Pathophysiology Exam 3
During the acute stress response, the body mobilizes energy stores to prepare for "fight or flight" or to restore homeostasis. This function can become pathological if sustained over prolonged periods or if a patient is critically ill by leading to all of the following EXCEPT _____.
hypoglycemia
neurogenic bladder
impairment of bladder control due to brain or nerve conduction; major cause of autonomic dysreflexia
chronic stress effects of immune system
impairs T cell proliferation, suppresses secretion of inflammatory cytokines, delayed wound heals, increased vulnerability to pathogens
What are the consequences of chronic alcohol use
inadequate dietary intake, impaired thiamine absorption (deficiency), alcohol induced liver disease, hypertension, cardiomyopathy, heart failure
A spinal cord injury resulting in some motor or sensory function below the level of the injury is classified as which type of injury?
incomplete spinal cord injury
effects of acute stress
increased arousal, contextual memory formation, concentration; can be caused surgery, severe trauma, infection, a short-lived threat or challenge
What are the effects of PTSD?
increased sympathetic activity via alpha receptor and levels of NE; impaired HPA axis functioning (decreased cortisol release), dysregulated activity in brain areas assoc. with fear/stress (increased amygdala activity)
acute stress effects of immune system
inhibit immune system function via NE and cortisol; limits inflammation
stress effects on metabolic system
inhibition of insulin release/functioning, increases in gluconeogenesis; increase in fat mobilization and redistribution
stress effects on reproductive system
inhibits reproductive function by inhibit of GnRH (corticotropin), inhibition of LH, FSH, testosterone, estrogen via cortisol
What is an example of a physiological stressor?
intensive daily exercise for multiple hours per day
substance-induced disorders
intoxication, withdrawal and other substance/medication-induced mental disorders
Right brain stroke manifestations
left sided paralysis and neglect; slurred speech, perceptual and memory deficits; right gaze preference
pressure ulcers
localized injuries to the skin or underlying tissue resulting from prolonged pressure on the skin
Frequent respiratory assessment is important in acute spinal cord injury because:
loss of defensive respiratory muscles places them at high risk for respiratory failure
What are the symptoms of SCI?
loss of movement, loss of sensation, including ability to feel heat, cold, touch, loss of bladder/bowel control, changes in sexual function, pain in head, neck, or back, difficulty breathing, coughing
areflexic bowel
lower motor neuron bowel syndrome; loss of peristalsis, leading to constipation with leaking of stool
chronic stress can lead to?
metabolic syndrome
A client sustained a closed head injury in a fall from a tree that happened 2 hours ago. There is MRI evidence of a contusion. The client has just begun to regain consciousness and has a current Glasgow Coma Scale (GCS) score of 11. The nurse should plan care for a client with which level of injury from this contusion?
moderate
Your patient presents to the emergency department for alcohol toxicity. While taking their history, you learn that they drink several glasses of whiskey each night to "get a good buzz." They have been increasing the number of glasses they drink each week, regularly experience tremors when not drinking, has drunken more than intended 3 times in the past month, and continues to drink although they get into physical altercations when drunk. A complete assessment reveals that they only exhibit these 4 symptoms. According to the DSM-5, what would their diagnosis be?
moderate SUD; exhibits 4-5 of symptoms
Alzheimer's disease
most common type of dementia; problems with memory, thinking, and behavior; experience behavioral and personality changes, depression, insomnia, delusions, hallucinations
positive reinforcement
motivation to consume substance because of good feeling it produces
negative reinforcement
motivation to consume substance to reduce negative feeling that occurs during abstinence and withdrawal
How do you treat opioid overdose?
narcan (naloxone hydrochloride): opioid receptor antagonist; displaces opioids bound to receptors
brainstem stroke
nausea, vomiting, or vertigo; speech problems, swallowing problems, abnormal eye movements; decreased consciousness
What is the functionally relevant muscle at C4?
neck muscles
The sympathetic nervous system is involved in the immediate stress response. It engages the "fight or flight" response in multiple organs by causing the release of norepinephrine and epinephrine from _____.
nerve terminals and the adrenal medulla
Excitotoxicity
neural injury such as stroke may cause excess release of glutamate, which is toxic to neurons
sub-acute SCI trauma
neuroimmune response by neutrophils and lymphocytes; upregulation of axonal growth inhibitors
Your patient, Theodore, is demonstrating signs and symptoms of stroke and reports loss of vision. What area of the brain do you suspect is affected based on this?
occipital lobe
While taking your patient's history, you learn that they have been increasing their oxycodone use because their prescribed usage is no longer managing their pain. At the cellular level, what is the cause of their tolerance to the analgesic effects of oxycodone?
opioid receptors have been downregulated
quadriplegia
paralysis of all four extremities
paraplegia
paralysis of both legs and the lower part of the body
autonomic dysreflexia
patients with spinal cord injuries are at risk for developing autonomic dyreflexia (T-7 or above); irritating stimuli below level of injury, leads to increase blood pressure and bradycardia
substance use disorder
pattern of symptoms resulting from the use of a substance that you continue to take, despite experiencing problems as a result
What are environmental risk factors of SUD development?
peer pressure, early first substance use, parental attitudes toward substance use, lack of family involvement and support, history of abuse, social isolation
allostasis
process by which the body responds to stressor in order to regain homeostasis
consequences of general chronic opioid use
produces systemic disturbances in homeostasis; opioid-induced bowel syndrome (pain, severe constipation), memory loss
SNS response to stress
rapid and short; signaled from the hypothalamus, increased catecholamines, norepinephrine and epinephrine, initiates "fight or flight responses"
Stress effects on the thyroid
receptors for cortisol, somatostatin, cytokines; suppressed TSH and decreased conversion of T4 to T3; leads to hypothyroidism
watershed areas
regions in the brain where the tissue is furthest from arterial supply; most vulnerable to reduction in perfusion
incomplete SCI
residual motor and sensory function below the level of injury
Left brain stroke manifestations
right-sided paralysis, difficulty forming words, comphrension and memory deficits, left gaze preference
What are some of the opioid withdrawal symptoms?
runny nose, chills, joint pain, diarrhea, nausea, hyperactive bowel sounds, mydriasis, tachycardia, hypertension, CNS stimulation
What are the collection of withdrawal symptoms for alcohol withdrawal?
shaking, confusion, hallucination, headache, sweating, nausea, loss of appetite, tachycardia, agitation, restlessness, anxiety, irritability
HPA axis response to stress
slower, more prolonged stress response; increases energy availability, inhibition of nonessential functions
What are the effects of acute alcohol use?
sobriety (talkativeness), euphoria-excitement (hyper-reflexia, lack of coordination, slurred speech), confusion-stupor (amnesia, hypothermia), coma-death (severe respiratory depression)
The frontal lobe controls
speech, smell, concentration, motor control
What are the stress response pathways?
sympathetic nervous system and HPA axis
A patient was admitted to the hospital after sustaining a closed head injury. Several hours later, the nurse assesses that she is more lethargic and confused, is mumbling her speech, and is very difficult to arouse. For which reason would the nurse take action?
the brain injury may be worsening
allostatic load
the long-term negative impact of the stress response on the body
chronic alcohol use can lead to the development of Wernicke-Korsakoff's syndrome, a disease caused by a deficiency in which vitamin?
thiamine
the parietal lobe controls
touch and pressure, taste, body awareness
The major cause of hemorrhagic stroke
uncontrolled hypertension
acute SCI trauma
uncontrolled influx of blood & blood proteins; hypoxia/ischemia; excitotoxic neurotransmitters
Hyperreflexic bowel
upper motor neuron bowel syndrome; involuntary contractions of muscles of the rectum and anus remain intact; inability to voluntary relax the anal sphincters and defecate
the occipital lobe controls
vision
the temporal lobe controls
hearing, facial recognition
ischemia
Lack of blood supply; cerebral ischemic can be focal (stroke) or global (cardiac arrest)
Chronic stress effects on the brain
hippocampus and frontal cortex have most cortisol receptors; structural changes, increased activity to the amygdala, memory impairments, behavioral changes
diffuse brain injury
Any injury that affects the entire brain; can occur with acceleration/deceleration or rotational
A patient with a spinal cord injury at the T1 level complains of a severe headache and an "anxious feeling." Which is the most appropriate initial reaction by the nurse?
Assess for a full bladder
What are the effects chronic stress?
anxiety, insomnia, fatigue, cognitive dysfunction, anorexia, depression
the cerebellum controls
Balance and coordination
chronic SCI trauma
axonal growth failure, demyelination, scar firmly established around lesion site
hyperacute SCI trauma
axons are severed & blood vessels rupture from mechanical forces
During the stress response, the hypothalamus releases _____, which causes the pituitary gland to release ______.
CRH; ACTH
What are the main causes of autonomic dysreflexia?
full bladder, impacted bowel, break down of skin
Opioid receptors are
G-protein coupled receptors
Opioid MOA
GPCRs that inhibits neurotransmission; leads to decreased cell activity and increases dopamine
PTSD
a mental health condition triggered by experiencing or witnessing a terrifying even or experiencing multiple repeated traumas; symptoms of intrusive thoughts, avoidance of trauma related contexts, mood disturbances, hyper reactivity
Traumatic brain injury
a nondegenerative, noncongenital insult to the brain from an external mechanical force; can be closed or penetrating, mild or moderate
Glasgow Coma Scale (GCS)
a scale used to assess the consciousness of a patient upon physical examination, typically in patients with neurological concerns or complaints; 13-15 score mild, 9-12 moderate, 3-9 severe
hemorrhagic stroke
a stroke where the blood loss is caused by the rupture of a blood vessel
ischemic stroke
a type of stroke that occurs when the flow of blood to the brain is blocked; due to a thrombus
What are the drugs used in the medical assisted treatment of alcohol abuse?
acamprosate to minimize the symptoms of withdrawal and naltrexone to reduce the pleasurable effects of alcohol usage
What are the clinical indications of opioid use?
acute pain and sedation (sudden pains), chronic pain (cancer, spinal fractures)
stress effects on the cardiovascular system
acute stress increases cardiac output and BP; catecholamines increase HR, and increase renin release in the kidneys, chronic stress impairs cardiovascular function
TBI can make people more susceptible to the effects?
alcohol abuse
What are the comorbid conditions of PTSD?
alcohol/substance use disorder, depression, anxiety, hypertension, asthma, chronic pain disorders
complete SCI injury
all sensory and motor function are lost below the spinal cord injury
signs of opioid intoxication
altered mental status (less responsive), bilateral miosis, respiratory depression, decreased HR, BP, hypothermia, decreased intestinal motility
What drugs are used as the medication assisted treatment for opioid abuse?
buprenorphine and methadone to reduce cravings
cytotoxic edema
cellular swelling caused by intracellular accumulation of fluid; leads to damage of neighboring cells
What are the effects of chronic opioid use?
chronic administration produces adaptations in the opioid receptor system; leads to new symptoms in the absence of drug; increases pain sensitivity, negative affect on the brain (depression, malaise), diarrhea upon cessation of use
Spinal cord injury
complete or partial damage to the neural elements of spinal cord that causes permanent changes in sensation and loss of voluntary control below the site of injury
neurogenic bowel
complete or partial loss of bowel control; symptoms comprise constipation and fecal incontinence
How might the stress response impair one's basal metabolic rate?
cortisol inhibits the production and action of T3/T4
diffuse axonal injury
damage to nerve cells in the connecting fibers of the brain; leads to functional cerebral impairment, confusion/coma, and possibly death
cerebral hypoxia
decrease of oxygen supply to the brain even though there is adequate blood flow; caused by reduced atmospheric pressure, severe anemia, etc.
What are the effects of acute opioid use?
decreases pain in the nerve cells, spinal cord, brain; induces constipation in the small intestine
repeat mTBI are associated with increased risk of degenerative disorders like?
dementias, amyotrophic lateral sclerosis, Parkinson's disease, multiple sclerosis
zone of partial preservation
dermatomes and myotomes caudal to the neurologic level that remain partially innervated in complete injuries
focal brain injury
direct blow to the head resulting from collision with an external object, a fall, or a penetrating injury
most substances of abuse stimulate an increase in?
dopamine; DA release= rewarding feelin g
vasogenic edema
extracellular edema resulting from disruption of the blood-brain barrier
What are the biological risk factors for SUD development?
family history of SUD, mental health disorders, sex assigned at birth, chronic physical illness, chronic o=pain
Mrs. Mendoza is a 75-year-old client who has dementia of the Alzheimer's type and confabulates. You understand that this client:
fills in memory gaps with fantasy
mild cognitive impairment
first stage of Alzheimer's disease; begins in the medial temporal lobe; symptoms short-term memory loss
Wernicke-Korsakoff syndrome
form of dementia that is characterized by decreased thiamine and B1; amnesia, confabulation, psychosis