1) The document discusses the pathophysiological mechanism of disease, specifically focusing on stress and inflammation. It defines stress, describes the stress response process and factors influencing stress. It also outlines the signs and symptoms of stress and methods of coping.
2) Inflammation is defined and the causes, signs, and types (acute and chronic) are described. The pathophysiology of acute inflammation is explained, including the vascular events of hemodynamic changes and altered permeability, as well as the cellular events of leukocyte exudation and phagocytosis.
3) Managing stress involves problem-solving, time management, relaxation techniques, exercise, nutrition, and social support to reduce vulnerability to stressors.
2. STRESS
DEFINITIONOF STRESS
According to Selye, Stress is the excessive burning of the energy
resources.
According to Harry Gottesfeld , It is defined as interference
which disturbs the functioning of organism at any level and
produces a situation natural for organism to avoid.
According to Atkinson, Berne and Woodworth, Stress is a state
of strain, whether physical or psychological.
3. STRESSORS
Any event or stimulus that causes an individual to
experience stress is called as stressor.
Types of stressors
1. Internal- the stressors that originate within the body of an
individual is called as internal stressors.
- depression, anxiety, etc.
2. External- the stressors originate outside the body of an
individual.
- death of a family member, peer pressure, migration, etc.
3. Developmental- these stressors occurs at various
developmental stages.
- occur in a specific time period in everyone’s life.
4. Cont…
4. Situational- these stressors are unpredictable & may occur at
any time during life.
- marriage, death, birth, illness & natural disaster.
5. Physiological- the stressors that affect the functioning of the
body.
- chemicals, poisons, nutrition and genetics.
6. Psychological- these stressors arise from the external stressors
like work, environment, social relationships and daily lives.
5. STRESSORS ASSOCIATED WITH DEVELOPMENTAL STAGES
Child Beginning school
Establishing peer groups & Coping with peer groups
Adolescent Changing physique
Career
Achieving independence
Maintaining self esteem
Young adult College life
Family separation
Marriage
Establishing career
Rearing children
Leaving a home
Middle adult Child rearing
Physical changes
Dealing with responsibilities- work, children, elder parents.
Maintaining social status
Older adult Physical liabilities and health environment
Reduced income
Loss of family and friends
Loss of independence
Health problems
7. Wellness cycle
When the people developed a way of coping to deal with the
stress it is called as wellness cycle.
The wellness cycle shows self-management strategies that
work together to reduce pain and to make the person healthy.
12. Cont…
1. Stimulus Based Model
In this model, stress is identified as a stimulus or a set of
circumstances that arouses various psychological or
physiological responses that may enhance individual’s
vulnerability to illness.
the Social Readjustment Rating Scales (SRRS) was
developed by Holmes and Rahe (1967) consists of 43 life
changes or events.
The more stressors, a person experiences in a short period (1-2
years) are likely to develop physical and mental disorders. For
example- divorce may be highly traumatic to one person and
cause less anxiety to other.
13. Cont…
2. Response Based Model
According to Selye, “stress is non-specific response, of the
body to any kind of demand made upon it”.
It is characterized by a chain or pattern of physiological events
called the General Adaptation Syndrome (GAS).
General Adaptation Syndrome (GAS)
• It consists of 3 stages-
1. Alarm
reaction
3.Stage of
Exhaustion
2. Stage of
Resistance
14. Cont…
A. Alarm reaction (Flight or Fight Response)
It is the set of reactions initiated when the hypothalamus
stimulates the autonomic nervous system and adrenal medulla.
The alarm reaction is an emergency response of the body which
alerts the body’s defenses.
In this phase-
Heart Rate increases.
Circulate blood quickly to the areas where it is needed to fight
the stress.
Blood vessels except of lungs and heart constrict.
Decreasing blood supply to organs.
RBC production increases and helps control bleeding.
Liver converts glycogen into glucose and release it into the
blood stream.
Respiration rate increases.
Saliva and digestive enzymes production reduces.
15. Cont…
B. Stage of resistance
In this stage, body attempts to cope with the stressor & to limit
the stressor to the smallest area.
Certain hormonal reactions of the body are an important line of
defense, among these is Adreno - Corticotropic Axis (ACTA).
The regulating hormone include CRH, GHRH & TRH.
CRH stimulates the anterior pituitary. ACTH stimulates
adrenal cortex. These help in controlling blood pressure.
GHRH stimulates anterior pituitary to release growth
hormone. TSH helps to supply additional energy to the body.
The reaction helps in infection, control to meet the emotional
crisis & to control bleeding.
In this stage, all biological resources are activated to their
maximum capacities to resist the stress.
Individual makes maximum attempts to control stress.
16. Cont…
C. Stage of exhaustion
If stress continues, the resources start to deplete and person
losses its ability to resist stress. This may lead to weakness &
death. This stage is called exhaustion.
For example, a person saw his son trapped in a criminal case and
was sent to jail.
Listening this news, he ran door to door but all in vain.
Activation of body rises up so much that he was unable to sleep
for last 4 days, but he continued to make all efforts. At last, he
died because of cardiac arrest.
17. Cont…
This theory was based on the Lazarus Model (1966).
He recognized that certain environmental changes produce
stress in a number of people.
People have different sensitivity, vulnerability and
cognitiveness.
Example- one person may respond with denial, another with
anxiety & still another with depression.
23. 1. Frustration
It can also be described as a mixture of feelings of anger,
irritation, depression as a blockage in the achievement of goal.
For example- a student want to go for higher studies but poor
financial position does not permit him- External blockage.
- In another case, a student wanted to achieve higher grades
but lower intelligence serves as blockage.
24. 2. Conflict
It is a condition, when two or more than two goals come into
competition with each other in such a way that achievement of one
goal is blocked by other goal. It is called conflict.
It has further 3 types-
1. Approach-
Approach
3.
Approach-
Avoidance
2.
Avoidance-
Avoidance
25. Cont…
a) Approach-Approach
It is a condition when two or more than two equally attractive goals come
into competition with each other in such a manner that only one can be
achieved.
For example- a student is having final exams and on the same day his
brother’s marriage is declared.
b) Avoidance-Avoidance
It is a condition in which two or more than two equally aversive goals
appear in such a manner that person wants to avoid the pain of both but only
one can be avoided.
For example, a nurse wants to avoid the pains of duty on one side and the
termination of job on other side.
c) Approach-Avoidance
It is the most serious type of conflict. It is a condition when a goal has both
attractive and aversive characteristics.
Attractiveness of goal attract for the achievement but the aversive
characteristics repels back.
26. 3. Pressure
The another force that serves as stress is pressure.
It is the stress particularly when it is unwanted and arbitrary.
For example, a student is already working very hard with his best
efforts but if parents unnecessarily put pressure to work hard, then it
is a serious stress.
27. Coping with stress
Coping is defined as assisting an individual to adopt to perceived
stressors, changes or threats which interfere with meeting life
demands or roles.
Coping focuses on permanent relief from stress.
In coping, there are 4 models of reaction-
ATTACK COMPROMISE
WITHDRAWL
FLEXIBILITY
28. 1. Attack
In attack, individual plans in different ways to solve the
problem, which is producing stress.
Individual analyses the situation seriously to identify the
obstacles that held him back in achieving the goal.
29. 2. Withdrawal
When the attack strategy fails then it is better to reserve
energy resources, so that wastage of energy or depletion of
resources may nt occur.
In such conditions, individual should withdraw from the
situation.
Withdrawing fro the situation will help the person to
overcome the stress.
Withdrawal can be physical or psychological.
In physical withdrawal, the person moves away physically
from the situation.
30. 3. compromise
It is done with the values or by substitution of goal or by partial
achievement of goal.
Values are the norms which are learned from the society and
culture but most of the values develop from personal
experiences.
The purpose of these values is to evaluate various events and
behaviors.
31. 4. Flexibility
Flexibility in coping reactions gives special advantage over defense
mechanisms.
An individual can change his reactions at any moment on the failure
of one kind of reaction.
It is this flexibility of coping strategies, which helps the individual
to shift from one strategy to another in changing conditions.
Thus, it restores the energy resources to work under other
emergency conditions.
There is a very interesting quotation that “what appears to be an
end, it can be a new beginning”. When river end, it appears
everything is finished. However, where river ends, sea starts.
32. Management of stress
Problem- solving prevents the recurrence of a stressful experience.
Proper time management is a balance between difficult and
pleasurable experiences.
Relaxation techniques, exercise, leisure and nutritional awareness
all play a part in improving your physical, behavioral and
emotional response to stress.
By increasing physical resistance to stress and learning how to
relax yourself, you can reduce your vulnerability to stressful
events.
Developing a network of social supports and adopting good self
care habits serve as buffers against the inevitable stressors to daily
living.
33. Nursing Intervention
Efforts should be directed towards removing the stressor. If this is
not feasible, then medication can be given to remove or decrease
stressor such as “pain”.
Provide information about forthcoming surgery. It may reduce a
patient’s anxiety. Anxiety and stress can produce severe stress
reaction especially, when a patient is suffering from serious injury.
Encourage the patient to express their feelings.
physical activity tends to decrease the sympathetic adrenal
mechanism e.g. ambulation decreases post operative pain and
promote resumption of gastrointestinal function.
To relieve stress avoid noise, avoid bright light and movement
should be kept at minimum.
34. Cont…
Efforts should be taken to prevent additional physical or emotional
stress.
Comfort measures may be helpful to relieve stress that appears due
to backache, general muscle tension, emotional stress.
Help the individual and their family to plan their life so as to avoid
unnecessary strain.
35. Seven simple ideas to be healthy
1. Having a purpose in life.
2. Maintaining positive attitude.
3. Using one’s own ability.
4. Having the will to be whole and healthy.
5. Being adaptable.
6. Co-operating with other people.
7. Accepting responsibility for one’s thoughts and actions.
36. Inflammation
Definition:
It is defined as the local response of living mammalian
tissues to injury due to any agent. It is a body defense reaction in
order to eliminate or limit the spread of injurious agent as well as
to remove the consequent necrosed cells and tissues.
Causes of inflammation
The agents causing inflammation are as follows :-
1. Physical agents: heat, cold, radiation, mechanical trauma.
2. Chemical agents: organic and inorganic poisons.
3. Infective agents: bacteria, viruses and their toxins.
4. Immunological agents: cell mediated and antigen-antibody
reaction.
37. SIGNS OF INFLAMMATION
The five cardinal signs of inflammation are:-
Rubor (redness)
Tumor (swelling)
Calor (heat)
Dolor (pain)
Loss of function (functio laesa)
38.
39. TYPES OF INFLAMMATION
Depending upon the defense capacity of the host and
duration of response, inflammation can be classified as:-
1) Acute inflammation
2) Chronic inflammation
40. Cont…
Acute Inflammation:-
It is of short duration and represents the early body
reaction and is usually followed by repair. It’s main
features are:-
Accumulation of fluid and plasma at the affected site.
Intravascular activation of platelets.
Polymorphonuclear neutrophils as inflammatory cells.
41. Cont…
Chronic Inflammation:-
It is of longer duration and occurs either of the causative
agent of acute inflammation persists for a long time or the
stimulus is such that it induces chronic inflammation from
the beginning.
The characteristic features of chronic inflammation is
presence of chronic inflammatory cells such as
lymphocytes, plasma cells and macrophages.
43. Pathogenesis of acute inflammation
Acute inflammatory response by the host to any agent
is a continuous processes. It can be divided into
following two events:-
Vascular events
Cellular events
44.
45. Vascular Events
Alteration in the microvascular (arterioles, capillaries and
venules) is the earliest response to the tissue injury. These
alterations include:-
1) Hemodynamic changes
2) Changes in vascular permeability
47. 2. Altered Vascular Permeability
In and around the inflamed tissues, there is
accumulation of edema fluid in the interstitial
compartment which comes from blood plasma from
its escape through the endothelial wall of peripheral
vascular bed.
In the initial stage, the escape of fluid is due to
vasodilation and consequent elevation in hydrostatic
pressure .
This is transudate in nature.
48.
49. Cellular Events:-
The cellular phase of inflammation consist pof two
processes:-
A. Exudation of leukocytes
B. Phagocytosis
Exudation of leukocytes:-
The sequence of these leucocytic events can be divided
into:
Adhesion
Emigration
Chemotaxis
50. CONT…
Phagocytosis:
It is defined as the process of engulfment of solid
particulate material by the cells (cell-eating).The cells
performing this function are called phagocytes.
There are two main types of phagocytic cells :-
Polymorphonuclear neutrophils (PMNs) which appear
early in acute inflammatory response sometimes called
as “microphages’’.
Circulating monocytes and fixed tissue mononuclear
phagocytes called as “macrophages’’.
51.
52.
53. Defense against injury
Specific and non-specific defense mechanisms against
infectious diseases.
Non specific defenses
Anatomical barriers
Physiological barrier
Inflammatory response.
Normal flora of body
54. cont…
Specific mechanismof host resistance
Immunity
Vaccination
Inflammation
Fever
Skin
Mucous membrane
Eyes
Respiratory system
Intestinal tract, urinary tract and vagina
Sheltered area
55. Nutritional consideration
Nutrition is defined as the sum of processes by which a living
organism ingests, digests, absorbs, transports, uses and excrete
nutrients and their metabolites.
Nutritional assessment
Observing patient’s general appearance.
Obtaining careful medical, social and dietary history.
Clinical examination: anthropometrics and biochemical data.
56. General appearance
Person look
Observing body built- obese, thin, normal.
Height and weight.
Mood- happy, sad, frowning.
Dietary history
Use of dietary supplements.
Likes and dislikes.
Usual food pattern.
Response to food.
Resources for food.
Facilities for purchasing.
Appetite and intake.
57. Medical andsocial history
History of current illness.
History of previous illness.
History of pregnancy.
History of blood loss and donation.
Medication use.
Psychosocial data- economic status, occupation,
education level, living and cooking arrangements, level of
physical activity.
58. Diet modification
Protein
Fat modification
Carbohydrate modification
Liquids pureed and soft diets
Meal size and frequency.
