Flashcards in 302 EXAM 2 Deck (212):
Amount of pain is related to amount of tissue injury
Pain is transmitted to spinal cord along pathways
Theory: painful stimuli prevented from reaching higher level of CNS by stimulation of larger sensory nerves.
Theoretical “gates” in dorsal horn of spinal cord
Small nerve fivers carry pain impulses through “gate”
When larger fibers are stimulated by touch, vibration, or thermal stimulation, causes “gate to close” which diminishes pain perception.
Does not explain chronic pain or phantom limb pain
Gate control theory (1965)
Interventions which are effective in pain management explained by the gate control theory:
TENS units (transcutaneous electrical nerve stimulation)
Heat and cold
process of how pain is recognized consciously
pain with a cause of normal tissue injury
internal organs, abdomen, or skeleton
Results from abnormal processing of stimuli (sensory function) in central or peripheral nervous system.
Non-nociceptive pain (Neuropathic)
pain of skin
pain of muscle, tendon, joint, and blood vessel pain.
organ pain. Ex: cramping, aching, & throbbing.
begins suddenly. self-limiting. ends when injured tissue heals.
pain that lasts a substantial amount of time.
Special types of pain:
Phantom limb pain
Present in an area distant from point of origin. Area of referred pain is supplied by same spinal segment as
actual site. Ex: Myocardial infarction pain ----> L arm pain.
Persistent or intermittent
Pain lasting beyond expected normal healing time -
Normal healing time varies depending on injury
Common chronic pain conditions?
Result of trauma or disease of nerves
Originates from pathology of nervous system.
Painful diabetic neuropathy.
Ex: feeling pins & needles poking or shooting pains.
Intense pain along course of a nerve (spinal or cranial)
Etiology of neuraglia
stimulation of cutaneous region supplied by nerve
Clinical manifestations of neuraglia
Severe, brief, often repetitive attacks of lightning-like or throbbing pain
Cranial nerve 5. Pain in face/mouth area. Even wind could hurt it.
Trigeminal neuralgia (tic douloureux)
Occurs in an amputated body part or limb
Possibly caused by spontaneous firing of spinal cord neurons that have lost their normal sensory input
Phantom limb pain
what % of adults report recurrent headaches
what percent report daily or nearly daily headaches
Headaches secondary to other medical conditions
how to diagnose headaches
comprehensive history/physical to exclude secondary causes.
lab and imaging studies
caused by genetic and environmental factors
Triggers include: Variations in estrogen level, Chemicals in foods (MSG, aged cheese, chocolate), & Stress
Affect 20 million people in the USA. Result in considerable time lost from work.
clinical manifestations for migrane headache
Pulsatile, throbbing, unilateral headache lasting 1 to 2 days
Pain worsens with activity,
moderate or severe pain intensity,
nausea and vomiting,
photophobia- sensitive to light
phonophobia- sensitive to sound
2 major types of migraine headaches
1. Migraine with aura 2. Migraine without aura
Visual sensory phenomenon that precedes migraine. Lasts from 5 minutes to 1 hour.
Etiology : mostly unknown
Autosomal dominant genes may be involved
manifestations for cluster headache
clusters or bouts of headaches for days followed by long period of spontaneous remission
extreme pain with short duration
redness and tearing of eyes, pupil constriction, ptosis
nasal congestion, runny nose
most common type of headache
Exact etiology is unknown,
May be caused by sustained tension of muscles of scalp and neck
Stress, anxiety, or depression
Exact mechanisms are not known
May be a form of migraine headache that transforms gradually into a chronic tension headache
clinical manifestations for tension headache
bilateral, dull , aching, diffuse(spread throughout)
mild to moderate bilateral headache
sensation of tight band or "hatband" around head
not associated with nausea or vomiting
not worsened by activity
may be infrequent, episodic, or chronic
how to diagnosis tension headache
responsive to OTC drugs
responsive to non-drug techniques
Headaches that occur 15 days or more a month
Chronic Daily Headache (CDH)
Etiology: imbalance in joint
movement due to:
bruxism (teeth grinding)
Temporomandibular joint (TMJ) pain
manifestation for TMJ
Usually referred pain and commonly presents as facial muscle pain, headache, neck ache, or earache.
Aggravated by jaw function
Chronic autoimmune disease
Caused by antibody-mediated destruction of acethylcholine receptors in the neuromuscular junction
Disorder of transmission at neuromuscular junction
Peak incidence 20-30 years of age
3 times more common in women
manifestations of myasthenia graves
difficulty chewing, dysphagia
facial muscle weakness
Acquired (immune-mediated) inflammatory disease - demyelination of peripheral nerves
Rapidly progressive limb weakness and loss of tendon reflexes
Acute onset, ascending motor paralysis
Usually a medical emergency – life-threatening - may progress to respiratory arrest
manifestations for Guillain-Barre' Syndrome
Ascending muscle weakness
Paresis of legs to quadriplegia
treatment for guillain-barre
Support of vial function
may use plasmapheresis or IV immunoglobulin
Most fully recover spontaneously within 6-12 months
Progressive degenerative disorder of basal ganglia function. causes dopamine depletion which causes abnormal movement
manifestations for parkinson's disease
tremors at rest - when they sit there at rest the tremors occur. when they move, they stop.
tremor lessons with purposeful movement
rigidity (muscle stiffness)
bradykinesia – extreme slowness of movement
-stooped, flexed, leaning
Lou Gehrig disease
Etiology unknown (5 to 10% are familial)
Men more than women
Middle to late adulthood
Progressive- mean survival 2-5 years from onset of symptoms
Affects upper and lower motor neurons of cerebral cortex, brain stem, and spinal cord
Leads to progressive weakness leading to respiratory failure and death
Normal intellectual and sensory function until death.
Amyotrophic lateral sclerosis (ALS)
manifestations for Amyotrophic lateral sclerosis (ALS)
Slowly progressive weakness and atrophy in distal muscles of one upper extremity followed by regional spread of weakness
Early symptom: muscle cramps in distal legs
Weakness in any or all muscles
Weakness, spasticity, impaired fine motor control
Dysphagia, dysarthria, dysphonia
diagnosis for Amyotrophic lateral sclerosis (ALS) is based on?
history and physical
treatment for ALS
psychological support of patient and family
progressive, autoimmune, inflammatory, demyelinating disorder -
Demyelination and subsequent degeneration of nerve fibers in the CNS
most common non-traumatic cause of neurologic disability among young and middle adults
Age of onset- between 18
and 45 years of age
Incidence double in women
Genetic predisposition suggested
Multiple Sclerosis (MS)
clinical features of MS
Paresthesias of face, trunk, or limbs (tingling sensation)
Optic neuritis (inflammation of optic nerve)
Fatigue – one of the most common problems
diagnosis of MS
treatment for MS
Most commonly occurs due to vertebral injuries.
Traumatic injury of vertebral and neural tissues.
spinal cord trauma
single break affecting transverse or spinous processes
vertebral body compressed
vertebral body shattered into several fragments
-temporary complete loss of function below the level of injury
-complete loss of reflex function
-paralysis and flaccidity in muscles
-loss of bladder and rectal control
-can last for hours, days, or weeks
how is spinal shock diagnosed? (3)
treatment for spinal shock
immobilization of spine
surgery may be necessary
lung function, skin integrity, and bladder and bowel function maintenance
-may occur after spinal shock resolves
-massive, uncompensated cardiovascular response to stimulation of sympathetic nervous system
stimulation of sensory receptors below level of cord lesion
-often associated with distended bladder or rectum
-bladder or bowel emptying will usually relieve syndrome
Autonomic hyperreflexia (dyxreflexia)
S/S of autonomic hyperreflexia
-sweating above level of lesion (with flushed skin)
-bradycardia (30-40 beats/min)
-increased risk for CVA
treatment for autonomic hyperreflexia
-antihypertensive meds if BP remains high
type of injury which has deprivation of oxygen with maintained blood flow
reduced atmospheric pressure
carbon monoxide poisoning
failure of lungs to oxygenate blood
condition in which not enough hemoglobin to carry oxygen
type of injury which has greatly reduced or interrupted blood flow
stroke. One area of brain affected
cardiac arrest. Heart isn't pumping blood to brain
increase in tissue volume in brain (secondary to fluid accumulation)
cerebral edema (brain swelling)
2 types of cerebral edema
blood-brain barrier disrupted - allows fluid to escape into the extracellular fluid that surrounds brain cells. (water and proteins transfer from vascular into interstitial space)
hemorrhage, brain injury, infections (meningitis)
swelling of brain cells (increase in intracellular fluid)
hypo-osmotic states (water intoxication, severe ischemia)
impair the function of the sodium-potassium membrane pump
increased intracranial pressure
cranial cavity contains
80% brain tissue
normal ICP is?
0-15 mm Hg
causes for IICP
develops in a couple of hours from head injury
traumatic injury to the brain. can produce physical, intellectual, emotional, social, and vocational changes
major head trauma
most traumatic brain injuries are caused by:
sports related events
head injuries are categorized as either
closed or open
blunt, non missile trauma
head strikes hard surface or rapidly moving object strikes head
dura remains in tact and brain tissues not exposed to environment
penetrating, missile trauma. injury breaks dura, brain tissues exposed to environment
two types of injury
primary & secondary
damage caused by impact
damage results from brain swelling, infection, hypoxia
injury within school on opposite from site of impact, brain rebounds, hits against inner skull surface
transient neurogenic dysfunction caused by mechanical force to the brain (there may be a momentary LOC)
temporary disturbance causing attention and memory deficits but no LOC
immediate LOC (<6 hours). return of consciousness may be gradual. confusional state lasting hours to days
classic cerebral concussion
protective membranes of brain and spinal cord.
(2 layers) outer protective membrane. subdural space
middle space. subarachnoid space contains CSF
internal (adheres to contours of brain and spinal cord)
result from vascular injury and bleeding. usually fixed with surgery!
between inner bones of skull and dura
between dura and arachnoid.
usually at top of skull.
acute developed within 24 hours
subacute develops 2-10 days after injury
chronic develops over several weeks
frontal and temporal lobes
results from shaking.
results in axonal damage.
severity corresponds to amount of shearing force applied to brain and brain stem.
"shaken baby syndrome"
diffuse axonal injury (DAI)
state of awareness of self and environment and of being able to become oriented to new stimuli.
2 major components:
-arousal and wakefulness
-content of thought
descending levels of consciousness
less than full alertness
check for what when checking for neurological function
pattern of breathing
On the glascow coma scale what score would be totally unresponsive
8 or lower
2 forms of neurologic death:
brain death & cerebral death
body can no longer maintain internal homeostasis
state law: defined as irreversible cessation of function of entire brain.
remain in coma
emerge into vegetative state
progress into a minimal conscious state (MCS)
fully conscious with intact cognitive function
communicates through blinking
"locked in syndrome"
-vascular disorder that injuries brain tissue
-leading cause of mortality and morbidity
-high risk: hypertension, diabetes.
-more common in men
stroke (brain attack)
thombi cause occlusions in arteries supplying brain or in intracranial vessels
thrombotic stroke (most common)
temporary decreases in brain blood flow
brief episode of neurologic dysfunction with symptoms lasting no more than 1 hour
transient ischemic attacks (TIAs)
caused by blood clots
fragments that break from thrombus formed outside brain
caused from a leaking or ruptured aneurysm.
hemorrhage associated with anticoagulants
-severe headache with immediate unresponsive state
-severe headache with consciousness
type of hemorrhage that blood escapes into subarachnoid space. caused by defective or injured vasculature.
lining of brain and spinal cord inflammation.
infection or direct extension from infected area to subarachnoid space.
otitis or sinusitis- predisposing conditions.
S/S- severe headache, nuchal rigidity (stiff neck). fever, tachycardia, petechial rash.
treatment- antibiotics, supportive measures
acute febrile illness. usually of viral origin with nervous system involvement.
most common forms of encephalitis caused by anthropoid-borne (mosquito) viruses and herpes simplex virus.
most cases are self-limiting
abrupt and temporary alteration in cerebral activity resulting in changes in electrical discharge from neurons.
causes brief disruption in brain's electrical functions.
will have a temporary alteration in level of arousal
term often applied to seizures.
tonic-clonic movements associated with some seizures.
excessive muscle tone, stiffening of body
jerking of extremities (alternating contraction and relaxation of muscles)
condition of having recurrence seizure activity with no known cause
most common type of seizure. involve one hemisphere of brain (begins in specific or focal area)
type of seizure that involves whole brain; begin simultaneously in both hemispheres
type of seizure that lasts only a few seconds.
blank stare, motionless, unresponsiveness; motion does occur in many cases
similar to typical; greater alterations in muscle tone and less-abrupt onset and cessation
two types of generalized seizures
absence (typical & atypical) & tonic-clonic (grand-mal)
early manifestations that may occur hours or days before seizure
immediately precedes onset of generalized seizure; "funny feeling," dizziness, numbness, peculiar sensation
sharp contraction of muscles with extension of extremities and immediate LOC
rhythmic contraction and relaxation of extremities
immediately following seizure (confusion).
lasts 30-90 min
continuing or repetitive seizure activity (seizures that do not stop spontaneously or occur in succession w/o recovery.)
medical emergency that requires immediate intervention.
decrease in memory
progressive failure of cerebral functions not caused by impaired LOC.
"the long goodbye"
-most common type of dementia
-progressive disorder begins with memory impairment.
-progresses to inability to recognize family members and loss of control over bodily functions.
-imaging of brain reveals atrophy of cerebral cortex with enlargement of ventricles.
alzheimer disease (AD)
protein in neurons become distorted and twisted
areas of degeneration in groups of nerve cells have a plaque-like material
manifestations of AD
lack of concentration
decline in abstraction, problem solving, and judgement
loss of ability to respond to environment
how is diagnosis made for AD?
diagnosis of exclusion.
made by ruling out other causes of dementia
loss of motor function
-hemiparesis or hemiplegia
-paraparesis or paraplegia
-quadriparesis or quadriplegia
cranial tumors (3)
-primary intracerebral tumors (glicomas)
-primary extracerebral tumors
you can loose how much of your blood and stay alive?
how many L can be lost in women?
how much blood in average body?
6 quarts. 5.5 L
Hb or Hgb
what gives blood its color
protein substance in RBCs
AKA myeloid tissue
2 types of bone marrow
red and yellow
hemopoetic (hips, shoulders, sternum)
thymus, lymph nodes, spleen, & lymph tissue
CFUs turn into?
mature blood cells
hormone like growth factor.
control proliferation, differentiation, function of blood cells
colony stimulating factors
leukocytes arrive from ____ _____.
leukocytes mature where?
Like PAC men and protect against infection.
granulocytes or agranulocytes
NEVER NORMAL and not beneficial
Low lymphocytes. seen with acute viral infection
causes: drugs, immune deficiencies, viruses, radiation, & AIDS
protect against infection.
live only 4-5 days
drugs, cancer, and & autoimmune disease.
immature WBCs released. termed a shift to the left.
shift the right?
normal mature WBCs again
allergic reactions -- release enzymes that limit histamine
protect against parasites -- attach to them and kill them
contain heparin (blood thinning), histamines (vasodilators)
involved in allergic and hypersensitivity reactions
similar to mast cells
destroy foreign cells
natural killer cells (NK)
in bone marrow
lymphoid tissue -- contains macrophages.
B lymphocytes mature in ___ then go to____ ____.
bone marrow; lymph nodes
T lymphocytes mature in ___ then go to ____ ____.
thymus; lymph nodes
cardinal sign is throat hurting.
B-lymphocytes become infected with Epstein-barr virus.
heterophil antibodies used to diagnose
Tx: rest, fluid, non-steroid anti-inflammatory
transmitted by: saliva through personal contact
asymptomatic patients spread EBV
infectious mononucleosis (MONO)
S/Sx of MONO
swollen lymph nodes
increased lymphocyte count
CA where the patient has no platelets.
excessive immature WBCs (leukocytes)
starts fast and if not intervened can kill quickly.
undifferentiated or immature cells, usually blast cells (baby cells)
cells are mature but do not function normally.
crowd out the bone marrow
malignant leukocytes form
RBCs down....these up....
adults more than children. acute and chronic.
Dx with blood work, bone marrow.
ALL and CML. chromosome translocation
risk factors for leukemia?
HIV, Hep C
type of leukemia in lymph tissue
type of leukemia in bone
WBCs last how long?
long life span
circulation in blood stream
cross blood-brain barrier
infiltrate many body organs
on top of head. take out 5mL of CSF and put in 5 mL of chemo
early detection is difficult
related to depressed bone marrow function
S/Sx of acute leukemia
fatigue (not enough RBCs---not enough Oxygen)
low grade fever
bleeding --- not enough platelets
absolute neutrophil count
when is an ANC ordered?
when WBCs are low
acute lymphocytic leukemia
acute myeloid leukemia
most common cancer in children and adults.
(acute lymphocytic leukemia)
myeloid cells are bone marrow.
associated with acquired genetic alterations -- blast cells occur
Sx: anemia, neutropenia, thrombocytopenia
(acute myeloid leukemia)
-blast count elevated
-blood viscosity increases
-treatment: lower blast cells quickly by aphaeresis and chemotherapy
small vessels in pulmonary and cerebral circulation affected
sudden SOB, dyspnea --- pulmonary sign
HA (headache) ---cerebral sign
Lethargy --- cerebral sign
no active symtoms stage
no cells at all in body
chronic lymphocytic leukemia
B lymphocytes involved---isolated increase.
most common form in western world
no therapy required - die of other dx
others- rapidly fatal in spite of tx
S/Sx of CLL
related for infiltration of bone marrow and lymphoid tissue by neoplastic lymphocytes
immunologic defects noted
lymph nodes involved. hard and not painful.
infections increase ---staph, strep, flu
treatment of CLL
indolent--nothing till sxs (may die of other disease)
chronic myeloid leukemia