Med-Surg · chapter 8 · Stress and Stress-Related Disorders
Inflammation: Cellular Response to Stress
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
Cellular stress signaling
The cellular stress response is a cascade of chemical and hormonal signals that activate cellular products needed to re-establish homeostasis.
Resource limits
However, if resources such as nutrition, oxygen, or fluids are not adequate, the cell will not survive.
Homeostasis regulation
Biological homeostasis is achieved by establishing an internal stability for the cell and adapting to demands of the external environment. The body accomplishes balance through regulatory processes known as positive and negative feedback.
Inflammation trigger
One powerful adaptation at the cellular level includes the inflammatory response, which is triggered by a stressor, pathogen, or antigen from inside or outside of the body. When a stressor is identified by chemicals and T cells in the blood, additional chemicals, called cytokines (e.g., histamine), are released to notify the surrounding area that an antigen is present.
Autoimmune hypersensitivity
Generally, inflammation is a helpful response to allergens and pathogens, but it can cause problems when the body attacks itself in a process called autoimmune hypersensitivity. Hypersensitivity is when the body’s response is overreacting and causes additional and unwanted problems for the body such as autoimmune diseases like type 1 diabetes, lupus, multiple sclerosis, Hashimoto’s thyroiditis, and others.
Acute inflammation duration
It can be either acute or chronic. An acute response is appropriate against a pathogen or antigen but can become detrimental when it continues for days, weeks, and even years.
Local versus systemic inflammation
Inflammation is often local, due to a physical injury to the body’s protective skin, but it can also be systemic when the body attempts to protect itself inside. When the inflammatory response becomes systemic, the body can experience great stress as it struggles to restore stability.
Shock and perfusion
Conditions that cause any type of shock, such as anaphylactic, neurogenic, sepsis, or cardiogenic shock, can result in massive circulatory vasodilation and cause hypotension that threatens adequate perfusion to tissues.
Severe systemic inflammation
It can be fatal if the body cannot overcome the extreme inflammatory response. What begins as the body’s attempt to protect itself becomes systemic and affects all body systems, which may not be able to accommodate the widespread reaction.
Inflammatory chemicals
Mediators of inflammation include leukotrienes, prostaglandins, vasoactive peptides known as kinins, phospholipids to activate clotting, and cytokines.
Classic inflammation signs
The classic signs of inflammation are rubor (redness), pallor (blanching caused by swelling tissue), dolor (pain caused by inflamed tissue pressing against nerves), tumor (swelling), and calor (heat).
Medication targets
Pharmacological interventions target one or more of the signs of inflammation. Anti-inflammatories decrease swelling and block prostaglandins.
PRICE actions
Decreasing cellular injury after a physical stressor can be managed with the actions abbreviated in the word PRICE: pain reduction, rest, ice, compression, and elevation.
Oxygen and nutrition support
Supporting the cells with adequate oxygenation and nutrition can increase the cells’ ability to function and recover. Cells that are well hydrated and nourished have a better chance of being able to adapt to stress.
Terms to know
- telomeres
- The distinct structures at the end of a strand of a chromosome within the cell are called telomeres.
- positive feedback
- The method the body uses to enhance a desired outcome by amplifying chemical or hormonal messages to the organs of influence is called positive feedback.
- negative feedback
- The feedback loop of communication of hormones and chemicals in the body to decrease a desired output is called negative feedback.
- Hypersensitivity
- Hypersensitivity is when the body’s response is overreacting and causes additional and unwanted problems for the body such as autoimmune diseases like type 1 diabetes, lupus, multiple sclerosis, Hashimoto’s thyroiditis, and others.
- chronic inflammatory response syndrome (CIRS)
- The term chronic inflammatory response syndrome (CIRS) refers to conditions of chronic stress caused by chronic inflammation in the body.
- systemic inflammatory response syndrome (SIRS)
- Massive vasodilation, hypotension, tachycardia, and tachypnea, in response to infection and autoimmune disorders or burns, is referred to as systemic inflammatory response syndrome (SIRS).
- rhabdomyolysis
- When the body’s muscles break down due to a stressor in a trauma or even a rigorous athletic event, high levels of proteins such as creatine kinase or creatine phosphokinase in both the blood and urine can reveal rhabdomyolysis, or massive destruction of muscle and the resultant increase in byproducts of muscle breakdown in the blood.
- thermoregulation
- The body strives to keep the body in an ideal temperature range throughout the organs; this process is called thermoregulation.
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 1500, a nurse assesses an ankle injured earlier that day. The ankle is swollen, and movement is painful and limited. Which assessment entry best reflects these findings without adding an unsupported conclusion?
- Permanent cellular damage evidenced by painful, limited ankle movement.
- Local inflammation with swelling-related pain and reduced ankle function.
- Systemic inflammatory response evidenced by ankle swelling and reduced mobility.
- Ankle pain and swelling indicate muscle destruction related to the injury.
Answer: Local inflammation with swelling-related pain and reduced ankle function.
The section explains that tissue swelling can make movement painful and reduce function. The documented findings support this local effect but do not establish muscle destruction, systemic inflammation, or permanent cellular damage.
At 1700, a nurse reviews assessment findings for a patient with an infection. Which findings support documenting concern for a systemic inflammatory response rather than simply describing classic local signs of inflammation? Select all that apply.
- Redness at the inflamed site
- Tachycardia
- Hypotension
- Tachypnea
- Pain at the inflamed site
Answer: Tachycardia, Hypotension, Tachypnea
The section identifies hypotension, tachycardia, and tachypnea among the features of systemic inflammatory response syndrome. Pain and redness are classic inflammatory signs, but their presence at the affected site does not by itself distinguish a systemic response from local inflammation.
At an 1800 assessment, a patient with chronic allergies reports constant itching eyes, a runny nose, skin inflammation, and emotional stress that have persisted for weeks. Which summary best captures the significance of this ongoing response?
- Systemic inflammatory response, based on symptoms involving the eyes, nose, skin, and emotional well-being.
- Acute protective response to seasonal allergens, without evidence of an ongoing inflammatory stressor.
- Persistent allergy-related inflammation with physical and emotional stress and potential depletion of nutrients and energy.
- Autoimmune hypersensitivity, based on the persistence of allergy symptoms.
Answer: Persistent allergy-related inflammation with physical and emotional stress and potential depletion of nutrients and energy.
The section links chronic allergies with lasting physical and emotional stress and explains that prolonged inflammation can become detrimental as nutrients and energy are depleted. Describing this persistent pattern only as an acute protective response misses its ongoing burden. Persistence alone does not establish autoimmune disease, and symptoms at several sites do not establish the systemic response described in the section.
Where every quote comes from
Section 8.6 Inflammation: Cellular Response to Stress 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.