose tissuetriglycerides
Mental Acuity
Alert stateIncreased amount oblood shunted to thebrain from theabdominal visceraand skin.
Dilated pupils
Increased awarenessContraction of radialmuscle of iris
Increased tensionof skeletalmuscles
Preparedness foractivity, decreasedfatigueExcitation of muscle;increase in amountof blood shunted tothe muscle from theabdominal visceraand skin.
Increased
Provision of oxygen Stimulation o

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