Immune System
Your client states he has "no problems" with his allergies in the fall despite frequent exposure to grain dust and working long hours without adequate rest. Why does this happen?
Stress response decreases eosinophils which decreases allergic response.
How does the stress response contribute to peptic ulcer disease?
Increased acidity with decreased GI motility
A 70 yr old client complained of increased angina during and after visiting her son who has terminal cancer. This is likely due to:
Increased epinephrine released as a result of the stress response. Epinephrine causes increased contractility and CO increasing myocardial O2 demand. Increased O2 demand and decreased O2 supply results in ischemia
A friend tells you she heard a story about a woman lifting a heavy piece of furniture off her child and asks how this is possible. You explain:
During the stress response, blood flow to the muscles increases and glucose is more readily available for use (caused by epinephrine release)
Your client with a diagnosis of diabetes has been started on steroids. What lab change do you expect and why?
Blood glucose. Steroids stimulate gluconeogensis and increase serum glucose.
A 30 year old client presents in the ER with an "allergy attack". Upon auscultation you hear wheezing with minimal air exchange. Name two drugs that would be appropriate
Epinephrine
Steroids
Why might Metoclopramide be included in standard trauma orders?
Stress decreases blood flow to the GI tract and therefore decreases peristalsis.
A 65 year old is admitted with an acute MI. The healthcare provider orders epinephrine for treatment of low HR and BP. The nurse questions this order because:
Epinephrine will place more demand for O2 on an already O2 deprived heart.
An 18 year old is involved in a trauma requiring a lengthy hospital stay. She refuses to adhere to the prescribed 6000 kcal/day diet because "I'll get fat". You explain at least two reasons for the need for increased calorie requirements.
Stress creates catabolism and increased energy is required for tissue repair and healing.
Activation of the Anterior Pituitary has what effect on serum potassium and sodium?
The anterior pituitary will increase aldosterone and therefore retain sodium and secrete potassium.
The nurse is caring for an 82 year old client with a history of steroid use for several years following a femoral popliteal bypass. Absolute sterile technique when handling her incision is necessary because:
Steroid use combined with the stress response decrease the inflammatory response putting the client at risk for infection.
What types of medications could contribute to sepsis originating in the GI tract?
Antibiotics can destroy natural flora and allow microbial growth. H2 blockers affect pH.
ABGs measured within minutes of the onset of the stress response would indicate:
Respiratory alkalosis secondary to increased respiratory rate.
Negative nitrogen balance refers to what phenomenon?
Increased protein catabolism occurs due to an increase of cortisol due to stress response. More protein is used than taken in.
Twenty four hours following surgery, your client reports an increased amount of urine output. The nurse explains:
A decrease in stress response will decrease aldosterone and ADH resulting in an increase in UO.
It is midterm, semester 3 nursing students are studying for a H&I3 exam, working on Picot questions, and preparing for pediatric clinicals in Fargo. The class is full of sneezing and coughing. The reason this is occurring is:
Cortisol decreases function of the thymus resulting in decreased lymphocytes causing a decrease in immunity
A 45 yr old is admitted for observation following a MVA in which his friend was seriously injured. The client refuses to eat and states they are not hungry. This is because:
Stress decreases peristalsis and gastric emptying, which decreases appetite.
An 85 yr old with Alzheimer's is admitted following an MI. He is ordered to be placed on strict bedrest. He states he "needs to go to the bathroom" and refuses to use the bedpan. As the nurse explains the reason he needs to stay in bed, he becomes angry and tries to get out of bed. You should:
Assist him to the bedside commode. Requiring him to stay in bed, increases the stress response and places greater demand on the heart.
How does stress increase serum cholesterol?
Epinephrine causes increased lypolysis which increases circulating free fatty acids, increasing triglycerides and in turn cholesterol.
A client who did not have a diabetes diagnosis recently underwent CABG surgery. Immediately post op the patient's blood sugar was 150. The reason for this is:
Surgery triggers the stress response which causes the anterior pituitary to produce ACTH which causes the release of cortisol which increases blood glucose. As the stress response decreases, blood glucose will return to normal.