NEURO - Pain/Temperature Flashcards
(194 cards)
1
Q
Large myelinated fibers
A
A delta fibers
2
Q
Small umyelinated fibers
A
C Fibers
3
Q
C fibers respond to broad range of painful stiumuli
A
mechanical
thermal
chemical
4
Q
Plasticity
A
the adaptable change in structure, and function of the brain
5
Q
Gate control theory of pain
A
Pain is modulated by a gate in the cells of the SUBSTANTIA GELATINOSA in the SPINAL CORD
6
Q
Gate control theory: Pain is modulated by a ___________in the cells of the______ _______ in the ________
A
gate in the cells; SUBSTANTIA GELATINOSA; SPINAL CORD
7
Q
*****Transduction
A
when tissues is damaged due to exposure to chemical, mechanical and thermal noxious stimuli converted to action potential
8
Q
Conduction
A
from delta and C fibers to interneurons in dorsal horn of spinal cord
9
Q
Interneuron does what
A
can excite or inhibit signal to second transfer order neurons.
10
Q
Transmission
A
Pain signals from delta and C fibers.
11
Q
**Myelinated A-delta fibers: Transmission is _____and conveys ______and ______pain.
A
fast ; sharp and localized pain.
12
Q
Unmyelinated C polymodal fibers: Transmission is _______ and conveys _______, _______ and _____sensations.
A
Transmission is slower and conveys dull, diffuse burning and aching sensations.
13
Q
Fast pain neurons synapse with _______ _____________
A
secondary neurons at the Dorsal Horn.
14
Q
A- beta
A
Large,
fast
sense mechanical touch and vibration
can modulate A delta and C fibers
15
Q
A- beta
A
Large,
fast- 70m/s, myelinated
sense mechanical touch and vibration
can modulate A delta and C fibers
16
Q
A- Delta
Size, speed, type
A
Medium
10m/s
sharp, localized
sense mechanical/extreme temperature
17
Q
C-fibers
A
Small
slow spee d 1m/s
dull, diffuse pain signal
sence mechanical/thermal/ chemical
18
Q
First order neuron
A
Nociceptors: respond to chemical, mechanical and thermal stimuli.
19
Q
2nd order neuron
A
interneurons in the dorsal horn
Function as a pain gate to regulate pain transmission.
****Cross over in the spinal cord and ascend.
20
Q
3rd order neuron
A
afferent neurons in the spino-thalamic tract.
21
Q
Delta fibers
A
laminae 1+ 5
22
Q
C fibers
A
1, 2
23
Q
A- Beta
A
3,4
24
Q
Lamina 3, 4, 5, send signals to where?
A
Send signals to Hypothalamus & AMYGDALA
25
Lamina 2 inhibit
Lamina 1
26
C fibers synapse with interneuron within the __________ -_________ prior to decussation.
substantia gelatinosa
27
Activation of the reticular system by _________ fibers results in ________ __________when in pain
Reticular System; C fibers; difficulty
| sleeping when in pain.
28
Activation of the ______ ______ by ________ results in distress and anxiety.
Limbic System;C fibers;
29
Postsynaptic 2nd Order neurons have ______ ________receptor.Normally inactive because ordinarily blocked by _______ ions. However, intense, prolonged pain signal releases Mg and ______ __________ to occur.
NMDA
(N-methyl-D-aspartate) ; Mg++ ions.
Mg and allows
postsynaptic depolarization to occur.
30
* 2nd Order Neurons can be _____ _______Or _______
| * Peripherally – NSAIDS: _____ ______(Ex: ____and ___-)
-Suppressed or
Facilitated Peripherally or Centrally
cox inhibitors (Ibuprofen, ASA, etc)
31
– Local Anesthetics: __________ (ex: __)
block Na+ channels (lidocaine)
32
– Hydrocortisone: actions
lipocortin-1 – blocks
| prostaglandins/leukotrienes from arachidonic acid
33
TENS (Transcuteneous Electrical Nerve stimulators) Unit or Mechanical Stimulation: does what? Stimulates ________ to release ______ and______ , inhibits ______ preventing ______
stim.s A-beta fibers to release GABA & glycine, inhibits glutamate preventing depolarization
34
Cite 2 Pain excitatory neurotransmitters
Glutamate (released by a-delta fibers), aspartate
35
Glutamate and aspartate are released by __________ and are (exc/inh) ______Neurotransmitters.
A Delta fibers, Pain excitatory
36
```
Pain inhibitors (analgesic system)
Serotonin, gamma-aminobutyric acid (GABA), glycine, Opioids:
(endorphins, enkephalins, dynorphins), norepinephrine
```
Serotonin, gamma-aminobutyric acid (GABA), glycine,
Opioids:
(endorphins, enkephalins, dynorphins), norepinephrine
37
___ _____ releases NE to Dorsal horn
Locus Ceruleus
38
Releases 5HT serotonin to Dorsal horn
Nucleus Raphe
39
Nucleus Raphe
Releases 5HT serotonin to Dorsal horn
40
Periaqueductal gray matter releases what to where?
releases
| Enkephalins to Nucleus raphe magnus
41
releases Enkephalins to Nucleus raphe magnus
Periaqueductal gray matter
42
____ _________in the midbrain is the coordinating center of the descending analgesic system
Periaqueductal gray matter
43
_______ acts via the ______ _________in the brain stem, to send
PAGM ; raphe nucleuslocated in the brain stem to send analgesic impulses to block pain transduction at the first order neuron-second order neuron synapse (at the dorsal horn).
44
_______ and _______which are opioids are the neurotransmitters released by the descending analgesic neurons.
Opioids (endorphins and enkephalins)
45
Analgesic pathways also use ______, _______ and _______
Serotonin, Norepinephrine, and GABA
46
Pain Modulation , definition
“the physiologic process of suppressing or facilitating pain”.
47
Descending modulation of pain
| Descending analgesic pathways are found where ?
Descending analgesic pathways are found in the dorsolateral tracts.
48
Pain reaches the brain via the ____ _______tract. It carries the most _____ ______
Lateral Spinothalamic Tract.; the most nociceptive information.
49
Affective component of pain is ____ ______ ______
the distress (anxiety) that goes with pain.
50
Autonomic component
| “sympathetic” – effect on HR, BP, resp,
“sympathetic” – increases HR, BP, sweating, respiratory
51
Pain Threshold: Point at which _____
| Does it significantly vary among people. ?
Is the point at which a stimulus is perceived as pain (patient becomes aware).
• Does not significantly vary among people or in the same person over time.
52
Nonsteroidal anti-inflammaatory drugs
| reduce ________ by _______
hyperalgesia by decreasing prostaglandins.
53
Acute Somatic
• Arises from ________
****• A-delta fibers: Pain is _____ and _____localized.
****C fibers: Pain is _____, _____,_____ and poorly localized
```
connective tissue,
muscle, bone, and skin.
Pain is sharp and well localized.
Pain is dull, aching,
throbbing, and poorly localized.
```
54
What is referred pain?
Predictable pain
can be ___ or ____
Pain in an area in part of the body distant from its point of origin.
Predictable - referred pain is supplied by same spinal segment as actual site.
Can be acute or chronic.
55
Injured nerves become _______Example: _______
Hyperexcitable. Example: Carpal Tunnel
56
Temperature regulation:is controlled by?
Thermoregulation: Is controlled by Central Thermo-receptors in the Hypothalamus
57
What are EXOgenous pyrogens,________
Endotoxins produced by pathogens
58
Endogenous pyrogens:
```
Prostaglandin-E2 (PGE2)
interleukin-1 (IL-1)
IL-6
tumor necrosis factor–alpha (TNF-α),
interferon-γ
```
59
__________Is a life-threatening complication of an inherited muscular disorder. What happens in Malignant hyperthermia??
Increased calcium release or decreased calcium uptake with muscle
contraction
Sustained muscle contractions
Increased oxygen consumption and lactic acid production
60
__________Is precipitated by the administration of volatile anesthetics and
depolarizing neuromuscular-blocking agents.
Malignant Hyperthermia
61
Treatment of Malignant Hyperthermia
Remove the agent
| Dandrolene
62
Malignant Hyperthermia can cause ______,______,and _______
Cardiac dysrhythmia, tachycardia, and hypotension
63
Most common chronic pain condition
low back pain
64
Second most common pain syndromes
Myofascial pain
65
Chronic post op pain
disruption or cutting of sensory nerves.
66
Deafferentation pain
Sympathetic dystrophies
67
Hyperesthesias
Increased sensitivity and decreased pain threshold to tactile and painful stimuli
68
Phantom Limb Pain
Associated with stroke
69
41° C (105.8° F):what happens
Nerve damage; convulsions
70
43° C (109.4° F): what happens ?
Death
71
What is heat cramp associated with ?
Prolonged sweating and associated sodium loss cause severe spasmodic cramps
in the abdomen and extremities.
72
What happens in heat exhaustion
Dehydration, depressed plasma volumes, hypotension, decreased cardiac output, tachycardia
73
Heat stroke
potentially lethal result of breakdown in an overstressed thermoregulatory center.
• Brain cannot tolerate temperatures higher than 43° C (109.4° F).
– Cardiovascular and thermoregulatory centers may cease functioning in high
temperatures.
74
Administration of _________ can cause malignant Hyperthermia
Succinylcholine
75
Be able to differentiate Malignant hyperthermia to
Thyroid Storm
76
Pain is
Unpleasant sensory and emotional experience with actual or potential tissue damage.
77
Patterning theory
theorizes that somatic receptors of variable sensitivity.
78
Specificity Theory
Theorizes that low and high threshold receptors with a specific pathway for pain.
79
massage therapy relieves pain by closing the pain gate with the stimulation of which fibers?
A beta
80
Which endogenous opioid is located in the hypothalamus and pituitary and is a strong M receptor agonist
ENDORPHINS
81
Term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding
Tolerance.
82
tolerance.
Term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding
83
Up to how many liters of fluid per hour may be lost by sweating?
2 L
84
What stimulus causes posthyperventilation apnea (PHVA)?
Changes in PaCO2 levels
85
What is the most common infratentorial brain disease process that results in the direct destruction of the reticulating activation system (RAS)?
a. Cerebrovascular disease
86
Which intracerebral disease process is capable of producing diffuse dysfunction?
Infarct emboli
87
Which pathway carries sensory information toward the central nervous system (CNS)?
Ascending
88
Which type of axon transmits a nerve impulse at the highest rate?
Large MYELINATED
89
Which nerves are capable of regeneration?
MYELINATED NERVES IN THE PERIPHERAL NERVOUS SYSTEM
90
The neurotransmitter, norepinephrine, is secreted in the:
Sympathetic postganglion
91
Both oligodendroglia and Schwann cells share the ability to:
FORM A MYELIN SHEATH
92
During a synapse, what change occurs after the neurotransmitter binds to the receptor?
The permeability of the postsynaptic neuron changes; consequently, its membrane potential is changed as well.
93
What name is given to a large network of neurons within the brainstem that is essential for maintaining wakefulness?
Reticular activating system
94
Thought and goal-oriented behaviors are functions of which area of the brain?
PRE-FRONTAL LOBE
95
The region responsible for the motor aspects of speech is located in the:
Broca area in the frontal lobe
96
Parkinson and Huntington diseases are associated with defects in which area of the brain?
BASAL GANGLIA
97
Maintenance of a constant internal environment and the implementation of behavioral patterns are main functions of which area of the brain?
HYPOTHALAMUS
98
The ability of the eyes to track moving objects through a visual field is primarily a function of which colliculi?
SUPERIOR
99
What are 2 parts of the brain that mediate the expression of affect, both emotional and behavioral states?
Limbic system and the pre-frontal cortex
100
Reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing are controlled by which area of the brain?
Medulla OBLONGATA
101
From which part of the midbrain do cranial nerves V to VIII emerge?
PONS
102
From which part of the midbrain do cranial nerves IX to XII emerge?
Medulla OBLONGATA
103
Which area of the brain assumes the responsibility for conscious and unconscious muscle synergy and for maintaining balance and posture?
CEREBELLUM
104
Which statement is true regarding upper motor neurons?
They modify spinal reflex arcs.
105
The membrane that separates the brain's cerebellum from its cerebrum is the:
Tentorium cerebelli
106
The function of arachnoid villi is to:
Absorb cerebrospinal fluid into the cerebral venous sinuses
107
Where is the cerebrospinal fluid produced?
CHOROID PLEXUS
108
Which of the meninges closely adheres to the surface of the brain and spinal cord and follows the sulci and fissures?
Pia Mater
109
Norepinephrine produces what primary response?
Vasoconstriction
110
What is an effect of the sympathetic nervous system?
Increased blood sugar
111
The brain receives approximately what percentage of the cardiac output?
20%
112
The collateral blood flow to the brain is provided by the:
CIRCLE OF WILLIS
113
The nurse recognizes that a patient's diagnosis of a viral infection of the brain's meningeal layer is supported by which diagnostic laboratory result?
Leukocytes >10
114
Which cranial nerves contain parasympathetic nerves? (Select all that apply.)
III, VII, IX, X
115
The sympathetic nervous system primarily serves to protect an individual by doing which of the following? (Select all that apply.)
b. Increasing blood sugar levels
c. Increasing body temperature
e. Increasing blood pressure
116
The aging process brings about what changes to human cells? (Select all that apply.)
a. Increased neurofibrillary tangles
b. Imbalance of neurotransmitters
d. Decreased myelin presence
e. Altered dendrite structure
117
Which statement is true regarding the blood-brain barrier (BBB)? (Select all that apply.)
a. The BBB is dependent on astrocytes.
c. It restricts the flow of large molecules, such as potassium.
d. Naturally occurring inflammatory mediators affect the BBB.
e. The BBB appears to play a role in slowing down the onset of degenerative brain disease.
118
A nurse caring for an older adult patient would expect which functional changes to occur? (Select
A nurse caring for an older adult patient would expect which functional changes to occur? (Select all that apply.)
a. Increased risk for falls
b. Increased risk for falls
c. Loss of muscle in the arms and legs
119
What evidence does the nurse expect to see when a patient experiences trauma to the hypothalamus? (Select all that apply.)
a. Uneven expression of mood
b. Unstable blood glucose levels
c. Poor regulation of body temperature
120
A Schwann cell: (Select all that apply.)
a. Can form the myelin sheath.
b. Is also referred to as a neurolemmocyte.
c. Affects the function of the nodes of Ranvier.
d. Is located in the peripheral nervous system.
121
Fibers emerge from the posterior midbrain and exit from the skull to run to the eye.
Trochlear
122
Provides motor and sensory functions to the face, mouth, nose, and eyes.
Trigeminal
123
Fibers emerge from the midbrain, exit from the skull, and extend to the eye.
Oculomotor
124
Controls motor functions to the pharynx and salivary glands and sensory functions from the pharynx and tongue.
Glossopharyngeal
125
Innervates muscles that move the eye laterally.
Abducens
126
Affects control over the motor fibers to the muscles of tongue and sensory impulses from the tongue to the brain.
Hypoglossal.
127
Is purely sensory and carries impulses for the sense of smell.
Olfactory.
128
Is made up of parasympathetic motor fibers that supply the smooth muscles of the abdominal organs.
Vagus.
129
Transmits impulses for the sense of hearing.
Vestibulocochlear
130
Carries sensory and motor fibers to the pharynx and larynx.
Spinal Accessory
131
Pricking one's finger with a needle would cause minimal pain, whereas experiencing abdominal surgery would produce more pain. This distinction is an example of which pain theory?
Specificity
132
Which pain theory proposes that a balance of impulses conducted from the spinal cord to the higher centers in the central nervous system (CNS) modulates the transmission of pain?
Gate Control Theory (GCT)
133
Which type of nerve fibers transmits pain impulses?
A DELTA FIBERS
134
Where are the primary-order pain transmitting neurons located within the spinal cord?
Dorsal root ganglia
135
The gate in the GCT of pain is located in the:
SUBSTANTIA GELATINOSA
136
Which neurotransmitters inhibit pain in the medulla and pons?
Norepinephrine and serotonin (5-hydroxytryptamine)
137
Which endogenous opioid is located in the hypothalamus and pituitary and is a strong -receptor agonist?
Endophins and Endormorphins
138
What is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding?
TOLERANCE
139
What is a long-term complication of rewarming as a treatment for hypothermia?
RENAL FAILURE
140
How does the release (increase) of epinephrine raise body temperature?
It raises the metabolic rate
141
Heat loss from the body via radiation occurs by:
Emanations of electromagnetic waves
142
Which cytokines are endogenous pyrogens?
IL-1, IL-6, TNF-alpha, and IFN-gamma
143
Which hormones help diminish the febrile response?
Arginine vasopressin (AVP), melanocyte-stimulating hormone-alpha (-MSH), and corticotropin-releasing factor
144
Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation?
Heat EXHAUSTION
145
In acute hypothermia, what physiologic change shunts blood away from the colder skin to the body core in an effort to decrease heat loss?
Peripheral Vasoconstriction
146
Cognitive operations cannot occur without the effective functioning of the brain's:
Reticular activating system
147
Pain that is thought to be caused by trauma or disease of nerves and leads to abnormal processing of sensory information by the peripheral and central nervous systems
Neuropathic pain
148
Pain that occurs after peripheral nerve injury and is described as continuous with severe sensations and a burning quality
Sympathetically maintained pain
149
It is true that a fever: (Select all that apply.)
a. Is a complex cascade involving several different systems.
b. Can be a result of a dysfunctional hypothalamus.
d. Triggers endocrine responses.
e. Is in response to a pyrogen.
150
Heat exhaustion results in: (Select all that apply.)
a. Profuse sweating
b. Profound vasodilation
c. A need to ingest warm liquids
151
Why are children more susceptible to heat stroke than are adults? (Select all that apply.)
a. Children produce more metabolic heat when exercising.
b. They have more surface area-to-mass ratio.
c. Children have less sweating capacity.
152
Which factors contribute to sensorineural hearing loss? (Select all that apply.)
a. Ménière disease
b. Aging
c. Diabetes mellitus
d. Noise exposure
153
Based on an understanding of the physiologic process of nociceptors, the nurse expects which surgical procedure to create more pain?
Repair of several crushed fingers
154
When considering the risk factors for the development of phantom limb pain, the nurse recognizes which as a primary contributing factor?
b. Presence of pain in the limb before amputation
155
Based on an understanding of the physiologic process of nociceptors, the nurse expects which surgical procedure to create more pain?
a. Repair of several crushed fingers
156
The basis of the specificity theory of pain is that:
c. The greater the tissue injury, the greater the pain.
157
Which statement is true regarding the gate control theory (GCT) of pain?
d. An open gate facilitates the brain in processing the pain.
158
Which medication is used to reverse the effects of malignant hyperthermia?
Dandrolene
159
A heat stroke is characterized by:
b. Sweat production on the face occurring even during dehydration
160
The four types of endogenous opioids include enkephalins, endorphins, dynorphins, and endomorphins.
enkephalins
endorphins
dynorphins
endomorphins.
161
*****___________ pain results from tumor infiltration of nerve tissue; trauma, or chemical injury to the nerve. Sympathetic pain occurs after a peripheral nerve injury and is characterized as continuous and severe with a burning quality
Deafferentiation
162
__________pain occurs after a peripheral nerve injury and is characterized as continuous and severe with a burning quality
Sympathetic
163
Pain at one location that may cause an increase in threshold at another location
PERCEPTUAL DOMINANCE
164
Pain tolerance is the duration of time or intensity of pain before overt pain responses are initiated. The pain threshold is the point at which pain is perceived.
Pain tolerance; decreases pain tolerance.
165
__________ is the point at which pain is perceived.
pain threshold
166
increase the levels of circulating endogenous endorphins?
STRESS
Sexual Intercourse
Increased levels of physical activity
Acupuncture
167
_____ ______ _____ _____ _____examples of myofascial pain syndromes.
```
Muscle strain
myositis
fibrositiS
myofibrositis
and myalgia
```
168
Chronic postoperative pain occurs in a small percentage of individuals after ______,_____, _____ AND ______
thoracotomy, mastectomy, neck dissection, and surgical amputation.
169
__________ is heat loss through electromagnetic waves
Radiation
170
_________ is heat loss by direct molecule-to-molecule transfer.
Conduction
171
___________is transfer of heat through currents of gases or liquids. .
Convection
172
___________ is the transfer of heat with conversion of liquid to gas.
Evaporation
173
Which of the following is a benefit of fever?
| SWITCHS TO _______ _____ TO _______ AND_______ THEREFORE _______BACTERIA OF A FOOD SOURCE
Switches to lipolysis and proteolysis
Fever has benefits. The higher body temperature decreases serum levels of iron, zinc, and copper, all of which are needed for bacterial replication. It switches from burning glucose to lipolysis and proteolysis, thus depriving bacteria of a food source. There is increased lymphocytic transformation, increasing the immune response. There is increased phagocytosis.
174
3 things that increases with fever
1)increased lymphocytic transformation --> 2)increasing the immune response 3) There is increased phagocytosis.
175
The four classifications of neurotransmitters are inflammatory, pain excitatory, pain inhibitory, and modulators of pain.
inflammatory
pain excitatory
pain inhibitory
and modulators of pain.
176
______ and_________ are the most common excitatory neurotransmitters in the brain and spinal cord.
Glutamate and aspartate
177
______ and _______ are inhibitory neurotransmitters
GABA and glycine
178
_______ is contained in neurons that synapse with ______ and ______ and they inhibit pain.
Substance P; GABA and glycine
179
Heat cramps__________
are severe spasmodic cramps in the abdomen and the extremities that follow prolonged sweating and associated sodium loss.
180
______________ is the result of prolonged high core temperatures. There is often dehydration, feelings of weakness, dizziness, nausea, and fainting.
Heat exhaustion
181
__________ may be lethal and is exposure to excessive heat and loss of the body’s protective mechanisms for cooling.
Heat stroke
182
is a lethal complication of a rare inherited muscle disorder.
Malignant Hyperthermia
183
Nociceptors are receptors______________.
receptors that perceive pain.
184
Second-order neurons are of three classes: _____,____ and
projection cells
excitatory interneurons
inhibitory interneuron
185
Fever is a normal adaptive response to _______ and _______
cytokines and prostaglandin E
186
Relates the amount of pain to the amount of soft tissue injury
SPECIFICITY theory
187
The _____ _______ is a structure involved in pain transmission.
The substantia gelatinosa
188
The ________ an d-________contains nerve cell bodies for efferent pathways leaving the spinal cord.
anterior or ventral horn
189
The posterior horn (dorsal horn) is composed primarily of ________ and ________
interneurons and axons from sensory neurons.
190
The ______ ________ is part of the sensory ganglion.
dorsal root ganglion
191
To withdraw CSF, needle is inserted into the _______space
Subarachnoid
192
Correct sequence for CONSCIOUS PERCEPTION of a SENSATION (DAP-CP)
```
depolarization or hyperpolarization of a receptor,
action potential generation
propagation
CNS processing, and then
perception.
```
193
Caudo equina
the filum terminale and the ventral and dorsal roots caudal to the conus medullaris
194
In an adult, the conus medullaris is found at about
L1
