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Chapter 6

Homeostasis, Stress, and Adaptation

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

Steady State
Internal constancy
Homeostasis
Stress
Adaptation

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Types of Stressors
Physical
Examples: cold, heat, and chemical agents
Physiologic
Examples: pain and fatigue
Psychosocial
Examples: developmental tasks/changes, anxietyproducing events such as losing job

Copyright 2008 Lippincott Williams & Wilkins.

Stress as a Stimulus for Disease


Links between stress and illness
Life event scales
Holmes and Rahe (1967)
Recent Life Changes Questionnaire (1982)
Each persons appraisal and response to an event or
stressor will vary.

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

Selyes 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 the stressor;
cortisol activity is still increased
Exhaustion: endocrine activity continues and the
body will fail if exposure to the stressor is prolonged

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Adaptive Processes
Hypertrophy
Atrophy
Hyperplasia
Dysplasia
Metaplasia

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Local Adaptation Syndrome


A local response to an injury.
Includes the inflammatory and tissue repair process.
If the injury is severe enough, General Adaptation
Syndrome will also be activated.

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

Nursing Implications
Use of Nursing Process
Assessment
Diagnosis
Planning
Interventions
Evaluation

Copyright 2008 Lippincott Williams & Wilkins.

Assessment
Subjective symptoms
Objective symptoms
Include indicators of stress response such as anxiety,
increased pulse, and increased respirations.
Also consider potential indicators for stress such as life
events, developmental tasks, and health risk appraisal.
See Chart 6-2.

Copyright 2008 Lippincott Williams & Wilkins.

Nursing Diagnosis
Anxiety
Impaired adjustment
Ineffective coping
Social isolation
Risk for powerlessness
Risk for spiritual distress
Decisional conflict
Situational low self-esteem
Copyright 2008 Lippincott Williams & Wilkins.

Interventions
Stress management interventions:
Relaxation techniques
Progressive muscle relaxation
Guided imagery
Assist and support coping and adjustment
Coping enhancement; see Chart 6-3
Enhance social support; support and therapy groups
Promote a healthy lifestyle
Copyright 2008 Lippincott Williams & Wilkins.