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Patho: Focus3-Neurologic

Terms in this set (61)

sympathetic nervous system
Fight or flight response
- Liver releases glucose
-Bronchodilation, HTN
-Uterus relaxes, bladder relaxes
-Tachycardia
-Decreased peristalsis and secreations
B
parasympathetic nervous system
Rest and digest / Breed and feed response
-Hypotension, bradycardia
-Liver releases bile
-Increased GI peristalsis and secretion
-Bladder contracts, ureter
Normal response in Oculomotor and oculovestibular reflexes
-Eye lag behind when head turned quickly
-Eyes move to side that h2O was injected into ear
Indicate brainstem is intact.
Abnormal response in oculomotor and oculovestibular reflexes
-Dysconjugate eye movement/ eyes moving in different directions from each other that indicating mild injury to the brainstem.
absent response in oculomotor
-No eye movement indicates severe injury to brainstem.
Decorticate posturing
Indicates damage to the cerebral hemisphere but not the brainstem. The elbows are flexed and arms are o the chest ( hugging the core).
Decerebrate posturing
Indicates damage to the cerebral hemisphere and brainstem. The elbows are extended and arms are at the pt's side.
An epidural hematoma is located between the:
dura mater and the skull
-Ipsilateral pupil dilation (on same side as hematoma), severe headache, LOC followed by a period of alerness, confusion, contralateral hemiparesis (weakness arms and legs on opposite side), and trauma to right temporal area.
Meningitis
-fever, petechial rash (red dots), severe headache, photophobia, stiff neck, positive Brudzinki sign (lift the head up cause the leg come up and fall down), nuchal igidity, positive kernig sign (neck/back pain if bring the leg/knee up), decreased LOC, hemiparesis, hemiplegia, and tachycardia.
ICP- Stage 1
Cerebrospinal fluid and blood forced out of cranial vault, pupils, BP, HR, RR, are normal.
ICP- Stage 2
symptoms are transcient (come and go) and subtle. symptoms: confusion, restlessness, drowsiness, BP starts to increase, slight decrease in RR, and pupils normal side with slightly sluggish pupillary response.
ICP- Stage 3
hypoxia, hypercapnia (increased CO2), acidosis occur. Widened pulse pressure (difference b/w systolic and distolic pressure increases) and bradycardia occur.
ICP- Stage 4
Ispilateral (same side) pupil dilation followed by bilateral pupil dilation
Autonomic Dysreflexia
Pt w/spinal cord injuries (T6) or above.
Conditions: a Full bladder, Full bowel, or Skin breakdown, vasoconstriction=severe headache/ sympathetic. Vasodilation=decrease bp and HR
Elevating HOB to prevent stroke and lower BP
Right sensory cortex (Damage the brain from Stroke)
Numbness of the face, arm, leg on the left side.
left motor cortex
Weakness on the face, arm, or leg on the right side.
Loft occipital lobe
Loss of balance in right half of both eyes
Cerebellum
Loss of balance and coordination and prob of this area causes dizziness as well.
Broca's area
Controls language-slow poorly articulated speech
Wernicke's area
poor comprehension of speech and rambling speech
Bleeding into brain
sudden severe headache with no known cause
Embolic Stroke (Ischemic/brain tissue dies b/c not getting enough O2)
-blood clot from the heart travels to the brain
-blood clot or mass originating outside to the brain
-bits of cholesterol travel to the brain
Thrombotic Stroke (ischemic)
-Blood clot or mass originating in a cerebral vessel
-Cholesterol builds up in a cerebral vessel and stuck
-Blood clot forms when a cholesterol plague ruptures in a cerebral vessel. (completely)
Watershed Stroke
Hypoperfusion= low blood flow into the brain
Hemorrhagic stroke
The rupture or broken of a cerebral vessel and can results from long-standing Hypertension in an Aneurysm and an Arteriovenous malform.
hemorrhagic (blood vessel is burst) stroke
causes Decreased blood flow tow the blood vessels downstream, Increased ICP, and Decreased blood flow due to vasospasm of normal blood vessels
Thrombolic stroke treatment
-Aspirin (prevent a new clot)
-MERCI retriever (mechanical embolus removal in cerebral ischemia)-
-Suction removal of clot
-Tissue plasminogen activator (TPA)- breaks up the clot
Hemorrhagic stroke treatment
Stop the bleeding:
-Antihypertensive medi
-Antiseizure medi
-Aneurysm clipping
-Coil emloliztion
-Stop aspirin and warfarin
_Elevate HOB
Signs of PD
1) Tremor: Involuntary shaking and occurs at rest + stop
2) Bradykinesia: Slow movements, shuffling gait, freezin
3) Rigidity: Stiff muscle, Jerky movements, Moves like cogwheel, Stooped posture, and decreased facial expression.
4) Postural instability: Unbalanced and Can cause loss of ability to walk.
PD
-First symptom may be loss of smell
-Cause mood changes: depression, apathy, anxiety, and panic (disease getting progressive)
-Cause difficult sleeping-getting to sleep and staying asleep
- Damage ANS- Cause constipation, lightheadedness, and sweating (temp)
-Trouble with multitasking
-Forgetfulness progressing to dementia
Treated w/medi to increase dopamine
AD
-Beta -amyloid plagues present b/w the neurons
-Tau protein tangles present w/in the neuron
-Cause memory loss, prob w/thinkin and planning, difficulty w/speech and communication, and loss of sense of their body is.
-Prevention can include learning new language and getting adequate sleep q night, exercise, diet.
Treated w/medi that increase ACEtycholine levels and decrease glutamate levels.
Affected in the temporal lobe.
Multiple Sclerosis (MS)
Symptoms come and go as the T-cell (autoimmune disease) attack and destruction of the myelin sheath on neurons in the CNS, and its replacement by plaques of sclerotic (hard) tissue.
Risk factors of MS
-Living away from the equator causing > exposure to sunlight.
-Low Vitamin D which helps to regulate the immune response.
-Exposure to viruses such as Epstein-Barr, measles, mumps, herpes
-Smoking causes progression disease and risk of MS
Symptoms of MS
- Vison is the 1St ones: Blurry vision, Washed out colors, ad double vision.
-Pain with eye movement (twitching or quickly moving vertical/horizontal).
-Talking and swallowing become impaired.
-Paresthesias in arms (pins and needles feeling), Muscle spasticity, Weakness in arms along with numbness.
_Bowel/Bladder control problem
-Memory loss, inability thinking, attention or solvi probl
Treatments of MS
Medications: -Decrease the immune attack on the brain
-Stop T-cells from crossing the blood brain barrier
-PT for m. spasticity or weakness
-Cognitive rehabilitation: Perform mental tasks
What is relapsing-remitting MS?
Symptoms Increase (relapse) in severity, then Decrease (remission) in severity, the Plateau. The immune syts. is not attacking the brain during remissions and plateau period.
What is the Secondary progressive MS?
Symptoms progressively get worse after pt. having Relapses and Remissions.
what is the Primary progressive MS?
Pt. never has had Relapses or Remissions from the beginning, the symptoms progressively get worse.
Progressive Relapsing MS?
Symptoms Increase (relapse) in severity, the Decrease (remission), but don't plateau, they get progressively worse as relapse and remission occur.
Focus 4: Endocrine
Growth Hormone (GH)
What is Giantism? What causes it?
-The skeletal bones haven't stopped growing and the child may reach 8 or 9 feet.
-Increasing in GH ac puberty.
What is Acromegaly?
-Increasing GH after qc puberty. The skeletal bone have Stopped growing and certain bony and CT grow.
+ Forehead enlarges (Frontal bossing)
+ Jaw enlarges (Macrognathia)
+ Tongue enlarges (Macroglossia)
+ Hands and feet enlarge
Dwarfism
-Decreased in GH ac puberty and causes with short statue and the head, trunk, and limbs in proportion.
What is manifestations occur with SIADH?
Holding onto a lot of H2O.
+ The Blood/Serum is going to HypoOsmo/dilute blood
+ Urine is gonna HyperOsmo/ concentrated Urine.
+High specific gravity
+Hyponatremia: confusion, lethargy, seizure
What causes diabetes insipidus?
Decreased secretion of ADH from the posterior pituitary gland or inadequate response of the kidney to normal amounts of ADH. Signs: polyuria and polydipsia of both diabetes insipidus and DM.
Diabetes Insipidus
+Serum hyperOsmo (concentrated blood)
+Urine hypoOsmo (dilute urine)
+Low specific gravity
+Hypernatremia
+Blood Na increase b/c fluid loss Na
thyroid gland (TH)
Produces hormones that regulate metabolism, body heat, and bone growth. The hypothalamus sends TRH to anterior Pit releases TSH to secrete T3 and T4/ TH
What does negative feedback mean in relation to thyroid hormone?
Signal sends back to TRH to anterior Pit. to stop secreted T3 and T4.
Hypothyroidism
Decreased basal metabolic rate-decreased metabolism, hypotension, bradycardia, weight gain, constipation, cold intolerance, goiter
Hyperthyroidism
Increased basal metabolic rate-increased metabolism, hypertension, tachycardia, weight loss, diarrhea, heat intolerance (low T).
S/S: Graves disease, protrusion eye ball, exophthalmos, goiter.
Parathyroid hormones (PTH)
+ Regulate blood Ca++ level and locate in the back of thyroid glands.
Hyperparathyroidism
+PHT is high causes Ca++ is high
S/S:
-Bone fractures (Ca+ pulls from bone)
-Kidney stones, weakness, confusion, loss appetite/ anorexia, abd pain and m. pain
-Hypercalcemia and Hypo-HPO4
Hypoparathyroidism
PTH levels are reduced and the condition of hypocalcemia and HyperHPO4 occur.
S/S: - Tetany/ m. spasm.
-Paresthesias: burning/ tingling of hands, feet, lips, and tongue.
-Chvostek sign
-Trousseau sign
-Hypocalcemia and hyperphosphatemia.
Adreanal glands
Is outside and on top of kidney. Secretes:
-cortisol, aldosterone, and sex hormones are called Corticosteroids.
Cushing disease
Cushing disease is excess glucocorticoid and mineralocorticoid (aldosterone) which affects carb, fat, and protein metabolism. It also effects carbohydrate and metabolism causes the blood glucose to elevate.
S/S: Buffalo hump, Moon face, Hyperglycemia, Central obesity, Purple striae, Increased cortisol and aldosterone, K+ loss/ hypokalemia, Na+ and H2O retention caused HTN, Suppression of the immune system. Metabolic alkalosis
Addion's disease
a condition that occurs when the adrenal glandes do not produce enough cortisol=hypoglycemia (carbo metabolism) or aldosterone = Na and H20 loss with lower BP
S/S: - Hyperkalemia, Hypoglycemia, inability handle stress, hypotension, K+ retention, decreased cortisol ad aldosterol.
Type I DM
-Destruction of the beta-cells of the pancreas
-Polydipsia, polyuria
-Not producing insulin
-Lethargy and fatigue
_Wt. loss
-Autoimmune process
Type 2 DM
Insulin resistance - consistently high blood glucose levels cause cells to become resistant to insulin
-Risk factor advancing age
Risk factor of HTN
Increased insulin secretion by the pancreas
Cells not responding to insulin
Risk factor of obesity
Hyperosmolar hyperglycemia nonketotic syndrome (type2)
-Hypokalemia
-No keystones in urine
-Hypovolemia
-Hyponatremia
-Polyuria, Polydipsia
-Glucose in urine
-Hyperglycemia
Diabetic Ketoacidosis (DKA/type1)
-Polydipsia, Poplyuria
-Glucose in urine
-Kussmaul repirations
-Hyperglycemia
-Hyponatremia
-Hyvolemia
_ Keystones in urine
-Fruit breath
-Acidosis
The clinical manifestation with the complications of DM
-Gastroparesis from diabetes neuropathy= Heartburn and constipation.
-Diabetic neuropathy= No chest pain when having a heart attack.
-D. Neuropathy= numbness or pins and needles feeling in the hands or feet.
-D. Nephropathy= Protein in urine and RF
-D. Retinopathy= Blindness.
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