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