Chapter 8 Pathological Conditions Flashcards
Alzheimer’s disease*
- deterioration of a person’s intellectual functioning
- progressive and extremely debilitating disease
- begins with memory loss and progresses to complete loss of mental, emotional, and physical functioning
- often occurs in people over 65
What occurs during the first stage of Alzheimer’s disease*?
Stage 1- appr. 1-3yrs;
- includes short term memory loss;
- decreased ability to pay attention or learn new information; -personality changes such as increased irritability, denial, and depression;
- difficulties in depth perception
- people often recognize and attempt to cover up the mental errors during this stage
What occurs during Stage 2 of Alzheimer’s disease?
- approx. 2-10 years
- person loses the ability to write, identify objects by touch, accomplish purposeful movements, and perform simple tasks such as getting dressed
- during this stage, safety is a big concern
- the person also loses the ability to communicate socially with others (uses the wrong words, repeating phrases, and may lose language function completely{aphasia*})
What is aphasia?
total loss of language function
What occurs during stage 3 of Alzheimer’s disease?
- for the last 8-10 years
- person has very little (if any) communication skills due to disorientation to time, place, and person
- bowel and bladder incontinence, posture flexion, and limb rigidity also are noted
- the person is completely dependent on others to provide basic needs
- additional complications possible such as malnutrition, dehydration, and pneumonia
What causes the changes in the brain in Alzheimer’s disease?
How is it diagnosed?
Treatment?
- both chemical and structural have been identified
- based on tests such as physical, psychological, neurological, and psychiatric examinations plus lab tests; can diagnose with 90% accuracy; biopsy or autopsy of the brain tissue is required for diagnosis confirmation
- tacrine hydrochloride (Cognex) used for mild to moderate cases to improve memory (works for 40% of people); antidepressants and tranquilizers used for symptoms
amyotrophic lateral sclerosis* (ALS)
-severe weakening and wasting of muscle groups, usually beginning with hands and progressing to arms, shoulders, and legs
a=without my/o=muscle troph/o=development -ic=pertaining to scler/o=hard, or sclera of the eye
-osis=condition
What is amyotrophic lateral sclerosis* (ALS) caused by?
- decreased nerve innervation to the muscle groups due to the loss of motor neurons in the brain stem and spinal cord
- the deficits are are specifically motor and does not involve cognitive or sensory* changes
What are symptoms of ALS?
- In the beginning-worsening fatigue with uncoordinated movements, spasticity, and eventually paralysis
- as the brain stem becomes involved=severe wasting of the muscles in the tongue, and face, causing speech, chewing, and swallowing difficulties
- other difficulties=clearing airway and breathing and loss of temperament control (fluctuating emotions)
What are complications of ALS?
loss of verbal communication, loss of ability to provide self-care, total immobility, depression, malnutrition, pneumonia, and inevitable respiratory failure
How long do people live with ALS?
approximately 50% of people die within 3-5 years
What is anencephaly*?
-the absence of the brain and spinal cord at birth, a congenital disorder
-the condition is incompatible with life
-can be detected through an amniocentesis or ultrasonography early in pregnancy
an=without, not encephal/o=brain -y=noun ending
Bell’s palsy*
Symptoms?
- the temporary or permanent unilateral weakness or paralysis of the muscles of the face following trauma, an unknown infection, or a tumor pressing on the facial nerve
- drooling, inability to close the eye or regulate salivation on the affected side; loss of appetite and taste perception
- gentle massage, warm moist heat applied, exercises, prednisone to reduce swelling, and analgesics to relieve pain
- early treatment is important for success
Brain abscess*
What is it?
What causes it?
What are the symptoms?
- localized accumulation of pus located anywhere in the brain tissue
- an infectious process-either primary local infection or a secondary infection from for example, bacterial endocarditis, sinusitis, otitis, or dental abscess
- initial symptom is headache from intracranial pressure (ICP); other symptoms follow according to location-vomiting, visual disturbances, seizures, neck stiffness, and unequal pupil size
How is a brain abscess diagnosed?
How is it treated?
- through the use of a computerized tomography scan (CT) and/or a electroencephalogram (EEG)
- aggressively with intravenous antibiotics; if ICP is apparent they use mannitol (an osmotic diuretic) to decrease pressure; if pressure does not decrease, surgical drainage may be required
What is carpal tunnel syndrome*?
-a pinching or compression of the median nerve within the carpal tunnel due to inflammation and swelling of the tendons, causing intermittent or continuous pain that is greatest at night
What is the carpal tunnel?
a narrow passage from the wrist to the hand that houses blood vessels, tendons, and the median nerve.
What causes the tendon inflammation found in carpal tunnel syndrome*?
largely as a result of repetitious overuse of the fingers, hands, or wrists
What is the treatment for carpal tunnel syndrome?
-anti-inflammatory medications, splints, physical therapy, and stopping repetitive overuse; surgery may be necessary if aforementioned does not work
True or False: The breakdown of the word anencephaly is an = without or not, encephal– = skull, and –y makes it a noun.
False. Cranium is the skull. Encephal- means brain
What is a cerebral concussion*?
What causes it?
- a brief interruption of brain function, usually with a loss of consciousness lasting for a few seconds
- usually by a blunt trauma (a blow) to the head
What are the symptoms of a cerebral concussion?
Severe concussion=unconsciousness for a longer time, a seizure, respiratory arrest, or hypotension;
- after gaining consciousness they will likely have a headache, not remember the events that caused the injury;
- -other symptoms include blurred vision, drowsiness, confusion, visual disturbances, and dizziness
What is the treatment for cerebral concussion?
observation for signs of ICP or intracranial bleeding during the period of unconsciousness and several hours after regaining consciousness; results will decide further necessary treatment
What is a cerebral contusion?
a small, scattered venous hemorrhage in the brain;
a “bruise” of the brain tissue; occurs when the brain strikes the inner skull
What does a cerebral contusion often cause? and when is it at its worse?
What are the symptoms of a cerebral contusion?
What is the treatment?
- cerebral edema-swelling of the brain tissue
- 12-24 hours after injury
- vary according to size and location; some symptoms include >in CIP, combativeness, and altered level of consciousness
- close observation for ICP and consciousness including hospital observation to monitor IPC, maintain cerebral perfusion, and administer corticosteroids and osmotic diuretics
What is cerebral palsy*?
a collective term used to describe congenital (at birth) brain damage that is permanent but not progressive. It is characterized by a child’s lack of control of voluntary muscles
cerebr/o=brain; cerebrum -al=pertaining to
What causes the lack of voluntary control seen in cerebral palsy?
injuries to the cerebrum which occur before birth, during birth, or during the first 3 to 5 years of a child’s life
What are the four major types of cerebral palsy?
spastic
ataxic
athetoid
mixed
Damage to what part of the brain causes spastic cerebral palsy?
What are the symptoms of spastic cerebral palsy?
- results from damage to the cortex of the brain
- causing tense muscles and very irritable muscle tone
e. g. a very tense heel cord that forces a child to walk on his or her toes
Damage to what part of the brain causes ataxic cerebral palsy?
What are the symptoms of ataxic cerebral palsy?
-results from damage to the cerebellum
-involves tremors, a disturbed equilibrium, loss of coordination, and abnormal movements
forces the child to stagger when walking
Damage to what part of the brain causes athetoid cerebral palsy?
What are the symptoms?
- damage to the basal ganglia
- abnormal movements such as twisting or sudden jerking from any stimulus* including the increased intensity brought on by stress
What is mixed CP?
a combination of symptoms* of the three types of CP previously discussed
What is the most common type of cerebral palsy?
Spastic
How is intellectual function impacted by CP?
may range from extremely bright, normal to severe mental retardation.
What are other common handicaps associated with CP?
oculomotor impairment, convulsive disorder (s), and hearing and speech impairments
Why is the disease called cerebral palsy* instead of cerebellar palsy?
a. It involves involuntary muscle.
b. It is all in the patient’s head.
c. It doesn’t sound as good.
d. It involves voluntary muscle.
d. The patient has no control over his or her own movement
What is a cerebrovascular accident* (CVA)?
death of a specific portion of brain tissue, resulting from a decrease in blood flow (ischemia) to that area of the brain; also called a stroke
cerebr/o=brain; cerebrum
What causes a CVA?
cerebral hemorrhage, thrombosis (clot formation), and embolism (dislodging of a clot)
What are transient ischemic attacks (TIA)?
brief periods of ischemia in the brain, lasting minutes to hours; “mini-strokes”.
What is important to remember about TIAs?
they often precede a full-blown thrombotic CVA
What are the symptoms?
- they range depending on the amount of ischemia and vessels involved
- if TIA, may experience numbness and weakness in the extremities or corner of the mouth, difficulty communicating, visual disturbances, or a “funny feeling”
What is a cerebral thrombosis* (clot)?
- also called a thrombotic CVA
- usually 50% of all CVAs in people over 50 years old during rest or sleep
- typically caused by a therosclerosis, thickened fibrotic vessel wall that causes the diameter to decrease or close off
- It is often preceded my many TIAs
- Once it becomes a full blown cerebral thrombosis, things happen quickly—-the occurrence is rapid but the progression is slow
What is a cerebral embolism*?
- when an embolus of fragments of a blood clot, fat, bacteria, or tumor lodge in a cerebral vessel and cause an occlusion* (blockage); the blocked area is then ischemic.
e. g. a piece of clot may break off in the carotid artery and move into circulation, causing a cerebral embolism*
e. g. a fat embolus can occur from the fracture of a long bone - will cause immediate neurological dysfunction until gone
What is a cerebral hemorrhage?
What is the most common cause?
What are the symptoms?
- when the cerebral vessel ruptures, allowing bleeding into the CSF, brain tissue, or the subarachnoid space*
- high blood pressure
- occur rapidly and include headache and other neurological dysfunctions, numbness, dizziness, or even impaired consciousness (stupor to coma, paralysis, and aphasia); differs widely according to the degree of involvment
What is a degenerative disk*?
the deterioration of the intervertebral disk, usually due to constant motion and wear on the disk
What causes a degenerative disk?
What are the symptoms?
What are the treatments?
- vertebral misalignment that causes constant rubbing, with gradual wasting and inflammation
- pain primarily, burning and continuous; motor function loss at times; people are often unable to carry out normal daily activities b/c of pain and motor function
- bed rest, bracing the back, nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, transcutaneous electrical nerve stimulation* (TENS), and surgical interventions
What is encephalitis*?
What causes it?
- the inflammation of the brain or spinal cord tissue that becomes invasive and destructive; at its worst the deterioration of nerve cells and increase of cerebral edema may result in permanent neurological damage or a comatose* state
- largely caused by a virus that enters the CNS when the person experiences a viral disease such as mumps, measles or through the bite of a mosquito or tick; other less common causes include parasites, rickettsia, fungi, or bacteria
What are the symptoms of encephalitis?
-symptoms similar to meningitis (but no build up of exudate) where small hemorrhages occur in the CNS tissue, causing the tissue to become necrotic; restlessness, seizure, headache, fever, stiff neck, altered mental function, and decreased level of consciousness; also could experience facial weakness, difficulty communicating and understanding verbal communication, personality changes, or weakness on one side of the body
what are treatments for encephalitis?
- administering medications, treating symptoms and preventing complications
- mild analgesics for pain, antipyretics for fever, anticonvulsants for seizure activity, antibiotics for intercurrent infections, and corticosteroids or osmotic diuretics to control cerebral edema
What is epilepsy*?
- a syndrome of recurring episodes of excessive irregular electrical activity of the brain resulting in involuntary muscle movements called seizures
- may occur w/ a diseased or structurally normal CNS and the electrical activity may involve part or all of the person’s brain
What can epileptic seizures affect?
consciousness level, skeletal motor function, sensation, and autonomic function of the internal organs; severe seizures may produce a decrease of oxygen in the blood circulation, acidosis, and respiratory arrest
How are seizures classified?
according to the area of the brain or the focus, cause, and clinical signs and symptoms
What are the two categories of seizures?
partial seizures and generalized seizures
What are partial seizures?
they arise from a focal area that may be sensory*, motor, or even a diverse complex focus
What are generalized seizures?
often result in a loss of consciousness and involve both cerebral hemispheres
What are the most common generalized seizures?
Grand mal and petit seizures
