Homeostasis, Stress and Adaptation

Homeostasis: The Dynamic Balance Each different body system performs specific functions to sustain optimal life for the organism. These mechanisms are compensatory in nature and work to restore balance in the body.

Constellation of System Each system is a subsystem of the larger system of which it is part. The goal of the interaction of the bodys subsystems is to produce a dynamic balance or steady state. Homeostasis - a steady state within the body ; the stability of the internal environment Homeostatic mechanisms - safeguard and control mechanisms of the body to keep conditions as close as to normal Example: a person in a hot room If he does not have a good homeostatic mechanisms, his temperature will increase greatly and this would lead to death

But if he has good homeostatic mechanisms, he will experience sweating to cool by evaporation and dilating blood vessels to expel body heat to help prevent the body temperature from rising above normal.

Stress and Adaptation Stress a state produced by a change in the environment that is perceived as challenging, threatening or damaging to the persons dynamic balance or equilibrium. Stressors an internal or external event or situation that creates the potential for physiologic, emotional, cognitive or behavioral changes in an individual. Adaptation a changed / alteration designed to assist in adapting to a new situation or environment The desired goal of adaptation are survival, growth and reproduction.

Types of stressors I. Physical a) Cold b) Heat c) Chemical agents Physiologic a) Pain b) Fatigue Psychosocial a) Fear of failing an exam b) Losing a job As normal Life transition a) Childhood to puberty b) Getting married c) Giving birth

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Other Classifications of stressors I. Day to day frustrations or Hassles a) Traffic jam b) Argument with a friend Major complex or occurrences involving large groups, even entire nations a) Terrorism and war b) Economical and technological changes Stressors that occur less frequently and involves fewer people a) Death,birth,marriage,divorse and retirement b) Chronic stressors; permanent functional disability or coping with difficulties of providing long-term care to a frail elderly relative

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An acute,time-limited stressor a) Studying for final exam b) Preparing for a report in class A stressor sequence Chronic intermittent stressors Chronic enduring stressor

Stress as a Stimulus for Disease Critical life events link illnesses

Psychological Responses to stress Stressor unconsciously) mediating process reaction (consciously /

After the recognition of a stressor, an individual consciously or unconsciously reacts to manage the situation.( mediating process)

Mediators of stress 1. Appraisal of stressful events -An event is evaluated with respect to what is at stake ( primary appraisal ) and what might and can be done ( secondary appraisal ). Primary Appraisal It is influenced by their personal goals, commitments or motivations The situation is identified as either non stressful or stressful Non stressful situation- irrelevant or benign ( positive ) Stressful situation - one in which harm or loss has occurred -one that is threatening - one that is challenging

Secondary Appraisal An evaluation of what might and can be done about this situation Action: -assigning blame for those responsible for a frustrating event -thinking about whether one can do something about the situation (coping potential )

-determining future expectancy or whether things are likely to change for better or worse

- Appraisal process contributes to the development of an emotion Negative emotions - harm, loss appraisals Positive emotions challenge -Emotions includes a tendency to act in a certain way Example: an unexpected quiz students threatening by unprepared

Fear, anger, resentment Hostile comments 1. Coping with Stressful event -consists of cognitive and behavioral effort made to manage the specific external or internal demands that tax a persons resources and maybe emotion-focused or problem-focused. - seeks to make the person feel better by lessening the emotional distress felt. Problem-focused -aims to make direct changes in the environment so that the situation can be manage more effectively. Appraisal and coping are affected by internal characteristics such as health, energy, personal belief system, commitments or life goals, self esteem, knowledge, problem solving skills and social skills. Hardiness name given to a general quality that comes from having rich, varied and rewarding experiences. Hardy people perceive stressors as something they can change and therefore control. Emotion-focused

Physiologic Response to Stress

A protective and adaptive mechanism to maintain the homeostatic balance of the body.

General Adaptation Syndrome

Hans Selye developed a theory of adaptation Described a syndrome consisting of enlargement of the adrenal cortex; shrinkage of the thymus, spleen, lymph nodes, and other lymphatic structures; and the appearance of deep, bleeding ulcers in the stomach and duodenum. It is a non specific response to diverse; noxious stimuli.

Phases of General Adaptation Syndrome A. Alarm Phase Stressor

Sympathetic fight or flight response is activated

Release of catecholamine

onset of adrenocorticotropic Hormone (ACTH)

B. Resistance Phase Adaptation to stressor

Increased cortisol activity If prolonged C. Exhaustion

Exhaustion

Increased endocrine activities

DEATH

Local adaptation Syndrome Inflammatory response and repair processes that occur at the local site of tissue injury Occurs in small topical injuries If local injury is severe, GAS is activated

Interpretation of stressful stimuli by the brain

Sympathetic-Adrenal-Medullary Response to Stress Effect Increased heart rate and blood pressure Increased blood glucose Mental acquity Dialted pupils Increased tension of skeletal muscles Increased ventilation Increased coagulability of blood Purpose Better perfusion of vital organs Increased available energy Alert state Increased awareness Preparedness for activity, decreased fatigue Provision of oxygen for energy Prevent hemorrhage

Hypothalamic Pituitary Response

Gluccocorticoids (Cortisol)

increased gluconeogenesis increased blood glucose level

Mineralcorticoids ( Aldosterones)

Sodium and water retention increased ECF; Increased BP

Sex Hormoes

Androgen, Estrogen

Immunologic Response Neuroendocrine hormones released by CNS and endocrine tissues can inhibit or stimulate leukocyte function. Multiple studies have demonstrated alteration of immune function in people who are under stress as evidenced by decreased number of leukocytes, impaired immune response to immunization.

Maladaptive Responses to Stress Chronic, recurrent responses or patterns of response over time that do not promote the goals of adaptation Goals of Adaptation a) Somatic or physical health b) Psychological health c) Having a sense of well being d) Enhanced social functioning, work, social life and family Faulty appraisals and inappropriate coping threaten the goals of adaptation Example: a) Use of alcohol / drugs to reduce stress increases the risk of illness b) Denial, avoidance and distancing c) Type A personality behavior are more prone to develop stress related illnesses

Equation Stress + maladaptation = precursors to illnesses

Diseases of Maladaptation

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High blood pressure Disease of the heart and blood vessels Diseases of the kidney Infections Metabolic diseases

Indicators of Stress General irritability, hyperexcitation or depression Easily fatigued, loss of interest Loss or excessive appetite Prone to injuries Disturbed behavior Excessive perspiration Tension, alertness Hypermotility Increased frequency of urination Nervous laughter

Laboratory Measurements during Stress Blood level of catecholamines, corticoids, ACTH Increased cholesterol and free fatty acids

Stress at Cellular Level

Health
Compensatory mechanisms; cells remains intact

Disease
Pathophysiologic mechanisms loss of cell integrity

The earliest changes occur at the molecular or subcellular level and are not perceptible until steady state functions or structures are altered. Example: tanning of skin, if its continuous it will lead to sunburn/ injury then to desquamations

Control of the Steady State I. Negative Feedback mechanisms throughout the body monitor the internal environment and restore homeostasis when conditions shift out of the normal range. Work by sensing deviations from a predetermined set point or range of adaptability and triggering a response aimed at offsetting the deviation.

Example:

CO2 in ECF CO2 in ECF Pulmonary ventilation CO2

In cellular level

CO2 in ECF

Hydrogen in blood

Chemoreceptors

Rate of discharge of neurons

Innervations of diaphragm and intercoastal muscles

Respiratory rate CO2 exhaled Normal level of hydrogen

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Positive Feedback Perpetuates the chain of events set in motion by the original disturbance instead of compensating for it. As the system becomes more imbalanced, disorder and disintegration occur. Cellular Adaptation to Stressors

Adaptation Hypertrophy

Stimulus Increased work load

Example Leg muscles of runner Cardiac muscle in persons with hypertension

Atrophy

Decrease in: Use Blood supply Nutrition Innervations

Secondary sex organs in aging persons Extremity immobilized in plaster cast

Hyperplasia

Hormonal influence

Breast changes during puberty

Dysplasia

Reproduction of cells with resulting alteration of their size and shape

Alterations in epithelial cells of the skin or the cervix, producing irregular tissue changes that could be the precursors of a malignancy Changes in epithelial cells lining bronchi in response to smoke irritation

Metaplasia

Stress applied to highly specializd cell

Cellular Injury

Any stressor that alters the ability of the cell or system to maintain optimal balance of its adjustment processes will lead to injury. Causes of Cellular Injury a) Hypoxia b) Nutritional imbalance c) Physical Agents -extremes of high temperature -extremes of low temperature -radiation and electrical shock -mechanical trauma d) Chemical agents e) Infectious agents f) Disordered immune responses

Cellular Response to Injury

Inflammation eliminate the repair. a defensive reaction intended to neutralize, control or offending agent and to prepare the site for

It is not specific response that is meant to serve a protective function

Chemical Mediators a) Histamine - released when injury occurs and is responsible for early changes in vasodilation and vascular permeability b) Kinins - attract neutrophils in the area Increase vasodilation and vascular permeability a) Prostaglandins

Cell Injury Transient Vasoconstriction Vasodilation

Increased blood flow Local heat and redness blood Increase vascular permeability vessels Leaking of plasma fluids into inflamed tiisues injury Formed elements remain in the Leukocytes collect in blood migration of leukocytes into the

Pain Loss of function Types of Inflammation

phagocytosis

1) Acute inflammation Characterized by local vascular and usually lasts less than two weeks Immediate and serve as protective function 1) Chronic inflammation Develops if the injurious agent persists and the acute response perpetuated Symptoms are present in many months or years Does not serve as beneficial and protective function

Cellular Healing
I. Healing by Regeneration a. Labile cells - multiply constantly to replace cells worn out by normal physiologic processes. b. Permanent cells - includes neurons, nerve bodies not axon Axons may regenerate a. Stable cells - have a latent ability to regenerate Under normal physiologic processes, they are not shed and do not need replacement, but if they are damaged,they are able to regenerate. Healing by Replacement a. Primary Intention Wound is clean and dry and the edges are approximated Little scar formation occurs Healed in a week a. Secondary Intention

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The wound is larger and gaping It has necrotic or dead material More scar formation Repair takes longer

Stress Management
The goal of relaxation training is to produce a response that counters the stress response.

Bensons Relaxation Response 1. 2. 3. 4. 5. 6. 7. 8. Pick a brief phrase or word that reflects your basic belief system. Choose a comfortable position. Close your eyes. Relax your muscles. Become aware of your breathing and start using your selected focus word. Maintain a passive attitude. Continue for a set period of time. Practice the technique twice daily.

Five Predominant ways of coping with illness ( Jalowiec,1993) 1. 2. 3. 4. 5. Trying to be optimistic about the outcome Using social support Using spiritual resources Trying to maintain control either over the situation or over feelings Trying to accept the situation