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patho ch 10
altered neuro function
| Question | Answer |
|---|---|
| component of neuron | cell body dendrites axon |
| types of functional neurons | sensory (afferent) motor (efferent) interneuron |
| afferent neurons | sensory neurons |
| efferent neurons | motor neurons |
| myelin sheathe | increase nerve impulse speeds nodes of ranvier between each sheathe |
| neuroglia | neural support cell provide nutrition, support, maintain homeostasis, form myelin |
| membrane potential of neurons | electrical event traveling down entire neuron for communication |
| component of membrane potential | - resting membrane potential - depolarizing phase - repolarization phase |
| resting membrane potential | potential inside plasma membrane (tension state) |
| depolarization | rapid movement of Na into cell generation of electrical impulse transmitted along axon to release neurotransmitters |
| repolarization | K leaves the cell and return to resting membrane potential |
| neural communication | electrical vs chemical synapse flow of information across synapse |
| nerve synapse structures | presynaptic terminal synaptic cleft postsynaptic membrane |
| presynaptic terminal | packaging center for neurotransmitters release into synaptic cleft |
| acetylcholine (ACh) | drive voluntary muscle movement binds nicotinic (Nm) receptors |
| neurotransmitters | chemical messengers to carry messages from neuron to target cell target can be nerve/muscle/gland |
| what drives ACh release | action potentials opening voltage gated Ca2+ channel |
| nicotinic receptors | receptors on neuromuscular junction that open cation channel and trigger muscle action potential/contraction |
| acetylcholinesterase | breaks down ACh into choline for reuptake and resynthesis |
| muscarinic receptors | mediate parasympathetic effects in organs ie. heart, smooth muscle, glands |
| types of nerve injury | chromatolysis atrophy neuronophagia intraneural inclusions |
| responses to neural injury | astrogliosis microglial nodules axonal degeneration axonal regeneration neuropathy demyelination |
| chromatolysis | swelling of neuron d/t injury |
| neuron atrophy | decrease in neuron size |
| neuronophagia | phagocytosis and inflammatory response caused by dead neuron damaging neighboring cells |
| intraneural inclusions | distinctive structures formed in the nucleus or cytoplasm |
| developmental considerations of embryo (neuron) | neural tube development |
| developmental considerations of newborn (neuron) | all needed neurons are present for life functions |
| developmental considerations of 2 year old (neuron) | brain is 80% of adult size |
| developmental considerations of aging (neuron) | decrease in number of nuerons enlargement of ventricle system widening of sulci decreased brain volume/weight sensory changes |
| mechanisms of neural injury | traumatic ischemic excitation (ie PTSD) pressure |
| nervous system functions | - control skeletal movement + involuntary muscle (cardiac/smooth) - reception/integration/perception of sensory information - provide foundation necessary for intelligence, anticipation and judgement - adjusting to external environment |
| CNS consists of | brain spinal cord |
| brain energy requirements | 15% of cardiac output 20% O2 consumption O2 and glucose requirement |
| brain is vulnerable after | 5 minutes of anaerobic environment lack of glucose |
| cerebral perfusion pressure | MAP - ICP = CPP MAP should be above 65 for adequate brain perfusion ICP should be around 5-10 mmHg |
| circle of willis | where blood flows thru into the brain, supplied by vertebral/carotid arteries and drained by jugular veins |
| corpus callosum | brain structure connecting 2 hemispheres together |
| 4 lobes of brain | frontal, temporal, parietal, occipital |
| 2 hemispheres | left/right hemispheres connected by corpus callosum R hemisphere controls left side of body L hemisphere controls right side of body |
| frontal lobe function | reasoning, speech, planning |
| parietal lobe function | conscious perception of touch, pressure, pain SENSORY |
| temporal lobe function | conscious perception of auditory/olfactory stimuli |
| occipital lobe function | vision interpretation |
| blood brain barrier | - network of blood vessel/tissue with selective permeability - H2O, CO2, anesthetics, water blocks pathogens |
| CSF | fluid sitting between meninges function as cushion and reduce pressure removal of harmful substance |
| spinal cord anatomy | gray/white matter ventral and dorsal horns |
| ventral horns (spinal cord) | anterior extension of gray matter efferent motor neurons leaving cord |
| dorsal horns (spinal cord) | posterior extensions of gray matter sensory neurons receiving afferent impulses |
| gray matter (spinal cord) | butterfly/H-shaped appearance in spinal cord containing sensory neurons (afferent impulse from dorsal horns) |
| white matter (spinal cord) | myelinated axons/dendrites ascending sensory and descending motor tracts |
| spinal nerves | peripheral nerves carrying info to and from spinal cord 31 pairs efferent/afferent neurons |
| how many spinal nerves in the cervical/thoracic/sacral/coccygeal | 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal |
| PNS | somatic vs autonomic nervous system |
| somatic nervous system | sensation and voluntary motor actions (body position/pain/temp/touch) somatic sensory fibers/motor fibers |
| autonomic nervous system | involuntary functions (HR/BP/RR/digestion/arousal) visceral motor/sensory sympathetic vs parasympathetic |
| sympathetic division | autonomic nervous system "fight or flight" and vital function maintenance |
| parasympathetic division | autonomic nervous system "rest + digest" -- energy conservation and resource replenishment |
| dermatomes | pathways for spinal nerves to transmit impulses |
| preganglionic neurons | axon fibers extending from cell bodies in brain/spinal cord projects to autonomic ganglion |
| autonomic ganglion | group of nerve cell bodies projecting from preganglionic neurons |
| postganglionic neuron | fibers projecting from autonomic ganglion to target organ |
| nerve fiber lengths in SNS | preganglionic neurons = short fiber synapsing outside spinal cord postganglionic = long fibers end at target organ |
| sympathetic nervous system spinal nerve exit | T1 and L2 exit |
| nerve fiber lengths in | preganglionic = long post ganglionic = short |
| parasympathetic nervous system spinal nerve exit | cranial nerves between midbrain/medulla spinal nerves between S2 and S4 |
| cerebral palsy pathophysiology | upper motor neuron damage during antenatal or postnatal periods |
| types of cerebral palsy | spastic (hemiplegia/diplegia/quadriplegia) athetoid/dyskenetic ataxic |
| athetoid/dyskinetic cerebral palsy | inability to control muscle movement |
| ataxic cerebral palsy | inability to control balance/coordination |
| spastic cerebral palsy | inability to relax muscles hemiplegia vs diplegia vs quadriplegia |
| hemiplegia | hemi meaning half (think hemisphere) 1 arm and leg on same side |
| diplegia | involving both legs |
| quadriplegia | quad meaning 4 all 4 extremities + trunk and neck muscles |
| clinical manifestations of cerebral palsy | limited fine motors skill coordination/balance deficit impaired cognitive function speech disorder seizure disorder |
| dx for cerebral palsy | history physical exam w/ neuro exam + developmental milestones dx of exclusion |
| tx for cerebral palsy | antiepileptics (lamotrigine, valproate) antispasmodics (baclofen, botox) assistive devices to help with ADLs |
| multiple sclerosis pathophysiology | autoimmune dz causing demyelination of axons progressive CNS vs PNS involvement -- mainly CNS involvement |
| causes of MS | genetics (autoimmune) environmental (sunlight/vit D) regional variation (north of 40 dg latitude) trigger event |
| primary vs secondary progressive multiple sclerosis | primary = slow/chronic deterioration w/ plateaus (no remission/exacerbations) secondary = flareups progressing into primary progressive |
| MS exacerbations | periods of demyelinating events of minimum 24h w/o fever or infection |
| relapsing-remitting multiple sclerosis | periods of acute neuro symptoms w/ FLAREUPS and EXACERBATION but with periods of relief |
| clinically isolated syndrome | initial presentations of symptoms (in MS) |
| clinical manifestations of MS | unilateral vision loss cognitive loss bowel/bladder dysfunction altered gait/balance paresthesia fatigue |
| dx of MS | H/P of clinical manifestations McDonalds Criteria MRI imaging (plaques/scarring in CNS) lumbar puncture/CSF analysis |
| tx of MS | symptom management + slow down progression DMT treatment (pharmacologic - Ocrevus/Kesimpta) balanced rest/activity + assistive devices |
| McDonald's Criteria | diagnostic criteria for MS; requires imaging confirmation of lesions in the CNS for Dx |
| DMT treatment is | disease modifying treatments |
| hydrocephalus pathophysiology | increased ventricular CSF accumulation CSF imbalance in production and absorption ventricular enlargement + ICP |
| hydrocephalus classifications | noncommunicating communicating congenital acquired |
| noncommunicating hydrocephalus | CSF flow obstruction |
| communicating hydrocephalus | impaired CSF absorption |
| congenital hydrocephalus | d/t neural tube defect ie spina bifida |
| acquired hydrocephalus | 2/2 other disease process eg. meningitis, intraventricular hemorrhage, brain tumor |
| hydrocephalus clinical manifestatiosn | ICP = increased BP and abnormal HR, headache, vomiting, decreased level of consciousness, papilledema |
| age dependent clinical manifestations of hydrocephalus (infants) | enlarged head with bulging fontanel scalp vein distension feeding difficulties high/shrill cry |
| age dependent clinical manifestations of hydrocephalus (older children/adults) | impaired cognitive/motor fn incontinence |
| dx criteria of hydrocephalus | head circumference transillumination CT/MRI - ventricle size and CSF flow |
| transillumination | shining light against head to see fluid accumulation |
| tx for communicating/noncommunicating hydrocephalus | VP/VA shunt to drain CSF with 1 way valve infection/blockage/malfunction risks |
| tx for obstructive noncommunicating hydrocephalus | endoscopic 3rd ventriculostomy = opening in 3rd ventricle -> CSF into subarachnoid spaces/basal cisterns for absorption |
| SCI | spinal cord injury |
| SCI pathophysiology | - altered neuronal transmission d/t partial/complete tear in spinal cord - nerve root/myelinated tract damage => impaired transduction of afferent/efferent neural impulse |
| SCI classifications | complete transection partial transection - central cord syndrome - anterior cord syndrome - brown-sequard syndrome |
| central cord syndrome | hyperextension injury - motor deficit in UE; bladder dysfunction of variable severity |
| anterior cord syndrome | anterior spinal artery occlusion/bone fragments loss of motor function/temperature/pain below injury loss of sensation (touch/pressure/vibration/position) |
| brown sequard syndrome | SCI hemisection of anterior/posterior cord d/t stabbing/gunshot injury ipsilateral complete/partial paralysis loss of touch/pressure/vibration/positional sense loss of temperature sensations contralaterally |
| what can cause SCI | ischemia hemorrhage necrosis traumatic injury |
| SCI dx criteria | Physical exam - cognitive/motor/sensory function eval CT/MRI evaluation |
| bodily functions affected by SCI | spinal reflex ventilation/communication ANS/sensorimotor function temp/pain perception edema/DVT bladder/bowel sexual |
| incomplete spinal cord transection tx | spine immobilization (traction) surgery - correct fracture/decompress SC promotion of functional abilities |
| nursing management for SCI | DVT prophylaxis (long periods of immobilization esp in paralysis) skin/pressure injury prevention bowel regimens manage skeletal muscle spasm |
| spinal traction is | use of C collar (collar for the spine for immobilization) |
| parkinson disease pathophysiology | degeneration of pigmented dopaminergic neurons of basal ganglia impaired dopamine transport Lewy bodies (protein) nigrostriatal pathway degeneration = reduction in dopamine |
| nigrostriatal pathway | B/L dopaminergic pathway connecting substantia nigra in midbrain to dorsal striatum in forebrain |
| lewy bodies | protein aggregations of protein located primarily in cells in substantia nigra |
| 4 primary parkinson's manifestations | tremor rigidity (jerky movement/flat affect) bradykinesia postural instability |
| bradykinesia | slowing of movements, can progress to akinesia (inability to move in PD) |
| dx criteria for parkinsons | H+P Hoehn/Yahr scale |
| Hoehn and Yahr scale | 1 - mild/unilateral 2 - B/L posture/gait afffected 3 - slow movement + impaired balance 4 - severe limited walking/rigidity 5 - cachectic + total disability |
| tx for parkinsons | pharmacologic - dopamine replacement, anticholinergics, dopamine antagonists surgical (pallidotomy, deep brain stimulation) |
| pallidotomy | irreversible procedure involving destruction of globus pallidus decreasing nerve firing in damaged tissues |
| deep brain stimulation | reversible procedure altering normal brain function insertion of neurostimulator that delivers electrical signals to target brain areas |
Created by:
sleepingbear