Exam 2 pathophysiology

BRAIN-ICHTN Stage three of intracranial hypertension

- ICP begins to reach arterial pressure - brain tissue begins to have hypoxia and hypercapnia - clinical manifestations: decreased LOC central neurogenic hyperventilation, widened pulse pressure, bradycardia, pupils small and sluggish.

BRAIN-ICHTN STAGE TWO stage two of intracranial hypertension

- ICP may exceed the brains' compensatory capacity to adjust. -pressure begins to compromise neuronal oxygenation -systemic arterial vasoconstriction occurs in an attempt to elevate the systemic blood pressure sufficiently to overcome the IICP. -clinical manifestations at this stage are usually subtle and transient including episodes of confusion restlessness drowsiness and slight pupillary and breathing changes.

BRAIN-HUNTINGTONS What is the manifestation of Huntington's disease

- abnormal movements that occur without conscious effort -emotional lability -progressive dysfunction of cognitive processes (dementia) -executive attention deficits and short-term memory loss(working memory) -reduced capacity to plan, organize and sequence -bradyphrenia (slow thinking) -apathy -restlessness, disinhibition, irritability are common

BRAIN-SPINA BIFIDA What is spina bifida

- birth defect in which there is a failure in closure of the vertebrae

BRAIN-ICHTN Stage 4 of intracranial hypertension

- brain tissue shift from compartment of greater pressure to lesser. -Herniated will brain tissues, blood supply is compromised, causing further ischemia and hypoxia -obstructive hydrocephalus may develop. - Manifestations mean systolic arterial pressure equals ICP treatment blood flow ceases causes herniation syndromes

BRAIN-PARKINSONS What is the clinical pathophysiology of parkinsons

- degeneration of the substantia nigra an area of the midbrain that sends dopaminergic projections to the striatum (caudate and putamen) - which sends projections to the cerebral cortex via a few intermediate structures. -dopaminergic projections to the striatum synapse on two pathways (direct, and indirect pathway) -direct pathway excites the cortex, -indirects pathway inhibits the cortex

BRAIN-MENINGOCELE What is a meningocele

- occur because of incompletely formed or absent posterior vertebral arch in the spinal column allowing protrusion of either a saclike cyst of meninges filled with spinal fluid.

PAIN-GATE CONTROL What is the gate control theory of pain

-Integrates and builds upon features of the other theories to explain the complex multidimensional aspects of pain perception and pain modulation. pain transmission is modulated by a balance of impulses conducted to the spinal cord where cells in the substantia gelatinosa function as a gate. The spinal gate regulates pain transmission to higher centers in the CNS. Large myelinated a-Delta fibers and will small unmyelinated C fibers respond to a broad range of painful stimuli. These fibers terminate on interneurons in the substantia gelatinosa.

DISEASE-MS What is the clinically isolated syndrome in MS

-First demyelinating event CIS is a single episode of neurologic dysfunctions lating greater than 24 hours that can be a prelude to MS -characteristic episodes include optic neuritis solitary brainstem lesions, and transverse myelitis.

BRAIN-COUP What is a coup brain injury. How does it occur

-Focal Injury that occurs directly below the point of impact. -Occurs with impact against an object causes direct trauma to the brain sharing of subdural veins

SPINAL CORD-INJJURY what happens to a patient after an acute spinal cord injury

-Immediately after cord injury, normal activities spinal cord cells below the level of injury ceases because of loss of the continuous tonic discharge from the brain or brainstem and inhibition of supra-segmental impulses, thus causing spinal shock. -Spinal shock is characterized by complete loss of reflex function flaccid paralysis sensory deficit, and loss of bladder and rectal control in all segments below the level of the lesion disruption of central communication was sympathetic spinal nerves causes a transient drop in blood pressure, poor venous circulation and disturbed thermal regulation

BRAIN-CONCUSSION what is a grade IV concussion

-Loss of consciousness up to 6 hours -retrograde and anterograde amnesia transient cessation of respiration brief periods of bradycardia decrease in blood pressure, lasting 30 seconds or less. -Confusional state persist for hours to days will

BRAIN-HYDROCEPHALUS Acute hydrocephalus

-May develop in several hours in persons who have sustained head injuries. -Acute hydrocephalus contribute significantly to increased ICP

BRAIN-CONCUSSION what is a grade I concussion

-Transient confusion and disorientation. -Momentary amnesia -no loss of consciousness. -Symptoms resolve within 15 minutes

BRAIN-GUILLAIN BARRE What is the pathophysiology of Guillain barre syndrome

-acquired acute inflammatory autoimmune disease causing demyelination of the peripheral nerves or axonal disorder

BRAIN-MYASTHENIA GRAVIS what is the etiology of myasthenia gravis

-affects 14 people per 100,000 -age of onset for women 20-30 -age of onset for men 70-80

BRAIN-PARKINSONS what is the etiology of parkinson's disease

-affects more men than women -usually occurs middle age or later -occurs in 1 in every 100 people over the age of 60.

DISEASE-PD What are the complications of panic disorder

-agoraphobia or phobic avoidance of places or situations where escape or help is not readily available. -agoraphobic individuals can at times become housebound

BRAIN-MYASTHENIA GRAVIS What is the pathophysiology of myasthenia gravis

-autoantibodies are produced against the acetylcholine receptors on muscle cells at the neuromuscular junction. -antibodies block the receptor so that acetylcholine cannot bind and stimulate muscular contraction -many cases are idiopathic -can also occur secondary to a thymoma(tumor of the thymus)

DISEASE-CLINICAL DEPRESSION what is clinical depression

-characterized by unremitting feelings of sadness and despair. -intensly painful mood is accompanied frequently by insomnia loss of appetite and body weight and reduced interest in pleasurable activities, fatigue, and guilt -ability to concentrate and function is decreased -suicide risk increases with depression

BRAIN-ICP What is normal intracranial pressure

5 to 15 mmHg or 60 to 180 MM H2O

QUESTION SECT 18 A nurse knows that spinal shock results in:

ANSWER AND RATIONALE: Poor venous circulation. In spinal shock there is a disruption of central communication with sympathetic spinal nerves which causes a transient drop in blood pressure, poor venous circulation, and disturbed thermal regulation.

QUESTION SECT 20 A nurse recalls that increased intracranial pressure with hydrocephalus may be the result of:

ANSWER AND RATIONALE: Reduced reabsorption of CSF. Reduced reabsorption produces an excess of CSF, ventricular dilation, and elevation in intracranial pressure.

QUESTION SECT 16 A nurse recalls the majority of the sleep cycle is spent in stage:

ANSWER AND RATIONALE: Stage N2. N2—Further slowing of the EEG (4 to 7 Hz) with the presence of sleep spindles and slow eye movements (45% to 55% of sleep time).

QUESTION SECT 17 A nurse knows the onset of an acute confusional state is:

ANSWER AND RATIONALE: Sudden. Acute confusion typically occurs abruptly and can consist of hyperkinetic or hypokinetic states.

QUESTION SECT 20 The most useful treatment for brain tumors in children is:

ANSWER AND RATIONALE: Surgical therapy. Surgical resection of the tumor may be curative or may be used to diagnose the tumor.

QUESTION SECT 20 Which finding will help the nurse determine whether the febrile seizure is a simple febrile seizure?

ANSWER AND RATIONALE: The convulsion is generalized. The convulsion is short (15 minutes or less), generalized, and predominantly tonic.

QUESTION SECT 16 Fever is stimulated by:

ANSWER AND RATIONALE: Tumor necrosis factor-α. Endogenous pyrogens, including PGE2, interleukin-1 (IL-1), IL-6, TNF-α, and interferon-γ, are produced by phagocytic cells as they destroy microorganisms within the host. The endogenous pyrogens act on the preoptic nucleus of the hypothalamus. These are endogenous pyrogens produced by phagocytic cells as they destroy invading organisms.

QUESTION SECT 17 A person is diagnosed with an alteration in arousal. Which clinical manifestation is typical of this diagnosis?

ANSWER AND RATIONALE: Vomiting without nausea. Vomiting without nausea indicates direct involvement of the central neural mechanism.

NEUROTRANSMITTERS-PREGANGLIONIC PARASYMPATHETIC *SLIDE QUESTION The neurotransmitter released by preganglionic parasympathetic fibers is:

Acetylcholine. Acetylcholine is the neurotransmitter released by preganglionic and postganglionic parasympathetic fibers, as well as preganglionic sympathetic fibers.

QEUSTION SECT 15 The neurotransmitter released by preganglionic parasympathetic fibers is

Acetylcholine. Acetylcholine is the neurotransmitter released by preganglionic and postganglionic parasympathetic fibers, as well as preganglionic sympathetic fibers.

EYE-VIRAL CONJUNCTIVITIS What is viral conjunctivitis

Caused by an adenovirus symptoms vary from mild to severe some strains cause conjunctivitis and pharyngitis. Others cause keratoconjunctivitis both diseases are contagious with watering redness, photophobia treatment is symptomatic

EYE-TRACHOMA/CHLAMYDIA CONJUNCTIVITIS What is trachoma or chlamydia conjunctivitis

Caused by chlamydia trachomatis often associated with poor hygiene, leading cause of preventable blindness involves inflammation with scarring of the conjunctiva and eyelids causing distorted lashes to abrade the cornea leading to corneal scarring and blindness

BRAIN INJURY Conduction-fluent but with paraphrasia in self initiated speech and writing or reading aloud with

Arcuate fasciculus, deep in supramarginal gyrus, disruption of the large bundle of fibers that arise from the tip oral lobe and passed posteriorly around the Sylvian Fissure and then project anteriorly to the premotor area. Typical cause is embolic occlusion of the ascending parietal posterior temporal branch of the middle cerebral artery, angular branch of middle cerebral artery

EYE-ALLERGIC CONJUNCTIVITIS What is allergic conjunctivitis

Associated with a variety of antigens, including pollens. Ocular itching is associated with photophobia, burning and gritty sensation in the eye treatment is symptomatic and may include antihistamines Low-dose corticosteroids mast cell stabilizers and vasoconstrictors

CSF FUNCTION What is the function of the CSF

CSF is a clear, colorless fluid similar to blood plasma and interstitial fluid. The intracranial and spinal cord structures float in CSF and thereby are partially protected from jolts and blows. The buoyant properties of the CSF also prevent the brain from tugging on meninges, nerve roots, and blood vessels.

PAIN-CHRONIC PAIN What is the clinical description of chronic pain

Defined as lasting at least 3 months and lasting well beyond the expected healing time following the initial onset of tissue damage or injury. The following mechanisms have been implicated in the initiation or entrenchment of chronic pain: changes in sensitivity of neurons. Spontaneous impulses from regenerating peripheral nerves. Alterations in the dorsal root ganglia on in response to peripheral nerve injury and neurotransmitters. Loss of pain inhibition in the spine. Up regulation of nociceptive chemokines and their receptors. Structural and functional alterations in brain processing neural networks persistent pain allowance for physiological adoption producing normal heart rate and blood pressure which leads to the conclusion that people with chronic pain are malingering. Chronic pain progresses certain behavioral and psychological Changes often emerge, including depression, difficulty eating and sleeping preoccupation with pain and avoidance of pain of provoking stimulus

BRAIN-RECOVERY INDICATOR Know the best prognostic indicator of recovery of consciousness and functional outcome after a brain event

Etiology of injury and time since onset of coma are currently the best prognostic indicators of recovery of consciousness or functional outcome.

BRAIN INJURY Global sensorimotor receptive expressive nonfluent produces little speech at best speaks a few words or phrases shows damage in

Frontotemporal lobe (left sylvian region) anterior and posterior speech areas extensively impaired occlusion of the left middle cerebral artery of left internal carotid artery, trauma, infection, tumors, other mass lesions and hemorrhage may be the cause

SLEEP-N2 PHASE What is the N2 phase of sleep

Further slowing of the EEG with the presence of sleep spindles and slow eye movements

BRAIN-CNS INJURY VOMITING What CNS injuries involve vomiting

Most CNS disorders produce, nausea and vomiting. Injuries include: 1. Involve the vestibular nuclear line or its immediate projections, particularly when double vision is also present. 2. Impinge directly on the floor of the 4th ventricle. Produce brainstem compression secondary to increased intracranial pressure.

DISEASE-PHENYLKETONURIA(PKU) What is the pathophysiology of PKU

Mutations of the phenylalanine (PAH) gene

TREATMENT CP what is the treatment for cerebral palsy

Magnesium sulfate, cooling, head, family focused multidisciplinary team approach

QUESTION SECT 16 A nurse recalls the initial sharp pain that is felt after an injury is carried along

Myelinated A fibers. These fibers carry sharp, localized pain stimuli that are important in the initiation of responses to pain. A fibers rapidly transmit sharp, well-localized "fast" pain sensations. These fibers are responsible for causing reflex withdrawal of the affected body part from the stimulus before a pain sensation is perceived.

DYSKINESIA-METABOLIC/POSTURAL TREMOR what is metabolic, postural tremor

Rapid, rhythmic tremor affecting fingers, lips, and tongue; essentially did by extending the body part; enhanced physiologic tremor *cause*-occurs in conditions associated with disturbed metabolism or toxicity, as in thyrotoxicosis (hyperthyroidism), alcoholism, and chronic use of barbiturates, amphetamines, lithium, amitriptyline (Elavil); exact mechanism responsible unknown

TEMPERATURE REGULATION-HEAT LOSS-CONDUCTION How does conduction relate to the loss heat in the body

Refers to heat loss by direct molecule to molecule transfer from one surface to another, the warmer surface loses heat to the cooler surface

TEMPERATURE REGULATION-HEAT LOSS-RADIATION How does radiation relate to the loss of heat in the body

Refers to heat loss through electromagnetic waves. These waves emanate from surfaces with temperatures higher than the surrounding air temperature. Thus, if the temperature of the skin is higher than that of air, the skin and therefore the body loses heat to air

PREGNANCY Prenatal and perinatal factors may result in what psychiatric condition?

early environmental factors that may alter brain development and increase the risk of developing schizophrenia include exposure to prenatal infections, prenatal nutritional deficiencies perinatal complications (such as birth defects and neonatal hypoxia) and upbringing in an urban environment.

PAIN-VISCERAL PAIN What is the clinical description of visceral pain

Refers to pain and internal organs or in the lining of body cavities with an aching, gnawing, throbbing, or intermittent cramping quality. It is transmitted by sympathetic afferents and is poorly localized because of the lesser number of nociceptors in the visceral structures. Visceral pain is associated with nausea and vomiting, hypotension, restlessness, and in some cases shock. It often radiates or is referred

DYSKINESIA-PARKINSONIAN TREMOR what is Parkinsonian tremor

Regular, rhythmic, slow flexion, extension contraction; involves principally the metacarpophalangeal and wrist joints; alternating movements between thumb and index finger described as pill-rolling; disappears during voluntary movement. *Cause*-loss of inhibitory influence of dopamine in the basal ganglia I, causing instability of basal ganglia feedback circuit within the cerebral cortex

BRAIN-BEHAVIOR CONTROL Which portion of the brain is responsible for controlling behavior

hypothalamus that forms the base of the diencephalon expression of affect is mediated by extensive connections with the limbic system and prefrontal cortex.

BRAIN-EMOTION Which portion of the brain is responsible for controlling emotions

hypothalamus that forms the base of the diencephalon expression of affect is mediated by extensive connections with the limbic system and prefrontal cortex.

PAIN-NEUROPATHIC PAIN What is a clinical description of neuropathic pain

Results from primary injury to the peripheral or central nervous system is not a result of pain signaling from peripheral tissues, organs, chronic neuropathic pain leads to long-term plastic changes along somatosensory pathways from the PNS and CNS. The pathogenesis of neuropathic pain syndromes include both peripheral and central mechanisms of pain, sensitization

DYSKINESIA-RUBRAL INTENTION TREMOR what is a rubral intentional tremor

Rhythmic tremor of limbs that originates proximally by movement. *Cause*-results from lesions involving the dentatorubrothalamic tract (a spinothalamic tract connecting the red nuclear's in the reticular formation in the dentate nucleus in the cerebellum)

DYSKINESIA-RESTING TREMOR what is tremor at rest

Rhythmic, oscillating movement affecting one or more body parts. *Cause*-caused by regular contraction of opposing groups of muscles

DYSKINESIA-AKATHISA what is akathisia

Special type of hyperactivity. Mild compulsion to move (usually more localized to the legs), severe frenzied motion possible. Movements are partly voluntary and may be transiently suppressed. Carrying out the movement brings a sense of relief, a frequent complication of antipsychotic drugs. *Cause*-dopaminergic transmission may be involved

DYSKINESIA-HYPERACTIVITY what is hyperactivity

State of prolonged, generalized, increased activity that is largely involuntary but may be subject to some voluntary control. Not highly stereotyped but rather manifests as continual changes in total body posture, or an excessive performance of some simple activity, such as pacing under inappropriate circumstances. *Cause*-may be caused by frontal and reticular activating system injury

BRAIN INJURY Auditory agnosia pure word deafness, inability to recognize speech sounds shows damage to

Superior temporal area

DYSKINESIA-WANDERING what is wandering

Tendency to wander without regard for environment *cause*-phenomenon, associated with bilateral injury to globus pallidus or putamen

BRAIN-HERNIATION what is transcalvarial herniation

The brain shifts through a skull fracture or surgical opening in the skull may occur during craniectomy will

CSF PRODUCTION Where is CSF produced

The choroid plexuses in the lateral, 3rd, and 4th ventricles produced a major portion of CSF. These plexuses are characterized by a rich network of blood vessels supplied by the pia mater that lie in close contact with the ventricular ependymal cells that secrete and absorb CSF

PAIN-PAIN TOLERANCE What is pain tolerance

The duration of time or the intensity of pain that an individual will endure before initiating overt pain responses and is generally decreased with repeated exposure to pain. Pain tolerance is influenced by a person's culture, perceptions, expectations, role behaviors, physical and mental health, gender, fatigue, anger, boredom, apprehension, and sleep deprivation tolerance may be increased by alcohol consumption. Persistent use of pain medication hypnosis warm distracting activities and strong beliefs in faith

TEMPERATURE REGULATION-HEAT LOSS-VASODILATION How does vasodilation relate to loss of the body

increases heat loss by diverting core warmed blood to the surface of the body as warmed blood passes to the periphery heat is transferred by conduction to the skin surface and from the skin to the surrounding environment vasodilation occurs in response to autonomic stimulation under the control of the hypothalamus

BRAIN-SPEECH Which portion of the brain is responsible for controlling speech

inferior frontal gyrus the broca speech area

EYE-MOVEMENT CONTROL What part of the brain controls movement of the eye

middle frontal gyrus the lower portion of brodman area 8

BRAIN-WAKEFULNESS Which portion of the brain is responsible for keeping you awake

reticular formation and the reticular activating system

TEMPERATURE REGULATION-HEAT LOSS-CONVECTION How does convection relate to. Heat loss in the body

The transfer of heat through currents of gases or liquids, it greatly aids heat loss through conduction by exchanging warmer air at the surface of the body with cooler air in the surrounding space. Occurs passively as warmer air at the surface of the body rises away from the body and is replaced by cooler air may be aided by fans or wind

PAIN A-BETA FIBERS What type of pain does the a-beta fibers transmit

These are large myelinated fibers that transmit touch and vibration sensations. They do not normally transmit pain but play a role in pain modulation.

BRAIN-TUMOR Know the most common primary CNS tumor.

astrocytoma

BRAIN-AXON DAMAGE what happens if there is damage to axons in the brain

damage to the axons can lead to a breakdown of communication

INTRO QUESTION SECT 19 The young man's mother discusses the issues that concern her as she cares for her son. She expresses feelings of stress and hopelessness and suffers from insomnia. These are characteristic of:

depression

BRAIN INJURY Object agnosia inability to recognize objects and pictures shows damage to

temporo-occipital area

BRAIN INJURY prosopagnosia inability to recognize faces, shows damage to

temporo-occipital ventromesial region

BRAIN-CLOSED HEAD INJURIES What are the characteristics of closed head injuries

*Concussion* -immediate loss of consciousness generally no longer than 5 minutes, loss of reflexes transient cessation of respiration brief period of bradycardia decrease in blood pressure, momentary increase in CSF pressure and changes in ECG in EEG *extradural hematomas*-bleeding between the dura mater and the skull loss of consciousness, followed by period of lucidness that last for a few hours to a few days as the hematoma accumulates a headache of increasing severity, vomiting, drowsiness, confusion, seizure. hemiparesis loss of consciousness ipsilateral. Pupillary dilation and contralateral. Hemiparesis *subdural hematoma*-develop rapidly, act as expanding masses, giving rise to increased intracranial pressure that compresses the bleeding vessels the displacement of brain tissue results in herniation syndrome. Begins with headache, drowsiness, restlessness or agitation, slowed cognition and confusion. Symptoms worsen over time and progresses to, loss of consciousness respiratory pattern changes and pupillary dilation manifestations are more pronounced than focal manifestations such as dysphasia dyspraxia or hemiparesis. Other clinical manifestations may include homonymous hemianopsia dysconjugate gaze and gaze palsies. *Intracerebral hematomas*-small blood vessels are traumatized by penetrating injury or sharing force acts as an expanding mass, resulting in increased ICP and compression of brain tissue which results in edema and ischemia symptoms of decreasing consciousness confusional state that can lead to coma contralateral hemiplegia ICP rises clinical manifestations of temporal lobe herniation may appear sudden rapidly progressive decreased level of consciousness with pupillary dilation breathing pattern changes hemiplegia and bilateral positive Babinski reflex is

BRAIN-GUILLAIN-BARRE Is the clinical manifestation a Guillain-Barré syndrome

--Impairment of dorsal nerve root affect sensory function, so the patient may experience tingling and numbness --impairment of ventral nerve root effects motor functions of the patient may experience muscle weakness, immobility in paralysis. --Other signs and symptoms include muscle stiffness and pain, sensory loss, loss of position sense and the minister absent deep tendon reflexes symptoms usually follow an ascending pattern beginning in the legs and progressing to the arms trunk and face. In mild forms only cranial nerves may be affected in some patients, muscle weakness may be absent. --The disorder commonly affects respiratory muscles of the patient dies it usually from respiratory complications paralysis of the internal and external intercostal muscles leads to reduction in functional breathing, vagus nerve paralysis causes a loss of protective mechanism that respond to bronchial irritation form bodies as well as the minister absent gag reflex

BRAIN-HYDROCEPHALUS EX VACUO Hydrocephalus ex vacuo

-A form of communicating hydrocephalus that arises from cerebral atrophy -CSF fills the unoccupied space. The amount of CSF is increased, but the fluid is not under pressure

BRAIN-HYDROCEPHALUS Normal pressure hydrocephalus (low-pressure, adult, or occult hydrocephalus)

-A form of communicating hydrocephalus that occurs mostly in late middle age. -Ventricles are enlarged in the cerebral spinal fluid pressure is minimally elevated. -This form of hydrocephalus this idiopathic worker secondarily as a complication of head injury or subarachnoid hemorrhage

PAIN NOCICEPTORS EXCITATORY What are 2 types of fibers that transmit nerve action potentials generated by excitation of any of the nociceptors

-A-delta fibers -C fibers

BRAIN-CONCUSSION what is a grade III Concussion

-Any loss of consciousness. -Confusion and retrograde and anterograde amnesia remain present from impact and persist for several minutes

BRAIN-AVM Arteriovenous malformations

-Arteries be directly into the veins through a vascular tangle of malformed vessels without a true capillary bed. -Usually present at birth AVMs exhibit a delayed age onset and symptoms most commonly occur before age 30 years. -Usually rupture in the 2nd and 3rd decade of life

DISEASE-(PKU) what is the clinical manifestations of PKU

-By age 4 months child begins to show signs of arrested brain development, including mental retardation. -Later personality disturbances occur, such as schizoid and antisocial behavior, and uncontrolled temper. -One third of patients have seizures which usually begin between ages of 6 and 12 -many patients show a precipitous decrease in cognitive ability -other signs include microcephaly eczematous skin lesions or dry, rough skin, hyperactivity, irritability, purpose purposeless in us. Repetitive motions awkward gait, you may also note a musty odor from scan and urine excretions of phenylacetic acid

BRAIN-MS What is the etiology of multiple sclerosis

-Cause of chronic disability and people between the ages of 18 and 40 -higher incidence in women in northern urban areas. -Higher socio-economic groups -people with family history of the disease

BRAIN-HYDROCEPHALUS Non-communicating hydrocephalus (obstructive) or internal intraventricular hydrocephalus

-Caused by obstruction within the ventricular system. -Impaired absorption of CSF from the subarachnoid space occurs when an obstructive process disrupts the flow of CSF through the subarachnoid space -the fluid is prevented from reaching the convex portion of the cerebrum where the arachnoid granulation's are located

GAD what is the underlying defect in GAD

-Cingulate cortex and amygdala abnormalities: -Prominent roles in stimulating anticipatory anxiety and attentional bias to threats -Norepinephrine and serotonin abnormalities -Gamma-aminobutyric acid (GABA)-BZ receptor alterations

BRAIN-CONCUSSION what are the 2 forms of grade IV concussion

-Classic cerebral concussion: uncomplicated classic cerebral concussion (without focal injury) -complicated classic cerebral concussion (accompanied by focal injury)

SPINAL CORD-SPINAL SHOCK What is the clinical manifestations of spinal shock

-Complete loss of reflex function. -Flaccid paralysis -sensory deficit -loss of bladder and rectal control in all segments below the level of lesion -disruption of central communication was sympathetic spinal nerves causing trying to drop in blood pressure -poor venous circulation -disturbed thermal regulation. -Damage causes faulty control of, diaphoresis, and he radiation to capillary dilation. -Hypothalamus cannot regulate body heat to vasoconstriction and increase metabolism so individuals body temperature sensitivity of the air

DISEASE - PYRAMIDAL/SPASTIC CP what is pyramidal or spastic cerebral palsy

-Damage or defects in the brains corticospinal pathways. -Spastic Quadriparesis vs. hemiparetic cerebral palsy

DISEASE-EXTRAPYRAMIDAL/NONSPASTIC CP

-Damage to cells in the basal ganglia, thalamus, or cerebellum. -Dyskinetic cerebral palsy vs. ataxic cerebral palsy

PARKINSON'S What is responsible for the tremors associated with Parkinson's disease

-Degeneration of the dopaminergic nigrostriatal pathway to the basal ganglia results in under activity of the direct motor pathway (normally facilitates movement) -overactivity of the indirect motor loop (normally inhibits movement) results in inhibition of the motor cortex manifested with bradykinesia and rigidity.

BRAIN-MS What is the clinical manifestations of multiple sclerosis

-Maybe transient, may last for hours or weeks. -Initial symptoms include vision problems, and sensory impairment, such as paresthesia. -After initial episode findings may vary but may include blurred vision, or diplopia emotionally lability from involvement of the white matter of of the frontal lobes and dysphasia. -Other signs and symptoms include: -poorly articulated speech caused by cerebellar involvement. -Muscle weakness and spasticity caused by lesions in the corticospinal tract, -hyperreflexia -urinary problems -intentional tremor -gait ataxia -bowel problems -cognitive dysfunction -fatigue -paralysis, ranging from monoplegia to quadriplegia -vision problems, such as scotoma (area of lost vision in the visual field), optic neuritis, and ophthalmoplegia (paralysis of the eye muscles)

BRAIN-HYDROCEPHALUS Clinical manifestations of hydrocephalus

-Most cases of hydrocephalus develop gradually over time -acute hydrocephalus presents with signs of rapidly developing increased intracranial pressure -person deteriorates rapidly into a deep, if not properly treated. -Normal pressure hydrocephalus has a long-term presentation and evolve slowly over time -a triad of symptoms including decreased memory loss of cognitive function and steady broad-based gate, urinary urgency and incontinence from detrusor overactivity are common to make diagnosis difficult to differentiate from other causes of dementia. -Additional clinical manifestations are, apathy, inattentiveness and indifference to sell family environment

DISEASE- CEREBRAL PALSY What is the pathophysiology of cerebral palsy

-Nonprogressive syndrome that causes motor deficits causes: -Prenatal cerebral hypoxia. -Perinatal, or postnatal trauma

BRAIN-HYDROCEPHALUS Pathophysiology of hydrocephalus

-Obstructionist CSF flows associated with hydrocephalus produces dilation of the ventricleS proximal to the obstruction. -Structured CSF is under pressure causing atrophy of the cerebral cortex and degeneration of the white matter tracts. -Their selective preservation of gray matter. -When excessive CSF fills a defect caused by atrophy and degenerative disorder or surgical incision. This fluid is not under pressure. Therefore atrophy in degenerative changes are not induced

BRAIN-HERNIATION what is cingulate gyrus herniation

-Occurs when the cingulate gyrus shifts under the falx cerebri. -manifestations: little is known about its clinical manifestations

BRAIN-HERNIATION What is uncal herniation syndrome

-Occurs when uncus or hippocampal gyrus shifts compressing the 3rd cranial nerve and the mesencephalon. -Manifestations: decreasing LOC pupils become sluggish before fixing and dilating 1st ipsalateral then contralateral Cheyne Stokes respiration which later shifts to central neurogenic hyperventilation and then the appearance decorticate and then the decerebrate posturing

BRAIN-BLOOD SUPPLY Review blood supply to the brain

-Receives 800 to 1000 ml per minute -Carbon dioxide (CO2) is the primary regulator for CNS blood flow -Internal carotid and vertebral arteries -Internal carotid supplies a proportionately greater amount of blood flow. -Arterial circle (circle of Willis) -Blood-brain barrier

BRAIN-HYDROCEPHALUS Hydrocephalus

-Refers to the various conditions characterized by an excess of fluid within the cerebral ventricles subarachnoid space or both -occurs because of interference with CSF flow caused by increased fluid production obstruction within the ventricular system or defective reabsorption of the fluid. -A papilloma or papilloma or epithelial tumor may in rare instances cause overproduction of CSF

BRAIN-HYDROCEPHALUS Communicating hydrocephalus (non-obstructive) extra ventricular hydrocephalus

-Results from impaired absorption of CSF in the absence of obstruction between the ventricles in subarachnoid space. -The most common causes of communicating hydrocephalus are subarachnoid hemorrhage, developmental malformation, head injury, neoplasm, inflammation (meningitis) very high pressure in the sagittal sinus and increase CSF secretion from the choroid plexus

BRAIN-HERNIATION What is the central herniation

-Straight downward shift of the diencephalon through the TENTORIAL Notch -manifestations: rapidly becomes unconscious moves from Cheyne Stokes respirations to apnea develop small reactive pupils and then dilated fixed pupils and passes from decortication to decerebration

BRAIN-HYDROCEPHALUS TX Evaluation and treatment of hydrocephalus

-The diagnosis is made on the basis of clinical history and physical exam -evaluation of CSF pressure and volume, and results of brain imaging -hydrocephalus can be treated by surgery to resect cysts, neoplasms or hematomas or biventricular bypass and the normal intracranial channel or into an extracranial compartment using a shunt -excision or coagulation of the cord plexus is needed occasionally when a papilloma is present

BRAIN-HERNIATION What is infratentorial herniation

-The most common syndrome cerebellar tonsillar. This cerebellar tonsil shifts through the foramen magnum due to increased pressure -clinical manifestations: arched stiff neck paresthesias in the shoulder area, decrease consciousness, respiratory abnormalities and pulse rate variations

BRAIN-EDEMA Cytotoxic (metabolic) edema

-Toxic factors directly affect the cellular elements of the brain of parenchyma (neuronal, glial, and endothelial cells), causing failure of the active transport systems. -The blood brain barrier is not disrupted -the cells lose their potassium and gain larger amounts of sodium. -Water follows by osmosis in the cell so that the cell's well. -Cytotoxic edema occurs principally in the gray matter and may increase vasogenic edema

BRAIN-CONCUSSION what is a grade II Concussion

-Transient confusion -retrograde amnesia-a that develops after 5 to 10 minutes -symptoms last more than 15 minutes

BRAIN-EDEMA Vasogenic edema

-clinically the most important caused by increased permeability of the capillary endothelium of brain after injury to vascular structures -result is a disruption in the BBB plasma proteins leak into extracellular spaces drawing water to them and the water content of the brain parenchyma increase. -vasogenic edema begins in the area of injury and spreads with preferential accumulation in the white matter of the ipsilateral side because the parallel myelinated fibers separate more easily. -edema then promotes more edema because of ischemia from increasing pressure.

PANIC DISORDER What is panic disorder

-consist of multiple disabling attacks and is characterized by intense autonomic arousal involving a wide variety of symptoms -symptoms include -lightheadedness -tachycardia -difficulty breathing -chest discomfort -sweating -weakness -trembling -abdominal distress -chills or hot flashes -fear of losing control or dying -last several minutes to an hour.

DISEASE-SCHIZOPHRENIA What part of the brain is associated with schizophrenia

-enlargement of the lateral and third ventricles -widening of frontocortical fissures and sulci

DISEASE-ANXIETY what is generalized anxiety disorder

-excessive and persistent worries are the hallmark s/s - 6 major s/s include -restlessness -muscle tension -irritability -easily fatigued -difficulty concentrating -difficulty sleeping -increased startle reflex

BRAIN-MYASTHENIA GRAVIS What is the clinical manifestations of myasthenia gravis

-extreme muscle weakness -fatigue -ptosis -diplopia -difficulty chewing an swallowing -sleepy,masklike expression -drooping jaw -bobbing head -arm or hand muscle weakness

BRAIN-COUNTERCOUP what is a contrecoup brain injury how does it occur

-impact within the skull; site of impact from brain hitting opposite side of skull; shearing forces through brain. - shearing forces through brain these injuries occur in one continuous motion the head strikes the wall (coup) and then rebounds (contrecoup)

SPINAL CORD=SPINAL SHOCK Why is spinal shock life-threatening

-more pronounced with transection injuries -bradycardia -hypotension -decreased thermal regulation (lose ability to sweat below level of injury)

BRAIN-HUNTINGTONS What is the etiology of Huntington's disease

-onset usually between 25-45 years of age -occurs in 2-8 per 100,000 -occurs in all races

DISEASE-BIPOLAR DEPRESSION what is bipolar depression

-periods of depression with mania

BRAIN-MS Pathophysiology of multiple sclerosis

-progressive chronic inflammatory demylinating autoimmune disorder of the CNS -occurs in the white and gray matter -degeneration of the mylin sheath in CNS neurons, scarring, and loss of axons

BRAIN-HUNTINGTONS what is the pathophysiology of Huntington's disease

-rare autosomal dominant hereditary-degenerative disorder ; short arm on chromosome 4 -severe degeneration of the basal ganglia (caudete and putmen)

BRAIN-ENCEPHALOCELE Define encephalocele

-refers to herniation or protrusion of various amounts of brain and meninges through a defect in the skull resulting in a sac like structure - incidence rate is 1 in 10.000 live births

BRAIN-MYELOMENINGOCELE what is myelomeningocele.

-results in a cyst dilation of meninges and protuberance of various amounts of spinal cord with more severe complications than those associated with a meningocele. - located in the lumbar and lumbosacral regions he last regions of the neural tube to close

BRAIN-EDEMA Interstitial edema

-seen most often with non-communicating hydrocephalus -edema is caused by transependymal movement of CSF from the ventricles into the extracellular spaces of the brain. -Brain fluid volume thus is increased predominantly around the ventricles. -Hydrostatic pressure within the white matter increases and the size of the white matter is reduced because of the rapid disappearance of myelin lipids

DISEASE-SCHIZOPHRENIA What is schizophrenia

-term coined by eugen bleuler in 1911 to describe a thought disorder. -reflects a break in reality or splitting of the cognitive from the emotional side of one's personality.

BRAIN-PARKINSONS What is the clinical manifestation of parkinson's

-tremors -rigidity -bradykinesia -loss of arm swing with walk -monotone speech -small indecipherable writing -shuffling steps -spastic movements -akinesia -progressive loss of memory -dementia -loss of facial expression (masklike face) -inability to tolerate heat -bladder/bowel incontinence -depression -bradyphrenia

BRAIN-ICHTN STAGE ONE stage one of intracranial hypertension

-vasoconstriction and external compression of the venous occur in an attempt to further decrease the intracranial pressure. - during the first stage of intracranial hypertension, ICP may not change because of the effective compensatory mechanisms and -there may be few symptoms. -small increases in volume, however, cause in increase in pressure, and the pressure may take longer to return to baseline. This can be detected with ICP monitoring.

DIAGNOSTIC CRITERIA-BRAIN DEATH what is the diagnostic criteria for brain death

1. Completion of all appropriate and therapeutic procedures with no possibility of brain function recovery. 2. Unresponsive, (absence of motor and reflex movements) 3. No spontaneous respirations (apnea)-a PaCO2 that rises above 60 mmHg without breeding efforts, providing evidence of nonfunctioning respiratory center (apnea challenge) 4. No brainstem function (ocular response to head turning her caloric stimulation; dilated, fixed pupils; no gag or corneal reflex) 5. Isoelectric (flat) EEG (electro cerebral silence) 6. Persistence of these signs for an appropriate observation.

DIAGNOSTIC CRITERIA-VEG STATE What is the diagnostic criteria for vegetative state

1. Period of eye-opening (spontaneous or following stimulation) 2. The potential for subcortical responses to external stimuli; including generalized physical responses to pain; such as posturing, tachycardia, and diaphoresis, and subcortical motor responses, such as grasp reflexes 3. Return of so-called vegetative (autonomic) functions, including sleep-wake cycles and normalization of respiratory and digestive system functions. 4. Occasional roving eye movements without concomitant visual tracking ability

DISEASE-DEPRESSION What is the etiology of depression

3-5% of the population for bipolar Twin studies: depression: Concordance rates Bipolar: monozygotic 79%; dizygotic 24% Unipolar: monozygotic 54%; dizygotic 19%

SEIZURE-DEFINITION Define seizure

A sudden transient disruption in the brain electrical function caused by abnormal excessive hyper synchronous discharges of cortical neurons

NEUROTRANSMITTER-ENDOGENOUS OPIOID What is an endogenous opioid will

A family of morphine like neuropeptides that inhibit transmission of pain impulses in the spinal cord, brain and periphery that receptors play a role in various central nervous system, gastrointestinal system immune system and other organ systems. There are 4 types of opiate neuropeptides: 1. enkephalins 2. Endorphins 3. dynorphins 4. endomorphins will will these substances are hormones that act as neurotransmitters by binding to one or more G-protein coupled opiate receptor

PAIN-ACUTE PAIN What is the clinical description of acute pain

A protective mechanism. That alerts the individual to a condition or experience that is immediately harmful to the body and mobilizes the individual to take prompt action to relieve it. Acute pain Is transient, usually lasting seconds to days sometimes up to 3 months begin suddenly and relieved after the chemical mediator that stimulated the pain receptors are removed. Stimulation of the autonomic nervous system results in physical manifestation, including increased heart rate, hypertension, diaphoresis, and dilated pupils. acute pain arises from cutaneous and deep somatic tissue or visceral organs and can be classified as acute somatic, acute visceral, and referred

BRAIN-ICP How does the body compensate for increased ICP

A shift in the CSF

QUESTION SECT 20 A child has meningitis. A nurse observes flexion of the knees and hips when the child's neck is rapidly flexed forward. Which sign did the nurse observe as positive?

ANSWER AND RATIONALE: Brudzinski sign. Irritation of the meninges and spinal roots causes pain and resistance to neck flexion (nuchal rigidity), a positive Kernig sign (resistance to knee extension in the supine position with the hips and knees flexed against the body), and a positive Brudzinski sign (flexion of the knees and hips when the neck is flexed forward rapidly).

QUESTION SECT 18 A patient has multiple sclerosis. Which pathophysiologic effect(s) will the nurse expect the patient to experience?

ANSWER AND RATIONALE: Demyelination and inflammation of the central nervous system. Various mechanisms cause irreversible tissue damage of the CNS (inflammation, oligodendrocyte injury, demyelination, scarring or plaque formation, and axonal degeneration) that characterizes multiple sclerosis.

QUESTION SECT 18 A nurse recalls that fusiform aneurysms are:

ANSWER AND RATIONALE: Due to arteriosclerotic changes. Arteriosclerotic changes in the basilar and internal carotid arteries produce fusiform aneurysms.

QUESTION SECT 18 An unconscious person is admitted to the hospital after a motorcycle accident. The person experienced a brief loss of consciousness at the scene followed by an awake, lucid period of 1 hour. The nurse suspects this individual has a(n):

ANSWER AND RATIONALE: Extradural hematoma. Individuals with classic temporal extradural hematomas (i.e., over the temporal lobe) experience loss of consciousness at the time of injury, followed by a lucid period that lasts from a few hours to a few days in one third of individuals (if bleeding from a vein).

QUESTION SECT 19 A patient has excessive and persistent worrying. Which diagnosis will the nurse observe documented on the chart?

ANSWER AND RATIONALE: Generalized anxiety disorder. Generalized anxiety disorder is associated with excessive and persistent worrying and restlessness, muscle tension, irritability, fatigue, difficulty concentrating, and difficulty sleeping.

QUESTION SECT 19 Which food item would be most appropriate for a person taking a monoamine oxidase inhibitor?

ANSWER AND RATIONALE: Ham. MAOIs also may induce acute and heightened elevations in blood pressure (e.g., hypertensive crisis) after intake of tyramine-rich foods, such as aged cheeses, sour cream, pods of broad beans, pickled herring, liver, canned figs, raisins, and avocados.

QUESTION SECT 17 Seizures are initiated by:

ANSWER AND RATIONALE: Hypersynchronization and bursts of action potentials. Two simultaneous events that include high-frequency bursts of action potential and hypersynchronization initiate seizure activity.

QUESTION SECT 16 A person has glaucoma. Which pathophysiologic process is occurring in this person?

ANSWER AND RATIONALE: Intraocular pressure is above normal. Glaucoma is a leading cause of visual impairment and blindness. It is characterized by intraocular pressures above the normal pressures of 12 to 20 mmHg maintained by the aqueous fluid. Amblyopia may occur in conjunction with strabismus and is reduction in visual acuity without ocular pathology.

QUESTION SECT 19 A person is admitted to the hospital after experiencing delusions. The nurse knows that a delusion:

ANSWER AND RATIONALE: Is a persistent belief that is contrary to the background of the individual. Delusions may involve grandiose, nihilistic, persecutory, somatic, sexual, and religious themes.

QUESTION SECT 18 A person arrives at the clinic and reports a unilateral headache for 2 days that worsens with movement and light. No trauma has occurred. The nurse suspects:

ANSWER AND RATIONALE: Migraine headache. Migraine is diagnosed when it is not attributable to any other disorder and when any two of the following features occur: unilateral head pain, pulsating pain, pain worsening with activity, moderate or severe pain intensity; and at least one of the following: nausea or vomiting, or both, or photophobia and phonophobia.

QUESTION SECT 17 During the morning report, a nurse is assigned to care for a person who is areflexic. The nurse understands this means the person has:

ANSWER AND RATIONALE: No tendon reflexes. This may occur with paralysis and be accompanied by muscle flaccidity.

TEMPERATURE REGULATION-HEAT PRODUCTION-THERMOGENESIS How does chemical thermogenesis relate to production in the body

Also known as Adrenergic thermogenesis results from the release of epinephrine and norepinephrine, which produce a rapid transit increased heat production by raising the body's basal metabolic rate different from hormone triggered increases in basal metabolic rate. Chemical thermogenesis produces a quick brief rise in basal rate, whereas the, thyroxine triggers a slow prolonged rise. Chemical thermogenesis occurs in brown adipose tissue, which is rich with mitochondria and blood vessels

QUESTION SECT 20 A 74-year-old man is diagnosed with Parkinson's disease (PD). PD is a complex motor disorder accompanied by systemic nonmotor and neurologic symptoms. Other nonmotor symptoms are common in PD, including sensory dysfunction, gastrointestinal dysfunction, sweating, fatigue, and weight loss. Early in the disease, people often experience a benefit of:

Although sleep disorders are common for patients with PD, *symptoms decrease with sleep* early in the disease. Individuals with PD experience disorientation, confusion and memory loss. Difficulty with concept formation and judgment are additional side effects. Slowness of thinking and poverty of thought, and decreased ability to plan or decide are common with PD. Dementia from PD is the third most common cause behind Alzheimer's disease and vascular disease.

EYE-KERATITIS What is keratitis

An inflammation of the cornea that can be noninfectious or caused by bacteria, viruses, or fungus bacterial infections often cause corneal ulcerations and require intensive antibacterial treatment staphylococcus aureus is the most common bacterial infection type I herpes simplex can involve the cornea and conjunctiva predisposing factors include contact lenses, and penetrating carrot to plasty. Common symptoms include photophobia pain, lacrimation severe ulcerations with residual scarring require corneal transplantation

EYE-CONJUNCTIVITIS What is conjunctivitis

And inflammation of the conjunctiva may be caused by bacteria, viruses, allergies or chemical irritations the inflammatory response produces redness, edema, pain, and lacrimation treatment is related to cause

TEMPERATURE REGULATION-HEAT LOSS-EVAPORATION How does evaporation relate to heat loss in the body

Body water from the surface of the skin and the linings of the mucous membranes is a major source of heat production insensible water loss accounts for a loss of about 600 mL of water per day. Heat is lost as surface fluid is converted to gas, so that heat lost by evaporation is increased if more fluids are available at the body surface to speed this process. fluids are actively secreted through sweat glands as much is 2.2, L of fluid per hour may be lost by sweating, electrolytes are lost with water. Large volumes of sweating may result in decreased plasma volumes, decreased blood pressure, weakness and fainting. Stimulation of sweating occurs in response to sympathetic neural activity in depends on a favorable temperature difference between the body and the environment

BRAIN-SUBARACHNOID SPACE *SLIDE QUESTION Which information is most accurate regarding the subarachnoid space? The subarachnoid space: Contains CSF. Lies above the dura mater. Lies below the pia mater. Adheres to the brain and spinal cord.

Contains cerebrospinal fluid. The subarachnoid space lies between the pia and arachnoid meningeal layers and contains CSF.

QUESTION SECT 15 Which information is most accurate regarding the subarachnoid space

Contains cerebrospinal fluid. The subarachnoid space lies between the pia and arachnoid meningeal layers and contains CSF.

DYSKINESIA-ATHETOSIS what is athetosis

Disorder of distal muscle, postural fixation, slowed, twisting sinuous, irregular movements most obvious in the distal extremities more rhythmic than CHOREIFORM movements always much slower, movements accompany characteristic hand posture, slowly fluctuating grimaces. *Causes*-occurs most commonly as a result of injury to the putamen of the basal ganglia on, exact pathophysiological mechanism is not known

DYSKINESIA-BALLISM what is ballism

Disorder of proximal-muscle, postural fixation with wild flinging movement of the limbs, movement is severe and stereotyped, usually lateral, does not lessen was sleep, ballism is most common on one side of the body, a condition termed him. Hemiballism *cause*-results from injury (vascular disease) to the subthalamic nucleus (one of the nuclei that comprise the basal ganglia I). Thought to be caused by reduced inhibitory influx in the nucleus, a release phenomena. Hemiballism results from injury to the contralateral subthalamic nucleus

SPINAL CORD-SPINAL SHOCK why would their temperature fluctuates in spinal shock

Disruption of central communication was sympathetic spinal nerves causes faulty control of diaphoresis and heat radiation through capillary dilation hypothalamus cannot regulate body heat through vasoconstriction and increase metabolism. Therefore, the individual's body temperature assumes the temperature of the air

DEVELOPMENT-NEURAL GROOVE when does the neural groove close during development?

During the 4th week of pregnancy

TEMPERATURE REGULATION-HEAT LOSS-PULMONARY VENT how does increased pulmonary ventilation relate to heat loss in the body

Exchanging air with the environment through normal pulmonary ventilation provide some heat loss. Although it is minimal in humans as air is inhaled from the upper respiratory tract. It is further warmed by the alveoli by blood in the microcirculation the warm air is then exhaled into the environment. The normal process occurs faster at higher body temperatures through increased ventilatory rates causing hyperventilation in hyperthermia

SLEEP-N3 PHASE What is the N3 phase of sleep

High amplitude Delta waves with occasional sleep spindles also known as slow-wave sleep, no slow eye movements

EYE-BACTERIAL CONJUNCTIVITIS What is acute bacterial conjunctivitis or pinkeye

Highly contagious and often caused by gram-positive organisms. Although bacteria may be involved is acute, characterized by mucopurulent drainage from one or both eyes often leads to otitis media in younger children often self-limiting and resolves spontaneously in 10 to 14 days. Antibiotic eyedrops are usually effective handwashing and the use of separate towels is important

HUNTINGTON'S DISEASE Where is the primary defect in huntington's disease?

Huntington disease Also known as chorea Rare, autosomal dominant hereditary-degenerative disorder; short arm on chromosome 4 Severe degeneration of the basal ganglia (caudate and putamen nuclei) and frontal cerebral cortex Depletion of gamma-aminobutyric acid (GABA) Abnormal movements that occur without conscious effort, emotional lability, and dementia

TEMP REGULATION-HEAT EXHAUSTION what is heat exhaustion

In a result of prolonged high core or environmental temperatures cause the appropriate hypothalamic response of profound vasodilation and profuse sweating. A prolonged period of hypothalamic response produces dehydration decrease plasma volumes hypotension decrease cardiac output, and tachycardia. The individual feels weak, dizzy, nauseated and faint. The symptoms of the heat exhaustion, causing the person who stop work lie down and rest individual should be encouraged to drink warm fluids to replace fluid loss during sweating

SEIZURE-STATUS EPILEPTICUS Define status epilepticus

In adults is a state of continuous seizure lasting more than 5 minutes, or rapidly reoccurring seizures before the person has fully regained consciousness from the preceding seizure, or seizure lasting more than 30 minutes. Status epilepticus can arise abnormal persistence of the excessive excitation or ineffective recruitment of inhibition

TEMP REGULATION-HEAT LOSS-VOLUNTARY CONTROL How does voluntary mechanisms relate to Heat loss in the body

In response to high body temperatures people physically stretch out, thereby increasing the body surface area available to heat loss and also slow down, take it easy, thereby decreasing skeletal muscle work and dress for warm weather with light-colored loosefitting garments to reflect heat and promote convection conduction and evaporation

BRAIN INJURY Color agnosia inability to understand colors as qualities of objects faulty color concepts and inability to bow color images and absence of colorblindness shows damage to

Inferior occipital cortex and left hemisphere

BRAIN-BRODMANN AREA *SLIDE QUESTION A nurse knows that the premotor area (Brodmann area is:

Involved in programming motor movements The premotor area is important in programmed motor movements and contains the basal ganglia or extrapyramidal system.

QUESTION SECT 15 A nurse knows that the premotor area (Brodmann area 6) is

Involved in programming motor movements. The premotor area is important in programmed motor movements and contains the basal ganglia or extrapyramidal system

DYSKINESIA-ASTERIXIS What is asterixis (tremor at hepatic encephalopathy)

Irregular flapping movement of the hands essentially did buy out stretching arms. *Cause*-caused by transient inhibition of muscles that maintain posture; thought to be related to accumulation of products normally detoxified by the liver

QUESTION SECT 16 Which finding would the nurse expect to recognize during the assessment of a person with chronic pain? The person is

Is often depressed. Chronic pain is associated with depression and hopelessness. As chronic pain progresses, certain behavioral and psychological changes often emerge, including depression, difficulty eating and sleeping, preoccupation with the pain, and avoidance of pain-provoking stimuli.42 The desire to relieve pain and the need to hide it becomes conflicting drives for those with chronic pain, who fear being labeled complainers.

PAIN-SOMATIC PAIN What is the clinical description of somatic pain

Is superficial, arising from connective tissue, muscle or bone, and skin. It is sharp and well localized or dull, aching, throbbing, and poorly localized as seen in poly-modal C fiber transmission

CSF ABSORBTION Where is CSF absorbed

It is reabsorbed into the venous circulation through the arachnoid villi, primarily located superior to the falx cerebri in the superior sagittal sinus

BRAIN INJURY Finger agnosia inability to identify the names of one's fingers shows damage to

Left angular gyrus

BRAIN INJURY Gersten syndrome loss of spatial orientation of fingers body sides and numbers damage to what part of the brain

Left angular gyrus

BRAIN INJURY Right left confusion, inability distinguish between the right and left shows damage to

Left angular gyrus

BRAIN INJURY acalculia , inability to perform mathematic calculations shows damage to

Left angular gyrus

BRAIN INJURY agraphia , inability to write shows damage to

Left angular gyrus

BRAIN INJURY Word blindness (Alexia/dyslexia) inability to recognize written symbols shows damage to

Left parietotemporal region

BRAIN INJURY Expressive (Broca dysphasia, motor) nonfluent impairment of ability to find words difficulty in writing shows damage to

Left posterioroinferior frontal lobe (Broca area) occlusion of one or several branches of middle cerebral artery, trauma, tumor, infection, abscess

BRAIN INJURY wernicke dysphasia fluid able to produce language the language is meaningless words are often inappropriate words with similar sounds or words with similar meanings are substituted for the correct words shows damage in

Left posterosuperior temporal lobe (Wernicke area) occlusion of inferior division of left middle cerebral artery, temporal abscess

LOC What is the most critical index of nervous system dysfunction/function

Level of consciousness

SLEEP-N1 PHASE What is the N1 phase of sleep

Light sleep with alpha waves, interspersed with low-frequency theta waves slow eye movement

PAIN-A/D FIBERS What type of pain does the a-Delta fibers transmit

Lightly myelinated, medium-size fibers that are stimulated by severe mechanical deformation or by mechanical deformation and/or extreme temperatures . They rapidly transmit sharp, well localized, fast pain sensation. They are responsible for causing reflex withdrawal of the affected body part of the stimulus before pain sensation is received

Chapt 16 INTRO QUESTIONS Several months ago, a young woman fell while rock climbing; her left leg was wedged tightly into a crevice. The resulting injury was severe and required amputation below the knee. She reported to her physician that she continues to suffer from phantom limb pain. The theory that best explains this type of pain is:

Neuromatrix theory

DYSKINESIA-CHOREA What is chorea

Nonrepetitive muscular contractions usually of the extremities of the random pattern of regular involuntary rapid contractions of group of muscles disappears with sleep decreases with resting increases with emotional stress and attempt at voluntary movements. *Causes*-associated with excess concentration of or a super sensitivity to dopamine within basal ganglia

SEIZURE-FEBRILE SEIZURE What is a benign febrile seizure

Occur in 2 to 5% of children they are benign in most common childhood type of seizure factors that contribute to susceptibility include familial incidents age degree and rate of temperature elevation nature of the particular fever inducing illness. The following characteristic features distinguishable febrile seizures from complex seizures precipitated by fever: 1. Simple febrile seizures are rare before 9 months of age or after 5 years of age. 2. The convulsions occur with the rise in temperature greater than 102.2°F for 39° C. 3. Acute respiratory tract or ear infection usually is present with no evidence of CNS infection or inflammation 4. Most seizures occur during the 1st 24 hours of illness. 5. The compulsion a short 15 minutes or less, generalized and predominately tonic 6. Enter EEG is normal. 7. Seizure. It usually does not recur during the same infection 8. No acute systemic metabolic disorders present

NERVE What nerves are capable of regeneration

Olfactory

PAIN-REFERRED PAIN What is the clinical description of referred pain

Pain is felt an area removed or distant from its point of origin. The area of referred pain is supplied by the same spinal segment as actual site of pain. Impulses for many cutaneous and visceral neurons converge on the same ascending neuron, and the brain cannot distinguish between the 2. Because the skin is more receptors, the painful sensations experience at the referred site and set of the site of origin. Referred pain can be acute or chronic

PAIN-TRANSMISSION/PERCEPTION Where in the CNS does pain perception occur

Pain transmission is the conduction of pain impulses along the alpha in C fibers into the dorsal horn of the spinal cord and to the brainstem, thalamus and cortex

BRAIN INJURY Spatial agnosia incapacity to find one's way around familiar places where is the location of the injury

Parietal lobe

PAIN-C FIBERS What type of pain does the unmyelinated C fibers transmit

Polymodal and are stimulated by mechanical, thermal and chemical nociceptors. The unmyelinated C fibers slowly transmit dull aching or burning sensations that are poorly localized and longer-lasting

BRAIN-MIDBRAIN DYSFUNCTION S/S Discuss the types of midbrain dysfunction in its physical symptoms

Possible causes of midbrain will dysfunction include Trauma Road traffic accidents Tumours Degenerative disorders Stroke Diabetes Hypertension physical symptoms include decerebrate posturing/rigidity: upper and lower extremity extensor responses. opisthotonos (hyperextension of the vertebral column) with clenching of the teeth;extension, abduction, and hyperpronation of the arms; and extension of the lower extremities.

TEMPERATURE REGULATION-HEATSTROKE What is heatstroke

Potentially lethal result of a breakdown in control of an overstressed thermo regulatory center brain cannot tolerate temperatures greater than 40.5 Celsius (104.9 Fahrenheit) heat loss through evaporation of sweat ceases core temperatures increase rapidly and vascular collapse produces cerebral edema degeneration of the CNS, swollen dendrites, renal tubular necrosis, and multiple organ failure. Death results unless immediate and effective treatment is initiated. If the individuals recover from heatstroke may have permanent damage to the thermal regulatory center and have difficulty tolerating environmental temperature changes. Systemic inflammatory response syndrome may ensue inducing following heat -induced tissue injury may cause long-term sequelae with heat injured tissue *TREATMENT* includes removing the person from the warm environment using cooling blankets or cold water bath or ice packs on the head, neck, groin, and neck cilia. Care must be taken to prevent to rapid cooling of the service which causes peripheral vasoconstriction and prevents core cooling

BRAIN-STRUCTURAL FUNCTION what is the function of the arachnoid villi

Protrude from the arachnoid space to the dura mater and lie within the blood flow of the venous sinuses CSF is reabsorbed by means of a pressure gradient between the arachnoid Villi and the cerebral venous sinuses. The villi function as a one-way valve directing CSF outflow into the blood but preventing blood flow into the subarachnoid space

BRAIN INJURY Anosognosia ignorance or denial of the existence of the disease shows damage to

Right parietal lobe

BRAIN INJURY autotopagnosia loss of ability to identify the body, in whole or in part, or to recognize relationships among various parts shows damage in

Right parietal lobe

BRAIN INJURY amusia (music deafness), loss of capacity to recognize tones and melodies shows damage to

Right superior temporal area

DYSKINESIA-MYOCLONUS INTENTIONAL TREMOR what is a myoclonus intentional tremor

Series of shock like, non-patterned contractions of a portion of a muscle, entire muscle, or group of muscles that cause throwing movements of a limb; usually appear at random but frequently triggered by sudden startle; do not disappear during sleep *cause*-associated with an irritable, nervous system and spontaneous discharge of neurons; structures associated with myoclonus include the cerebral cortex, cerebellum, reticular formation and spinal cord

PARKINSON'S DISEASE Where is the primary defect in Parkinson's disease

Severe degeneration of the basal ganglia (corpus striatum) involving the dopaminergic nigrostriatal pathway --Loss of dopaminergic-pigmented neurons in - _the substantia nigra --Rigidity: Cogwheel, plastic --Bradykinesia and akinesia --Resting tremor --Postural abnormalities: Postural fixation, _equilibrium, righting --Autonomic-neuroendocrine symptoms --Cognitive-affective symptoms and dementia

TEMPERATURE REGULATION AND EPINEPHRINE What is the relationship between epinephrine and body temperature

The heat producing mechanism begins with the hypothalamus on TSH-Rh in turn this stimulates the anterior pituitary to release TSH, which acts on the thyroid gland, stimulating release of thyroxine (T4), one of the thyroid hormones. This hormone and acts on the adrenal medulla, causing the release of epinephrine into the bloodstream. Epinephrine causes vasoconstriction improving thermal insulation stimulates gylcolysis, an increase metabolic rates, increasing heat production

QUESTION SECT 20 A 74-year-old man is diagnosed with Parkinson's disease (PD). PD is a complex motor disorder accompanied by systemic nonmotor and neurologic symptoms. The main disease feature of PD is the degeneration of the:

The inferior-most portion of the basal ganglia synthesizes dopamine, a neurotransmitter. Dysfunction in this area of the brain in associated with Parkinson disease. The brainstem provides the main motor and sensory innervation to the face and neck, as well as a passageway of the nerve connections of the motor and sensory systems from the main part of the brain. The cerebellum id important in motor control and may also be involved in some cognitive functions. The medulla contains the cardiac, respiratory, vomiting and vasomotor centers and deals with autonomic, involuntary functions, such as breathing, heart rate and blood pressure.

SEIZURE-MEDICAL SIGNIFICANCE What is the medical significance of the seizure

The onset of seizures may point to the presence of an ongoing primary neurological disease, etiologic factors, and seizures include: 1. Cerebral lesions 2. Biochemical disorders 3. Cerebral trauma 4. Epilepsy conditions that may produce a seizure or metabolic defects congenital malformations genetic predisposition, prenatal injury, postnatal trauma, myoclonic Syndromes infection brain tumor and vascular disease. It may also be precipitated by hypoglycemia, fatigue, lack of sleep, emotional or physical stress, fever, large amounts of water ingestion hyponatremia, constipation, use of stimulant drugs, withdrawal from depressant drugs or alcohol hyperventilation or respiratory alkalosis. Some environmental stimuli such as blinking lights poorly adjusted television screens, loud noises, certain odors are merely being startled

PAIN What is pain threshold

The point at which the stimulus is perceived as pain it does not vary significantly among people or in the same person over time, intense pain at one location, however, may cause an increase in the threshold in another location. For example, a person with severe pain in one knee like is less likely to experience chronic back pain that is less intense the phenomenon is, perceptual dominance because of the perception dominance pain at one site may mask other painful areas

EYE-CHRONIC CONJUNCTIVITIS What is chronic conjunctivitis

The result of any persistent conjunctivitis cause requires identification for effective treatment

BRAIN-GUILLAIN BARRE What is the etiology the guillain barre syndrome

The syndrome occurs equally in both sexes. It usually Occurs between ages of 30 and 50 it affects about one out of every hundred thousand people. As a result of better symptom management, 80 to 90% of patients recover with few or no residual symptoms

tEMPERATURE REGULATION-HEAT PRODUCTION-SKELETAL CONTRACTION How does skeletal muscle contraction relate to heat production in the body

They produce heat through 2 mechanisms: 1. Gradual increase in muscle tone. 2. Production of rapid muscle oscillations (Shivering does not occur in neonates) both of these mechanisms are controlled by posterior hypothalamus and occur in response to cold shivering is a fairly effective method for increasing heat production because no work is performed and all the energy produced is retained as heat

DISEASE-PKU What is the etiology of PKU

This disorder occurs in about 1 of 14,000 births in the US and about 1 person in 60 is an asymptomatic carrier PKU has a low incidence among Blacks and Jews at a higher incidence among whites and Native Americans

SLEEP-REM What is REM sleep

Time of most dreaming, body is paralysed rapid eye movement occurs.

TEMPERATURE REGULATION-HEAT LOSS-MUSCLE TONE How is decreased muscle tone related to heat loss of the body

To decreased heat production, muscle tone, may be moderately reduced, And Involuntary muscle activity curtailed. These mechanisms explain in part the washed out feeling associated with high temperatures and warm weather decreased muscle tone and reduced activity have a limited effect on decreasing heat production because muscle tone and heat production cannot be reduced below basal body temperature

NEURONS-ASSOCIATIONAL/INTERNEURONS *SLIDE QUESTION Which information is correct regarding associational neurons? Associational neurons:

Transmit impulses from neuron to neuron. These interneurons are multipolar and are involved in cognitive function.

DYSKINESIA-CEREBELLAR INTENTIONAL TREMOR what is a cerebellar intentional tremor

Tremor initiated by movement, maximal toward the end of movement. *Cause*-occurs in disease of the dentate nucleus (one of the deep cerebellar nuclei responsible for Efferent output) and the superior cerebellar peduncle (a stock like structure connected to the pons); caused by errors and feedback from the periphery and errors in pre-programming goal-directed movement

DYSKINESIA-ESSENTIAL FAMILIAL TREMOR what is an essential familial tremor

Tremor of fingers, hands and feet absent at rest, but accentuated by extension of body part prolonged muscular activity and stress. *Cause*-not associated with any neurological abnormalities cause unknown

SLEEP-AWAKE PHASE What is the awake phase of sleep

Wakefulness with eyes closed and predominated by alpha waves

BRAIN-CONCUSSION what is a concussion

a mild traumatic brain injury characterized by immediate but transitory clinical manifestations including: CSF pressure rise; ECG, EEG changes; may or may not be loss of LOC, glasgow coma score is 13-15; initial confusional states lasts 1-several minutes; possible retrograde amnesia; has 3 grades

DYSKINESIA-DEFINITION What is dyskinesia

abnormality or impairment of voluntary movement.

DISEASE-DEPRESSION what is stress-induced depression

accompanied by deficit in brain derived neurotrophic factor and neurogenesis in the hippocampus.

BRAIN-RAS-COGNITIVE FUNCTION What part of the brain must be functioning for cognitive operations

cognitive cerebral functions require of functioning reticular activating system

TREATMENT-ECT How does ECT treat depression

known to produce alteration in monoamine systems.

BRAIN-THOUGHT Which portion of the brain is responsible for controlling thoughts

limbic region

BRAIN-BALANCE,POSTURE Which portion of the brain is responsible for controlling balance and posture

major structure of the metencephalon the cerebellum

BRAIN INJURY Tactile agnosia inability to recognize objects by touch. Where is the location of the injury

parietal lobe

INTRO QUESTIONS SECT. 19 A psychiatrist is seeing a young man in his late teens after his mother notices changes in her son's behavior. For the past 6 months, the young man has become enthralled with a specific television show, believing that the host is specifically directing information to him. As the son walks in, the physician notes that the young man's personal hygiene has been neglected. The psychiatrist talks to the son and notes that he repeatedly uses the same phrases throughout the conversation. An initial diagnosis of schizophrenia is made. The most common symptoms in schizophrenia are:

positive

CHAPT 16 INTRO QUESTION Nociceptors are free nerve endings in the afferent peripheral nervous system that selectively respond to different stimuli. They are characterized according to the stimulus to which they respond and the properties of the nerve fibers associated with them. The fibers that transmit dull, aching or burning sensation are:

unmyelinated C fibers