HOMEOSTASIS, STRESS and ADAPTATION

Homeostasis
 “steady state”, dynamic balance, equilibrium
 the stability of the internal environment, was coordinated by homeostatic or compensatory processes
that responded to changes in the internal environment. Any change within the internal environment
initiated a “righting” response to minimize the change. These biologic processes sought physiologic and
chemical balance and were under involuntary control. – Walter Cannon

Stress
 is a state produced by a change in the environment that is perceived as challenging, threatening, or
damaging to the person’s dynamic balance or equilibrium
o eustress = positive level of stress (a nonspecific stress response associated with desirable events
such as marriage or a job promotion
o distress = negative level of stress (is
a subjective response to internal or Types of Stressors:
external stimuli that are Physiologic Emotional/Psychologic
threatening or perceived as Skin burn Diagnosis of cancer
threatening to the self) Chronic pain Marital problem
 is a response to an environmental demand Hypothermia Failing an examination
or stressor (stress-inducing demands)– Infectious disease Inadequate financial resources to
Excessive noise meet needs
Hans Selye.
Starvation Grieving the loss of a family
Running a marathon member
Adaptation Caring for a disabled child
 Adjustment to change to restore Winning or losing an athletic
equilibrium event
 Process of coping with stress which has Winning lottery
both physiological and psychological
component
 Ongoing process that requires adjustment in structure, function or behavior to better suit the changes
 Ongoing process of modifying one’s behavior in changes circumstances or an altered environment to
fulfill psychological, physiological, and social needs.

General Adaptation Syndrome (GAS)

 Consists of processes that are normal responses and are considered as adaptation measures to help
people cope with the immediate threat.
 Has three stages: stage of alarm, stage of resistance, and stage of exhaustion
 Alarm reaction:
o The individual perceives the stressors physically or mentally and the fight-or-flight response is
initiated.
o It leads to a series of physiologic changes that promote adaptation.
o Temporarily decreases the individual’s resistance
 Resistance:
o Physiologic reserves are mobilized to increase the resistance to stress.
o The person is expending energy in an attempt to adapt, and at this time, adaptation may occur.
o If adaptation may not occur, the person may move to the next phase.
Stages of General Adaptation Syndrome
Alarm Resistance Exhaustion
 Increased secretion of  Corticosteroid secretion  Increased corticosteroid
corticosteroids and resultant returns to normal secretion but eventually
changes marked decreased secretion
 Increased activity of  Sympathetic activity returns  Stress triad (hypertrophied
sympathetic nervous system to normal adrenals, atrophied thymus
 Increased norepinephrine  Norepinephrine secretion and lymph nodes, bleeding
secretion by adrenal medulla returns to normal ulcers in stomach and
 Fight-or-flight response  Fight-or-flight syndrome duodenum)
disappears
 Low resistance too stressor  High resistance (adaptation)  Loss of resistance to stressor;
to stressors may lead to death
  Exhaustion:
o It occurs when all of the energy for adaptation has been expended.
o The individual usually becomes ill and may die if assistance from the outside sources is not
available.
o Can be reversed by external sources of adaptive energy, such as medication

Physiologic Response to Stress:

 Nervous system
o Cerebral cortex = evaluates the emotional/psychologic event (stressor)
o Limbic system = is an important mediator of emotions and behavior.
 When limbic system is stimulated, emotions, feelings, and behaviors can occur that
ensure survival and self-preservation
o Reticular formation = contains the reticular activating system (RAS)
 When RAS is stimulated, it increases its output of impulses, leading to wakefulness, and
can lead to sleep disturbances
o Hypothalamus = limbic system stimulates the hypothalamus.
 Because hypothalamus secretes hormones that regulate the release of anterior
pituitary, it is central to the connection between the nervous and endocrine systems in
responding to stress.

 Endocrine system
Hypothalamic-pituitary-adrenal axis:
Stress
↓
Hypothalamus activation
↓
↓ ↓
Corticotrophin-releasing hormone (CRH) SNS Activation
↓ ↓
Anterior Pituitary gland activation stimulation of adrenal medulla
↓ ↓
Proopiomelanocortin (POMC) production of catecholamines
↓ (epinephrine, norepinephrine)
↓ ↓
Adrenocoticotropic hormone (ACTH) ß-endorphin (a
↓ neuropeptide that
Adrenal cortex stimulation has analgesic-like
↓ effect)
Corticosteroid (Cortisol)

Fight-or-flight Reaction of the Alarm Stage:

Increased sympathetic nervous system activity
↓
↓ ↓ ↓ ↓ ↓ ↓
Heart Blood vessels Lungs Adrenal medulla Liver GiI system
 Increased HR  Peripheral  Increased RR  Increased  Glycogenolysis  Decreased
 Increased vasoconstricti  Shallow epinephrine secretions
stroke volume on breathing  Increased  Decreased
norepinephrin peristalsis
e
↓ ↓ ↓ ↓ ↓
 Increased  Increased  Prolonged SNS  Increased  Decreased
cardiac output systolic BP response blood glucose digestion
 Redistribution
→ of blood to
vital organs
 Effects of Corticosteroid:
 Immune system  Increases blood glucose levels
o Psychoneuroimmunology (PNI) = is an  Inhibits the inflammatory response
interdisciplinary science that seeks to understand o It suppresses the release of
the interactions among psychologic, neurologic, and proinflammatory mediators
immune responses. such as cytokines tumor
necrosis factor (TNF) and
o Acute and chronic stress affect function:
interleukin-1 (IL-1).
 Decreased number and function of natural o Immune system depression
killer cells
 Altered lymphocyte proliferation
 Decreased production of cytokines (such as interferon and interleukin)
 Decreased phagocytosis by neutrophils and monocytes.

Effects of Stress on Health

 Cognitive function: poor concentration, memory problems, distressing dreams, sleep disturbances, and
impaired decision making
 Behavioral: withdrawing from others, becoming very quiet or unusually talkative, changing eating
habits, drinking alcohol excessively, or becoming irritable
 Physiologic:
o Risk of cardiovascular disease and hypertension (due to long-term exposure to catecholamines)
o Migraine headaches, irritable bowel syndrome, and peptic ulcers
o Diabetes mellitus (due to catecholamines and corticosteroid effects)
o Stress-induced immunosuppression (risk for developing cold colds)

Coping
 Is a person’s cognitive and behavioral efforts to manage specific external or internal stressors that seem
to exceed available resources.
o Positive coping: includes activities such as exercise, and use of social support
o Negative coping (maladaptive behavior): substance abuse and denial
Reducing Environmental Distress
for Critically Ill Patients:
 Coping strategies:  Provide private room if
o Emotional-focused coping = involves managing the possible.
emotions that an individual feels when a stress event  Dim the lights or close
occurs. window blinds.
 Is helpful when the problem or situation is  Maintain an environment in
uncontrollable or unchangeable. which patient feels free to
express emotions.
 Ex: discussion of feelings with a friend or taking a
 Limit contacts with other
hot bath patients to minimize
o Problem-focused cooping = attempts to find solutions to contagious aspects of
resolve the problems causing the stress. anxiety.
 Is the most helpful coping strategy when the  Limit the length of stay and
problem can be changed or controlled. number of visitors at any
 Ex: setting priorities or collecting information and one time.
seeking advice  Limit visits with family and
visitors that may contribute
to patient’s anxiety.
Environmental Stress  Assist anxious family
 Hospitalization can be a stressful experience for anyone. The members to relax.
unfamiliar environment, multiple stimuli, and contacts with  Introduce supportive
numerous hospital personnel can lead to exhaustion and measures such as massage,
confusion. warm baths, and relaxation
techniques.
 Use soft background music if
Nursing Diagnoses: it is soothing to patient.
 Ineffective coping = is defined as the inability to form a valid  Personalize the environment
with patient’s familiar
appraisal of the stressors, inadequate choices of practiced
objects.
response, and/or inability to use available resources.
  Compromised family coping = refers to usually supportive primary person (family members or close
friend) providing insufficient, ineffective, or compromised support, comfort, assistance, or
encouragement, which may be needed by the patient to manage or master adaptive tasks related to the
health challenge.

CELLULAR ADAPTATION
- Structural and/or functional changes in response to stress which can be HYPERTROPHY, ATROPHY,
HYPERPLASIA, DYSPLASIA and METAPLASIA

- Cells possess a MAINTENANCE FUNCTION (activities cell must perform for itself) and SPECIALIZED
FUNCTION (activities cell performs in relation to tissue/organ from which it is a part)

Cellular Hypertrophy Atrophy Hyperplasia Dysplasia Metaplasia

Adaptation Increase in cell Decrease in cell Increase in the Cell grows in Transformation of
size leading to size leading to number of cells different size, highly specialized
increase in organ decrease in organ leading to shape and cell into less
size size enlargement of arrangement specialized cell
tissue mass from cells of its
own type
Cause Prolonged and Disease or aging Hormonal Chronic irritation Stress applied to
increased process; decrease influences and highly specialized
workload in or loss of blood some idiopathic cells
supply; loss of causes.
nerve supply,
inadequate
nutrition
Tissues/Organ Skeletal and - Secondary sex - Breast changes Epithelial cells of Changes in
s commonly cardiac muscles organs in aging in puberty or the bronchi, skin, epithelial cells
affected and person pregnant cervix lining bronchi in
examples - Affected limbs woman response to
of patient with - Regeneration of smoke irritation
muscle liver cells
weakness or - Enlargement of
paralysis (polio, thyroid gland
marasmus) (goiter)
Michael D. Manglapus, BSN-RN, RM, MAN, PhD(InP)