Med-Surg · chapter 8 · Stress and Stress-Related Disorders
Homeostasis, Stress, and Adaptation
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Adaptation and homeostasis
Through these adjustments, the body attempts to keep all its systems in a state of balance, or homeostasis, that is conducive to life (Venes, 2017).
Autonomic homeostasis processes
To maintain homeostasis, the body relies on biological, chemical, and fluid processes that occur autonomically in response to change (Venes, 2017).
Homeostasis failure
When the body cannot maintain homeostasis, it experiences illness or disease, and, eventually, death.
Balance during illness
Even when injury, illness, or disease is present, the body still attempts to find balance. It uses all its systems to regain that balance until it either overcomes the injury or illness or perishes.
Holistic system response
Although body systems may seem like segmented pieces of the whole body, they are completely interdependent and respond to each other in a holistic manner through the process of adaptation.
Respiratory renal pH control
For example, the respiratory and renal systems interact to keep the blood pH in the normal range of 7.35 to 7.45. Carbon dioxide, which affects the acid level in the blood, is controlled by the respiratory system, whereas bicarbonate, which controls alkalinity, is controlled by the kidneys.
Vital sign regulation
For example, the medulla oblongata in the brainstem helps control vital signs such as breathing, pulse, temperature, and respiratory rate; the carotid arteries and the kidneys contain chemoreceptors (which measure chemicals) and baroreceptors (which measure pressure) to help regulate blood pressure.
Stress as normal process
Because stress is universal, it is considered a normal physiological process as the body adjusts to change and attempts to restore homeostasis.
Individual stress responses
Even though all people experience stress, the experience itself is highly individualized and varies from one person to another. Several factors affect a person’s response to a stressor, including their physical and emotional states.
Stressors and immunity
A person may struggle to fight off a virus if there are additional stressors taxing the immune system. For example, if the person lost a job or is not getting adequate sleep or nutrition, the body may be weaker against a physical stressor such as a virus.
Coping and adaptation
A crucial part of adaptation is the ability to cope with stressors to decrease negative stress. A person’s coping ability depends on multiple variables, including their mental and physical abilities (Segerstrom Miller, 2017).
Maladaptive coping outcomes
Both may reduce stress, but maladaptive coping creates additional negative outcomes. An example is dealing with emotional stress by overusing alcohol, which may result in social distress, financial problems, and alcoholism leading to physical illness.
Nursing assessment of adaptation
Nurses are in a position to assess adaptation to stress in their patients and educate them on positive adaptive behaviors. For example, a nurse might teach a patient with chronic obstructive pulmonary disease to use pursed-lip breathing to release more carbon dioxide trapped in the lungs.
Stress response stages
The response by any individual experiencing stress passes through three stages: (1) the alarm reaction, (2) resistance, and (3) exhaustion if the stressor continues unresolved.
Terms to know
- adaptation
- The process of adjusting to the environment as conditions change, either suddenly or over time, is called adaptation.
- homeostasis
- Through these adjustments, the body attempts to keep all its systems in a state of balance, or homeostasis, that is conducive to life (Venes, 2017).
- stress
- We define stress as any disruption to the body’s normal state.
- positive stress
- A positive stress is when a stressful event produces healthful outcomes such as breathing, which provides us the oxygen our bodies need to live.
- negative stress
- A negative stress, also called distress, is when a stressful event produces unhealthful outcomes, such as illness or disease (Lazarus Folkman, 1984).
- stressor
- A stressor is an event or stimulus that activates an individual’s stress response (Centre for Studies on Human Stress, n.d.).
- adaptive behaviors
- Behavioral approaches to coping with stress are called adaptive behaviors.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
At 1000, you review documented changes in a patient's breathing rate and renal bicarbonate handling. Blood pH remains within 7.35 to 7.45. Which interpretation is most appropriate to include in the nursing assessment?
- Blood pH is being maintained through respiratory regulation of bicarbonate and renal regulation of carbon dioxide.
- The renal system is maintaining blood pH independently of the changes in breathing rate.
- The normal blood pH indicates that ongoing adjustments to maintain acid–base balance are unnecessary.
- The respiratory and renal changes are consistent with coordinated efforts to maintain blood pH.
Answer: The respiratory and renal changes are consistent with coordinated efforts to maintain blood pH.
The section describes respiratory and renal adjustments as interdependent mechanisms for maintaining normal blood pH. A normal pH does not mean those adjustments are unnecessary or that the kidneys act independently. The reversed-role entry is incorrect because the respiratory system regulates carbon dioxide, while the kidneys regulate bicarbonate.
At 1400, a patient with a seasonal viral illness reports recently losing a job, sleeping inadequately, and eating poorly. The patient previously recovered from a similar illness with few symptoms. Which interpretations are supported when documenting factors that may affect the current stress response? Select all that apply.
- Inadequate sleep may leave the body less able to respond to the viral stressor.
- The viral illness is the only relevant stressor because the current concern is physical.
- Previous recovery with few symptoms indicates that the patient will respond similarly during this illness.
- Poor nutrition may contribute to the body's difficulty responding to the viral stressor.
- Recent job loss may add emotional stress to the physical stress of illness.
Answer: Inadequate sleep may leave the body less able to respond to the viral stressor., Poor nutrition may contribute to the body's difficulty responding to the viral stressor., Recent job loss may add emotional stress to the physical stress of illness.
Job loss, inadequate sleep, and poor nutrition can add burdens that make the body less able to respond to a virus. Previous recovery does not establish the current response because the person's circumstances have changed, and focusing only on the virus overlooks the additional stressors.
At 1900, a patient reports overusing alcohol to relieve emotional stress and describes resulting financial problems and conflict with others. Which assessment entry best captures the patient's adaptation?
- Alcohol use is a positive adaptive behavior because the patient reports relief from emotional stress.
- Alcohol use and the reported financial and social difficulties are separate issues rather than a coping-related pattern.
- Alcohol use is a maladaptive coping behavior that provides stress relief while creating additional negative outcomes.
- The patient's adaptation cannot be evaluated until alcohol use produces physical illness.
Answer: Alcohol use is a maladaptive coping behavior that provides stress relief while creating additional negative outcomes.
Short-term stress relief does not make a coping behavior positively adaptive when it also creates harm. The section specifically links alcohol overuse with social distress and financial problems, so these effects should not be treated as unrelated, and physical illness is not required to recognize the maladaptive pattern.
Where every quote comes from
Section 8.1 Homeostasis, Stress, and Adaptation of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.