NRS 232 Pathophysiology Final Exam Latest 2024-
2025 Exam 100% Accurate Fall-Spring Term
What Does Stress SNS Activation Do?
-Increased epinephrine and norepinephrine
-Increased heart rate and blood pressure
-Increased cortisol release and blood sugar
-Pupils dilate
-Decreased gut motility
-Vasoconstriction to shunt blood to muscles, brain, and heart
-Increased muscle contractility
-Increased stomach acid
-Increased breathing rate
-Bronchodilation (increased airflow)
-Increased blood coagulability
-Dry mouth
-Water retention (edema)
-Increased growth hormone (developmental issues)
Epinephrine and Norepinephrine
-Released from adrenal medulla (inner part of adrenal gland)
,-Release is stimulated by SNS activation
-Limbic system (portions of the brain that regulate emotions) detects fear and signals
the hypothalamus to release corticotropin-releasing factor (CRF). CRF triggers the
locus coeruleus (located in brainstem) to activate SNS.
-SNS signals the release of epinephrine and norepinephrine
-Approximately 80% epinephrine and 20% norepinephrine released from adrenal
medulla
-Increases heart rate and blood pressure, vasoconstriction, respiratory rate,
bronchodilation (increased airflow), and other symptoms related to SNS activation
Cortisol
-Limbic system activates hypothalamus to release corticotropin-releasing factor
(CRF), which signals the anterior pituitary gland to release adrenocorticotropic
hormone (ACTH). ACTH acts on the adrenal cortex to release cortisol. This is regulated
by a negative feedback loop (more cortisol disrupts CRF release).
-Cortisol increases blood sugar, fat, and protein for body use
-Cortisol suppresses the immune system
Reticular Activating System (RAS)
,-Sensory input recognized by thalamus and cerebral cortex, which activates RAS
-RAS communicates to the skeletal muscles via gamma neurons to cause increased
muscle tension (explains why chronic stress may lead to muscle soreness)
-RAS also increases alertness and arousal
Anterior Pituitary Gland Vs. Posterior Pituitary Gland
Anterior Pituitary: Releases Adrenocorticotropic hormone (ACTH), which acts on the
adrenal cortex to release cortisol
Posterior Pituitary: Releases ADH in response to high blood sodium (main stimulus)
and decreased perfusion to kidneys (lesser stimulus). ADH acts on the kidneys to
retain water only.
Consequences of Chronic Stress
-Chronic stress inhibits the negative feedback loop and causes constant release of
cortisol. Constant release of cortisol suppresses the immune system and increases
blood sugar. This increases the risk of diabetes, infection, and poor wound healing.
Increased cortisol also increases stomach acid production, fat redistribution, sodium
and water retention (ECV excess, edema, and hypokalemia), and increased calcium
release from bones (increased risk of osteoporosis among post-menopausal women)
-Increased epinephrine and norepinephrine leads to hypertension, endothelial cell
dysfunction, vasoconstriction, and tachycardia. All of this increases the risk of
coronary artery disease, myocardial infarction, kidney disease. and stroke.
-Constant activation of the reticular activating system (RAS) causes prolonged muscle
tension and soreness. Muscle soreness is a stressor as well, so it amplifies the body's
stress response
How to Treat Patient Stress After Experiencing a Traumatic Event
-Provide insulin to lower blood sugar and risk of infection
-Address increased stomach acid by providing a proton pump inhibitor, which will help
lower the risk of stomach ulcers
-Monitor and intervene for constipation, increased blood pressure, and increased heart
rate
Stretch Reflex
-Also called myotatic reflex
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