chapter 006

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 6

Homeostasis, Stress, and Adaptation

Chapter 6

Homeostasis, Stress, and Adaptation


Steady StateSteady State


Steady State (cont’d)Steady State (cont’d)

• Internal constancy

• Homeostasis

• Stress

• Adaptation


Types of StressorsTypes of Stressors

• Physical

– Examples: cold, heat, chemical agents

• Physiologic

– Examples: pain, fatigue

• Psychosocial

– Examples: developmental tasks/changes, anxiety-producing events (losing job)


Stress as a Stimulus for DiseaseStress as a Stimulus for Disease

• Links between stress, illness

• Life-event scales

– Holmes and Rahe (1967)

– Recent Life Changes Questionnaire (1982)

• Each person’s appraisal, response to event or stressor will vary


Stress as a Stimulus for Disease (cont’d)Stress as a Stimulus for Disease (cont’d)

• Refer to fig. 6-2


Stress as a Stimulus for Disease (cont’d)Stress as a Stimulus for Disease (cont’d)


Selye’s General Adaptation Syndrome Selye’s General Adaptation Syndrome

• Theory of adaptation to biologic stress

• Three phases:

– Alarm: SNS fight or flight response; catecholamines released onset of ACTH response, self-limiting

– Resistance: adaptation occurs to stressor; cortisol activity still increased

– Exhaustion: endocrine activity continues, body will fail if exposure to stressor is prolonged


QuestionQuestion

• Tell whether the following statement is true or false:

• The neural and hormonal activities that respond to stress and maintain homeostasis are located in the cerebral cortex.


AnswerAnswer

• False.

• Rationale: The neural and hormonal activities that respond to stress and maintain homeostasis are located in the hypothalamus.


Adaptive ProcessesAdaptive Processes

• Hypertrophy

• Atrophy

• Hyperplasia

• Dysplasia

• Metaplasia


Local Adaptation SyndromeLocal Adaptation Syndrome

• Local response to injury

• Includes inflammatory, tissues-repair process

• If injury is severe enough, general adaptation syndrome will be activated


Local Adaptation Syndrome (cont’d)Local Adaptation Syndrome (cont’d)


QuestionQuestion

• Tell whether the following statement is true or false:

• The five cardinal signs of inflammation are redness, heat, swelling, pain, and loss of function.


AnswerAnswer

• True.

• Rationale: The five cardinal signs of inflammation are redness, heat, swelling, pain, and loss of function.


AssessmentAssessment

• Subjective symptoms

• Objective symptoms

– Include indicators of stress response such as anxiety, increased pulse, increased respirations

• Consider potential indicators for stress (life events, developmental tasks, health risk appraisal)


Nursing ImplicationsNursing Implications

• Are heart rate, respiratory rate, temperature normal?

• What emotional distress may be contributing to patient’s health problems?

• Are there other indicators of steady-state deviation?

• What are patient’s blood pressure, height, weight?

• Are there problems in movement or sensation?

• Are there problems with affect, behavior, speech, cognitive ability, orientation, or memory?

• Are there obvious impairments, lesions, or deformities?


Nursing DiagnosisNursing Diagnosis

• Anxiety

• Impaired adjustment

• Ineffective coping

• Social isolation

• Risk for powerlessness

• Risk for spiritual distress

• Decisional conflict

• Situational low self-esteem


Stress Management: Nursing InterventionsStress Management: Nursing Interventions

• Promoting healthy lifestyle

• Enhancing coping strategies

• Teaching relaxation techniques

– Progressive muscle relaxation

– Benson’s relaxation response

– Relaxation with guided imagery


Stress Management: Nursing Interventions (cont’d)Stress Management: Nursing Interventions (cont’d)

• Educating about stress management

• Enhancing social support

• Recommending support, therapy groups


QuestionQuestion

• A nursing student is getting ready to take a final exam. Based on the understanding of the sympathetic nervous system’s response to stress, which assessment finding will be noted?

A.Hot, sweaty skin

B.Rapid respirations

C.Decreased heart rate

D.Skeletal muscle relaxation


AnswerAnswer

• B. Rapid respirations

• Rationale: Common assessment findings with the sympathetic nervous system’s response to stress are cold, clammy skin; increased heart rate; rapid respirations; and skeletal muscle tension.

chapter 006

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