what are the three stages of the PSR?
- hypothalamus receives inputs about the stressor
- SNS activation releases catecholamines (epi/norepi) from adrenal medulla
- corticotropin releasing hormone (CRH) causes pituitary gland to release ACTH, which causes adrenal cortex on kidneys to produce cortisol (HPA axis)
What is the result of the PSR being activated? (general idea)
- fight or flight
- immediate response to stress/prepares for danger
What are the physiological effects of PSR on the heart?
increased HR and contractility
What are the physiological effects of PSR on the respiratory system?
increased RR, bronchodilation
What are the physiological effects of PSR on skeletal muscle?
increase muscle tension
What are the physiological effects of PSR on the vascular system?
vasodilation of skeletal and heart muscle (not brain, just gets redirected to brain)
vasoconstriction of non-essential organs
What are the physiological effects of PSR on the GI system?
decreased GI motility and digestive secretion
What are the physiological effects of PSR on the metabolic system?
glycogenolysis, lipoysis, increased blood glucose
What are the physiological effects of PSR on the brain
increased alertness, arousal, vigilance
What kind of hormone is cortisol?
gluticocorticoid, derived from cholesterol
Where are corticosteroids produced?
in the adrenal cortex
What is the onset and duration of cortisol?
15 minutes, 4-6 hours
what are the physiological functions of cortisol?
- mobilizing energy stores: protein breakdown, lipolysis, gluconeogenesis
- immune system: anti-inflammatory, initial increase in WBCs, long term decreased immunity, increased clotting
- hormones: sodium retention, releases endorphins
what are two negative side effects of cortisol?
- decreased wound healing r/t collagen catabolism in the skin
- causes muscle loss
What are five hormones involved in the PSR?
- cortisol
- aldosterone
- ADH
- GH
- glucagon
Why is aldosterone released as part of the PSR?
when there is decreased blood flow to the kidneys (or a lot of blood loss) –> sodium and water gets retained, potassium is lost in urine
Why is ADH released as part of the PSR?
retains water in the kidneys to counter dehydration
Why is growth hormone released as part of the PSR?
acute stress only: mobilizes energy stores by breaking down muscle, fat, bone and glycogen stores
Why is glucagon released as part of the PSR?
SNS activation triggers glucagon to increase blood glucose levels (NOT to counter hyperglycemia, it’s being released by SNS activation)
Why do people have post-operative hyperglycemia?
PSR decreases insulin sensitivity
Why would a patient have an upset stomach r/t PSR?
less mucus in the stomach causes irritation; decreased gastric perfusion causes dyspepsia
Why would a decrease in urine output be related to the PSR?
decreased blood flow to the kidneys from SNS activation triggers RAAS, ADH causes water retention
Pt is drowsy. Is this r/t the PSR?
probably not, more likely r/t opioids and the anesthesia
- can mask arousal effects of the PSR
What is the normal range for CBG?
4-7 mmol/L
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Module 3 Post-Op Pain29
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Module 1 Perioperative Environment20
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Module 1 PSR26
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Module 2 Inflammation and Arthritis30
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Module 2 Osteoarthritis18
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Module 4 Tissue Integrity11
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Module 4 Post-Op Infection19
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Module 5 Elimination38
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Module 5 Elimination Part 217
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Module 6 Antibiotics12
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Module 7 Thermoregulation25
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Module 8 Venous Thrombosis34
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Module 9 Sodium33
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Module 9 Potassium18
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Module 10 CAD/Angina/MI52
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Module 11 Cancer Part 145
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Module 11 Cancer Part 229
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extra questions for final19
