Patho Chapter 15 Disorders of motor function (Part 1), Porth's Patho Ch. 16: Disorders of Brain Function, Porth's Patho Ch. 15: Disorders of motor function

Mononeuropathies

Caused by localized conditions such as trauma, compression, or infections that affect a single spinal nerve, plexus, or peripheral nerve trunk. -Fractured Bones -Excessively tight tourniquets -Infection such as varicella/ Herpes zoster -Shingles Chickenpox virus which undergoes reactivation.

A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as:

Normal manifestations of Parkinson disease

The brainstem contains gray matter that is made up of:

Neurons

The transmission of impulses mediated by

the release of acetylcholine from the axon terminal's

primary motor cortex

the section of the frontal lobe responsible for voluntary movement

Causes of polyneuropathies

*Immune Mechanisms (Guillain-Barre' Syndrome) *Toxic Agents (Arsenic polyneuropathy, Lead polyneuropathy, Alcoholic Polyneuropathy) *Metabolic Diseases ( Diabetes Mellitus, Uremia)

peripheral neuropathy

-Any primary disorder of the peripheral nerves. -Muscle weakness with or without atrophy and sensory changes

upper motor neuron lesion

-Can involve the motor cortex -The internal capsule or the brain structures through the corticospinal or corticobulbar tracts descend, or the spinal cord

What disease results from the degeneration of the dopamine Nigrostriatal system of the basal ganglia?

Parkinson disease

For which common manifestation of acute meningococcal meningitis should the school nurse be assessing students?

Petechiae

A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which treatment measure is most likely to resolve this health problem?

Placement of a shunt

Which treatment should take place immediately in a client experiencing autonomic dysreflexia?

Position the client in upright position, and correct the initiating stimulus

A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing:

Transient Ischemic Attack (TIA)

Autonomic dysreflexia (autonomic hyperreflexia) is characterized by which of the following?

Vasospasms and hypertension

premotor cortex

area of the frontal cortex, active during the planning of a movement

supplemental motor cortex

preparing motor system for action

Synergist

muscle that aids a prime mover in a movement and helps prevent rotation

pyramidal motor system

originates in the motor cortex, provides control of delicate muscle movement

peripheral nervous system

-Motor And sensory branches of the cranial and spinal nerves. -The Peripheral parts of autonomic nervous system. - Peripheral ganglia

Extra Pyramidal Symptoms

-Originates in the basal ganglia. -Provides a background for the more crude, supportive movement patterns. (If infected you can suffer from Parkinson's disease)

What medication teaching should be done for a woman of childbearing age with a seizure disorder?

Antiseizure drugs increase the risk for congenital abnormalities.

When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present?

Brudzinski sign and Kernig sign

The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include?

CT scan

Peripheral nerve disorders or not uncommon. What is an example of a fairly common mononeuropathy?

Carpal tunnel syndrome

Which intracranial volume is most capable of compensating for increasing intracranial pressure?

Cerebrospinal fluid

The parents of an infant born with hydrocephalus are concerned about the size of the baby's head. The doctors are telling them that the infant needs the surgical placement of a shunt. The nurse caring for the infant in the neonatal intensive care unit explains that placement of a shunt will:

Decrease the likelihood of further neurological deficits

Which statement best describes the pathophysiology of Parkinson disease?

Degeneration of the Nigrostriatal dopamine system

The underlying causative problem in parkinsonism is:

Failure of dopamine release

Reflexes are basically "hardwired" into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron to cause muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons?

Interneuron

Which neuron connections sensory and motor neurons?

Interneurons

The nurse reading a client's lumbar puncture results notifies the physician of findings consistent with meningitis when which sign/symptom is noted?

Large number of polymorphonuclear neutrophils

Functioning neuromuscular junction

Links nervous system activity with muscle contraction

A nurse is caring for a client experiencing muscle fasciculations. Fasciculations appear as:

Spontaneous contractions of muscle fibers presenting as twitching

The motor unit

The motor neuron and all of the muscle fibers it innervates

Extensors

These muscles increase the angle at the joint.

Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury?

altered level of consciousness

Flexors

decrease angle of joints

myasthenia gravis

-Disorder Of transmission at the neuromuscular junction that affects communication between the motor neuron and the innervated muscle cell. -Autoimmune disease caused by anti-body mediated last of acetylcholine receptors in the neuromuscular junction. -Women are commonly more affected than men. -Patients suffer facial muscles swelling affects Neuromuscular junction at the receptor site -Receptor sites become blocked with antibodies

Alterations in Neuromuscular Function

-Drugs & agents can alter neuromuscular function by changing the release, inactivation or receptor binding of acetylcholine. -Cureare acts on the postjunctional membrane of the motor endplate to prevent the depolarizing effect of the Neurotransmitter -Prevents The release of acetylcholine from the axon terminal -used during many types of surgical procedures -Clostridium botulinum blocks ACH And results in paralysis

Peripheral nerve regeneration

-Peripheral nerves do regenerate Either completely or partially because they have a myelin sheath which helps them regenerate. -Damage to a peripheral nerve Axon Due to injury or neuropathy. Results and degenerative changes followed by breakdown of Mylan sheath and Schwan cells.

upper motor neurons

-Projects from the motor cortex to the brain stem or spinal cord. -Directly or indirectly innervate the lower motor neuron's or contracting muscles. -Motor unit is a motor neuron and all the muscle fibers it innervates.

muscular atrophy

-Shrinkage of muscle -Muscle loses much of their contractile protein and weaken

neuromuscular junction

-synapse between a motor neuron and a skeletal muscle fiber. -Consist of the axon terminal of a motor neuron and a specialize region of the muscle membrane called the end plate.

Which individual has the highest chance of having a primary central nervous system lymphoma?

A 24-year-old man with acquired immunodeficiency syndrome (AIDS) and behavioral and cognitive changes

Duchenne muscular dystrophy

A human genetic disease caused by a sex-linked recessive allele; characterized by progressive weakening and a loss of muscle tissue.

Which principle best explains symptoms of amyotrophic lateral sclerosis (ALS), including dysphasia, muscle weakness and spasticity, and dysphonia?

ALS is caused by both an upper motor neuron and lower motor neuron disturbance

Myasthenia gravis is characterized by muscle weakness caused by antibody-mediated loss of which physiologic function?

Acetylcholine receptors

A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to:

Administer IV tissue plasminogen activator (tPA)

A client with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her:

Arms

The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?

Assess for other signs/symptoms of increased intracranial pressure

The spouse of a client admitted to the hospital after a motor vehicle accident reports to the nurse that the client has become very drowsy. The nurse should:

Assess the client for additional signs and symptoms of increased intracranial pressure

The parent of an infant who developed hydrocephalus while in utero is very concerned that the child will have significant intellectual dysfunction. The best response to the parent would be:

Because the skull sutures are not fused, there may be no brain damage

Acetylcholine

Binds to receptors in the motor end plate region of the muscle fiber surface to cause the muscle contraction.

The nurse is conducting a community education program on concussions. The nurse evaluates that the participants understand the education when they state that which of these offers the brain protection from external forces?

Cerebrospinal fluid

Sensory feedback from muscles

Continuously relayed to the cerebellum and basal ganglia and sensory cortex.

mononeuropathy

Disease affecting a single nerve such as: -Carpal tunnel syndrome median nerve and tendon becomes compress. -Bells palsy temp damage to cranial nerve 7

lower motor neuron lesion

Disruptive munication between the muscle in on Nuro input from spinal cord reflexes including the stretch reflex which maintains muscle tone

A client's recent diagnosis of Parkinson disease has prompted the care provider to promptly begin pharmacologic therapy. The drugs prescribed will likely influence the client's levels of which substance?

Dopamine

A client with Parkinson disease presents with Bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain?

Dopamine nigrostriatal system

Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury?

Excitotoxic

In what part of the body does the highest level of motor function occur?

Frontal cortex of the brain

The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced:

Generalized seizure

A high school student sustained a concussion during a football game. The school nurse will educate the family about postconcussion syndrome and ask them to watch for and report which manifestations of its presence?

Headaches and poor concentration

A nurse is assessing a client with symptoms of botulism. The nurse will question the client regarding ingestion of which food?

Home-grown and canned vegetables

The nurse is assessing a client with a traumatic brain injury and assesses for changes in which neurologic component? Select all that apply.

Motor function, cognition, level of consciousness, sensory function

Restoration of the integrity of Myelin sheaths would likely result in a slowing or stopping of the progression of:

Multiple Sclerosis (MS)

The nurse is caring for an older adult client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for developing which condition?

Muscle atrophy

Which disease is thought to be caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction?

Myasthenia gravis

Components of neuromuscular system

Neuromuscular unit containing motorneurons Myoneural Junctions Muscle Fibers Spinal Cord Descending pathways from the brain stem circuits

A nurse is caring for a client with multiple sclerosis notes that the client has mood swings. Which cars can best explain this?

Psychological manifestation due to involvement of white matter of cerebral cortex

The nurse observes a new nurse performing the test for Kernig's sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that:

Resistance should be provided with the knee in a flexed position

A client has started having uncontrolled seizures that are not responding to usual medications. Nurses working with the client must pay special attention to which priority aspects of this client's care? Assessment of:

Respiratory status and oxygen saturation

The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as:

Rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet

A family brings their father to his primary care physician for a check up. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait?

Slow to start walking and has difficulty when asked to "stop" suddenly

The nurse is explaining to a client's family how vasogenic brain edema occurs. The most appropriate information for the nurse to provide would be:

The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid

What do you deep tendon reflexes assess?

The stretch reflex at different spinal cord segments

A client suffering a thrombotic stroke is brought into the emergency department by ambulance and the healthcare team is preparing to administer a synthetic tissue plasminogen activator for which purpose?

Thrombolysis

The most common cause of an ischemic stroke is which of the following?

Thrombosis

Guillain-Barre syndrome (Polyneuropathy)

autoimmune condition that causes acute inflammation of the peripheral nerves in which myelin sheaths on the axons are destroyed, resulting in decreased nerve impulses, loss of reflex response, and sudden muscle weakness. Can cause paralysis of respiratory muscles

A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for:

brain death

Select the laboratory blood test that would be used to suggest a diagnosis of muscular dystrophy (MD).

creatine kinase

muscular dystrophy

genetic diseases with progressive Deterioration of skeletal muscles