Week 12: Endocrine & Nervous System Flashcards
1
Q
Endocrine System
- ___________ as chemical messengers
- Target receptors
- ___________ feedback systems
- Chemical structure
— Peptide
— Steroid
A
- Hormones as chemical messengers
- Target receptors
- Negative feedback systems
- Chemical structure
— Peptide
— Steroid
2
Q
Steroid
- They are _______ and enter the cell nucleus to initiate transcription __________.
Nonsteroid
- Needs a ____________________________ to activate transcription in the nucleus
A
Steroid
- They are lipids and enter the cell nucleus to initiate transcription directly.
Nonsteroid
- Needs a secondary messenger system to activate transcription in the nucleus
3
Q
The endocrine and nervous systems regulate ___________ activities.
A
metabolic
4
Q
Some hormones act as _______________, such as:
-Calcitonin and parathyroid hormone
-Insulin and glucagon
A
antagonists
5
Q
Hormone Release
-Most often controlled by ____________ feedback mechanisms
- Endocrine and nervous systems work together to regulate ____________ activities.
- Complex system for some hormones
- Secretion may be controlled by more than one mechanism.
- Rate and timing of secretion may vary.
* Cyclic patterns
A
-Most often controlled by negative feedback mechanisms
- Endocrine and nervous systems work together to regulate metabolic activities.
- Complex system for some hormones
- Secretion may be controlled by more than one mechanism.
- Rate and timing of secretion may vary.
* Cyclic patterns
6
Q
Endocrine Disorders
- All disorders reflect _____________ control or feedback.
Excess hormone levels
- Tumor produces ___________
-Excretion by liver or kidney is impaired
- Congenital condition produces excess hormone
Deficit of hormone or reduced effects
-Tumor produces ___________ hormone
- Inadequate tissue receptors present
- Antagonistic hormone production is increased.
- Malnutrition; Atrophy, surgical removal of gland
- Congenital deficit
A
- All disorders reflect impaired control or feedback.
Excess hormone levels
- Tumor produces high levels
-Excretion by liver or kidney is impaired
- Congenital condition produces excess hormone
Deficit of hormone or reduced effects
-Tumor produces too little hormone
- Inadequate tissue receptors present
- Antagonistic hormone production is increased.
- Malnutrition; Atrophy, surgical removal of gland
- Congenital deficit
7
Q
Treatment
- Deficit may be treated with ____________________
- Excessive secretion may be treated with
-Medications - Surgery
- Radiation
A
- Deficit may be treated with replacement therapy.
- Excessive secretion may be treated with
-Medications - Surgery
- Radiation
8
Q
Diabetes mellitus—basic problem is inadequate ____________________ in receptor tissues
-Deficit of insulin secretion
- Production of insulin antagonists
A
insulin effects
9
Q
___________ results in abnormal carbohydrate, protein, and fat metabolism.
A
Diabetes
10
Q
Some tissues can transport ___________ in the absence of insulin:
-CNS, kidney, myocardium, gut, skeletal muscle
* Skeletal muscle can partially meet tissue needs without insulin.
A
glucose
11
Q
Type 1 Diabetes
-Autoimmune destruction of ____________ in pancreas
- Insulin replacement required
- Acute onset in children and adolescents
- Not linked to __________
- Genetic factors may play a role.
A
-Autoimmune destruction of beta cells in pancreas
- Insulin replacement required
- Acute onset in children and adolescents
- Not linked to obesity
- Genetic factors may play a role.
12
Q
Type 2 Diabetes
-Non–insulin-dependent
- Oral hypoglycemic medications may be used.
- Caused by ____________ production of insulin/increased resistance by body cells to insulin
- Onset is slow and insidious, usually in those older than 50 years
- Associated with ___________
- Component of metabolic syndrome
-Increasing incidence in teens and young adults
A
-Non–insulin-dependent
- Oral hypoglycemic medications may be used.
- Caused by decreased production of insulin/increased resistance by body cells to insulin
- Onset is slow and insidious, usually in those older than 50 years
- Associated with obesity
- Component of metabolic syndrome
-Increasing incidence in teens and young adults
13
Q
Diabetes manifestations
Insulin deficit results in decreased transport and use of _________ in many cells.
- Polyphagia
- Fatigue
Blood _________ levels rise—hyperglycemia
Excess glucose in urine—glucosuria
-_______________ results from hyperosmolar filtrate.
-Polyuria
- Polydipsia
A
Insulin deficit results in decreased transport and use of glucose in many cells.
- Polyphagia
- Fatigue
Blood glucose levels rise—hyperglycemia
Excess glucose in urine—glucosuria
-Dehydration results from hyperosmolar filtrate.
-Polyuria
- Polydipsia
14
Q
Diabetes: Diagnostic Tests
- __________ blood glucose level
- Glucose tolerance test
- Glycosylated ______________ test
-Monitor glucose levels over several months
A
- Fasting blood glucose level
- Glucose tolerance test
- Glycosylated hemoglobin test
-Monitor glucose levels over several months
15
Q
Diabetes: Treatment Principles
- Maintenance of blood ________ levels in normal range
- Diet and exercise - Exercise reduces blood glucose level as ______________ uses glucose.
- Oral medication- Increase ____________ secretion. Reduce blood glucose levels.
- Insulin replacement
A
- Maintenance of blood glucose levels in normal range
- Diet and exercise - Exercise reduces blood glucose level as skeletal muscle uses glucose.
- Oral medication- Increase insulin secretion. Reduce blood glucose levels.
- Insulin replacement
16
Q
Type 1 Diabetes
Metabolic changes
-_____________ of fats and proteins
* Excessive amounts of fatty acids and metabolites
* Ketones in the blood
-Ketonuria
* Decreased serum ______________
* Decrease in pH of body fluids
* Ketoacids excreted in urine
- Decompensated metabolic acidosis
A
Metabolic changes
-Catabolism of fats and proteins
* Excessive amounts of fatty acids and metabolites
* Ketones in the blood
-Ketonuria
* Decreased serum bicarbonate
* Decrease in pH of body fluids
* Ketoacids excreted in urine
- Decompensated metabolic acidosis
17
Q
Diabetes Complications
- Complications are directly related to duration and extent of abnormal blood __________ levels.
-Many factors lead to fluctuations in serum __________ levels.
*Variations in diet and alcohol use - Change in physical activity
- Infection, Vomiting
- Complications may be acute or chronic.
A
- Complications are directly related to duration and extent of abnormal blood glucose levels.
-Many factors lead to fluctuations in serum glucose levels.
*Variations in diet and alcohol use - Change in physical activity
- Infection, Vomiting
- Complications may be acute or chronic.
18
Q
Diabetes: Acute Complications
_____________ (insulin shock)
- More common with insulin _____________ treatment
- Can occur because of excess oral hypoglycemic drugs
- Excess __________ in circulation
* Glucose deficit in blood
* Can be life-threatening or cause brain damage if untreated
* Often follows strenuous exercise
* Dosage error
* Vomiting
* Skipping meal after taking insulin
A
Hypoglycemia (insulin shock)
- More common with insulin replacement treatment
- Can occur because of excess oral hypoglycemic drugs
- Excess insulin in circulation
* Glucose deficit in blood
* Can be life-threatening or cause brain damage if untreated
* Often follows strenuous exercise
* Dosage error
* Vomiting
* Skipping meal after taking insulin
19
Q
Hypoglycemic Shock: Signs and Symptoms
- _______________ and change in behavior
-Anxiety or decreased responsiveness - Decreased blood glucose level
-Decreased _____, increased ___________ - Decreasing level of consciousness
Note: Immediate administration of glucose Is required to prevent brain damage.
A
- Disorientation and change in behavior
-Anxiety or decreased responsiveness - Decreased blood glucose level
-Decreased BP, increased heart rate - Decreasing level of consciousness
20
Q
Diabetes: Acute Complications (Cont.)
Diabetic ketoacidosis
- Occurs in ____________________ clients
- More commonly seen in type __ diabetes
- Result of insufficient __________ in blood
- High blood glucose levels
- Mobilization and use of lipids to meet cellular needs result in production of ketoacids
- May be initiated by infection or stress
- May result from error in dosage, infection, change in diet, alcohol intake, or exercise
A
- Occurs in insulin-dependent clients
- More commonly seen in type 1 diabetes
- Result of insufficient insulin in blood
- High blood glucose levels
- Mobilization and use of lipids to meet cellular needs result in production of ketoacids
- May be initiated by infection or stress
- May result from error in dosage, infection, change in diet, alcohol intake, or exercise
21
Q
Signs and Symptoms of Diabetic Ketoacidosis
-Dehydration
- Thirst, dry, rough oral mucosa
- Warm, dry skin
- Rapid, deep respiration—_________ breath
-______________, decreased responsiveness
- Metabolic ______________
-May lead to loss of consciousness
- Electrolyte imbalances
- Abdominal cramps, nausea, vomiting, lethargy, weakness
A
-Dehydration
- Thirst, dry, rough oral mucosa
- Warm, dry skin
- Rapid, deep respiration—acetone breath
-Lethargy, decreased responsiveness
- Metabolic acidosis
-May lead to loss of consciousness
- Electrolyte imbalances
- Abdominal cramps, nausea, vomiting, lethargy, weakness
22
Q
Acute Complications: HHNK Syndrome
- HHNK: Hyperglycemic hyperosmolar nonketotic
- Occurs in type ____ diabetes
- Insidious in onset and diagnosis may be missed
- Often occurs in _________ clients and assumed to be cognitive impairment
-Results in severe dehydration and electrolyte imbalances
A
- HHNK: Hyperglycemic hyperosmolar nonketotic
- Occurs in type 2 diabetes
- Insidious in onset and diagnosis may be missed
- Often occurs in older clients and assumed to be cognitive impairment
-Results in severe dehydration and electrolyte imbalances
23
Q
HHNK Manifestations
- Hyperglycemia
- Severe _______________
-Increased ____________
- Loss of turgor
- Increased heart rate and respirations
-Electrolyte imbalances result in:
- Neurologic deficits
- Muscle weakness
- Difficulties with speech
- Abnormal reflexes
A
HHNK Manifestations
- Hyperglycemia
- Severe dehydration
-Increased hematocrit
- Loss of turgor
- Increased heart rate and respirations
-Electrolyte imbalances result in:
- Neurologic deficits
- Muscle weakness
- Difficulties with speech
- Abnormal reflexes
24
Q
Chronic Complications of Diabetes
- Vascular problems
- Increased incidence of atherosclerosis
-Changes may occur in small and large arteries. - Microangiopathy—changes in ________________
-Obstruction or rupture of small capillaries and arteries - Tissue necrosis and loss of function
- Neuropathy and loss of sensation
- Retinopathy—leading cause of ____________
- Chronic _______failure—degeneration in glomeruli of kidney
A
- Vascular problems
- Increased incidence of atherosclerosis
-Changes may occur in small and large arteries. - Microangiopathy—changes in microcirculation
-Obstruction or rupture of small capillaries and arteries - Tissue necrosis and loss of function
- Neuropathy and loss of sensation
- Retinopathy—leading cause of blindness
- Chronic renal failure—degeneration in glomeruli of kidney
25
Chronic Complications of Diabetes (Cont.)
Macroangiopathy—affects ___________________
-Result of abnormal lipid levels
* High incidence of heart attacks, strokes, peripheral vascular disease
* May result in ulcers on feet and legs—slow-healing
* Frequent infections and gangrenous ulcers
* Amputation may be necessary.
______________ neuropathy
- Common complication caused by ischemia in microcirculation to peripheral nerves
* Impaired sensation, numbness, tingling, weakness, muscle wasting
Macroangiopathy—affects large arteries
-Result of abnormal lipid levels
* High incidence of heart attacks, strokes, peripheral vascular disease
* May result in ulcers on feet and legs—slow-healing
* Frequent infections and gangrenous ulcers
* Amputation may be necessary.
Peripheral neuropathy
- Common complication caused by ischemia in microcirculation to peripheral nerves
* Impaired sensation, numbness, tingling, weakness, muscle wasting
26
Chronic Complications of Diabetes (Cont.)
Infections
-Common and often more severe in diabetics
- Infections in ______________________ caused by vascular and neurological impairment
- ____________ infections common
* Caused by Candida
* In vagina and/or oral cavity
- Urinary tract infections
- Dental caries
- Gingivitis and periodontitis
Infections
-Common and often more severe in diabetics
- Infections in feet and legs caused by vascular and neurological impairment
- Fungal infections common
* Caused by Candida
* In vagina and/or oral cavity
- Urinary tract infections
- Dental caries
- Gingivitis and periodontitis
27
Chronic Complications of Diabetes (Cont.)
____________
- Opacity of lens in eye
- Related to abnormal metabolism of glucose
Pregnancy
- Complications in both mother and fetus may occur.
- Increased incidence of spontaneous ___________
- Infants born to diabetic mothers:
* Increased size and weight for date
* May experience hypoglycemia in first hours postnatally
Cataracts
- Opacity of lens in eye
- Related to abnormal metabolism of glucose
Pregnancy
- Complications in both mother and fetus may occur.
- Increased incidence of spontaneous abortions
- Infants born to diabetic mothers:
* Increased size and weight for date
* May experience hypoglycemia in first hours postnatally
28
Control of Type 2 Diabetes
Diet should contain:
- Increased ______
- Reduced ___________ and simple carbohydrates
Regular exercise to reduce ___________ levels
Reduce insulin resistance by reducing BMI to normal range
Monitoring blood glucose levels as ordered
Medication to stimulate the beta cells of the pancreas to produce more insulin
If insulin-dependent— administration of insulin to maintain glucose level normal range
Routine follow-up and blood testing
Diet should contain:
- Increased fiber
- Reduced lipids and simple carbohydrates
Regular exercise to reduce glucose levels
Reduce insulin resistance by reducing BMI to normal range
Monitoring blood glucose levels as ordered
Medication to stimulate the beta cells of the pancreas to produce more insulin
If insulin-dependent— administration of insulin to maintain glucose level normal range
Routine follow-up and blood testing
29
Hypoparathyroidism
- Leads to _____________
* _______ cardiac muscle contractions
* Increased excitability of nerves—spontaneous
contractions of skeletal muscle
Causes
* Tumor
* Congenital lack of ______________
* Surgery or radiation in neck region
* ___________ disease
- Leads to hypocalcemia
* Weak cardiac muscle contractions
* Increased excitability of nerves—spontaneous
contractions of skeletal muscle
Causes
* Tumor
* Congenital lack of parathyroid
* Surgery or radiation in neck region
* Autoimmune disease
30
Hyperparathyroidism
- Results in ______________
* ___________ cardiac contractions
* Osteoporosis
* Predisposition to kidney stones
Causes
* Tumor
* Secondary to renal failure
* Paraneoplastic syndrome
- Results in hypercalcemia
* Forceful cardiac contractions
* Osteoporosis
* Predisposition to kidney stones
Causes
* Tumor
* Secondary to renal failure
* Paraneoplastic syndrome
31
_____________ are the most common cause of pituitary disorders.
Effect of mass
-May cause __________ in the skull
* Headaches, seizures, drowsiness, visual deficits
- Effect on hormone secretion
-Dependent on cells and location involved
-May cause excessive or decreased release of ___________
Adenomas are the most common cause of pituitary disorders.
Effect of mass
-May cause pressure in the skull
* Headaches, seizures, drowsiness, visual deficits
- Effect on hormone secretion
-Dependent on cells and location involved
-May cause excessive or decreased release of hormones
32
Growth Hormone (GH)
____________
- Deficit in growth hormone production and release
___________
- Excess GH prior to puberty and fusion of epiphysis
______________
-Excess GH secretion in adults
- Often associated with adenoma
- Bones become broader and heavier.
-Soft tissue grows.
* Enlarged hands and feet, change in facial features
Dwarfism
- Deficit in growth hormone production and release
Gigantism
- Excess GH prior to puberty and fusion of epiphysis
Acromegaly
-Excess GH secretion in adults
- Often associated with adenoma
- Bones become broader and heavier.
-Soft tissue grows.
* Enlarged hands and feet, change in facial features
33
Diabetes insipidus—deficit of ________
-Adenoma
- May originate in the neurohypophysis
* Head injury or surgery
* Possible genetic problem
* ________________ treatment required
Diabetes insipidus—deficit of ADH
-Adenoma
- May originate in the neurohypophysis
* Head injury or surgery
* Possible genetic problem
* Replacement treatment required
34
Inappropriate ADH syndrome
- Excess ADH
* May be temporary, triggered by ______; may be secreted by ectopic source, such as a ________
Treatment
* Diuretics
* Sodium supplements
- Excess ADH
* May be temporary, triggered by stress; may be secreted by ectopic source, such as a tumor
Treatment
* Diuretics
* Sodium supplements
35
Goiter—enlargement of _______________
-Endemic goiter
* Hypothyroid condition in regions with low ________ levels in soil and food
- Goitrogens
* Foods that contain elements to block synthesis of triiodothyronine (T3) and thyroxine (T4)
- Toxic goiter
* Results from ______________ of thyroid gland
Goiter—enlargement of thyroid gland
-Endemic goiter
* Hypothyroid condition in regions with low iodine levels in soil and food
- Goitrogens
* Foods that contain elements to block synthesis of triiodothyronine (T3) and thyroxine (T4)
- Toxic goiter
* Results from hyperactivity of thyroid gland
36
Hyperthyroidism (Graves’ disease)
- Related to __________ factor
- Hypermetabolism and increased stimulation of _______
* Increased body temperature, Sweating
* Soft silky hair and skin
* Reduced BMI
* Insomnia, Hyperactivity
- Toxic goiter
-Exophthalmos
* Presence of protruding, staring eyes, decreased blink and eye movement
* Result of increased tissue mass in the orbit
* May result in visual impairment
- Related to autoimmune factor
- Hypermetabolism and increased stimulation of SNS
* Increased body temperature, Sweating
* Soft silky hair and skin
* Reduced BMI
* Insomnia, Hyperactivity
- Toxic goiter
-Exophthalmos
* Presence of protruding, staring eyes, decreased blink and eye movement
* Result of increased tissue mass in the orbit
* May result in visual impairment
37
Hypothyroidism
- __________ deficit
- Hashimoto’s thyroiditis
* Autoimmune disorder
- Tumor
-Surgical removal or treatment of gland
- Cretinism
* Results in short stature and severe __________ deficits
* Untreated congenital hypothyroidism
* May be related to iodine deficiency during pregnancy
- Iodine deficit
- Hashimoto’s thyroiditis
* Autoimmune disorder
- Tumor
-Surgical removal or treatment of gland
- Cretinism
* Results in short stature and severe cognitive deficits
* Untreated congenital hypothyroidism
* May be related to iodine deficiency during pregnancy
38
Hypothyroidism Manifestations
- ___________ if cause is endemic iodine deficiency
- Intolerance to ______
- Increased BMI
- Lethargy and fatigue
- Decreased ___________
- Myxedema in severe, untreated hypothyroidism
- Nonpitting edema in face, thickened tongue
-Myxedema coma—acute hypotension, hypoglycemia, and hypothermia result in loss of consciousness; life-threatening if untreated
- Goiter if cause is endemic iodine deficiency
- Intolerance to cold
- Increased BMI
- Lethargy and fatigue
- Decreased appetite
- Myxedema in severe, untreated hypothyroidism
- Nonpitting edema in face, thickened tongue
-Myxedema coma—acute hypotension, hypoglycemia, and hypothermia result in loss of consciousness; life-threatening if untreated
39
Adrenal medulla
- ____________________
* Benign tumor of adrenal medulla—secretes epinephrine, norepinephrine, etc..
* Occasionally, multiple tumors
* Headache, heart palpations, sweating, intermittent or constant anxiety
- Pheochromocytoma
* Benign tumor of adrenal medulla—secretes epinephrine, norepinephrine, etc..
* Occasionally, multiple tumors
* Headache, heart palpations, sweating, intermittent or constant anxiety
40
Cushing’s syndrome
- Caused by an _______________________________ ; possible result of:
* Adrenal adenoma
* Pituitary adenoma
* Ectopic carcinoma
* Iatrogenic conditions
* Substance abuse
- Caused by an excessive level of glucocorticoids; possible result of:
* Adrenal adenoma
* Pituitary adenoma
* Ectopic carcinoma
* Iatrogenic conditions
* Substance abuse
41
Changes associated with Cushing’s syndrome
- Change in person’s ____________
* _________ face, with ruddy color
* Truncal _________ , with fat pad between scapulae
* Thin limbs
* Thin hair
* Fragile skin, striae
- Change in person’s appearance
* Round face, with ruddy color
* Truncal obesity, with fat pad between scapulae
* Thin limbs
* Thin hair
* Fragile skin, striae
42
Cushing’s Syndrome (Cont.)
- Retention of __________ and water
- Suppression of the ___________ response
- Stimulation of ____________ production
- Emotional lability and euphoria
- Increased catabolism of bone and protein
- Delayed healing
- Increased insulin resistance and possible glucose intolerance
- Retention of sodium and water
- Suppression of the immune response
- Stimulation of erythrocyte production
- Emotional lability and euphoria
- Increased catabolism of bone and protein
- Delayed healing
- Increased insulin resistance and possible glucose intolerance
43
Addison’s Disease
- Deficiency of _____________ secretions
- _____________ reaction is a common cause.
- ________ gland may be destroyed by hemorrhage or infection
- Deficiency of adrenocorticoid secretions
- Autoimmune reaction is a common cause.
- Adrenal gland may be destroyed by hemorrhage or infection
44
Addison’s Disease (Cont.)
Manifestations
- Decreased blood __________ levels
- Inadequate stress response
- Fatigue
- Weight loss, frequent infections
-Low serum _________ concentration
* Decreased blood volume
* Hypotension
* High potassium levels
- Decreased blood glucose levels
- Inadequate stress response
- Fatigue
- Weight loss, frequent infections
-Low serum sodium concentration
* Decreased blood volume
* Hypotension
* High potassium levels
45
Local (Focal) Effects of NS disorders
-Signs related to the specific area of the brain or spinal cord in which __________ is located
*Example—paresis or paralysis of the right arm
- Results from damage to a section of the ______________ lobe
- Expanding lesions
*Caused by growing tumor or hemorrhage
-Signs related to the specific area of the brain or spinal cord in which lesion is located
*Example—paresis or paralysis of the right arm
- Results from damage to a section of the left frontal lobe
- Expanding lesions
*Caused by growing tumor or hemorrhage
46
Supratentorial lesions
-Occur in the __________ hemispheres above the tentorium cerebelli
- Lead to specific dysfunction in a discrete area
-Occur in the cerebral hemispheres above the tentorium cerebelli
- Lead to specific dysfunction in a discrete area
47
Infratentorial lesions
- Located in the __________ or below the tentorium
- May affect many motor and sensory fibers
*Results in ___________ impairment
-Respiratory and circulatory function may be impaired.
- Level of consciousness may be impaired.
- Located in the brainstem or below the tentorium
- May affect many motor and sensory fibers
*Results in widespread impairment
-Respiratory and circulatory function may be impaired.
- Level of consciousness may be impaired.
48
Damage to left hemisphere
-Loss of __________ thinking ability, analytical skills, other _____________ abilities, communication skills
-Loss of logical thinking ability, analytical skills, other intellectual abilities, communication skills
49
Damage to right hemisphere
- Impairs appreciation of ________________
-Causes _____________ problems
- Spatial orientation and recognition of relationships may be deficient
- Self-care deficits common
- Impairs appreciation of music and art
-Causes behavioral problems
- Spatial orientation and recognition of relationships may be deficient
- Self-care deficits common Left and Right Hemispheres
50
Levels of reduced consciousness may lead to:
- Confusion and ___________
- ___________ loss
- Unresponsiveness to verbal stimuli
- Difficulty in arousal
- Loss of consciousness or coma
- Confusion and disorientation
-Memory loss
- Unresponsiveness to verbal stimuli
- Difficulty in arousal
- Loss of consciousness or coma
51
Vegetative state
-Loss of __________ and mental capabilities
* Result of _________ brain damage
* Brainstem function continues.
* Appearance of a sleep-wake cycle
* Person unresponsive to external stimuli
-Loss of awareness and mental capabilities
* Result of diffuse brain damage
* Brainstem function continues.
* Appearance of a sleep-wake cycle
* Person unresponsive to external stimuli
52
Locked-in syndrome
- Individual is aware and capable of thinking but is _____________ and cannot _____________
- Individual is aware and capable of thinking but is paralyzed and cannot communicate
53
Criteria for brain death
- Cessation of brain function
- Including function of the cortex and the brainstem
-_______ or inactive electroencephalogram (EEG)
- Absence of brainstem _________ or responses
- Absence of spontaneous _____________ when ventilator assistance is withdrawn
- confirmation of cause of the dysfunction
- Evaluation twice by different physicians Level of Consciousness
- Cessation of brain function
- Including function of the cortex and the brainstem
-Flat or inactive electroencephalogram (EEG)
- Absence of brainstem reflexes or responses
- Absence of spontaneous respirations when ventilator assistance is withdrawn
- confirmation of cause of the dysfunction
- Evaluation twice by different physicians Level of Consciousness
54
Motor Dysfunction
Damage to upper motor neurons
- Interference with ___________ movements
-Weakness or paralysis on the contralateral side of the
Damage to lower motor neurons
- Weakness or ______________ on the same side of the body
- At and below the level of spinal cord damage
Decorticate and decerebrate posturing
- Severe brain damage
Damage to upper motor neurons
- Interference with voluntary movements
-Weakness or paralysis on the contralateral side of the
Damage to lower motor neurons
- Weakness or paralysis on the same side of the body
- At and below the level of spinal cord damage
Decorticate and decerebrate posturing
- Severe brain damage
55
Visual Loss: Hemianopia
-Depends on site of damage in visual pathway
Optic chiasm damage
- Vision lost in both eyes if ________ is totally destroyed
-Partial loss
- Depends on particular fibers damaged
Optic tract or occipital lobe damage
- Loss of the visual field on side __________ to that of the damage
-Depends on site of damage in visual pathway
Optic chiasm damage
- Vision lost in both eyes if chiasm is totally destroyed
-Partial loss
- Depends on particular fibers damaged
Optic tract or occipital lobe damage
- Loss of the visual field on side opposite to that of the damage
56
Aphasia
-Inability to comprehend or express __________
- __________ —damage to Wernicke’s area
- ____________ —damage to Broca’s area
- Mixed, global—damage to both areas or to the fibers and tracts between them
-Inability to comprehend or express language
- Receptive—damage to Wernicke’s area
- Expressive—damage to Broca’s area
- Mixed, global—damage to both areas or to the fibers and tracts between them
57
Dysarthria
- Words cannot be _____________ clearly
- ___________ dysfunction—usually results from cranial nerve damage or muscle impairment
- Words cannot be articulated clearly
- Motor dysfunction—usually results from cranial nerve damage or muscle impairment
58
Agraphia
-Impaired _________ability
Alexia
- Impaired ___________ ability
Agnosia
-Loss of ____________ or association
Agraphia
-Impaired writing ability
Alexia
- Impaired reading ability
Agnosia
-Loss of recognition or association
59
Seizures or convulsions
- Caused by spontaneous, excessive discharge of ____________ in the brain
Causes
- Inflammation
- Hypoxia
- ___________ in the brain
Focal
-Related to the particular site of the irritation
-May become generalized
- Manifested by involuntary repetitive movements or abnormal sensations (aura) Seizures
- Caused by spontaneous, excessive discharge of neurons in the brain
Causes
- Inflammation
- Hypoxia
- Bleeding in the brain
Focal
-Related to the particular site of the irritation
-May become generalized
- Manifested by involuntary repetitive movements or abnormal sensations (aura) Seizures
60
Increased Intracranial Pressure
- Brain is encased in rigid, nonexpendable skull.
- Fluids, blood, and CSF are not compressible.
- Increase in fluid or additional mass causes increase in _____________ in the brain
- Ischemia and eventual infarction of brain tissue
- Increased ICP is common in many ____________ problems.
- Brain hemorrhage, trauma, cerebral edema, infection, tumors, abnormal circulation of CSF
- Brain is encased in rigid, nonexpendable skull.
- Fluids, blood, and CSF are not compressible.
- Increase in fluid or additional mass causes increase in pressure in the brain
- Ischemia and eventual infarction of brain tissue
- Increased ICP is common in many neurological problems.
- Brain hemorrhage, trauma, cerebral edema, infection, tumors, abnormal circulation of CSF
61
Increased Intracranial Pressure
Early signs—if cause is not removed
-Decreasing level of _____________ or decreased responsiveness (lethargy)
- Decreased __________ responses
- Severe ___________ - from stretching of dura and walls of large blood vessels
- Vomiting- Often projectile, not associated with food intake
*Result of pressure stimulating the emetic center in the medulla
-Papilledema Caused by increased ICP and swelling of the optic disc
Early signs—if cause is not removed
-Decreasing level of consciousness or decreased responsiveness (lethargy)
- Decreased pupillary responses
- Severe headache- from stretching of dura and walls of large blood vessels
- Vomiting- Often projectile, not associated with food intake
*Result of pressure stimulating the emetic center in the medulla
-Papilledema Caused by increased ICP and swelling of the optic disc
62
Brain Tumors
Space-occupying lesions that cause increased _____
-Benign and malignant tumors can be life-threatening unless accessible and removable
- ________ form the largest category of primary malignant tumors.
* Classified according to cell derivation and location of the tumor
Space-occupying lesions that cause increased ICP
-Benign and malignant tumors can be life-threatening unless accessible and removable
- Gliomas form the largest category of primary malignant tumors.
* Classified according to cell derivation and location of the tumor
63
Brain Tumors
Tumors in the meninges or pituitary gland cause similar neurological effects.
- Primary malignant tumors rarely metastasize outside the _____.
- Secondary brain tumors
*Metastasize from breast or lung tumors
*Cause effects similar to those of primary brain tumors
Tumors in the meninges or pituitary gland cause similar neurological effects.
- Primary malignant tumors rarely metastasize outside the CNS.
- Secondary brain tumors
*Metastasize from breast or lung tumors
*Cause effects similar to those of primary brain tumors
64
Brain Tumors
Pathophysiology
-Primary ___________ brain tumors
* Usually no well-defined margins
* Invasive and have irregular projections into adjacent tissue
* Difficult to remove completely
-Usually inflammation around the tumor
Occurrence
-Brainstem and cerebellar tumors common in young children
- Adults—occur more frequently in the ___________ hemispheres
Pathophysiology
-Primary malignant brain tumors
* Usually no well-defined margins
* Invasive and have irregular projections into adjacent tissue
* Difficult to remove completely
-Usually inflammation around the tumor
Occurrence
-Brainstem and cerebellar tumors common in young children
- Adults—occur more frequently in the cerebral hemispheres
65
Brain Tumors (Cont.)
Signs and symptoms
- _____ of tumor determines focal signs
- ___________ often first sign
- Headaches (increased ICP), vomiting, lethargy, irritability, personality and behavioral changes, possible unilateral facial paralysis or visual problems
- Do not cause systemic signs of malignancy
- Will cause death before they cause general effects
Treatment—may cause damage to normal CNS tissue
- _____________ if tumor is accessible
- Chemotherapy and radiation (many are radioresistant)
Signs and symptoms
- Site of tumor determines focal signs
- Seizures often first sign
- Headaches (increased ICP), vomiting, lethargy, irritability, personality and behavioral changes, possible unilateral facial paralysis or visual problems
- Do not cause systemic signs of malignancy
- Will cause death before they cause general effects
Treatment—may cause damage to normal CNS tissue
- Surgery if tumor is accessible
- Chemotherapy and radiation (many are radioresistant)
66
Vascular Disorders
Interference with ________ supply
- Local damage and manifestations depend on cerebral artery involved
Hemorrhage
-Increased ICP will cause local ischemia and generalized symptoms
Global cerebral ischemia
- Impaired perfusion of entire brain
- Loss of function and generalized cerebral edema
- Brain death if not reversed quickly
Interference with blood supply
- Local damage and manifestations depend on cerebral artery involved
Hemorrhage
-Increased ICP will cause local ischemia and generalized symptoms
Global cerebral ischemia
- Impaired perfusion of entire brain
- Loss of function and generalized cerebral edema
- Brain death if not reversed quickly
67
Transient Ischemic Attacks (TIAs)
May occur singly or in a series
- Result from temporary localized reduction of ______________ in the brain
- Partial occlusion of an artery
- Atherosclerosis
- Small embolus
- Vascular spasm
- Local loss of autoregulation
May occur singly or in a series
- Result from temporary localized reduction of blood flow in the brain
- Partial occlusion of an artery
- Atherosclerosis
- Small embolus
- Vascular spasm
- Local loss of autoregulation
68
Transient Ischemic Attacks (TIAs)
Signs and symptoms
- Difficult to diagnose after the attack
- Directly related to __________ of ischemia
- Intermittent short episodes of impaired function
- e.g., muscle weakness in arm or leg
- Visual disturbances
- Numbness and paresthesia in face
- Transient aphasia or confusion may develop.
- Repeated attacks may be a warning sign for obstruction related to atherosclerosis
Signs and symptoms
- Difficult to diagnose after the attack
- Directly related to location of ischemia
- Intermittent short episodes of impaired function
- e.g., muscle weakness in arm or leg
- Visual disturbances
- Numbness and paresthesia in face
- Transient aphasia or confusion may develop.
- Repeated attacks may be a warning sign for obstruction related to atherosclerosis
69
Cerebrovascular Accidents (CVAs)
- A CVA (stroke) is an infarction of brain tissue that results from _______________
- Occlusion of a cerebral blood vessel
- Rupture of cerebral vessel
- 5 minutes of ischemia causes irreversible nerve cell damage.
- Central area of necrosis develops
- All function lost
- Surrounded by an area of inflammation. this zone will regain function following healing.
- A CVA (stroke) is an infarction of brain tissue that results from lack of blood.
- Occlusion of a cerebral blood vessel
- Rupture of cerebral vessel
- 5 minutes of ischemia causes irreversible nerve cell damage.
- Central area of necrosis develops
- All function lost
- Surrounded by an area of inflammation. this zone will regain function following healing.
70
MRI can determine cause of the stroke
Risk factors include:
- Diabetes, hypertension, systemic lupus erythematosus, atherosclerosis, history of TIAs, increasing age, obstructive sleep apnea, heart disease, smoking, sedentary lifestyle
-Combination of oral contraceptives and ____________________
- Congenital malformation of blood vessels
-Increasing age
Risk factors include:
- Diabetes, hypertension, systemic lupus erythematosus, atherosclerosis, history of TIAs, increasing age, obstructive sleep apnea, heart disease, smoking, sedentary lifestyle
-Combination of oral contraceptives and cigarette smoking
- Congenital malformation of blood vessels
-Increasing age
71
Cerebrovascular Accidents (CVAs)
Treatment
- Clot-___________ agents
- Surgical intervention
- Glucocorticoids
-Supportive treatment
- Occupational and physical therapists; ________________ pathologists
- Treat underlying problem to prevent recurrences.
- Rehabilitation begins immediately
- Clot-busting agents
- Surgical intervention
- Glucocorticoids
-Supportive treatment
- Occupational and physical therapists; speech-language pathologists
- Treat underlying problem to prevent recurrences.
- Rehabilitation begins immediately
72
Cerebral Aneurysms
Localized weakness in the wall of an _________
- Often aggravated by hypertension
- Initially small and asymptomatic
- Slow bleed causes vascular type headache.
- Rupture leads to sudden fatal increase in _________&________
Localized weakness in the wall of an artery
- Cerebral aneurysms frequently multiple.
- Often aggravated by hypertension
- Initially small and asymptomatic
- Slow bleed causes vascular type headache.
- Rupture leads to sudden fatal increase in ICP and death.
73
Cerebral Aneurysms
Signs and symptoms
- Loss of visual field or __________ disturbances
- Headache and photophobia
- Intermittent periods of dysfunction
- Nuchal rigidity caused by meningeal irritation
- Vomiting, seizures, loss of consciousness in case of massive rupture; rapid followed by death
Treatment
- Surgical treatment before rupture
- ______________ drugs
Signs and symptoms
- Loss of visual field or visual disturbances
- Headache and photophobia
- Intermittent periods of dysfunction
- Nuchal rigidity caused by meningeal irritation
- Vomiting, seizures, loss of consciousness in case of massive rupture; rapid followed by death
Treatment
- Surgical treatment before rupture
- Antihypertensive drugs
74
Infections
Different age groups are susceptible to infection by different causative organisms.
Children and young adults
- Neisseria meningitidis or _____________
- Classic ___________ pathogen
- Frequently carried in the nasopharynx of asymptomatic carriers
- Spread by respiratory droplets
- Occurs more frequently in late winter and early spring
-Neisseria meningitidis or meningococci
-Classic meningitis pathogen
75
Infections (Cont.)
Neonates
- ______________ most common causative organism
- Usually in conjunction with a neural tube defect, premature rupture of the amniotic membranes, difficult delivery
Young children
- Most often caused by Haemophilus __________
- More often in the autumn or winter
Older adults
- Streptococcus ____________ —major cause Infections (Cont.)
Neonates
- Escherichia coli most common causative organism
- Usually in conjunction with a neural tube defect, premature rupture of the amniotic membranes, difficult delivery
Young children
- Most often caused by Haemophilus influenzae
- More often in the autumn or winter
Older adults
- Streptococcus pneumoniae—major cause Infections (Cont.)
76
Infections (Cont.)
Diagnostic tests
- Examination of _______ (obtained by lumbar puncture)
- Identification of causative organism
Treatment
- Aggressive ______________ therapy
- Specific treatment measures for ICP and seizures
- Glucocorticoids
- Reduction of cerebral inflammation and edema
- Vaccines are available for some types of meningitis.
Diagnostic tests
- Examination of CSF (obtained by lumbar puncture)
- Identification of causative organism
Treatment
- Aggressive antimicrobial therapy
- Specific treatment measures for ICP and seizures
- Glucocorticoids
- Reduction of cerebral inflammation and edema
- Vaccines are available for some types of meningitis.
77
Brain Abscess
- Frequently in ________ or __________ lobes
-Usually necrosis of brain tissue and surrounding area of edema
- May spread from organisms in ear, throat, lung,sinuse
- May result from septic emboli, acute bacterialend ocarditis, site of injury, or surgery
- Surgical drainage and antimicrobial therapy
Frequently in frontal or temporal lobes
-Usually necrosis of brain tissue and surrounding area of edema
- May spread from organisms in ear, throat, lung,sinuse
- May result from septic emboli, acute bacterialend ocarditis, site of injury, or surgery
- Surgical drainage and antimicrobial therapy
78
Encephalitis
Infection of the parenchymal or connective tissue in the ____________________
- Necrosis and inflammation develop in brain tissue; result in some permanent damage
- Infection may include meninges.
- Usually of _________ origin
- Early signs - Severe headache, stiff neck, lethargy, vomiting, seizures, fever
Infection of the parenchymal or connective tissue in the brain and spinal cord
- Necrosis and inflammation develop in brain tissue; result in some permanent damage
- Infection may include meninges.
- Usually of viral origin
- Early signs - Severe headache, stiff neck, lethargy, vomiting, seizures, fever
79
Encephalitis (Cont.)
Western equine encephalitis
- Arboviral infection spread by _________
- More frequent in summer months
- Common in young children
St. Louis encephalitis
- Affects ___________________ more seriously than younger individuals
West Nile fever
- Caused by a flavivirus
- Spread by ___________
Western equine encephalitis
- Arboviral infection spread by mosquitoes
- More frequent in summer months
- Common in young children
St. Louis encephalitis
- Affects older persons more seriously than younger individuals
West Nile fever
- Caused by a flavivirus
- Spread by mosquitoes
80
Encephalitis (Cont.)
Neuroborreliosis (Lyme disease)
- Caused by Borrelia burgdorferi
- Transmitted by ________
- Typical bull’s-eye lesion—sore throat, dry cough, fever, headache, cardiac arrhythmias, neurological abnormalities
- Antimicrobial therapy
Herpes simplex encephalitis
- Occurs occasionally
- Spread from herpes simplex I
- Extensive necrosis and ______________ in the brain
Neuroborreliosis (Lyme disease)
- Caused by Borrelia burgdorferi
- Transmitted by ticks
- Typical bull’s-eye lesion—sore throat, dry cough, fever, headache, cardiac arrhythmias, neurological abnormalities
- Antimicrobial therapy
Herpes simplex encephalitis
- Occurs occasionally
- Spread from herpes simplex I
- Extensive necrosis and hemorrhage in the brain
81
Rabies
Viral—transmitted by: Bite of _________________ or transplantation of contaminated tissues
- Virus travels along peripheral nerves to CNS
- Headache and fever, nervous hyperirritability, sensitivity to touch, seizures
- Virus also travels to ___________________ ; Difficulty swallowing & Fear of fluids
- Respiratory failure, death
Viral—transmitted by: Bite of rabid animal or transplantation of contaminated tissues
- Virus travels along peripheral nerves to CNS
- Headache and fever, nervous hyperirritability, sensitivity to touch, seizures
- Virus also travels to salivary glands; Difficulty swallowing & Fear of fluids
- Respiratory failure, death
82
Tetanus
- Caused by Clostridium tetani
- Spores can survive in ________ for _________
- Wound
- Exotoxin enters __________________
- Tonic muscle spasms
- Jaw stiffness
- Difficulty swallowing
- Stiff neck
- Headache and skeletal muscle spasm
- Respiratory failure
- Caused by Clostridium tetani
- Spores can survive in soil (years).
- Wound
- Exotoxin enters nervous system
- Tonic muscle spasms
- Jaw stiffness
- Difficulty swallowing
- Stiff neck
- Headache and skeletal muscle spasm
- Respiratory failure
83
Poliomyelitis (infantile paralysis)
- Polio virus
- Immunization available
- Endemic in West and Central Africa
- Highly contagious; Direct contact/ Oral droplets
- Attacks motor neurons of spinal cord and medulla
- Fever, headache, vomiting, stiff neck, pain, flaccid paralysis
- Polio virus
- Immunization available
- Endemic in West and Central Africa
- Highly contagious; Direct contact/ Oral droplets
- Attacks motor neurons of spinal cord and medulla
- Fever, headache, vomiting, stiff neck, pain, flaccid paralysis
84
Herpes zoster (shingles)
- Caused by _______________ virus in adults
- Can occur years after primary infection of varicella (chickenpox)
- Usually affects cranial nerve or one dermatome
- Pain, paresthesia, vesicular rash
- If _____________ drugs started within 48 hours of onset, pain is significantly reduced
- Lesions and pain persist for several weeks.
- Postherpetic pain may persist for months to years in some cases.
- Vaccine available for those 60 years or older
- Caused by varicella-zoster virus in adults
- Can occur years after primary infection of varicella (chickenpox)
- Usually affects cranial nerve or one dermatome
- Pain, paresthesia, vesicular rash
- If antiviral drugs started within 48 hours of onset, pain is significantly reduced
- Lesions and pain persist for several weeks.
- Postherpetic pain may persist for months to years in some cases.
- Vaccine available for those 60 years or older
85
Reye’s syndrome
- Cause not fully determined
- Linked to viral infection in children treated with ________
- Pathological changes in ______ and ________
- Brain Function severely impaired by cerebral edema
- Liver: Enlarged, fatty changes develop in tissue; Can result in acute failure
- Manifestations vary in severity.
- No immediate cure
- Cause not fully determined
- Linked to viral infection in children treated with aspirin
- Pathological changes in brain and liver
- Brain Function severely impaired by cerebral edema
- Liver: Enlarged, fatty changes develop in tissue; Can result in acute failure
- Manifestations vary in severity.
- No immediate cure
86
Guillain-Barre syndrome
- Postinfection polyneuritis, acute idiopathic polyneuropathy, acute infectious polyradiculoneuritis
-Inflammatory condition of the _______
- Exact cause unknown
- Local inflammation with accumulated lymphocytes, demyelination, axon destruction
- Changes cause impaired ____________________
- Postinfection polyneuritis, acute idiopathic polyneuropathy, acute infectious polyradiculoneuritis
-Inflammatory condition of the PNS
- Exact cause unknown
- Local inflammation with accumulated lymphocytes, demyelination, axon destruction
- Changes cause impaired nerve conduction.
87
Guillain-Barre syndrome (Cont.)
-Critical period develops.
- Ascending paralysis involves ___________ and respiratory muscles
- Progressive muscle weakness, lack of reflex response, ascending flaccid paralysis, pain, general muscle aching
- Paralysis may move upward—vision and speech may be impaired.
- Process may occur rapidly over a few hours or several days.
- may become Life-threatening
- Treatment primarily supportive
-Critical period develops.
- Ascending paralysis involves diaphragm and respiratory muscles
- Progressive muscle weakness, lack of reflex response, ascending flaccid paralysis, pain, general muscle aching
- Paralysis may move upward—vision and speech may be impaired.
- Process may occur rapidly over a few hours or several days.
- may become Life-threatening
- Treatment primarily supportive
87
Concussion (minimal brain trauma)
- Reversible interference with ________________
- Causes sudden excessive movement of the brain
- Result of mild blow to the head or whiplash-type injury
- Amnesia and headaches may follow.
- Recovery usually within 24 hours, without permanent damage
Contusion
- _________ of brain tissue, rupture of small blood vessels, and edema
- Blunt blow to the head, possible __________ damage
Concussion (minimal brain trauma)
- Reversible interference with brain function
- Causes sudden excessive movement of the brain
- Result of mild blow to the head or whiplash-type injury
- Amnesia and headaches may follow.
- Recovery usually within 24 hours, without permanent damage
Contusion
- Bruising of brain tissue, rupture of small blood vessels, and edema
- Blunt blow to the head, possible residual damage
88
Closed head injury
- ______ is not fractured in injury.
- Brain tissue is injured and blood vessels may be ruptured.
- Extensive damage may occur when head is rotated.
Open head injuries
- Involve fractures or penetration of the _______
Closed head injury
- Skull is not fractured in injury.
- Brain tissue is injured and blood vessels may be ruptured.
- Extensive damage may occur when head is rotated.
Open head injuries
- Involve fractures or penetration of the brain
89
Depressed skull fractures
- Involve displacement of a piece of _______ below the level of the skull
- _______________ of brain tissue
- Blood supply to area often impaired—pressure to brain
- Involve displacement of a piece of bone below the level of the skull
- Compression of brain tissue
- Blood supply to area often impaired—pressure to brain
90
Basilar fractures
- Occur at the ________ of the skull
- Leakage of CSF through ears or nose is possible
- May occur when forehead hits windshield
Contrecoup injury
-Area of the brain ______________ to the site of direct damage is injured
- As brain bounces off the skull
- May be secondary to acceleration or deceleration injuries
Basilar fractures
- Occur at the base of the skull
- Leakage of CSF through ears or nose is possible
- May occur when forehead hits windshield
Contrecoup injury
-Area of the brain contralateral to the site of direct damage is injured
- As brain bounces off the skull
- May be secondary to acceleration or deceleration injuries
91
Primary brain injuries
- Laceration or compression of brain tissue
-Rupture or compression of cerebral blood vessels
- Damage because of rough or irregular inner surface of the skull
-Movement of _______ against each other
Secondary injuries
- Result from additional effects of cerebral edema, hemorrhage, hematoma, cerebral vasospasm, infection, ischemia related to systemic factors
Primary brain injuries
- Laceration or compression of brain tissue
-Rupture or compression of cerebral blood vessels
- Damage because of rough or irregular inner surface of the skull
-Movement of lobes against each other
Secondary injuries
- Result from additional effects of cerebral edema, hemorrhage, hematoma, cerebral vasospasm, infection, ischemia related to systemic factors
92
Trauma to brain tissue
- Causes loss of function in part of body controlled by that _______________
- Cell damage and bleeding lead to inflammation and vasospasm around injury site
- Increased ICP, general ischemia, dysfunction
- Some recovery may occur—scar tissue formation
Hematoma
- Classified by _________ in relation to the meninges
Trauma to brain tissue
- Causes loss of function in part of body controlled by that area of the brain
- Cell damage and bleeding lead to inflammation and vasospasm around injury site
- Increased ICP, general ischemia, dysfunction
- Some recovery may occur—scar tissue formation
Hematoma
- Classified by location in relation to the meninges
93
Epidural hematoma
- Results from bleeding between _______ and skull
- Signs usually arise within few hours of injury
Subdural hematoma
- Develops between dura and ___________
- Hematoma may be acute or subacute
- Tear in arachnoid may allow CSF to leak into subdural space
- Creates additional pressure
- Hematoma disintegrates about 7 days postinjury.
- Hemolysis increases osmotic pressure → ICP
Epidural hematoma
- Results from bleeding between dura and skull
- Signs usually arise within few hours of injury
Subdural hematoma
- Develops between dura and arachnoid
- Hematoma may be acute or subacute
- Tear in arachnoid may allow CSF to leak into subdural space
- Creates additional pressure
- Hematoma disintegrates about 7 days postinjury.
- Hemolysis increases osmotic pressure → ICP
94
Subarachnoid hemorrhage
- Occurs in space between ____________and pia
- Associated with traumatic bleeding from the blood vessels at the base of the brain
- Blood mixes with CSF—no localized hematoma formation
Intracerebral hematoma
- Results from ___________ or shearing injuries
- May develop several days after injury
Subarachnoid hemorrhage
- Occurs in space between arachnoid and pia
- Associated with traumatic bleeding from the blood vessels at the base of the brain
- Blood mixes with CSF—no localized hematoma formation
Intracerebral hematoma
- Results from contusions or shearing injuries
- May develop several days after injury
95
All types of hematomas lead to local ____________ on adjacent tissue.
- General increase in ICP
Causes
- In young adults—sports injury, automobile or motorcycle accident
- Falls are common causes in any age group.
All types of hematomas lead to local pressure on adjacent tissue.
- General increase in ICP
Causes
- In young adults—sports injury, automobile or motorcycle accident
- Falls are common causes in any age group.
96
Head Injuries
Signs and symptoms
-Focal signs and general signs of increased _______
- Seizures
- Often focal but may be generalized
- Cranial nerve impairment may occur
- Otorrhea or rhinorrhea
- Leaking of ______ from ear or nose
- Fever
- May be sign of hypothalamic impairment or cranial or systemic infection
-Focal signs and general signs of increased ICP
- Seizures
- Often focal but may be generalized
- Cranial nerve impairment may occur
- Otorrhea or rhinorrhea
- Leaking of CSF from ear or nose
- Fever
- May be sign of hypothalamic impairment or cranial or systemic infection
97
Head Injuries
CT and MRI
- Useful to determine extent of brain injury
Treatment
- _______________ agents [Decrease edema]
- ___________ [reduce risk of infection]
- Surgery may be necessary. [Reduction in ICP]
- Blood products and oxygen [protect remaining brain tissue]
CT and MRI
- Useful to determine extent of brain injury
Treatment
- Glucocorticoid agents [Decrease edema]
- Antibiotics [reduce risk of infection]
- Surgery may be necessary. [Reduction in ICP]
- Blood products and oxygen [protect remaining brain tissue]
98
Spinal Cord Injury
Results from fracture, dislocation of ___________
- Compresses, stretches, or tears spinal cord
- Cervical spine injuries
- May result from hyperextension or hyperflexion of neck with possible fracture
- Dislocation of vertebra
- May crush or compress spinal cord
- Causes injury to spinal cord when great force is applied to top of the skull or to the feet
Results from fracture, dislocation of vertebrae
- Compresses, stretches, or tears spinal cord
- Cervical spine injuries
- May result from hyperextension or hyperflexion of neck with possible fracture
- Dislocation of vertebra
- May crush or compress spinal cord
- Causes injury to spinal cord when great force is applied to top of the skull or to the feet
99
Spinal Cord Injury
Damage may be temporary or permanent.
- _________ regrowth may occur.
- ____________ of nerve tissue by bone fragments
- Usually permanent loss of conduction in affected tracts
-Complete transsection or crushing of cord
- Irreversible loss of all sensory and motor function at and below the level of injury
- Partial transection or crushing
- May allow recovery of some function
Damage may be temporary or permanent.
- Axonal regrowth may occur.
- Laceration of nerve tissue by bone fragments
- Usually permanent loss of conduction in affected tracts
-Complete transsection or crushing of cord
- Irreversible loss of all sensory and motor function at and below the level of injury
- Partial transection or crushing
- May allow recovery of some function
100
Spinal Cord Injury
Bruising ~ ___________ damage
- Prolonged ischemia and necrosis
- Lead to permanent damage
- Release of norepinephrine, serotonin, histamine
-Released by damaged tissue—vasoconstriction
- Assessment using dermatome map
-Assessment of movement and sensory responses
- Can determine the degree of damage or recovery
Bruising ~ Reversible damage
- Prolonged ischemia and necrosis
- Lead to permanent damage
- Release of norepinephrine, serotonin, histamine
-Released by damaged tissue—vasoconstriction
- Assessment using dermatome map
-Assessment of movement and sensory responses
- Can determine the degree of damage or recovery
101
Spinal Cord Injury
Recovery
- Gradual return of reflex activity below level of injury
- No ___________ through specific area of damage
- Hyperreflexia may develop.
- Gradually, extent of damage will be revealed.
- __________ motor activity and sensory impulses are blocked at and below the level of damage.
- Many injuries are incomplete, and permanent damage varies among individuals.
- Gradual return of reflex activity below level of injury
- No impulses through specific area of damage
- Hyperreflexia may develop.
- Gradually, extent of damage will be revealed.
- Voluntary motor activity and sensory impulses are blocked at and below the level of damage.
- Many injuries are incomplete, and permanent damage varies among individuals.
102
Spinal Cord Injury
Tetraplegia (quadriplegia)
- Paralysis of ___________ extremities
Paraplegia
- Paralysis of the ____________ of the trunk and legs
- Ipsilateral paralysis and contralateral loss of pain and temperature sensation
- Depends on the point of decussation and location
Tetraplegia (quadriplegia)
- Paralysis of all four extremities
Paraplegia
- Paralysis of the lower part of the trunk and legs
- Ipsilateral paralysis and contralateral loss of pain and temperature sensation
- Depends on the point of decussation and location
103
Autonomic Dysreflexia
Massive sympathetic reflex response that cannot be controlled from the _______
- Often initiated by infection, genital stimulation, or other stimuli
Leads to:
- Increased blood pressure
- Vasoconstriction below the injury
- Vasodilation above the injury
- Tachycardia
Massive sympathetic reflex response that cannot be controlled from the brain
- Often initiated by infection, genital stimulation, or other stimuli
Leads to:
- Increased blood pressure
- Vasoconstriction below the injury
- Vasodilation above the injury
- Tachycardia
104
Complications of Spinal Cord Injury
- _______________ infections
- Pneumonia
- Skin breakdown
- Spasm and pain
- Depression
Treatment
- _____________ spine.
- Maintain breathing and prevent shock.
- Hospital traction or surgery
-Relieve pressure and repair tissues
- Glucocorticoids
-Reduce edema and stabilize vascular system
- Ongoing care to prevent complications related to immobility
Urinary tract infections
- Pneumonia
- Skin breakdown
- Spasm and pain
- Depression
Treatment
- Immobilize spine.
- Maintain breathing and prevent shock.
- Hospital traction or surgery
-Relieve pressure and repair tissues
- Glucocorticoids
-Reduce edema and stabilize vascular system
- Ongoing care to prevent complications related to immobility
105
Multiple Sclerosis (MS)
Progressive _________________ of neurons in the brain, spinal cord, and cranial nerves
- Different types of MS
- Variation in effects, severity, and progression
- Loss of myelin interferes with conduction of impulses in affected fibers
- May affect motor, sensory, and autonomic fibers
- Occurs in diffuse patches in the nervous system
Progressive demyelination of neurons in the brain, spinal cord, and cranial nerves
- Different types of MS
- Variation in effects, severity, and progression
- Loss of myelin interferes with conduction of impulses in affected fibers
- May affect motor, sensory, and autonomic fibers
- Occurs in diffuse patches in the nervous system
106
Multiple Sclerosis (MS)
Signs and symptoms (some may apply)
- Manifestations determined by areas of demyelination
- __________ vision, weakness in legs
- Diplopia (__________ vision), scotoma (spot in visual field)
- Dysarthria
- Paresthesia, areas of ____________ , burning, tingling
- Progressive weakness and paralysis extending to the upper limbs
- Loss of coordination, bladder, bowel and sexual dysfunction, chronic fatigue
- Manifestations determined by areas of demyelination
- Blurred vision, weakness in legs
- Diplopia (double vision), scotoma (spot in visual field)
- Dysarthria
- Paresthesia, areas of numbness, burning, tingling
- Progressive weakness and paralysis extending to the upper limbs
- Loss of coordination, bladder, bowel and sexual dysfunction, chronic fatigue
107
Multiple Sclerosis (MS)
Diagnostic tests
- No definitive test
- ____ for diagnosis and monitoring
Treatment
- No definitive treatment approved at this time
- Several research trials in progress
- Therapy includes __________ therapy, occupational therapy
- Manifestations require individual attention
Diagnostic tests
- No definitive test
- MRI for diagnosis and monitoring
Treatment
- No definitive treatment approved at this time
- Several research trials in progress
- Therapy includes physical therapy, occupational therapy
- Manifestations require individual attention
108
Parkinson’s Disease
Progressive degenerative disorder
- Dysfunction of the extrapyramidal motor system
- Progressive degeneration in ____________
-Imbalance between excitation and inhibition in ______________
- Excess stimulation affects movement and posture.
- Resting tremors
- Muscular rigidity
- Difficulty initiating movement
- Postural instability
Progressive degenerative disorder
- Dysfunction of the extrapyramidal motor system
- Progressive degeneration in basal nuclei
-Imbalance between excitation and inhibition in basal nuclei
- Excess stimulation affects movement and posture.
- Resting tremors
- Muscular rigidity
- Difficulty initiating movement
- Postural instability
109
Parkinson’s Disease
Early signs and symptoms
- Fatigue
- Muscle weakness, muscle __________,
- Decreased flexibility
- Less spontaneous changes in __________________
- ____________ in the hands at rest, repetitive pill-rolling motions of hands
- Fatigue
- Muscle weakness, muscle aching,
- Decreased flexibility
- Less spontaneous changes in facial expression
- Tremors in the hands at rest, repetitive pill-rolling motions of hands
110
Parkinson’s Disease
Later signs and symptoms
-Tremors affect hands, feet, face, tongue, lips
- Increased muscle rigidity
-Slow/Difficulty initiating movements
- Lack of associated involuntary movements
- Characteristic standing posture is stooped, leaning __________
-Propulsive gait
Other functions affected
-______ voice, devoid of inflection
-Dysarthria
- Chewing and ______________ become difficult.
- Prolonging eating time
- Recurrent drooling
-Face might resemble a mask
-Blinking of eyelids reduced
- Blank, staring face
- Impairs communication
Autonomic dysfunction
- Urinary retention, Constipation
- Orthostatic hypotension
- Threat of falls increases
- Urinary tract and respiratory tract infections are common
-Tremors affect hands, feet, face, tongue, lips
- Increased muscle rigidity
-Slow/Difficulty initiating movements
- Lack of associated involuntary movements
- Characteristic standing posture is stooped, leaning forward
-Propulsive gait
Other functions affected
-Low voice, devoid of inflection
-Dysarthria
- Chewing and swallowing become difficult.
- Prolonging eating time
- Recurrent drooling
-Face might resemble a mask
-Blinking of eyelids reduced
- Blank, staring face
- Impairs communication
Autonomic dysfunction
- Urinary retention, Constipation
- Orthostatic hypotension
- Threat of falls increases
- Urinary tract and respiratory tract infections are common
111
Parkinson’s Disease
Treatment
- Removal of cause, if known
- ____________ replacement therapy
- Levodopa—dopamine precursor
- Anticholinergic drugs
- Speech and language pathologist
- Physical therapy
- Occupational therapy improves balance, coordination
- Monitoring and treatment of respiratory and urinary tract infections
- Removal of cause, if known
- Dopamine replacement therapy
- Levodopa—dopamine precursor
- Anticholinergic drugs
- Speech and language pathologist
- Physical therapy
- Occupational therapy Improves balance, coordination
- Monitoring and treatment of respiratory and urinary tract infections
112
Amyotrophic Lateral Sclerosis (ALS)
Also referred to as _________________ disease
- No identified cause
- _______ on various chromosomes have been linked to the disease.
- Progressive degenerative disease affecting upper motor neurons in the cerebral cortex and lower motor neurons in brainstem and spinal cord
- No indication of inflammation around the nerves
- Cognition unimpaired
Also referred to as Lou Gehrig’s disease
- No identified cause
- Genes on various chromosomes have been linked to the disease.
- Progressive degenerative disease affecting upper motor neurons in the cerebral cortex and lower motor neurons in brainstem and spinal cord
- No indication of inflammation around the nerves
- Cognition unimpaired
113
Amyotrophic Lateral Sclerosis (ALS)
Loss of ____________________ in cerebral cortex
-Spastic paralysis and hyperreflexia
Damage to lower motor neurons
- Flaccid paralysis
- Decreased muscle tone and reflexes
- Progressive muscle weakness and loss of fine motor coordination
- Stumbling and falls are common.
- ________ occurs because of respiratory failure
Loss of upper motor neurons in cerebral cortex
-Spastic paralysis and hyperreflexia
Damage to lower motor neurons
- Flaccid paralysis
- Decreased muscle tone and reflexes
- Progressive muscle weakness and loss of fine motor coordination
- Stumbling and falls are common.
- Death occurs because of respiratory failure
114
Amyotrophic Lateral Sclerosis (ALS)
Treatment
- No specific treatment to slow _____________
- _______ cell therapy under investigation
-Pharmaceutical treatment (e.g., with Riluzole [Rilutek]) to slow further damage to neurons
- Moderate exercise and rest
- Respiratory therapy, appropriate nutrition, speech pathology, occupational therapy, physical therapy, psychological treatment
- No specific treatment to slow degeneration
- Stem cell therapy under investigation
-Pharmaceutical treatment (e.g., with Riluzole [Rilutek]) to slow further damage to neurons
- Moderate exercise and rest
- Respiratory therapy, appropriate nutrition, speech pathology, occupational therapy, physical therapy, psychological treatment
115
Myasthenia Gravis
_______________ disorder
- _____________ to acetylcholine (ACh) receptors form.
- Destruction of receptor site
- Prevention of further muscle stimulation
- Skeletal muscle weakness
- Facial and ocular muscles usually affected first
- NOTE: Dysphagia and aspiration are significant problems!
Autoimmune disorder
- Autoantibodies to acetylcholine (ACh) receptors form.
- Destruction of receptor site
- Prevention of further muscle stimulation
- Skeletal muscle weakness
- Facial and ocular muscles usually affected first
- NOTE: Dysphagia and aspiration are significant problems!
116
Myasthenia Gravis
Diagnostic tests
- Electromyography
- Serum antibody test
Signs and symptoms
-_________ weakness in face and eyes
- ____________ vision, monotone speech
- Difficult chewing and swallowing
- Head droops, arms become weaker
- Upper respiratory infections common
Diagnostic tests
- Electromyography
- Serum antibody test
Signs and symptoms
-Muscle weakness in face and eyes
- Impaired vision, monotone speech
- Difficult chewing and swallowing
- Head droops, arms become weaker
- Upper respiratory infections common
117
Myasthenia Gravis
Treatment
- Anticholinesterase agents; Temporary improvement of neuromuscular transmission
- ______________ ; Suppression of immune system
- Plasmapheresis; Removal of antibodies from the blood
- Thymectomy
- Anticholinesterase agents; Temporary improvement of neuromuscular transmission
- Glucocorticoids; Suppression of immune system
- Plasmapheresis; Removal of antibodies from the blood
- Thymectomy
118
Huntington’s Disease
Inherited disease
- Autosomal dominant gene
- Carried on chromosome ___
- Does not usually manifest until individual is older than _____ years
-Progressive atrophy of _________
- Particularly in basal ganglia (nuclei) and frontal cortex
- Depletion of gamma-aminobutyric acid (GABA) in the basal nuclei
-Levels of ACh in brain appear to be reduced.
- Autosomal dominant gene
- Carried on chromosome 4
- Does not usually manifest until individual is older than 40 years
-Progressive atrophy of brain
- Particularly in basal ganglia (nuclei) and frontal cortex
- Depletion of gamma-aminobutyric acid (GABA) in the basal nuclei
-Levels of ACh in brain appear to be reduced.
119
Huntington’s Disease
Signs and symptoms
-Mood swings, ____________ changes
- Restlessness, choreiform movements in arms and face
Diagnostic tests
- DNA analysis
Treatment
- Currently no therapy to slow progression of disease
- _______________ therapy only
Signs and symptoms
-Mood swings, personality changes
- Restlessness, choreiform movements in arms and face
Diagnostic tests
- DNA analysis
Treatment
- Currently no therapy to slow progression of disease
- Symptomatic therapy only
120
Dementia
Progressive chronic disease
- ___________ function is decreased.
- Impaired ___________ skills
- Impaired thinking, judgment, and learning
-Memory loss
- Confusion
- Behavioral and personality changes
Many causes of dementia
- Vascular disease
- Infections
-Genetic disorders
Progressive chronic disease
- Cortical function is decreased.
- Impaired cognitive skills
- Impaired thinking, judgment, and learning
-Memory loss
- Confusion
- Behavioral and personality changes
Many causes of dementia
- Vascular disease
- Infections
-Genetic disorders
121
Alzheimer’s Disease (AD)
Progressive cortical atrophy
-Neurofibrillary tangles and plagues
- ACh deficit caused by loss of _________
- No definite diagnostic tests available
- Exclusion of other disorders
- Careful medical and psychological history
- Specific cause unknown
- Repetitive DNA sequences on different chromosomes have been associated with AD.
Progressive cortical atrophy
-Neurofibrillary tangles and plagues
- ACh deficit caused by loss of neurons
- No definite diagnostic tests available
- Exclusion of other disorders
- Careful medical and psychological history
- Specific cause unknown
- Repetitive DNA sequences on different chromosomes have been associated with AD.
122
Alzheimer’s Disease (AD)
Signs and symptoms
- Extend over 10 to 20 years
- Irritability, hostility, mood swings
- Gradual loss of __________ and lack of concentration
- Impaired ___________ , poor judgment
-Decline of cognitive function, memory, language
- Change in ______ intake
- Inability to recognize family, lack of environmental awareness, incontinence
- Extend over 10 to 20 years
- Irritability, hostility, mood swings
- Gradual loss of memory and lack of concentration
- Impaired learning, poor judgment
-Decline of cognitive function, memory, language
- Change in food intake
- Inability to recognize family, lack of environmental awareness, incontinence
123
Alzheimer’s Disease (AD)
Treatment
- No specific treatment
- __________________ drugs; some temporary improvement
- Occupational therapy, psychologists, speech therapy
- Team approach needed to support client and caregivers
- No specific treatment
- Anticholinesterase drugs; Some temporary improvement
- Occupational therapy, psychologists, speech therapy
- Team approach needed to support client and caregivers
124
Vascular dementia
- Caused by _____________ disease
- Often a result of multiple small brain infarctions
-Common in persons older than ____ years; Especially in those with hypertension
- Onset insidious
-Memory loss, apathy, inability to manage daily routines
- Progression may be in stages.
- Other neurologic impairment is common.
- Caused by cerebrovascular disease
- Often a result of multiple small brain infarctions
-Common in persons older than 70 years; Especially in those with hypertension
- Onset insidious
-Memory loss, apathy, inability to manage daily routines
- Progression may be in stages.
- Other neurologic impairment is common.
125
Creutzfeldt-Jacob disease (CJD)
- Rare, rapidly progressive
- Caused by ________ ingested or transmitted through contaminated blood
- May be iatrogenic
- Invasive procedures, surgery (e.g., corneal transplantation) transfer prions
- Most sporadic
- Long incubation period
- Memory loss, behavioral changes, motor dysfunction, progressive dementia
- Rare, rapidly progressive
- Caused by prion ingested or transmitted through contaminated blood
- May be iatrogenic
- Invasive procedures, surgery (e.g., corneal transplantation) transfer prions
- Most sporadic
- Long incubation period
- Memory loss, behavioral changes, motor dysfunction, progressive dementia
