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Cellular Adaptation and Response to Stress.docx

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NURS 2090
Heather Helpard

Cellular Adaptation and Response to Stress Causes of Disease (according to Heather Helpard) 1. Adaptation 2. Injury: adaptation is no longer helpful and there is a perm change. ** inflammation/infection 3. Death 4. Neoplasms: cancer 5. Aging Response to Change - CellularAdaption – Occurs in response to physiologic or pathophysiologic changes – Adaptive responses to cellular changes are usually only temporary – enlargement of uterus, – Cell injury may be reversible or irreversible -ARF – Cell injury may cause different clinical and pathophysiological manifestations - LVH – Cellular aging –inevitable and normal MajorAdaptive Reactions to Persistent Stress 1. Atrophy 2. Hypertrophy 3. Hyperplasia 4. Metaplasia 5. Dysplasia 6. Intracellular deposits Atrophy: decrease in size of a cell The decrease due to: a) A decrease in functional demand (immobilized limb) b) A decrease in oxygen supply or ischemia (blockage in arterial blood supply) c) Decreased hormone and/or neural signals (menopause; innervation to a muscle) d) Chronic nutritional deprivation e) Aging processes Cerebral Atrophy: - A reduction in size of the cells in the cerebellum of the brain, leading to a reduction in the brain tissue itself. - There will be more gaps and holes, which will increase the level of cognitive impairment and increase communication problems in the brain, along with an unsteady gait. - With atrophy of the nerves, there are significant issues, because they will be more susceptible to injury because they do not have as much protection. Clinical Manifestations: As neurons decrease in size, communication is further impaired as the distance between neurons increases  Frontal/Temporal Lobes- cognitive impairment  Hippocampus and Cerebral Cortex- Alzheimer’s Disease  Basal Ganglia- movement disorders; lack of the production of neurotransmitter dopamine  Neuronal insult- cerebral palsy for example during the prenatal, perinatal or postnatal periods (range from mild to moderately severe involving motor skills, coordination and balance and seizure activity). This depends largely on where the injury is, as each person’s case is different. Diagnosis and Treatment  Early diagnosis is critical due to limited reserve to restore function  Medical hx: signs and symptoms, onset, duration, severity, physical examinations and screening, MRI  Supportive care; physical, speech and occupational therapy; pharmacologic measures  Treatment is individualized based on diagnosis and type of brain atrophy involved with goal of maximizing function and minimizing continued pathology. 2. Hypertrophy: An increase in cell size (increased organ size, usually heart & kidneys)  Increase in size associated with increase in protein without an increase in cellular fluid  Example: Adenoid tissue at the back of the nasal passage can enlarge and result in the blockage of the nasal passage with upper respiratory infections (e.g. Stuffy nose) ** there are not additional cells, just increased expansion in cell due to proteins Caused by: a. specific hormone stimulation/functional demand (breastfeeding/pregnancy) (Positive adaptation) b. increase in growth signals (puberty) (Positive adaptation) c. Strength building exercises (Positive adaptation) d. Increased demand Cardiac Hypertrophy: A disease of cardiac muscle that results from excessive workload and functional demand. The increase in blood pressure makes hypertrophic cells, but the fibers eventually will degenerate and lose contractile elements. Primary Vascular Disease= genetic, under 30 Secondary Vascular Disease= starts with high BP - Hypertrophy can occur in RV due to increase pressure in pulm circ. OR LV due to increased pressure in systemic. (happens with hypertension) Clinical Manifestations  Symptoms are based on severity and can include shortness of breath, chest pain and syncope (fainting)  Can lead to irregular heart rates and rhythm as the cardiac conducting cells become altered, disrupting neurologic signalling in the heart Diagnosis and Treatment  Genetic testing (for primary)  Two dimensional echocardiogram  Blood pressure screening  Exercise stress testing  12 Lead ECGs; Holter monitor  Physical exam Treatment: antihypertensive medications, such as beta blockers, surgery to replace heart valves, activity prescriptions Case Study In Class: Harriet- Cardiac Hypertrophy - BP 125/80, Resp 28 and labored, P125 and irregular, Temp 37.3C - Overweight and is short of breath - Her body needs more blood (needs more cardiac output); however, she is not getting it because her heart is not able to fill with as much blood. This is due to the fact that a hypertrophic heart has think walls and is enlarged, which leaves less space in the ventricles to fill. Therefore her heart needs to increase the workload to get blood to the body. - She has atherosclerosis, which means that the arteries will have plaque deposits. This increases the problem because when the heart tries to push the blood out of the aorta the valves will fail, which causes blood to go backwards (into the pulmonary circuit). With increased fluid in the pulmonary circuit, she will have shortness of breath. The extra fluid would sound girgly when listening to her chest. - She has excess fluid in her feet, which indicates that she has right sided heart failure - She is waking up at night with SOB, but this is because she has extra fluid in her lungs and needs to sit up right to maximize intake of air. -She had a heart attack 4 years ago, which killed some cells. This could be why she got a hypertrophic heart because it had to work harder to pump the blood to her body. The causes CVD later in life. -Harriet is a heavy smoker. This is bad because it causes vasoconstriction in the arteries, which creates more SOB, blood clotting and coagulation. This will increase the hypertrophy as well. (High cholesterol does the same, which she also has) -She has osteoarthritis and gout- which makes it harder for her to work out. Interventions: Beta blockers, water pills to lessen the fluid and ace inhibitors for her arrhythmia Diagnostic: - examine the JVC extention (a fat coronary vein, which is due to increased water) - listen to the chest to hear fluid - X-ray of the chest will show big heart and white - Echocardiogram- measures the ejection fraction. If CO is low then she is getting less blood than needed. ( normal is 55%, but
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