One of the most important jobs of a health professional is to predict and identify complications - new problems that can arise as a result of a patient's original ailment. Many patients die of complications that went unrecognized because the health professionals thought only about the original diagnosis and not how the patient's problem was linked to other body systems.In this case study, the doctor identifies a developing complication of a very common lung disease.Mr. V is in the emergency room for severe shortness of breath; you are taking his history. He tells you he has smoked a pack a day for forty years, and his primary diagnosis is chronic obstructive pulmonary disease (COPD), which he treats with an inhaled bronchodilator.Mr. V presents as an overweight 60-year-old with a barrel-shaped chest. His breath sounds are reduced, and his lips and fingertips are bluish. His hands and wrists look puffy, and his watchband is very tight. You ask him if this is normal, and he says it has been that way for a while, but he keeps forgetting to go to the jeweler and have another link put in it. His heart rate is 90 bpm, blood pressure is nearly normal at 125/90 mm Hg, and respiratory rate is a little high - 26 breaths/min. - with audible wheezing. His pulse oximeter is low, reading 85% even though he is breathing supplemental oxygen. His temperature is 101.6∘F∘F.The doctor orders sputum cultures to check for a respiratory infection. She also examines Mr. V's legs. His ankles are bluish and swollen, and the doctor says she is worried about pulmonary hypertension (high blood pressure). Why is the doctor worried about hypertension (high blood pressure) when Mr. V's blood pressure is only a little bit above normal? To understand this, you need to analyze the diagnosis. The doctor has mentioned pulmonary hypertension. Let's review what the pulmonary circuit is and how pulmonary blood pressure might be different from the blood pressure you measure in someone's arm.To start, review the path blood takes through the body and lungs. Students also viewedRecommended textbook solutions HDEV56th EditionSpencer A. Rathus 380 solutions Consumer Behavior: Buying, Having, Being13th EditionMichael R Solomon 449 solutions Myers' Psychology for the AP Course3rd EditionC. Nathan DeWall, David G Myers 955 solutions Organizational Behavior13th EditionRicky W. Griffin, Stanley Gully 174 solutions what is stress? Stress is a perturbation that upsets the physiological balance and the body's efforts to reestablish balance. stressor agent that causes imbalance stress response response to the stressor Homeostasis and the nature of stress: Two systems respond to perceived threat to try and maintain normal functioning--what are they Two systems respond to perceived threat to try and maintain normal functioning: Autonomic (i.e., sympathetic nervous system, specifically) Endocrine (i.e., hormonal) pathophysiology prolonged physiological imbalances can lead to disease stress and performance A moderate amount of stress is optimal for peak performance, but too much is deleterious Not a linear relationship (ie, more stress does not mean higher performance after a certain point) if stress is too low you get sleep/awareness, if it is too high you get anxiety/disorganization Historical Stress Conceptualizations: walter cannon Fight or flight response, The concept of homeostasis fight or flight response sequence of internal processes preparing an organism for struggle or escape Historical Stress Conceptualizations: Hans Selye General adaptation syndrome, Nonspecific response to many different kinds of stressors General Adaptation Syndrome Selye's concept of the body's adaptive response to stress in three phases—alarm, resistance, exhaustion. what happens in our bodies/brains when we get stressed? key players 1) the "HPA axis" 2) the autonomic nervous system 3) the central nervous system HPA hypothalamic-pituitary-adrenal axis The hypothalamus has projections down through the brainstem and spinal cord controls outgoing information in both branches of the autonomic nervous system the pituitary gland The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands. is called the "master gland" of the body releases hormones into the blood stream that cause a cascade of physiological responses adrenal glands are located at the top of the kidneys release stress hormones into the bloodstream endocrine system the body's "slow" chemical communication system; a set of glands that secrete hormones into the bloodstream CNS The central nervous system (CNS) is made up of the brain and spinal cord. The primary form of communication in the CNS is the neuron. The brain and spinal cord are absolutely vital to life and functioning Think of these structures as the literal "center" of the body's communication system. The CNS is responsible for processing every sensation and thought you experience. The sensory information that is gathered by receptors throughout the body then passes this information on to the central nervous system. The CNS also sends messages out to the rest of the body in order to control movement, actions, and responses to the environment. PNS The peripheral system (PNS) is composed of a number of nerves that extend outside of the central nervous system. The nerves and nerve networks that make up the PNS are actually bundles of axons from neuron cells. Nerves can range from relatively small to large bundles that can be easily seen by the human eye. The PNS can be further divided into two different systems: the somatic nervous system and the autonomic nervous system. somatic nervous system The somatic system transmits sensory communications and is responsible for voluntary movement and action. autonomic nervous system The autonomic nervous system is responsible for controlling involuntary functions such as certain aspects of heartbeat, respiration, digestion and blood pressure. This system is also related to emotional responses such as sweating and crying. The autonomic system can then be further subdivided into two subsystems known as the sympathetic and parasympathetic systems. sympathetic nervous system The sympathetic system controls the body's response to emergencies. When this system is aroused, a number of things begin to occur: your heart and breathing rates increase, digestion slows or stops, the pupils dilate and you begin to sweat. Known as the fight-or-flight response, this system responds by preparing your body to either fight the danger or flee. parasympathetic nervous system The parasympathetic nervous system functions to counter the sympathetic system. After a crisis or danger has passed, this system helps to calm the body. Heart and breathing rates slow, digestion resumes, pupil contract and sweating ceases. Endocrine and nervous system relationship So how are the endocrine and nervous system linked? The brain structure known as the hypothalamus connects these two important communication systems. The hypothalamus is a tiny collection of nuclei that is responsible for controlling an astonishing amount of behavior. Located at the base of the forebrain, the hypothalamus regulates basic needs such as sleep, hunger, thirst, and sex in addition to emotional and stress responses. The hypothalamus also controls the pituitary glands, which then controls the release of hormones from other glands in the endocrine system. Two main adrenal responses to a range of different kinds of stressors fast and slow "Fast" sympathetic response norepinephrine and adrenaline "slow" "Slow" glucocorticoid response of the HPA axis the stress cycle (with physiology) stressor --> Sympathetic Nervous System, FIGHT OR FLIGHT --> Chronic catecholamines and cortisol, resistance/continued coping --> Ulcers and cardiovascular disease, exhaustion and depletion "Fast" Stress Response: Sympathetic/Catecholamine Response When stressor perceived by brain: In brainstem: Locus coeruleus releases norepinephrine, which influences the reticular formation. Results in arousal, vigilance for unpredictable emergencies Activation of sympathetic branch of autonomic nervous system Tachycardia (increased heart rate) The sympathetic nervous system activates the adrenal gland. The adrenal medulla secretes epinephrine and norepinephrine (catacholamines) Epinephrine adrenaline Norepinephrine helps control alertness and arousal (noradrenaline) EP AND NEP: These hormones quickly mobilize energy resources. Increase in heart's output Increase in blood flow to muscles Decrease in blood flow to extremities HPA axis' chain of responses to a stressor The paraventricular nucleus of the hypothalamus secretes corticotropin releasing hormone (CRH) into the hypothalamic pituitary portal circulation to trigger... Release of adrenocorticotropic hormone (ACTH) from the anterior pituitary, which triggers... Release of cortisol from cortex of the adrenal gland effects of cortisol Mobilization of amino acids and lipids for potential energy use, increased blood sugar, immune response initially increased (brief stress) and later decreased (chronic stress) negative feedback loop (to keep cortisol level in check) Hippocampus monitors cortisol levels for potential negative feedback Amygdala (AMYG) and hippocampus (HPC) regulate stress response (what stress response?) AMYG: "on" switch HPC: "off" switch SLOW stress response Slow Stress Response System 1) sensory info about threat reaches the amygdala. 2) amygdala sends signals to the hypothalamus via stria terminalis. (OTHER STEPS) --> 3) hippocampus has receptor sites for cortisol, activates to inhibit excessive release of GRH. other stress hormones -- Anterior pituitary gland: endorphin Participates in reduced sensitivity to pain Adaptive: allows one to persist with "fight or flight" activity for extended period of time Endorphin = Endogenous morphine Function of Stress Response Purpose: Divert resources from homeostasis and long-term goals. Survive short-term threat. This is done by 1. Mobilize energy: inhibit energy storage (glucose) 2. Inhibit anabolic processes related to digestion, reproduction, growth, tissue repair, and immune system 3. Inhibit pain perception (endogenous opioids) and inflammation (corticosteroids) stress problem Chronic, unrelieved stress --> Health problems systems inhibited by stress: Metabolic stress response 1. Stressor inhibits insulin Net effect: raises blood glucose (to feed brain and muscle) Blocks formation of glycogen, the storage form of glucose Promotes uptake of glucose by cells to generate energy for the cell 2. A prolonged stressor inhibits growth hormone (GH) systems inhibited by stress: Gastrointestinal stress response Inhibition of digestive enzymes --> Chronic stress associated with gastric ulcers Helicobacter pylori bacteria (weakens protective coating of stomach from acidic digestive juices) systems inhibited by stress: immune response Normally, white blood cells (lymphocytes) release antibodies to destroy foreign invaders Chronically heightened cortisol suppresses lymphocyte activity Chronic stress leads to increased vulnerability to disease mouse experiment Control over an aversive experience can greatly impact the organism's response to subsequent stressors. We compared the effects of escapable (ES) and yoked inescapable (IS) electric tail shocks on the hypothalamic-pituitary-adrenal (HPA) axis hormonal (corticosterone and ACTH), neural (c-fos mRNA) and behavioral (struggling) response to subsequent restraint. We found that although the HPA axis response during restraint of both previously stressed groups were higher than stress-naïve rats and not different from each other, lack of control over the tailshock experience led to an increase in restraint-induced struggling behavior of the IS rats compared to both stress-naïve and ES rats. Diurnal Pattern of Cortisol secretion with the highest levels in the morning and a gradual decrease throughout the day. CAR magnitude is higher on work days than on weekends. This difference is related to perceived stress levels. Low diurnal slope (i.e., less of a drop in stress throughout the day) predicts poor health: Increased coronary calcification, Reduced breast cancer recovery rates Core features of emotion regulation Activation of regulatory goal, engagement of regulatory processes, effects on emotion dynamics e.g., latency, rise time, magnitude, duration, offset time the process model of emotional regulation -Situational Selection which of the preceding steps are part of the Cognitive contributors to emotion -Attentional Deployment (attention, appraisal) Is worrying associated with high blood pressure? stressor --> Perseverative Cognition --> Subjective Stress --> Elevated Blood Pressure Are chronic symptoms of stress associated with elevated heart rate? Physiological hyperarousal is a component of post traumatic stress that poses a serious health risk. Diurnal heart rate patterns differed for patients with versus without post traumatic stress symptoms. In particular, patients with elevated symptoms showed: less nighttime dipping in heart rate and a 50% smaller peak-trough amplitude in heart rate (it was higher and dropped less) |
Why do your heart rate and blood pressure increase when we are worried quizlet?
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