pain, sleep, temp, and sensory function Flashcards
(58 cards)
1
Q
what is pain?
A
active tissue damage. sensory info as a through, emotion, feeling
- no correlation between amount of tissue damage and amount of pain
2
Q
nociceptive pain
A
- nociceptor receptors
- sharp, distinct pain
- triggers nociceptors (pain receptors)
- somatic: joints, muscle, skin
- visceral: organs (tumors/obstruction). fewer nocireceptors. broad, referred pain
3
Q
neuropathic
A
- pain without a stimulus
- nociceptive can lead to neuropathic
- central: central or peripheral NS
- peripheral: neuropathies (DM/GB disease)
4
Q
Large A Fibers
A
- initial, immediate, sharp pain
- a stab or cut
- myelinated fibers travel fast impulses
5
Q
small c fibers
A
- prolonged, dull pain, achy, persistent
- non-myelinated, slower impulses
6
Q
good side of pain
A
analgestic: we produce these pain-relievers ourselves
* Endorphins: exercise, runner’s high
- neuropeptides that inhibit transmission of pain impulses in the spinal cord and brain by binding to opiod receptors
- Enkephalin: less potent than endorphins
- weaker anelgestic but more potent and longer lasting than morphine
- dynorphin: inhibits but can also INCITE pain
7
Q
nociceptors
A
- “free nerve ending”
- dermis, muscle, joints, viscera
- respond to chemical, mechanical, and thermal stimuli
- large A/delta fibers - detect touch, vibration, thermal and sharp pain
- small c/unmyelinated - long-lasting dull pain
8
Q
nociception pain pathway
A
- transduction - tissue damage releases substances that bind to nociceptors and activate small C fibers
- transmission - from small c fibers –> spinal cord –> brain stem –> thalamus –> cerebral cortex
- perception - in the cerebral cortex detect pain.
- modulation - inhibit or control pain. brain releases endorphins down spinal cord
9
Q
- transduction
A
- tissue damange
- sensitizing substances - prostaglandins, bradykinis, substance p (all cause pain)
- action potential - wave of depolarization
- SMALL C starts action potential
10
Q
- Transmission
A
tissue damange –> spinal cord –> brain stem and thalamus –> cerebral cortex
11
Q
- Perception
A
awareness of pain
12
Q
- modulation
A
endogenous - from within body
- inhibition of nociceptive impulses SMALL C
- brain stem (endorphins, serotonin) –> spinal cord (block signals at spinal cord)
- norepinephrine stops anticipated pain
13
Q
pain - gate control theory
A
- small c fibers - pain (diffuse, burning, aching, itches). = open pain gate –> heat pad, itching, etc. stimulates large A
- Large A - touch, vibration, thermal inhibition of pain = close pain gate = exogenous modulation
- large A beats nocicpetors to stimulus and blocks pain
14
Q
endogenous vs exogenous pain
A
endogenous = down spinal cord. (still nociceptors)
exogenous = outside of body, rubbing, itching, heat (still nociceptors)
15
Q
acute pain
A
- immediate, harmful alert, acute anxiety
- tissue damage, self-limiting, ends with healing
- SOMATIC: superficial, sharp, well-localized
- VISCERAL: referred pan, decreased nociceptors. internal organs, abdoment, skeletal, poorly localized. nausea and vomiting, hypotension, restlessness and shock
16
Q
referred pain
A
pain in one location referrs pain to another areas associated with it
17
Q
chronic pain
A
chronic inflammation/injury
- greater than 3 months
- related to tissue damage, inflammation or injury of nervous system
a) intermittent = comes and goes, chronic migraines
b) persistent = continual, lumbago. sacrolumbar pain
c) neuropathic - brain’s perception of pain - hyperalgesia = hypersensitibity to stimuli
- allodynia - perception of pain w/o stimuli (fibromyalgia)
18
Q
Fever
A
- means presence of a foreign body
- resetting of hypothalamic thermostat
- heat = muscle contractions
- exogenous pyrogens (endotoxins) = increase in hypothalamus temperature control
- endogenous pyrogens = mast, basophils. body processes
BENEFITS: kills pathogenic microorganisms (denaturing and inhibiting) & incrases reactions and pathways in cells that may increase dense mechanisms)
19
Q
hyperthermia
A
high body temp
- NOT mediated by pyrogens, no resetting of the hypothalamic set point
- nerve damage at 105
- death at 109
- heat cramps = increase in sweating, pulse, blood pressure, electrolyte loss
- Heat exhaustion = dizziness, wekaness, nausea, confusion, syncope
- heat stroke = cerebral edema, degeneration of CNS, necrosis and death
20
Q
malignant hyperthermia
A
rare, inherited muscle disorder
- anesthesia
- precipitated by inhaled anesthetics and neuromuscular blocking agents. increase o2 and lactic acid
- incrased muscle contractions, body temp
21
Q
hypothermia
A
body temp below <35 c
- decreases response and reactions
- produces depression of CNS and resp systems, vasoconstriction, microcirculation, coagulation and ischemic tissue damage
- severe - ice crystals form within the cells and rupture and death
22
Q
Sleep
A
temporary state of restful unconsciousness with spontaneous arousal
- two main stages:
- REM: 60-90 mins, dreams. awake, very active brain
- non-REM: stages 1-4, deep restful sleep. 6-8 hours for deep, restful sleep
23
Q
sleep disorders
A
- insomnia: inability to fall or stay asleep
- sleep disordered breathing
- obstructive sleep apnea = obese, overweight
- nocturnal paroxysmal dyspnea = shortness of breath, postural dependent (CHF)
- Hypersomnia: too much sleep
- primary hypersonmnia - no root cause
- secondary hypersomnia - something induces it. drugs, meds.
24
Q
visual dysfucntion
A
from cranial nerves III (oculomotor), IV (cochlear), VI (abducens)
* strabismus: lazy eye. cases diplopia (double vision)
* Nystagmus: eyes shaking or twitching
CAUSES: inner ear, cerebellum, CN, drugs, retinal disease, cerbical cord disease
25
alterations in refractions
* myopia: nearsightedness (long eye ball, focus in front of the retina) can't see far, only near
* hyperopia - farsigntedness (focus behind retina, fat eye ball). can't see close, only far
* astigmatism: uneven corneal curvature (no single retinal focus). blurry vision
26
the ear
```
cochlear = hearing
vestibules = balance
```
27
ear infections
* otis externa: outside of tympanic membrane
- infection of outer ear
- prolonged moisture exposure and bacteria (swimmers ear)
* otitis media: infants and children
- acute - pain, fever, inglamed tympanic membrane with middle ear fluid
- tubes
28
ear - proprioceptive dysfuction
* vestibular nystagmus: eyeball movement, overstimualtino of semicircular canals ( spin way too fast)
* Vertigo: spining senstation to inflammation of semicircular canals. meniere's disease. neuro disorders, changes in elevation, pressure on inner ear by tumor)
29
aphasia
loss of language and speech, basic communication
- CVA/stroke, brain tumor, infection, head injury, dementia
- symptom of brain damage, not a disease itself
30
boca area
mouth, motor speech
31
wernickie's area
sensory, understanding speech and written word
32
4 categories of aphasia
1. anomic/amnesia aphasia: can't come up with name/word.
2. expressive aphasia: damage to brocas area. difficulty conveying thoughts through speech or writing
* ischemia, damage to brocas area
3. receptive aphasia: bilateral, difficulty in understanding spoken or written language. wernickie
* ischemia, damage to wernickie area
4. global aphasia: most severe. both broca and wernickie. lose comprehension and expression of speech
* damage to both brocas and wernickie
33
cognition
full consciousness: awareness of self and environment
- arousal: state of awareness. mediated by RAS. consciousness
- thought: all cognitive functions. awareness of self, enviro, afective state/mood
34
decorticate posturing
flexed arms up
- severe brain damage symptom
- symptoms contralateral to lesion
- damage to cortical tract
35
decerebrate posturing
extended arms and adducted
- damage to upper brainstem and has worse prognoses that decorticate.
- symptoms are ipsilateral (same side)
- upper brainstem
36
brain stem death
never recover nor maintain internal homeostasis
- midrbain, medulla, pons
- affects vital reflexes (breathing, heart rate, BP)
- vegetative state - on life support
37
cerebral brain death
coma survivors
- can breath, heart beat
- minimal conscious state
- locked-in syndrom = lack of expression cannot speak or write but can totally understand speech and written word
38
seizures
* Partial: only part of the brain affected
- focal and unilateral
* Generalized: bilateral, symmetic
- absence: spacing out for a few minutes
- tonic clonic: ridig and relaxed state, convulsice, grand mal
- epileptic: chronic reoccurrence of grand mal/tonic clonic
39
Increase Intracranial Pressure (ICP)
* Hydrocephalaus: excess fluid within cranial vault, subarachnoid space, or both
- interference in CSF flow. decreased reabsorption, increased fluid production, or obstruction.
- infancy through adulthood
40
Coup Countercoup Injury
coup = initial impact
countercoup = secondary response
- stretch and pull brain tissue and neurons
- shreds veins and nerves
41
cerebral concussion
1. chemical injury with loss of ATP
2. scary of neurons
most common type of TBI
- micro tearing of brain tissue
- 2/3 of head injury deaths
- no major broken blood vessels
- no active bleeding, no LOC
* damages neurons, chemical injury with ATP Loss
- brain heals by scarring
- confusion, amnesia, dizziness, fatigue, change in personality
42
Brain Trauma
- contusion/hematoma
- brain bleed
- broken blood vessels
- direct contract (severe blunt trauma)
43
Epidural Hematoma
- arterial bleeds
- b/n scull and dura
- BBB doesn't break
- lucid interval - no there symptoms but headache
- fast bleed
- blunt trauma, car accident
44
Subdural hematoma
- venous bleed
- below dura but above pia
- slow bleed
- most common and most fatal
- increased ICP = lack of o2, hypoxia
- BBB is broken = leukocytes and macrophages, inflammation, liquify brain tissue
- elderly alcoholics - slips and falls
- shaken baby syndrome
45
Intracerebral hematoma
- small arteries/veins
- inside brain tissue/hemisphere
- slow
- produces symptoms quicker - decreased cognition, LOC, confusion
- loss of BBB = liquefactive necrosis
- penumbra = self limiting bleed
- little to no change in ICP, bleeding doesn't spread
- CVA
46
spinal cord trauma
* quadriplegia - cervical and down damaged
* paraplegia - below t1
* hemiplegia - stroke, half of body affected
47
degenerative disc disease
herniated nucleus pulposis
- dorsal pinching = dull achy pain/shooting pain
- ventral pinching = muscle weakness and pain
48
circle of willis
collateral flow in brain. if there is damage or blockage in area still all areas can receive blood
49
CVA/stroke
most frequent neuro disorder
- ischemia = infarction. death of brain tissue
- hemorrhage
- >65 years
- > men
- > african americans
50
inflammation of the CNS
* meningitis: infection of the meninges
1. bacterial: pia mater, arachnoid, subarachnoid, ventricles and CSF
- systemic blood stream or direct extension from an infected area
2. aspetic: viral meningitis
- enterovirus, mumps, herpes simplex, west nile, influenza
3. fungal: chronic, less common
* Encephalitis: infection of the brain
- caused by arthropod-borne viruses and herpes simplex type 1
51
Degenerative Diseases
- dimentia
- mild cognitive impairment
- alzheimers disease
- parkinsons
- amyotrophic lateral sclerosis
- multiple sclerosis
- gullain-barre
- senility: decreased cognitive function
- dementia, mental impairment of elderly
- MCI - loss of memory, recognition, mental calculations, mental pressing
52
AD – Alzheimer’s Disease
Initial symptoms = memory loss (dementia); secondary (later) = motor function loss
Has strong genetic component
Tau tangles and Amyloid plaques inhibit brain neuron transmission = neurons deteriorate/degenerate = brain atrophy
53
PD – Parkinson’s Disease
Initial symptoms = motor function loss; secondary (later) = memory loss (dementia)
Loss of dopamine production/release
Dopamine balances (counteracts) Acetylcholine (AcH) (think muscle contraction…)
Loss of inhibition by dopamine causes more action by AcH = muscle TREMORS
54
ALS – Amyotrophic Lateral Sclerosis (Lou Gehrig’s)
Primary symptom = muscle weakness
Degeneration of somatic motor neurons (loss of voluntary skeletal muscle control)
Rapidly progressive - leads to respiratory failure and death
- normal intellectual and sensory function until death
55
MS – Multiple Sclerosis
Primary symptom = muscle weakness
Demyelination of CNS neurons
Autoimmune disease = cyto t’s damaging oligo’s
Slower degeneration than ALS
56
GB – Guillan Barre
Primary symptom = muscle weakness
Demyelination of PNS neurons
From infection (usually EBV virus)
- acute peripheral neuropathy results in limb weakness.. progress in days to weeks
- demyelination of peripheral neurons
-
57
MD – Muscular Dystrophy
Primary symptom = muscle weakness
Muscle protein (dystrophin) problem (=musculoskeletal, not really neuro problem)
Duchenne MD = Most common in kids
Myotonic MD = most common in adults
58
MG – Myasthenia Gravis
Primary symptom = muscle weakness
Autoimmune disease = Ab to AcH receptor = blocks/destroys = low muscle function
