Maria is a 21-year-old single mother. On the way to work, she ...

[Beheh]

Maria is a 21-year-old single mother. On the way to work, she drops off her 3-EEyear-old daughter at a community day care center and picks her up on the way home.
 
  Because her income is low, Maria works at a second job from home in the evening and rarely goes out for social interaction. For the last several days, her daughter has been sick with influenza, so Maria has stayed awake throughout the night to care for her. One morning, while preparing her daughter's breakfast, Maria realized they had run out of milk and bread again. Maria sat down on the floor and began to cry.
 
  One of the effects of chronic stress is an impaired immune response. What are the physiological mechanisms that will make Maria particularly prone to contracting her daughter's illness?
 
  Assuming the stressors are the same, how is it that someone might react differently than Maria? From what you know of her history, what are some factors affecting Maria's ability to cope both physically and psychologically?
 
  What are the signs and symptoms that would distinguish a person with posttraumatic stress disorder from an individual like Maria?

Question 2

Anna is a small, frail 89-year-old woman. She resides in a nursing home and receives regular nursing care. One afternoon Anna did not go to the lunch room for a mid-afternoon tea and cookie break.
 
  When a nurse noticed this, he went to Anna's room to see how she was feeling. Anna was lying down, and told him she felt tired and very weak. The nurse asked her some more questions about her health, and Anna seemed confused when trying to answer him. He decided to take Anna's temperature and discovered it was 1.6 C above her baseline temperature of 36.3 C. He took her pulse and noted her heart rate was elevated. He offered Anna some cold water and went to contact the physician.
 
  Why would Anna's temperature of 37.9 C be of particular concern to the nurse? How is the physiological mechanism for the production of a fever in the elderly different from that of adults?
 
  What disorder of acid-base imbalance will Anna be at risk for developing?
 
  Why is it harmful to cool a patient with pyrexia too quickly?

[ynlevi]

Answer to Question 1

Psychological stress is a contributing factor to the development of physical illness. While the exact mechanisms are not known, immune suppression is a result of a series of endocrine-immunological interactions that include the following:
Hormone receptors on lymphocytes: suppression of lymphocyte activity occurs under the influence of a variety of CNS-controlled hormones.
Catecholamine release: the SNS innervates lymph nodes, thymus, and spleen. A synergistic relationship between epinephrine, CRF, and cortisol act to suppress the function of lymphatic structures.
Alteration of T-cell production: stress hormones stimulate the proliferation of particular subtypes of T-lymphocyte helper cells. This creates a physiologically altered immune response.

Conditioning factors contribute to an individual's response to a stressor. Some factors affecting Maria's ability to cope might include the following suggestions:
Time: students might identify the illness of her daughter, loss of sleep, and lack of food within a short length of time to be factors in Maria's adaptive abilities.
Age: it may be indicated by some students that she is a young mother and therefore less able to cope with daily stressors
Nutrition: there is indication that food security has been a problem in the household.
Sleep-wake cycles: decreased sleep disrupts both immunologic and psychological functioning.
Hardiness: while not addressed specifically in the case study, some students may suggest that Maria's sense of control of her life is limited by her circumstances.
Psychosocial factors: social support mechanisms and personal relationships are limited in this situation.

The individual with posttraumatic stress disorder presents with the following triad:
Intrusion: flashbacks and nightmares recounting the traumatic event
Avoidance: emotional numbing and withdrawal from relationships. There are also feelings of guilt and depression following the event.
Hyperarousal: There is increased emotional irritability, anxiety, decreased concentration, hypervigilance, and strong concern for safety. The patient will also demonstrate sleeping difficulties and an increased startle reflex.

Answer to Question 2

There are a number of reasons why a slight increase in temperature in the elderly is clinically significant:
Basal temperature is often lower in the elderly.
The febrile response can often be blunted or absent. Any increase in temperature is therefore clinically remarkable and may indicate serious illness.
Physiologically, the thermoregulatory center in the hypothalamus is less effective at set-point regulation in the elderly. There are also alterations in the release of endogenous pyrogens. Finally, neurological responses in eliciting heat generation in the body can be diminished or absent.

Anna is at risk for metabolic acidosis. Anorexia is a common finding with fever. There is also a significant increase in metabolic rate with protein catabolism and lipolysis for energy production. With prolonged fever, these findings collectively lead to a state of metabolic acidosis.

Rapid cooling causes superficial vasoconstriction, which impedes heat loss. It may also generate shivering and thereby promote increased heat production.