Ch. 7 & 33: Stress + Steroids Flashcards
Explain what stress is… what is the key to stress?
Stress: Inability to cope with demands or threats to one’s well-being
Key: Perception
What are 3 variables affecting responses to stress?
Type/Source
Duration: acute vs. chronic
Intensity
What are 4 internal influences on stress?
Age
Health status
Previous experiences of stress
Personality
While stress is more prevalent in _____, ____ are more likely to die from stress-related illnesses
women
men
List and explain 3 stress buffers
Resilience: Resourcefulness, ability to bounce back, problem solving/flexibility, perception of stress
Hardiness: handling stress, turning it into an opportunity
Attitude: positive attitudes linked to better health outcomes
What 3 things does the CNS control?
Through what 2 lenses does the CNS evaluate a stressor?
Cognition
Affect
Movement
“Rational brain”
Past experiences
Future consequences
What does the limbic system “emotional brain” mediate?
What is the goal of the limbic system?
Mediates between emotions and behavior
Self-preservation, survival
Explain the RAS
Reticular Activating System
Alerts limbic/cerebral cortex w/ impulses
Stress increases impulse frequencies
Increases degree of wakefulness
-Can lead to sleep disturbances
What does the hypothalamus communicate between?
What does it regulate?
Endocrine and nervous systems
Autonomic Nervous System-parasympathetic and sympathetic
How do the following respond to sympathetic stimulation?:
Heart
Blood vessels
Lungs
Adrenal Medulla
Liver
GI System
Heart: increased HR, SV, CO
Vessels: peripheral constriction
(raises BP, redirects to vital organs)
Lungs: increased RR, shallow breathing
Adrenal Medulla: Epinephrine, Norepinephrine, prolonged SNS response
Liver: glycogenolysis: raises BG
GI: decreased everything
Explain the HPA Axis
Fight or Flight Stress Response:
Stressor-Hypothalamus- CRH- Anterior Pit.- ACTH- adrenal medulla- Cortisol/stress hormone release
What are the 4 things that cortisol increases for the stress response?
Blood Glucose (fuel)
Focus
BP/bloodstream speed
Pain tolerance
What 3 things does cortisol decrease for the stress response?
Nonessential functions:
Peristalsis
Urine formation
Immune functions/inflammatory response
How does stress affect the immune system?
Causes opposite effects of acute inflammatory response
Decreases NK cells, lymphocyte proliferation, phagocytosis
Alters cytokine production
What is exogenous cortisol?
Cortisol given to the body- corticosteroids
List the glucocorticoid med indications!
Conditions that end in “itis”
-Addison’s disease
-Cerebral edema
-Endocrine disorders
-GI diseases (IBS)
-Exacerbated chronic respiratory illnesses-COPD
-Organ transplants- acute rejection
-Nephrotic syndrom- inflamed nephrons
What is a contraindication for glucocorticoid med use?
Severe infections such as bacterial meningitis- reducing inflammation stunts immune response to infection
Peptic ulcer disease or history of ulcers
List the Steroid Side Effects with the CORTICOSTEROIDS mneumonic
Cushing’s Syndrome
-moon face, buffalo hump
Osteoporosis
-decreased Ca2+ absorption
Retardation of Growth
Thinning of Skin
-easy bruises, delayed wound healing
Immunosuppresion
Cataracts + Glaucoma
Oedema (edema)
Suppression of HPA Axis
Teratogenic
Emotional Disturbances
Raised BP, Heart failure
Obesity
-Central/truncal obesity
Increased body hair growth- Hirutism
Diabetes
-hyperglycemia
Stomach Ulcers + Striae
How do steroids interact with the following drugs?
Non-K+-Sparing diuretics
NSAIDS
Anticholinesterase for myasthenia gravis
Immunizing Biologics
Antidiabetic Drugs
Severe hypocalcemia and hypokalemia
Increase gastric ulcer risk
Increase weakness
Inhibit immune response to biologic and increase risk of infection
Decrease hypoglycemic effects of antidiabetic drugs
List the 6 S’s: side effects of steroids
Sick- easier to get sick
Sad: causes depression
Sex: decreases libido
Salt: retains- weight gain
Sugar: raises blood sugar
Skin: thin, slowed wound healing, bruising
Which glucocorticoid taken PO is most common?
Prednisone
anti-inflammatory
immunosuppressant
Taken for:
exacerbations of chronic illnesses, like COPD
Which glucocorticoid taken PO is most potent?
Fludrocortisone
Taken for Addison’s Disease
Which IV Glucocorticoid is taken most commonly?
Methylprednisone (Solu-Medrol)
Immediately enters circulation
Onset faster than PO
What things in the nursing assessment are important for patients taking steroids?
Weight, height, I/O, vitals, hydration, nutrition, immune status
Labs- blood glucose, electrolytes
Edema
Skin condition
How should a pt on long-term steroids go off the meds?
Don’t stop suddenly, follow prescribed taper
adrenal crisis: if they suddenly don’t have help from the meds, they can stop working instead of restarting on their own
How should PO steroids be given?
What should be done after inhaling a steroid med?
With food or milk to minimize GI upset
Rinse mouth to prevent oral fungal infections (thrush)
