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patho exam 4

Terms in this set (110)

hydrocephalus is caused by
blockage in flow of the CSF through ventricles of the brain or when can it be reabsorbed by arachnoid villi causing too much fluid in the brain
hydrocephalus is caused by: (summarized)
lesions that obstruct flow of CSF & problems with resorption
highly lipophilic substances cross blood-brain barrier:
cross directly
most nutrients cross blood-brain barrier by:
facilitated diffusion (active transport/ATP)
water cross blood-brain barrier by:
simple diffusion
with cerebral blood flow, arteries respond to:
pH, carbon dioxide, & oxygen
increased BP =
constricted cerebral capillaries
Decrease BP =
dilated cerebral capillaries
cerebral autoregulation is
A mechanism that maintains steady flow of blood to the brain and spinal cord
Decreased PaCo2 levels =
constrict cerebral vessels
Increased PaCo2 levels rise =
dilated cerebral vessels
autoregulatory mechanisms fail because:
loss of match between oxygen supply and demand of tissues
Intracranial Pressure (ICP) is
pressure exerted by contents of cranium
Monro-Kellie hypothesis is
compensatory relationship maintaining cerebral compliance in response to changes in volume (the body trying to correct itself)
hydrocephalus is
excessive accumulation of CSF in cranial vault, compressing surrounding structures
Transient Ischemic Attack (TIA) is
a temporary episode of neurological dysfunction
TIA is caused by
focal brain, spinal cord, or retinal ischemia without infarction. From a clot blocking blood supply to region of brain or atherosclerosis
TIA: FAST stands for?
- Facial drooping
- Arm or leg weakness on one side of body
- Speech difficulty
- Time; what is the time frame
A stroke is
interruption in blood supply to region of the brain or bleeding of vessel resulting in brain tissue damage or infarction
an Ischemic stroke is
partial or complete occlusion of cerebral blood flow due to thrombus or embolus
a Hemorrhagic stroke is
bleed into the brain from a. burst blood vessel
hemorrhagic stroke causes
-intracerebral/intraventricular/extracerebral burst
-subarachnoid hemorrhage
-cerebral aneurysm
-arteriovenous malformation (AVMs)
tx for ischemic stroke
-Restore blood flow & reduce area of infarction (penumbra: tissue surrounding infarction)
-Supplemental oxygen
-Glycemic control
-Fibrinolytic therapy
-Antihypertensive therapy
-Aspirin 325mg
-Hypothermia
Tx for hemorrhagic strok
-Osmotic diuretics (drain excess fluid)
-Surgical evacuation
-Craniotomy with aneurysm clipping
-Endovascular therapy with coil embolization
-Delayed cerebral ischemia (DCI)
subdural hematoma is
bleeding from bridging veins between dura mater and arachnoid membrane
subdural hematoma is caused by
trauma from high-speed impact to skull, causing a leak or burst
acute subdural hematoma
bleeding identified immediately after an injury
chronic subdural hematoma
brain atrophy, mostly from re-injury
subdural hematoma can cause _________ depending on the area of the brain
seizure
tx for subdural hematoma
surgery ("burr hole", bone flap), releasing pressure & letting the brain heal
cognition
way in which people acquire, store, learn, use, communicate information
development
-ability to adapt to environment
-behavioral aspects of growth
neurocognitive disorders (NCDs)
Primary features are cognitive impairments; mild or major
neurodevelopmental disorders
impairments of brain function occurring as brain develops. (language, coordination, attention, behavior)
conditions that impairs cerebral perfusion:
-cerebral edema or stroke (CVA)
-spasms or compression of cerebral vessels
-hypotension
-shock
decreased oxygen causes::
-Respiratory acidosis
-Hypoxia & hypoxemia
fluid & electrolyte balance causes
change in mental status, memory, attention
alteration in normal glucose supply or excess or deficiency of other metabolic products causes:
- hallucinations
- changes in consciousness
what's cusss an inflammatory response and the release of cytokines
-stress
-infection
-surgery
-cancer
chronic or persistent inflammation causes
-irreversible neuronal changes
-alzheimer's disease
-schizophrenia
psychosis is
an abnormal thought processes that interfere significantly with perceptions of reality (hallucinations, delirium)
pysychosis is associated with
underlying illness or substance use
mean duration of untreated psychosis (DUP)
364-721 days due to less resources for mental health
delirium is
-an acute disturbance in cognition with rapid onset
-lasting hours to days
- acute confusion, mood swings, delusions, hallucinations
delirium is caused by
illness (infection: uti) or injury
-substance use, overdose, or withdrawal
Delirium clinical manifestations
-acute confusion
-inattention
-perceptual disturbances (sight, hearing, spacial reasoning)
-alternating between hyperactive and hypoactive states (bipolar)
delirium tx
-fluid & nutrition (electrolyte disturbance)
-alcohol withdrawal: multivitamins (thiamine;antidote)
- reorientation techniques or memory cues
-stable, quiet, well-lit environment
-sensory deficits should be corrected (reorientate)
- physical restraint: AVOIDED
-constant observation
dementia is
-a chronic (persistent) disorder of the mental processes
-memory disorders, personality changes, impaired reasoning
Dementia Clinical Manifestations
-slow, progressive onset with impairments in abstract thinking and memory loss
-eventually will be unable to care for self or communicate
dementia is caused by
brain disease (AD & vascular dementia ) or injury
dementia tx
-regular monitoring of health & cognitive status
-reinforcing orientation to person, place, time
-encouraging establishment of advance directives
-providing pharmacologic interventions (will only delay)
Autism Spectrum Disorder (ASD) is
restricted & repetitive patterns of behavior; not explained by another medical or psychiatric diagnosis
asperger syndrome
is least invasive disorder of ASD, lacking the ability with social ques
ASD characteristic cognitive impairments: theory of mind
social understanding ability
ASD characteristic cognitive impairments: executive function
flexibility of thought (routine is important)
ASD characteristic cognitive impairments: weak central coherence
tendency toward piecemeal processing "tunnel thought/mind"
ASD clinical manifestations
-series of deficits in social interaction and communication
-restricted, repetitive, stereotyped behavior patterns
-anxiety disorders
Down Syndrome (DS) is
- chromosomal disorder (3 chromosome 21s) associated with intellectual disability & other serious morbidity
- causing total intracranial volume to be smaller, especially cerebellum, brainstem (intellectual disability), frontal lobes
chronic degenerative neurological disorders..
most are labeled movement disorders but are typically multisystem disorders
common movement disorders: (4 total)
-parkinson's disease
-multiple sclerosis
-amyotrophic lateral sclerosis
-huntington disease
musculoskeletal system
-supports body weight, controls movements, provides stability
-work with circulatory & nervous systems (ex. skeletal muscle pumps, getting blood back up)
Parkinson's disease (PD) is
-idiopathic, chronic, progressive degenerative manifestation disorder of CNS
-has motor, nonmotor, neuropsychiatric manifestations
PD symptoms
-tremors
-bradykinesia
-rigidity
-postural instability
proteolytic stress of PD
- accumulation and aggregation of proteins
-Lewy bodies (shown on MRI)
decrease risk of PD
-cigarette smoking, caffeine intake
-high blood urate levels
oxidative stress of PD
- generation of reactive oxygen species (ROS)
-depletion of glutathione; increase in iron levels
mitochondrial dysfunction of PD
decrease mitochondrial complex activity (by 30-40%) (ATP converting energy)
inflammation of PD
-overactivation of microglia
-excess production of neurotoxic factors
motor function hindered by
-injuries
-infections
-disease processes
fractures are
a break in a bone resulting from an increase in energy beyond what bone can tolerate
other causes of fractures
-compression (spine)
-torsion (twisting)
-pathological condition (ex. osteoporosis)
what helps with creatinine of the bone? (3)
-vitamin D
-calcium
-phosphorus
Fracture clinical manifestations
-pain
-deformity, edema, numbness (nerve entrapment)
-muscle spasms, skin bruising
-hypovolemia, crepitus (crackle noise)
inflammatory stage of healing
-bleeding causes hematoma
inflammatory cells degrade debris and bacteria
Reparative Stage of Fracture Healing
-fibrocartilage formed
-soft callus join fracture bone
-hard callus develops
-blood vessels form
remodeling stage of fracture healing
lamellar bone replaces woven bone
union
normal healing
nonunion
no progress towards complete healing for at least 3 months according to x-ray
delayed union
significantly longer than expected healing time
malunion
bone fragments joined in position not anatomically correct
direct healing is
use of surgical procedures to realign bone
external fixation
pins are inserted through the skin with a rod holding the pins in place
internal fixation
a fracture treatment in which a plate or pins are placed directly into the bone to hold the broken pieces in place
closed reduction
nonsurgical realignment of broken bone ends and splinting of bone
open reduction
surgical realignment of broken bone ends
common agents for infection of fractures
-Pseudomonas
-Staphylococcus
-Clostridium
those at increased risk for infection with fractures
-Greater soft tissue damage
-Compromised immune system
tx for an infected fracture
-antibiotics
-Proper hygiene of infected site
compartment syndrome is
edema and swelling cause increased pressure in muscle compartment
compartment syndrome causes
-decreased blood flow & oxygen
-possible muscle & nerve damage
-cycle of continually increasing pressure in limb
-ischemic may cause muscles and nerves to die (may need amputation)
compartment syndrome is most common in
the lower leg and forearm
prevention of compartment syndrome
elevation and ice
complications of compartment syndrome
-paralysis
-need for amputation
-volkmann contracture (deformity)
fracture blisters are
-tense vesicles or bullae arising swollen skin directly overlaying fracture
-contains sterile fluid that can contribute to infection
Fat embolism syndrome
•Closed long bone or pelvic fractures
•Fat emboli becomes trapped in pulmonary and dermal capillaries
•No symptoms in most patients
•Large amounts of fat released may cause fat embolism
tx for Fat embolism syndrome
-oxygen administration
-mechanical ventilation
-prophylactic tx with corticosteroids & early immobilization of injury
dislocation is
-ends of bones moved out of normal position
-attachment to join lost
dislocation tx
-Manual traction (closed reduction)
-Open reduction (surgery)
-Closed reduction and short-term immobilization
- Bedrest after closed reduction (depending on location, ex hip)
carpal tunnel syndrome is
nerve entrapment
nerve entrapment is
neuropathy causing nerve damage & muscle weakness or atrophy
carpal tunnel syndrome is most prone to
where nerves pass over rigid areas or through narrow canals
carpal tunnel syndrome is caused by
repetitive motion injury; ex. typing
Clinical Manifestations of carpal tunnel syndrome
- Numbness and tingling of thumb, index finger, and lateral ventral surface of middle finger
- Hand weakness
diagnosis for carpal tunnel syndrome
- Tinsel test
- Phalen maneuver
- Nerve conduction studies with ultrasound
a strain is
overstretching injury to muscle or muscle-tendon unit
a sprain is
ligament around joint stretched or torn
Sprains manifestations
"pop" or "rip" when injury occurs
tx for strains and sprains
RICE & NSAIDs
Osteoporosis is
A bone infection that occurs after penetrating wound, from blood infection, skin breakdown
bone infection caused by
-bacteria, fungi, parasites, viruses
-infection from another body area carried to bone
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