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holistic man
1.3, 1.4, & 1.5 HOLISTIC MAN
Question | Answer |
---|---|
general adaptation syndrome: aka; def; how many stages; name the 3 stages; | GAS; physical response to stress; 3; alarm, resistance, exhaustion; |
general adaptation syndrome: alarm stage- what is stimulation; what happens; | SNS; shock and countershock; |
general adaptation syndrome: resistance- this is an adaptation to what; does it expend energy; this is dpendent on what; | stressor; yes; magnitude of stressor and coping resource; |
general adaptation syndrome: exhaustion- this occurs because ____ cannot be maintained; what is depleted; what is needed; what is adaptive energy; | adaption; resources; outside sources of adaptive energy; rest or death |
is stress always negative | no |
stressor classifications: are they internal or external; is it acute or chronic; | all; all |
General Adaptation Syndrome (GAS): begins with what; what is the stimulus; the stimulus is recognized by what; this recognition by the brain is called what; the brain initiates what; this fight and flight is ___ response; | stimulus; stress; the brain; stress reception; the physiological fight/flight/fright system; stress response; |
General Adaptation Syndrome (GAS): what is the desired outcome of stress; adaptation is achieved through what; what are goals of adaptation; maladaptive coping responses are often percursors to what; | adaptation; coping; physical and psychological health; disease; |
physical response to stress: CNS integration activates what in brain; this axis activates what; | hypothalamic-pituitary-adrenal axis; autonomic system; |
body organs affected by prolonged stress: what happens to GI tract; what happens to the adrenal glands; what happens to lymphatic structures; | the rugae in stomach deepen; they enlarge with prolonged stress; thymus, spleen, lymph nodes atrophy; |
alarms: Shock- this is a ___ reaction; ANS reaction is AKA; what is released with ANS reaction; how long does it last; | ANS; fight or flight; epinephrine and cortisone; a few minutes to an hour |
ALARM: def countershock; | reverse or shock |
s/s sns stimulation: what happens to BP; what happens to HR; what happens to RR; what happens to GI motility; what happens to pupils; what happens GI; | increases; increases; increases; decreases; dilates; nasea, fatigue, anorexia, wt loss |
resistance: this mediates what; the body attempts to cope with what; what happens with the physical s/s; | internal and external environments; stressor and localize it the smallest area; they return to normal |
exhaustion: when does it develop; are there physical s/s; | when stressor is overwhelming, ongoing or coping mechanisms are inadequate/dysfunctional; yes they return |
Stress stages: def homeostasis; what are the stages of stress in order; in what stage is stress perceived; | all systems are reactive to everyday stressors in a balanced and healthful manner; alarm, resistance, exhaustion; alarm; |
alarm: what happens to homeostasis; | it slightly drops as the mind body temporarily lose balance; |
resistance: what is mobilized to combat stress; what system comes into play; | adaption of resources; the endocrine system;Q |
exhaustion: what is depleted; when the energy and adaptation stores and replenished what happens; | adaption and energy stores; body returns to homeostasis; |
stages of stress: what are 2 things that can happen after exhaustion; why would death happen; when does recovery happen; | death or recovery; chronic exhaustion is soo bad; stress that is managed ok; |
stress response: epinephrine release: what happens to HR; what happens to heart contraction; what happens to bronchials; what happens to blood; what happens to metabolism; | tachycardia; increases; dilates; blood clotting; increases; |
stress response: noepinephrine release- where in body is blood not shunted to; what happens to renin; | kidneys; it increase |
stress response: release of cortisone- what happens to protein; | it is cotabolism |
stress response: in what stage does shock phase occur; what 3 things are released in shock phase; the release of these 3 things cause what phase | alarm; epi, norepi, cortisone; contershock phase |
what effects bodies stress response | the intensity, the amount of stress that occurs in one time |
stress response: what happens after stress occurs; the perception of the stress response occurs where; where in the brain causes the SNS response; the pituitary releases what; | our response to stress; in the cerebral cortex; hypothalamus; ADH, ACTH |
what is internal conditioning; | age,heredity, pre-existing physical conditions, previous experiences, nutrition |
stress response: release of ADH causes what; release of aCTH retains what; release of ACTH eliminates what; | aliguria; Na, Cl, H2O; K |
stress response: SNS- it is responsible for changes where; | in VS; |
vsriables affecting stress response: what in stress affects response; what other variables; | intensity, duration, number and type; perception, conditioning factors |
impact of ICU: stress- what deficit do these pt often experience; nutritional deficits removes ___ resistance to things; there is a loss of what; what are environmental stresses in ICU; there is isolation from whom; | nutritional; bodies; control; lights, noise, equipment, 24/7 activity; support ppl |
impact of ICU: why is there sleep issues; sensory perception deprivation why; sensory overload why; | pt not getting good rem sleep bc of constant waking of pt; day-night issues, isolation or comfort touch; overload of light, noise, equipment lights and alarms, pain, procedures |
impact of ICU: nutritional deficits- there is a hyper____ states; what other state is there | hypermetabolic states; catabolic and malnourished |
impact of ICU: sleep- this process facilitates ___ growth; sleep also repairs ___; def NREM; def REM; what sleep cycle is 75% of the sleep time; what is 25% of sleep time; | cell; damaged aging tissue; non rapid eye movement; rapid eye movement; NREM; REM |
impact of ICU: sleep- what happens in nrem; what happens in rem sleep; | metabolic, cardiac resp rate decreases, bp decreases, bone marrow activity increases, protein synthesis occurs; sns accelerates and increases COand HR RR, perfusion to grey matter doubles, info is stored, |
sleep cycle: each cycle is completed in an interval of __ min; the cycle should occur how many times in a 24 hour period; | 70-100; 4-6 cycles; |
Delirium: what age is at risk; who else is at risk; what environmental factors puts one at risk; what physical factors increase risk; what meds increase risk | increase in age; cognitive impairments, sensory deficits, substance abuse; sleep deprivation, anxiety, sensory overload, immpbilization; severe infection, hemodynamic instability, decreased 02, increased co2, electrolyte imbalance; benzos |
ex of nezodiazapine meds | Ativan, xanax |
altered family processes: why does this happen when pt is sick; what are cultural factors; | change in role, responsibility, multiple stressors, family loss of control, anxiety over pt condition, cultural factors, spiritual crisis; meaning of sickness and health, caregiver responsibility, pain, death and dying, grief |
what are behavioral reactions to stress | anxious, aggressive irritable, depressed, withdrawal, decreased motivation, forgetful, suspicion, somatization, changes in eating/sleeping patterns |
def somatization | the production of recurrent and multiple medical s/s with no discernible organic cause |
nursing interventions to reduce fear and enhance family coping: acknowledge ___; note s/s of prolonged ___ stage; | source of emotional discomfort; alarm; |
nursing interventions to reduce fear and enhance family coping: how nurse can reduce stress- give info how; increase fam sense of __; don't personalize ____ reactions; involve ___ in care; reduce ___ overload; refer what | simple explanations; control; negative; family; sensory; support systems - spiritual care, SW, community supports |
nursing interventions to reduce fear and enhance family coping: fear is a response to what; | and identifiable threat, |
physiologic stress response: adrenal hormones- adrenal cortex produces what; where are adrenal glands located; name 3 corticosteroids; | corticosteroids; triangles on top of the kidneys; glucocorticoids, mineralcorticoids, androgens; |
physiologic stress response: adrenal hormones- what is a glucocorticoid; cortisol regulates ___; what can cortisol increase; cortisol retains ___ and gets rid of ___; it increases or decreases formation of gastric acids | cortisol; metabolism; BG: Na, K; increases |
physiologic stress response: adrenal hormones- what is a mineral corticoid; helps body save what; aldosterone regulates what balance; | aldosterone; salt; sodium-k+ balance; |
physiologic stress response: adrenal hormones- what are androgens; androgens are responsible for what; | testosterone and estrogen; growth and development and sexual function in females; |
physiologic stress response: adrenal hormones- the adrenal medulla is responsible for what response; the adrenal medulla produces _____; epi and norepi and aka; | fight or flight; epi and norepi; catecholamines |
adrenal anatomy: where is cortex located; where is medulla located; | outside portion; inside portion; |
cushings syndrome: this is an excess of ____; | cortisol; |
cushings syndrome: causes- what long term drug use can cause this; what adenomas cause an increase in ACTH; what tumors cause this; | steroid; pituitary; adrenal |
cushings syndrome: s/s are r/t what; | exaggerated cortisol actions; |
cushings syndrome: dx- what would cortisol levels be; what other labs are assessed; what other test is done; | high in serum and urine; serum electrolytes, glucose; dexamethasone suppression test |
Addison's disease is r/t ____ destruction or dysfunction | adrenal |
cushings syndrome: CMs- what is deposited in body; where is fat deposited; what happens to bp; what happens to salt; what happens to BG: what happens to muscles; what happens to skin; there is delayed ___; what happens to bones; what are emotional changes | fat; truncal obesity, moon face, buffalo hump; increases; it is retained; increases; weakness and wasting; thins and striae occur; healing; osteoporosis; depression to psychosis |
cushings syndrome: there is abnormal ___ metabolism; there is an excess of what hormone; since there is a decrease in fibroblasts this = ___ loss; what response is inhibited; | carb, protein, glucose; aldosterone; collagen loss; immune; |
cushings syndrome: Nursing Dx; tx depends of what | fluid vol excess, risk for infection, disturbed body image, risk for injury, impaired tissue integrity, acute confusion; what cause |
Addison's disease: this is a deficiency in what; what is the primary cause; other causes; adrenal hemorrhage is caused by what; what is a secondary cause; | cortisol; adrenal dysfunction; autoimmune disease, adrenal hemorrhage; trauma, sepsis, anticoagulants; pituitary fails to produce ACTH, withdrawal of steroid therapy abruptly; |
Addison's disease: s/s are r/t what hormone levels; how is it dx; | increase in ACTH, decrease in aldosterone and cortisol; decreased cortisol levels, increased ACTH levels, ACTH stim test, lytes, glucose |
Addison's disease: CMs- decreased aldosterone levels- what happens to salt; what happens to fluid volume; hyponatremia causes what s/s; hypovolemia causes what s/s; | decreased levels; hypovolemia; dizziness, confusion, irritability; hypotension, shock, syncope |
why does hypovolemic shock kill you | b/c organs cannot be perfused |
Addison's disease: CMs- cortisol deficiency- what happens to BG; what happens to stress response; weak or strong; GI issues; | hypoglycemic, decreases stress response; weak; anorexia, n/v, diarrhea |
Addison's disease: CMs- ACTH excess- causes ___pigmentation | hyperpigmentation |
Addison's crisis: is it life threatening; this is acute ___ insufficiency; what triggers it; | yes; adrenal; surgery, trauma, systemic infection or abrupt withdrawal long term steroid use; |
Addison's crisis: s/s- what happens to temp; where is severe pain; GI; what happens to heart; what are dysrhythmias r/t; what happens to bp; hypotension leads to what; | high fever; abd, back and legs; severe Vomiting and diarrhea; dysrhythmias; possible increase in k+; hypotension; shock-coma-death; |
Addison's crisis: tx- what needs to be replaced; what fluid should be used; why is D5.9 used; why does pt need dextrose; what meds are given; what precipitating stressors be treated to prevent occurance | fluid; D5.9NS; pt needs dextrose Na and fluid; bc they do not have ability to create sugar in the liver; glucocorticoids- hydrocortisone, fludrocortisone; infection and underlying cause |
Addison's crisis/disease: nursing DX- | fluid volume deficit, risk for ineffective self health management, acute pain, diarrhea, anxiety, knowledge deficits |
what are the three stages of GAS | alarm reaction, stage of resistance, stage of exhaution |
stress response: what part of the body evals the emotional response to stress; | cerebral cortex; |
hypthalamus and stress: Cstress activates ___ system; the limbic system in turn activates what; it is the central connection between the ____ and ___ systems in responding to stress; | limbic system; the hypothalamus; nervous and endocrine system |
hypthalamus and stress: the hypothalamus stimulates the release of ___ inf the pituitary | ACTH; |
endocrine system and stress: the SNS stimulates the adrenal medulla to release what; epi and norepi prep the body for what stress reposnse; ACTH stimulates ___ to release ___; | epi and norepi; fight or flight; the adrenal coretx to synthesize and secrete cortisol and aldosterone; |
cortisol: what is it; what do they do; | a corticosteroid; increase BG, inhibit inflam response; |
stress and the immune system: chronic stress induces what; | immunosuppression; |
addison's disease: is hypo function of ___; is there too much or too little ACTH secretion; what are the 3 classes of adrenal corticosteriods; | the adrenal cortex; too little; glucocorticoids, mineralcorticoids and androgens; |
addison's disease: are the 3 classes of corticosteroids increased of reduced in this disease; ACTH deficiency is caused by what suppression and disease; what is the most common cause; in the autoimmune response what is destroyed; | reduced; pituitary; an autoimmune response; adrenal tissue; |
addison's disease: what destroys the adrenal tissue; what resp disease can cause this; | pt antibodies; TB; |
addison's disease: CMs are not noticeable until __% of the adrenal cortex is destroyed; so is the disease advanced or in early stages usually when it is Dx; are CMs slow or fast onset; what are the common slow onset s/s; | 90%; advanced; slow; fatigue, wt loss, anorexia; |
addison's disease: what happens to the skin; where on body is skin hyperpigmented; where is hyperpigmentation most noticable on body; what causes hyperpigmentation | it is hyperpigmented; on sun exposed areas of the body, creases, joints, pressure areas; in creases of hands; incrased secretion of B liptropin |
addison's disease: increased secretion of B lipotropin stimulates what; what happens to BP; is sodium high or low; is K+ high or low; what happens GI; | melanocyte production; orth HTN;low; high; N&V&D |
addison's disease: what is a serious complications; what happens to bg; | acute adrenal insufficiency/addisonians crisis; it decreases; |
addisonian crisis: what is there a sudden decrease of; what triggters this; ex of stressers; sudden withdrawn of what medication therapy can cause this; | adrenocrotical hormones; stress; trauma, hemmorhage, surgery; corticosteroid hormone replacement therapy; |
addisonian crisis: s/s are similar to addisonians crisis but more__; where does pain occur; what happens to circulatory system; circ. collapse does not respond to what type of Tx; what does severe hypotension lead to; | severe; abdomen, lower back and legs; it collapses; norm fluid replacement and vasopressors; shock and circulatory collapse |
addison's disease: dx- what is acth stimulation test; if pt is having s/s of this but cortisol levels do rise with ACTH stim testing what is issue | when this test is done and acth is stimulated the cortisol levels do not rise like they should and pt dx with addisonians disease; usually pituitary issue |
addison's disease: lab findings- what is sodium; what is k+; what is chloride; what is BG; what does H&H show; what does BUN show; what does urine levels of free cortisol reveal; | low; high; low; low; anemia; it is higher; they are low; |
addison's disease: Dx- what does ECG reveal; why does ECG show tented T waves; why are Cts and MRIs used | peaked/tented T wave; due to increased k+; to find tumor |
addison's disease: what is treatement; what is the med used for replacement therapy; during situations of anticipated stress what may physician increase to prevent the crisis; | replacement therapy; hydrocortisone; glucocorticoid ; |
addison's disease: tx- what is main tx for crisis; what fluids are given in the crisis; | hydrocortisone therapy and shock management; 0.9% and 5% dextrose; |
addison's disease: nursing interventions- why should pt be protected from noise, light, and environmental temp extremes; teach what | they cannot cope with these stressers b/c of the inability to produce corticosteroids; the importance to maintain corticosteroid therapy |
addison's disease: what conditions would increase the need for more meds; pt will need lifelong what | trauma, infection, surgery and emotional crisis'; med therapy |
addison's disease: why is the dosage of meds given at certain times of the day; we need to teach ___ management; when in doubt it is better to error on the side of over or under replacement; s/s of corticosteroid excess is what; | to reflect the circadium rhythm of hormone secretion; stress; over; cushings syndrome; |
addison's disease: waht meds increase the need for more corticosteroids; pt needs to learn how to take what vital sign; in emergency what should pt have at how if unable to take oral dose of corticosteroids; | dilantin, antacids; BP; IM hydrocortisol; |