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Med-Surg · chapter 8 · Stress and Stress-Related Disorders

Physiological Response

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.

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Key points

  1. Hallmark stress response

    The physiological response to stress includes each body system’s attempt to adapt to stressors. Activation of the sympathetic nervous system is the hallmark response to stress.

  2. Nursing stress role

    The nurse plays an important role in identifying factors that contribute to stress, the patient’s response to stress, and intervening to help restore balance to the patient.

  3. Fight-flight-freeze activation

    It activates all body systems to be prepared to fight or flee against the stressor. The classic scenario is a threat of attack, so the body is primed for defense.

  4. Limits of acute response

    This stress response is useful for acute and immediate stress but is not meant for chronic stress. The wear and tear of the body in constant stress exhausts the body and may end in collapse.

  5. Brain interpretation of stress

    The complex process responds to perceived stress or threats with a sympathetic fight, flight, or freeze behavior—even if the threat is actually quite irrational.

  6. Nursing calming techniques

    Nurses can help decrease a patient’s sympathetic response by role modeling breathing techniques and reorienting the patient to reality.

  7. Autonomic stress systems

    Whereas the parasympathetic system is known as the “rest and digest” or “feed and breed” response, the sympathetic system is primed for fight-flight-freeze activities for the body under stress.

  8. Sympathetic organ effects

    Pupils dilate, muscles become tense and engorged with needed oxygen rich blood, glucose levels are elevated by the adrenal glands and liver for energy, lungs and airways dilate, and blood from the gastrointestinal system is shunted to more vital organs. The result is elevated blood pressure to support activity to fight the stressor.

  9. Chronic sympathetic consequences

    If the sympathetic nervous system remains activated for a long time, it results in constipation, chronic hyperglycemia, decreased immune response, and overall body fatigue. People with chronic stress, therefore, may develop chronic disease such as hypertension, hyperglycemia, poor nutritional absorption, and ulcers (Sheng et al., 2021).

  10. Sympathomimetic triggers

    Recognize that medications and substances can trigger a sympathomimetic response, such as caffeine consumption and cocaine. Excessive use of these substances can create stress on the heart.

  11. HPA regulation targets

    These messages are mediated by the brain to regulate metabolism, the immune response, body temperature, body fluids balance, and the autonomic nervous system.

  12. Cortisol effects over time

    Short-term elevation of the cortisol level allows the body to have the energy it needs; however, long-term release of cortisol can create chronic hyperglycemia and its associated complications.

  13. Adrenal medulla response

    Commonly known as adrenaline, the adrenal medulla makes epinephrine and norepinephrine, which activate sympathetic nervous system responses, including tachycardia and vasoconstriction, to elevate blood pressure.

  14. Long-term stress immunity

    Therefore, long-term stress can decrease the effectiveness of the immune system and put someone at risk for infection because the body may not be able to fight off infections.

Terms to know

fight-flight-freeze system
The body’s key adaptation response to stress is activation of the sympathetic nervous system, known as the fight-flight-freeze system.
hypothalamic-pituitary axis (HPA)
A complex system that helps the brain respond to stress is the hypothalamic-pituitary axis (HPA).
cortisol
A main function of cortisol, also known as the stress hormone, is to elevate the blood glucose level; glucose is needed to supply muscles for the flight-fight-freeze response of stress.
immune system
Another system affected by the autonomic system is the immune system, which helps fight antigens and pathogens.
antigen
An antigen is something that generates an antibody response—hence, the term “anti-gen.”
General Adaptation Syndrome
The General Adaptation Syndrome is a process comprising three distinct physiological stages the body passes through when experiencing stress.
local adaptation syndrome
In contrast, local adaptation syndrome is when the body responds only locally to an external stressor such as a wound, which may result in only a local response of the nearby tissues and circulation.

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

  1. At 0915, a patient is preparing to ride an elevator. The patient says, "I know it is unlikely to crash," but reports a racing heart and is hyperventilating. Which assessment entry best reflects the section's explanation?

    1. Racing heart and hyperventilation are consistent with sympathetic activation in response to a perceived threat.
    2. Racing heart and hyperventilation reflect parasympathetic activation as the body attempts to restore balance.
    3. Difficulty controlling breathing indicates exhaustion from prolonged stress rather than an immediate stress response.
    4. Symptoms reflect recovery from the alarm stage because the patient can accurately describe the low risk.

    Answer: Racing heart and hyperventilation are consistent with sympathetic activation in response to a perceived threat.

    A perceived threat can trigger sympathetic activation even when the patient recognizes that the feared event is unlikely. That insight does not establish recovery, the immediate symptoms do not establish exhaustion, and the section associates this pattern with sympathetic—not parasympathetic—activation.

  2. At 1000, a patient describes ongoing work stress and reports constipation and fatigue. The record also shows chronically elevated blood glucose. Which statements are supported for the nurse's assessment documentation? Select all that apply.

    1. Persistent glucose elevation may be associated with prolonged activation of the stress response.
    2. The elevated glucose is unrelated to ongoing stress because cortisol raises glucose only during brief threats.
    3. Constipation may be associated with sustained sympathetic activation.
    4. Ongoing stress may decrease immune effectiveness and increase susceptibility to infection.
    5. Fatigue indicates that sympathetic activation has ended and the body's resources have been restored.

    Answer: Persistent glucose elevation may be associated with prolonged activation of the stress response., Constipation may be associated with sustained sympathetic activation., Ongoing stress may decrease immune effectiveness and increase susceptibility to infection.

    Prolonged sympathetic activation can contribute to constipation and chronic hyperglycemia, while long-term stress can weaken immune defenses. Cortisol's glucose-raising effects are not limited to brief threats; sustained release can contribute to chronic hyperglycemia. Fatigue can accompany prolonged activation and does not establish that the response has ended or resources have been restored.

  3. At 1400, a nurse documents swelling confined to tissues around a wound. The assessment shows no change in blood glucose and no overall sympathetic response. Which interpretation should accompany these findings?

    1. Stable systemic findings indicate resistance following an earlier generalized alarm response.
    2. Unchanged blood glucose indicates that the swelling is unrelated to the body's physiological response to stress.
    3. Findings establish an early systemic alarm response; generalized sympathetic changes are expected to follow the swelling.
    4. Findings are consistent with local adaptation; a wound can produce a localized response without generalized sympathetic changes.

    Answer: Findings are consistent with local adaptation; a wound can produce a localized response without generalized sympathetic changes.

    The section describes a wound as a stressor that may produce only a local inflammatory response without systemic changes. Local swelling does not establish a systemic alarm or an earlier alarm-to-resistance sequence, and unchanged blood glucose does not rule out local adaptation.

Where every quote comes from

Section 8.4 Physiological Response 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.