General
Distractions, calm environments, and breathing techniques help with this
Anxiety
What are some manifestations of increased cortisol levels?
- Increased BP, CO
- Decreased testosterone, estrogen
- Increased facial, abdominal fat
- Decreased fat on arms, legs
- Lymphoid tissue atrophy, immunosuppression
Which kind of feedback is involved in the HPA axis?
Negative
Increased blood cortisol levels should cause CRH to decrease, thereby decreasing ACTH, and thus, returning cortisol levels to a homeostatic balance.
A 36 y.o. female presents to the clinic for "prolonged head colds." While assessing her, she tells you she is a single mother of a 5 y.o. child. She also works 52 hours per week while in school full-time for an associate's degree. She knows she's tired, but wants to know why her colds "never seem to go away." How would you explain the cause of this?
Explain to her that when the body experiences prolonged periods of stress, it causes cortisol levels to increase.
When cortisol remains high, it can cause lymphocytes (WBCs) to decrease, which makes it harder to fight off infection.
This is can be done before bed to calm the restless mind as a way to alleviate stress
Stretching, meditation, bubble baths
Felicia just passed the NCLEX. She notices her heart is racing and she has butterflies in her stomach. What type of stress is Felicia experiencing?
Eustress (good)
Eustress is associated with motivation, healthy challenges, accomplishments, excitement, and physical exercise.
This hormone is secreted from the anterior pituitary gland and stimulates the adrenal cortex to secrete cortisol
Adrenocorticotropic Hormone (ACTH)
What are the 3 stages of general adaptation syndrome?
Alarm
Resistance
Exhaustion
Which non-specific inflammatory markers may increase as a result of stress and why?
ESR and CRP.
When cortisol levels remain increased, inflammation can develop.
How do biking, swimming, weightlifting, and hiking help to reduce stress?
Exercise releases endorphins, boost mood, and regulate the HPA-axis. Thus, decreasing stress.
Caution: over-exercising or pushing oneself too hard at the gym can cause "bad" stress.
Headache, chest pain, fatigue, change in libido, and sleep problems are all physical signs of this
Stress
This hormone -- released during times of stress and sleep -- increases water retention.
Antidiuretic hormone (ADH)
These are characteristics of the ebb phase of the metabolic stress response
Increased blood glucose, lipolysis, increase in lactic acid levels, increase of glucose production and insulin resistance
You are the nurse caring for a 68 y.o. male who is 2hr post-op from a difficult AAA resection. The client's wife wants to know why the resident ordered Q4h blood sugar checks on her husband when he is not diabetic. How would you explain to her the purpose of checking his blood sugar?
Inform her that his body is experiencing stress because of surgery.
When the body is under stress, there are changes that occur that cause the blood sugar levels to increase temporarily.
(E.g. Decreased insulin, increased glucagon, increased glycogenolysis)
Sertraline, citalopram, escitalopram, and fluoxetine are what types of medication?
SSRIs
SSRIs have been shown to help regulate the HPA-axis and cortisol levels.
These are included with psychological signs of stress
Restlessness, anxiety, lack of motivation, sadness or depression
The body's response to this hormone (or pharmaceutical) involves bronchodilaton, coronary artery dilation, increased rate/force of cardiac contraction, and increased blood glucose.
Epinephrine
This stage is when the body tries to restore homeostasis during prolonged stress. Immunosuppression begins to develop here.
The resistance stage of general adaption syndrome
Which hormone lab can be checked when there is too much or too little cortisol?
Adrenocorticotropic hormone (ACTH)
These medications work by enhancing GABA effects. They are calming and can be sedative.
Benzodiazepines (the "-pams")
Different categories of stress include...
Acute
Episodic Acute
Chronic
Post-Traumatic
This hormone comes from the hypothalamus and is released during stress
Corticotropin-releasing hormone (CRH)
It is the main element that kickstarts HPA-axis.
The nurse is caring for a client who is a doctor in a general hospital. He complains about the stressful condition of his job. Lately, he has become increasingly susceptible to colds, headaches, muscular tension, excessive tiredness, and many other symptoms. Which stage of stress is the client in?
Exhaustion Stage
The client's adaptive/resistive mechanisms are depleted and can no longer protect him from stressors. Rest is vital to recovering.
True or False:
Cortisol levels remain constant throughout the day.
False.
Cortisol naturally fluctuates -- Highest in the morning, gradually declining until its lowest around midnight.
These drugs can be dependency inducing, and are considered a live IV controlled substance
Benzodiapzepines (Pams)