Mr. Jones is a 35-year-old male with severe depression and has had failed treatment with SSRIs such as Citalopram (Celexa) and Fluoxetine (Prozac). He has a passive concentration and anhedonia. He has also lost 20 lbs in the last 3 months and has a poor appetite. He is scheduled for ECT tomorrow, and you are his nurse.
Some important considerations prior to ECT may be on a Pre-Op checklist that the nurse completes and some interventions include (select all that apply):

Stress can increase the basal metabolic rate (BMR) due to the release of stress hormones like adrenaline and cortisol, which can increase the body's energy expenditure.

Stress Response Mechanism

1. Brain and Pituitary Gland:
   • The stress response begins in the brain, specifically the hypothalamus, which signals the pituitary gland to release adrenocorticotropic hormone (ACTH).
2. Adrenal Glands:
   • ACTH travels through the bloodstream to the adrenal glands, located above the kidneys. The adrenal glands then release cortisol and adrenaline into the bloodstream.
3. Cortisol and Adrenaline Effects:
   • Cortisol:
     • Cortisol increases glucose production in the liver by converting glycogen (the stored form of glucose) to glucose, making more energy available to the body.
     • It also promotes protein breakdown into amino acids, which can be converted to glucose, further increasing energy availability.
   • Adrenaline (Epinephrine):
     • Adrenaline increases heart rate and blood pressure, enhancing the delivery of oxygen and nutrients to tissues.
     • It stimulates glycogenolysis (the breakdown of glycogen to glucose) and lipolysis (the breakdown of fat into fatty acids), providing additional energy sources.
4. Physiological Changes:
   • Liver: Converts glycogen to glucose, increasing blood glucose levels.
   • Heart: Accelerated heart rate and increased blood pressure improve oxygen and nutrient delivery.
   • Lungs: Increased breathing rate (fast breathing) ensures more oxygen enters the bloodstream.
   • Sweat Glands: Increased sweating helps cool the body.
   • Digestive System: Digestion slows down, conserving energy for more immediate demands.
   • Vision: Tunnel vision may occur as the body focuses on immediate threats.

Impact on Basal Metabolic Rate (BMR)

The combined effects of cortisol and adrenaline lead to an increase in BMR. The body’s energy expenditure rises due to:

• Increased Glucose and Fat Availability: Enhanced breakdown of glycogen and fats provides more fuel for cellular metabolism.
• Heightened Cardiovascular Activity: Increased heart rate and blood pressure raise energy demands.
• Enhanced Cellular Activity: The overall increase in cellular processes, including metabolism and energy production, results in higher energy expenditure.

Asthma is a chronic respiratory condition that affects the airways, causing episodes of wheezing, breathlessness, chest tightness, and coughing. The underlying changes in the respiratory system due to asthma include inflammation, increased mucus production, and bronchoconstriction (narrowing of the airways). Here’s a detailed explanation of how asthma affects the respiratory system and leads to increased mucus production:

Detailed Explanation

Inflammation:

Asthma causes inflammation of the bronchial walls. The airways become swollen and sensitive, responding strongly to various triggers such as allergens, pollutants, cold air, or exercise.

1. Bronchoconstriction:

The muscles around the bronchi (the large air passages leading from the trachea to the lungs) tighten, causing the airways to narrow. This constriction makes it difficult for air to flow in and out of the lungs.

Increased Mucus Production:

In response to the inflammation, the goblet cells and submucosal glands in the bronchial walls produce excess mucus. This mucus is thicker and stickier than normal, contributing to the obstruction of the airways. The buildup of mucus further narrows the airways and makes it harder to breathe.

Airway Remodeling:

Over time, chronic inflammation can lead to structural changes in the airways, known as airway remodeling. This includes thickening of the airway walls, increased smooth muscle mass, and more mucus-producing cells, which perpetuates the cycle of airway obstruction and difficulty breathing.