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Anatomy and Physiology-DNP > Alterations in Cognitive systems > Flashcards

Alterations in Cognitive systems Flashcards

1
Q

Alterations in arousal

A
  • structural
  • metabolic alterations
  • psychogenic or psychiatric
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2
Q

Neuro functions critical to eval process

A
  • LOC
  • Pattern of breathing
  • pupillary reaction
  • oculomotor responses
  • motor responses
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3
Q

Obtundation

A

-mild to moderate reduction in arousal w/ limited response to the environment; falls asleep unless verbally or tactilely stimulated; answers questions w/ minimum responses

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4
Q

stupor

A

-condition of deep sleep or unresponsiveness; person may be aroused or caused to open eyes only by vigorous and repeated stimulation; responses is often withdrawal or grabbing at sitmulus

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5
Q

S/S of alterations in arousal: pattern of breathing

A

-helps eval level of brain dysfunction and level of coma
-posthyperventilation apnea: lower brainstem centers regulate breathing pattern
-cheyne-stokes respirations
-central neurogenic hyperventilation
-cluster respirations
-ataxic respirations
apneustic respirations

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6
Q

cheyne-stokes respirations

A

-abnormal rhythm of breathing w/ alternating periods of hyperventilation and apnea

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7
Q

Central neurogenic hyperventilation

A

-sustained hyperventilation caused by a lesion in the central pons

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8
Q

apneustic respirations

A

-prolonged inspiratory and expiratory phases caused by injury to the pons or upper medulla

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9
Q

cluster respirations

A

-periods of clusters of rapid respirations of near or equal depth, resulting from trauma or compressions to the medulla or from chronic opioid abuse

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10
Q

Ataxic respirations

A

-irregular respirations w/ prolonged periods of apnea associated w/ damage to the medulla

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11
Q

Dilated, fixed pupils

A
  • Ischemia/hypoxia
  • atropine/scopolamine
  • barbiturate intoxication
  • hypothermia
  • Opiates: pinpoint pupils
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12
Q

Oculomotor responses

A
  • doll’s eyes

- help determine the levels of brain dysfunction

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13
Q

Brain death (total brain death)

A
  • body cannot maintain internal homeostasis

- irreversible cessation of the entire brain, including brainstem and cerebellum occurs

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14
Q

Brain death criteria

A
  • completion of all appropriate, therapeutic procedures
  • unresponsive coma (absence of motor and reflex responses)
  • No spontaneous respirations (apnea)
  • no brainstem function
  • isoelectric (flat) electroencephalography (EEG) for 6-12 hours
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15
Q

Cerebral death

A
  • irreversible coma
  • death of the cerebral hemispheres, exclusive of the brainstem and cerebellum
  • no behavioral or environmental responses
  • brain continues to maintain normal respiratory and cardiovascular functions, temp, control and metabolic functioning
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16
Q

Dysmnesia

A

-Retrograde amnesia: loss of past memories
-anterograde amnesia
inability to form new memories

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17
Q

Agnosia

A
  • failure to recognize the form and nature of objects

- Can be tactile, visual, auditory

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18
Q

Dysphagias

A
  • wernicke
  • conductive
  • anomic
  • transcortical
  • broca aphasia
  • global aphasia
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19
Q

Acute confusional states

A

Disruption of reticular-activating system of upper brainstem and its projections to the thalamus, basal ganglion, and specific areas of the cortex and limbic areas

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20
Q

Hyperactive delrium

A
  • agitated delirium

- excited delirium syndrome

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21
Q

acute state of brain dysfunction

A

-Associated w/ the right middle temporal gyrus or disruption of the left temporo-occipital junction

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22
Q

Hypoactive delirium: hypoactive confusional state

A

-is associated w/ the disruption of the right-sided, frontal-basal ganglion

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23
Q

S/S Delrium

A
  • autonomic nervous system overactivity
  • typical development of over 2-3 days
  • difficulty concentrating
  • restlessness and irritability
  • insomnia
  • tremulousness
  • poor appetite
24
Q

Dementia

A
  • progressive failure of cerebral functions that cause impairment
  • pathophys:
  • -neuron degeneration
  • -compression of brain tissue
  • -athersclerosis of cerebral vessels
  • -brain trauma
  • -genetic predisposition
  • -CNS infections
25
Q

Alzheimer type

A
  • Dementia of the alzheimer type DAT
  • Specific dx can only be made by postmortem exam
  • leading cause of dementia
  • is irreversible
  • neurofibrillary tangles
  • neuritic plaques
  • degeneration of basal forebrian cholinergic neurons (loss of acetylcholine)
26
Q

Tx alzheimer disease

A
  • no disease-arresting therapies are available
  • cholinesterase inhibitors can enhance cholinergic transmission
  • antiamyloid drugs
27
Q

Frontotemporal dementia

A
  • was previously called pick disease
  • rare, severe degenerative disease of the frontal lobes
  • age onset: younger than 60 yrs
  • familial association
28
Q

Increased ICP

A
  • Stage 1: vasoconstriction and external compression
  • stage 2: continued expansion of intracranial content
  • stage 3: brain hypoxia and hypercapnia; autoregulation lost
  • stage 4: brain herniates; several herniation syndromes
29
Q

Herniation

A
  • shifting of brain tissue
  • -disrupts blood flow and damages brain tissue
  • types: uncal, supratentorial, central, cingulate gyrus, transclavarial, infratentorial
30
Q

supratentorial herniation

A

involves the temporal lob and hippocampal gyrus, shifting from the middle fossa to the posterior fossa

31
Q

infratentorial hernation

A

involves shift of the cerebellar tonsils through the foramen magnum

32
Q

Cerebral edema types

A
  • vasogenic: clinically the most important type
  • cytotoxic: toxic factors affect the brain parenchyma
  • interstitial: volume increases around the ventricles
33
Q

Hydrocephalus

A
  • Variety of conditions
  • excess fluid accumulation w/in the cerebral ventricles, subarachnoid space or both
  • caused by interference in cerebrospinal fluid flow
  • -decreased reabsorption
  • -increased fluid production
  • -obstruction in the ventricular system
  • Surgery. shunt
34
Q

Noncommunicating (obstructive) (intraventricular) hydrocephalus

A

-caused by obstruction

35
Q

Hypotonia

A

-Decreased muscle tone

36
Q

Hypertonia

A

increased muscle tone

  • Spasticity
  • paratonia (gegenhalten): resistance to passive movement
  • dystonia: increased involuntary muscle contraction
  • Rigidity: firm and tense muscles
37
Q

Hyperkinesia

A
  • excessive movement

- chorea, wandering, tremors at rest, postural tremors

38
Q

Paroxysmal dyskinesias

A

abnormal, involuntary movements that occurs as spasms

39
Q

Tradive dyskinesia

A
  • slow onset, usually from antipsych agents

- rapid, repititive, stereotypic movements

40
Q

Huntington disease

A

-aka chorea
-rate, autosomal dominant hereditary-degenerative disorder(short arm chromosome 4)
-severe degeneration of striatum and basal ganglia
-abnormal movements that occur w/ conscious effort, dementia, emotional liability
-no known tx, symptomatic drug therapy
-

41
Q

Akinesia

A

-absence of voluntary movement

42
Q

Parkinsons disease

A

-severe degeneration of basal ganglia (corpus striatum) involves dopaminergic nigrostriatal pathway

43
Q

S/S Parkinsons

A
  • rigidity
  • postural abnormalities
  • autonomic-neuroendrocrine symptoms
  • cognitive-affective symptoms and dementia
  • loss of dopaminergic-pigmented neurons in substantia nigra
  • bradykinesia and akinesia
  • resting tremor
44
Q

Manifestations of Parkinsons

A
  • wide-eyed unblinking staring expression w/ immobile facial muscles
  • frequent drooling
  • slow gait
  • short, shuffling steps
  • flexed and abducted arms held stiffly at the side
  • slightly forward bending
45
Q

Tx of parkinsons

A
  • drug therapy: levodopa, anticholinergic drugs, antihistamines, amantadine
  • surgery
  • rehab
  • OT
46
Q

Upper and lower motor neuron syndromes

A
  • paresis: weakness, partial paralysis
  • upper motor neuron syndromes: hemiparesis and hemiplegia
  • diplegia (both upper and lower)
  • parapesis or paraplegia (lower)
  • quadriparesis or quadriplegia
  • pyramidal motor syndrome: spinal shock-loss of function below lesion
47
Q

Motor neuron diseases

A
  • progressive degeneration of the upper or lower motor neurons in spinal cord, brainstem, and cortex
  • Amyotrophic lateral sclerosis (ALS)
  • Paralytic poliomyelitis
  • progressive spinal muscular atrophy
  • progressive bulbar palsy
  • bulbar palsy
  • inflammatory process may injure or destroy anterior horn cells or cranial nerve cell bodies
48
Q

Amyotrophic lateral sclerosis (ALS)

A
  • AKA sporadic motor system disease, Lou Gehrig disease
  • degenerative disorder diffusely involving the lower ad upper motor neurons
  • movement is more affected than the brain
  • Progressive muscle weakness leads to respiratory failure
49
Q

ALS s/s

A
  • limb cramping or weakness
  • incoordination
  • slurring of speech
  • single muscle group paresis that spreads
  • hypotonia
  • difficulty swallowing
50
Q

ALS Tx

A
  • administer riluzole (Rilutek), and antiglutamate which is standard tx that prolongs life for months but doesn’t cure
  • maintain quality of life
  • involve family in the tx
51
Q

Decorticate

A

-posturing towards body

52
Q

Decerebrate

A

-posturing away from body

53
Q

Frontal lobe ataxic

A
  • wide based
  • body sways and falls
  • loss of truncal motion
  • gait ignition failure
  • start hesitation
  • shuffling
  • freezing
54
Q

Extrapyramidal motor syndromes: basal ganglia

A
  • involvement of either a paucity or an excess of movements
  • rigidity w/ cogwheel phenomenon
  • alterations in posture and muscle tone
55
Q

Extrapyramidal motor syndromes: cerebellar motor syndrome

A
  • chiefly ipsilateral (same side)
  • loss of muscle tone
  • ataxia
  • muscle weakness
  • disorders of equilibrium, posture and gait

Anatomy and Physiology-DNP (18 decks)

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