NEURO - Pain/Temperature Flashcards
Large myelinated fibers
A delta fibers
Small umyelinated fibers
C Fibers
C fibers respond to broad range of painful stiumuli
mechanical
thermal
chemical
Plasticity
the adaptable change in structure, and function of the brain
Gate control theory of pain
Pain is modulated by a gate in the cells of the SUBSTANTIA GELATINOSA in the SPINAL CORD
Gate control theory: Pain is modulated by a ___________in the cells of the______ _______ in the ________
gate in the cells; SUBSTANTIA GELATINOSA; SPINAL CORD
*****Transduction
when tissues is damaged due to exposure to chemical, mechanical and thermal noxious stimuli converted to action potential
Conduction
from delta and C fibers to interneurons in dorsal horn of spinal cord
Interneuron does what
can excite or inhibit signal to second transfer order neurons.
Transmission
Pain signals from delta and C fibers.
**Myelinated A-delta fibers: Transmission is _____and conveys ______and ______pain.
fast ; sharp and localized pain.
Unmyelinated C polymodal fibers: Transmission is _______ and conveys _______, _______ and _____sensations.
Transmission is slower and conveys dull, diffuse burning and aching sensations.
Fast pain neurons synapse with _______ _____________
secondary neurons at the Dorsal Horn.
A- beta
Large,
fast
sense mechanical touch and vibration
can modulate A delta and C fibers
A- beta
Large,
fast- 70m/s, myelinated
sense mechanical touch and vibration
can modulate A delta and C fibers
A- Delta
Size, speed, type
Medium
10m/s
sharp, localized
sense mechanical/extreme temperature
C-fibers
Small
slow spee d 1m/s
dull, diffuse pain signal
sence mechanical/thermal/ chemical
First order neuron
Nociceptors: respond to chemical, mechanical and thermal stimuli.
2nd order neuron
interneurons in the dorsal horn
Function as a pain gate to regulate pain transmission.
****Cross over in the spinal cord and ascend.
3rd order neuron
afferent neurons in the spino-thalamic tract.
Delta fibers
laminae 1+ 5
C fibers
1, 2
A- Beta
3,4
Lamina 3, 4, 5, send signals to where?
Send signals to Hypothalamus & AMYGDALA
Lamina 2 inhibit
Lamina 1
C fibers synapse with interneuron within the __________ -_________ prior to decussation.
substantia gelatinosa
Activation of the reticular system by _________ fibers results in ________ __________when in pain
Reticular System; C fibers; difficulty
sleeping when in pain.
Activation of the ______ ______ by ________ results in distress and anxiety.
Limbic System;C fibers;
Postsynaptic 2nd Order neurons have ______ ________receptor.Normally inactive because ordinarily blocked by _______ ions. However, intense, prolonged pain signal releases Mg and ______ __________ to occur.
NMDA
(N-methyl-D-aspartate) ; Mg++ ions.
Mg and allows
postsynaptic depolarization to occur.
- 2nd Order Neurons can be _____ _______Or _______
* Peripherally – NSAIDS: _____ ______(Ex: ____and ___-)
-Suppressed or
Facilitated Peripherally or Centrally
cox inhibitors (Ibuprofen, ASA, etc)
– Local Anesthetics: __________ (ex: __)
block Na+ channels (lidocaine)
– Hydrocortisone: actions
lipocortin-1 – blocks
prostaglandins/leukotrienes from arachidonic acid
TENS (Transcuteneous Electrical Nerve stimulators) Unit or Mechanical Stimulation: does what? Stimulates ________ to release ______ and______ , inhibits ______ preventing ______
stim.s A-beta fibers to release GABA & glycine, inhibits glutamate preventing depolarization
Cite 2 Pain excitatory neurotransmitters
Glutamate (released by a-delta fibers), aspartate
Glutamate and aspartate are released by __________ and are (exc/inh) ______Neurotransmitters.
A Delta fibers, Pain excitatory
Pain inhibitors (analgesic system) Serotonin, gamma-aminobutyric acid (GABA), glycine, Opioids: (endorphins, enkephalins, dynorphins), norepinephrine
Serotonin, gamma-aminobutyric acid (GABA), glycine,
Opioids:
(endorphins, enkephalins, dynorphins), norepinephrine
___ _____ releases NE to Dorsal horn
Locus Ceruleus
Releases 5HT serotonin to Dorsal horn
Nucleus Raphe
Nucleus Raphe
Releases 5HT serotonin to Dorsal horn
Periaqueductal gray matter releases what to where?
releases
Enkephalins to Nucleus raphe magnus
releases Enkephalins to Nucleus raphe magnus
Periaqueductal gray matter
____ _________in the midbrain is the coordinating center of the descending analgesic system
Periaqueductal gray matter
_______ acts via the ______ _________in the brain stem, to send
PAGM ; raphe nucleuslocated in the brain stem to send analgesic impulses to block pain transduction at the first order neuron-second order neuron synapse (at the dorsal horn).
_______ and _______which are opioids are the neurotransmitters released by the descending analgesic neurons.
Opioids (endorphins and enkephalins)
Analgesic pathways also use ______, _______ and _______
Serotonin, Norepinephrine, and GABA
Pain Modulation , definition
“the physiologic process of suppressing or facilitating pain”.
Descending modulation of pain
Descending analgesic pathways are found where ?
Descending analgesic pathways are found in the dorsolateral tracts.
Pain reaches the brain via the ____ _______tract. It carries the most _____ ______
Lateral Spinothalamic Tract.; the most nociceptive information.
Affective component of pain is ____ ______ ______
the distress (anxiety) that goes with pain.
Autonomic component
“sympathetic” – effect on HR, BP, resp,
“sympathetic” – increases HR, BP, sweating, respiratory
Pain Threshold: Point at which _____
Does it significantly vary among people. ?
Is the point at which a stimulus is perceived as pain (patient becomes aware).
• Does not significantly vary among people or in the same person over time.
Nonsteroidal anti-inflammaatory drugs
reduce ________ by _______
hyperalgesia by decreasing prostaglandins.
Acute Somatic
• Arises from ________
**• A-delta fibers: Pain is _____ and _____localized.
**C fibers: Pain is _____, _____,_____ and poorly localized
connective tissue, muscle, bone, and skin. Pain is sharp and well localized. Pain is dull, aching, throbbing, and poorly localized.
What is referred pain?
Predictable pain
can be ___ or ____
Pain in an area in part of the body distant from its point of origin.
Predictable - referred pain is supplied by same spinal segment as actual site.
Can be acute or chronic.
Injured nerves become _______Example: _______
Hyperexcitable. Example: Carpal Tunnel
Temperature regulation:is controlled by?
Thermoregulation: Is controlled by Central Thermo-receptors in the Hypothalamus
What are EXOgenous pyrogens,________
Endotoxins produced by pathogens
Endogenous pyrogens:
Prostaglandin-E2 (PGE2) interleukin-1 (IL-1) IL-6 tumor necrosis factor–alpha (TNF-α), interferon-γ
__________Is a life-threatening complication of an inherited muscular disorder. What happens in Malignant hyperthermia??
Increased calcium release or decreased calcium uptake with muscle
contraction
Sustained muscle contractions
Increased oxygen consumption and lactic acid production
__________Is precipitated by the administration of volatile anesthetics and
depolarizing neuromuscular-blocking agents.
Malignant Hyperthermia
Treatment of Malignant Hyperthermia
Remove the agent
Dandrolene
Malignant Hyperthermia can cause ______,______,and _______
Cardiac dysrhythmia, tachycardia, and hypotension
Most common chronic pain condition
low back pain
Second most common pain syndromes
Myofascial pain
Chronic post op pain
disruption or cutting of sensory nerves.
Deafferentation pain
Sympathetic dystrophies
Hyperesthesias
Increased sensitivity and decreased pain threshold to tactile and painful stimuli
Phantom Limb Pain
Associated with stroke
41° C (105.8° F):what happens
Nerve damage; convulsions
43° C (109.4° F): what happens ?
Death
What is heat cramp associated with ?
Prolonged sweating and associated sodium loss cause severe spasmodic cramps
in the abdomen and extremities.
What happens in heat exhaustion
Dehydration, depressed plasma volumes, hypotension, decreased cardiac output, tachycardia
Heat stroke
potentially lethal result of breakdown in an overstressed thermoregulatory center.
• Brain cannot tolerate temperatures higher than 43° C (109.4° F).
– Cardiovascular and thermoregulatory centers may cease functioning in high
temperatures.
Administration of _________ can cause malignant Hyperthermia
Succinylcholine
Be able to differentiate Malignant hyperthermia to
Thyroid Storm
Pain is
Unpleasant sensory and emotional experience with actual or potential tissue damage.
Patterning theory
theorizes that somatic receptors of variable sensitivity.
Specificity Theory
Theorizes that low and high threshold receptors with a specific pathway for pain.
massage therapy relieves pain by closing the pain gate with the stimulation of which fibers?
A beta
Which endogenous opioid is located in the hypothalamus and pituitary and is a strong M receptor agonist
ENDORPHINS
Term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding
Tolerance.
tolerance.
Term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding
Up to how many liters of fluid per hour may be lost by sweating?
2 L
What stimulus causes posthyperventilation apnea (PHVA)?
Changes in PaCO2 levels
What is the most common infratentorial brain disease process that results in the direct destruction of the reticulating activation system (RAS)?
a. Cerebrovascular disease
Which intracerebral disease process is capable of producing diffuse dysfunction?
Infarct emboli
Which pathway carries sensory information toward the central nervous system (CNS)?
Ascending
Which type of axon transmits a nerve impulse at the highest rate?
Large MYELINATED
Which nerves are capable of regeneration?
MYELINATED NERVES IN THE PERIPHERAL NERVOUS SYSTEM
The neurotransmitter, norepinephrine, is secreted in the:
Sympathetic postganglion
Both oligodendroglia and Schwann cells share the ability to:
FORM A MYELIN SHEATH
During a synapse, what change occurs after the neurotransmitter binds to the receptor?
The permeability of the postsynaptic neuron changes; consequently, its membrane potential is changed as well.
What name is given to a large network of neurons within the brainstem that is essential for maintaining wakefulness?
Reticular activating system
Thought and goal-oriented behaviors are functions of which area of the brain?
PRE-FRONTAL LOBE
The region responsible for the motor aspects of speech is located in the:
Broca area in the frontal lobe
Parkinson and Huntington diseases are associated with defects in which area of the brain?
BASAL GANGLIA
Maintenance of a constant internal environment and the implementation of behavioral patterns are main functions of which area of the brain?
HYPOTHALAMUS
The ability of the eyes to track moving objects through a visual field is primarily a function of which colliculi?
SUPERIOR
What are 2 parts of the brain that mediate the expression of affect, both emotional and behavioral states?
Limbic system and the pre-frontal cortex
Reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing are controlled by which area of the brain?
Medulla OBLONGATA
From which part of the midbrain do cranial nerves V to VIII emerge?
PONS
From which part of the midbrain do cranial nerves IX to XII emerge?
Medulla OBLONGATA
Which area of the brain assumes the responsibility for conscious and unconscious muscle synergy and for maintaining balance and posture?
CEREBELLUM
Which statement is true regarding upper motor neurons?
They modify spinal reflex arcs.
The membrane that separates the brain’s cerebellum from its cerebrum is the:
Tentorium cerebelli
The function of arachnoid villi is to:
Absorb cerebrospinal fluid into the cerebral venous sinuses
Where is the cerebrospinal fluid produced?
CHOROID PLEXUS
Which of the meninges closely adheres to the surface of the brain and spinal cord and follows the sulci and fissures?
Pia Mater
Norepinephrine produces what primary response?
Vasoconstriction
What is an effect of the sympathetic nervous system?
Increased blood sugar
The brain receives approximately what percentage of the cardiac output?
20%
The collateral blood flow to the brain is provided by the:
CIRCLE OF WILLIS
The nurse recognizes that a patient’s diagnosis of a viral infection of the brain’s meningeal layer is supported by which diagnostic laboratory result?
Leukocytes >10
Which cranial nerves contain parasympathetic nerves? (Select all that apply.)
III, VII, IX, X
The sympathetic nervous system primarily serves to protect an individual by doing which of the following? (Select all that apply.)
b. Increasing blood sugar levels
c. Increasing body temperature
e. Increasing blood pressure
The aging process brings about what changes to human cells? (Select all that apply.)
a. Increased neurofibrillary tangles
b. Imbalance of neurotransmitters
d. Decreased myelin presence
e. Altered dendrite structure
Which statement is true regarding the blood-brain barrier (BBB)? (Select all that apply.)
a. The BBB is dependent on astrocytes.
c. It restricts the flow of large molecules, such as potassium.
d. Naturally occurring inflammatory mediators affect the BBB.
e. The BBB appears to play a role in slowing down the onset of degenerative brain disease.
A nurse caring for an older adult patient would expect which functional changes to occur? (Select
A nurse caring for an older adult patient would expect which functional changes to occur? (Select all that apply.)
a. Increased risk for falls
b. Increased risk for falls
c. Loss of muscle in the arms and legs
What evidence does the nurse expect to see when a patient experiences trauma to the hypothalamus? (Select all that apply.)
a. Uneven expression of mood
b. Unstable blood glucose levels
c. Poor regulation of body temperature
A Schwann cell: (Select all that apply.)
a. Can form the myelin sheath.
b. Is also referred to as a neurolemmocyte.
c. Affects the function of the nodes of Ranvier.
d. Is located in the peripheral nervous system.
Fibers emerge from the posterior midbrain and exit from the skull to run to the eye.
Trochlear
Provides motor and sensory functions to the face, mouth, nose, and eyes.
Trigeminal
Fibers emerge from the midbrain, exit from the skull, and extend to the eye.
Oculomotor
Controls motor functions to the pharynx and salivary glands and sensory functions from the pharynx and tongue.
Glossopharyngeal
Innervates muscles that move the eye laterally.
Abducens
Affects control over the motor fibers to the muscles of tongue and sensory impulses from the tongue to the brain.
Hypoglossal.
Is purely sensory and carries impulses for the sense of smell.
Olfactory.
Is made up of parasympathetic motor fibers that supply the smooth muscles of the abdominal organs.
Vagus.
Transmits impulses for the sense of hearing.
Vestibulocochlear
Carries sensory and motor fibers to the pharynx and larynx.
Spinal Accessory
Pricking one’s finger with a needle would cause minimal pain, whereas experiencing abdominal surgery would produce more pain. This distinction is an example of which pain theory?
Specificity
Which pain theory proposes that a balance of impulses conducted from the spinal cord to the higher centers in the central nervous system (CNS) modulates the transmission of pain?
Gate Control Theory (GCT)
Which type of nerve fibers transmits pain impulses?
A DELTA FIBERS
Where are the primary-order pain transmitting neurons located within the spinal cord?
Dorsal root ganglia
The gate in the GCT of pain is located in the:
SUBSTANTIA GELATINOSA
Which neurotransmitters inhibit pain in the medulla and pons?
Norepinephrine and serotonin (5-hydroxytryptamine)
Which endogenous opioid is located in the hypothalamus and pituitary and is a strong -receptor agonist?
Endophins and Endormorphins
What is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding?
TOLERANCE
What is a long-term complication of rewarming as a treatment for hypothermia?
RENAL FAILURE
How does the release (increase) of epinephrine raise body temperature?
It raises the metabolic rate
Heat loss from the body via radiation occurs by:
Emanations of electromagnetic waves
Which cytokines are endogenous pyrogens?
IL-1, IL-6, TNF-alpha, and IFN-gamma
Which hormones help diminish the febrile response?
Arginine vasopressin (AVP), melanocyte-stimulating hormone-alpha (-MSH), and corticotropin-releasing factor
Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation?
Heat EXHAUSTION
In acute hypothermia, what physiologic change shunts blood away from the colder skin to the body core in an effort to decrease heat loss?
Peripheral Vasoconstriction
Cognitive operations cannot occur without the effective functioning of the brain’s:
Reticular activating system
Pain that is thought to be caused by trauma or disease of nerves and leads to abnormal processing of sensory information by the peripheral and central nervous systems
Neuropathic pain
Pain that occurs after peripheral nerve injury and is described as continuous with severe sensations and a burning quality
Sympathetically maintained pain
It is true that a fever: (Select all that apply.)
a. Is a complex cascade involving several different systems.
b. Can be a result of a dysfunctional hypothalamus.
d. Triggers endocrine responses.
e. Is in response to a pyrogen.
Heat exhaustion results in: (Select all that apply.)
a. Profuse sweating
b. Profound vasodilation
c. A need to ingest warm liquids
Why are children more susceptible to heat stroke than are adults? (Select all that apply.)
a. Children produce more metabolic heat when exercising.
b. They have more surface area-to-mass ratio.
c. Children have less sweating capacity.
Which factors contribute to sensorineural hearing loss? (Select all that apply.)
a. Ménière disease
b. Aging
c. Diabetes mellitus
d. Noise exposure
Based on an understanding of the physiologic process of nociceptors, the nurse expects which surgical procedure to create more pain?
Repair of several crushed fingers
When considering the risk factors for the development of phantom limb pain, the nurse recognizes which as a primary contributing factor?
b. Presence of pain in the limb before amputation
Based on an understanding of the physiologic process of nociceptors, the nurse expects which surgical procedure to create more pain?
a. Repair of several crushed fingers
The basis of the specificity theory of pain is that:
c. The greater the tissue injury, the greater the pain.
Which statement is true regarding the gate control theory (GCT) of pain?
d. An open gate facilitates the brain in processing the pain.
Which medication is used to reverse the effects of malignant hyperthermia?
Dandrolene
A heat stroke is characterized by:
b. Sweat production on the face occurring even during dehydration
The four types of endogenous opioids include enkephalins, endorphins, dynorphins, and endomorphins.
enkephalins
endorphins
dynorphins
endomorphins.
*****___________ pain results from tumor infiltration of nerve tissue; trauma, or chemical injury to the nerve. Sympathetic pain occurs after a peripheral nerve injury and is characterized as continuous and severe with a burning quality
Deafferentiation
__________pain occurs after a peripheral nerve injury and is characterized as continuous and severe with a burning quality
Sympathetic
Pain at one location that may cause an increase in threshold at another location
PERCEPTUAL DOMINANCE
Pain tolerance is the duration of time or intensity of pain before overt pain responses are initiated. The pain threshold is the point at which pain is perceived.
Pain tolerance; decreases pain tolerance.
__________ is the point at which pain is perceived.
pain threshold
increase the levels of circulating endogenous endorphins?
STRESS
Sexual Intercourse
Increased levels of physical activity
Acupuncture
_____ ______ _____ _____ _____examples of myofascial pain syndromes.
Muscle strain myositis fibrositiS myofibrositis and myalgia
Chronic postoperative pain occurs in a small percentage of individuals after ______,_____, _____ AND ______
thoracotomy, mastectomy, neck dissection, and surgical amputation.
__________ is heat loss through electromagnetic waves
Radiation
_________ is heat loss by direct molecule-to-molecule transfer.
Conduction
___________is transfer of heat through currents of gases or liquids. .
Convection
___________ is the transfer of heat with conversion of liquid to gas.
Evaporation
Which of the following is a benefit of fever?
SWITCHS TO _______ _____ TO _______ AND_______ THEREFORE _______BACTERIA OF A FOOD SOURCE
Switches to lipolysis and proteolysis
Fever has benefits. The higher body temperature decreases serum levels of iron, zinc, and copper, all of which are needed for bacterial replication. It switches from burning glucose to lipolysis and proteolysis, thus depriving bacteria of a food source. There is increased lymphocytic transformation, increasing the immune response. There is increased phagocytosis.
3 things that increases with fever
1)increased lymphocytic transformation –> 2)increasing the immune response 3) There is increased phagocytosis.
The four classifications of neurotransmitters are inflammatory, pain excitatory, pain inhibitory, and modulators of pain.
inflammatory
pain excitatory
pain inhibitory
and modulators of pain.
______ and_________ are the most common excitatory neurotransmitters in the brain and spinal cord.
Glutamate and aspartate
______ and _______ are inhibitory neurotransmitters
GABA and glycine
_______ is contained in neurons that synapse with ______ and ______ and they inhibit pain.
Substance P; GABA and glycine
Heat cramps__________
are severe spasmodic cramps in the abdomen and the extremities that follow prolonged sweating and associated sodium loss.
______________ is the result of prolonged high core temperatures. There is often dehydration, feelings of weakness, dizziness, nausea, and fainting.
Heat exhaustion
__________ may be lethal and is exposure to excessive heat and loss of the body’s protective mechanisms for cooling.
Heat stroke
is a lethal complication of a rare inherited muscle disorder.
Malignant Hyperthermia
Nociceptors are receptors______________.
receptors that perceive pain.
Second-order neurons are of three classes: _____,____ and
projection cells
excitatory interneurons
inhibitory interneuron
Fever is a normal adaptive response to _______ and _______
cytokines and prostaglandin E
Relates the amount of pain to the amount of soft tissue injury
SPECIFICITY theory
The _____ _______ is a structure involved in pain transmission.
The substantia gelatinosa
The ________ an d-________contains nerve cell bodies for efferent pathways leaving the spinal cord.
anterior or ventral horn
The posterior horn (dorsal horn) is composed primarily of ________ and ________
interneurons and axons from sensory neurons.
The ______ ________ is part of the sensory ganglion.
dorsal root ganglion
To withdraw CSF, needle is inserted into the _______space
Subarachnoid
Correct sequence for CONSCIOUS PERCEPTION of a SENSATION (DAP-CP)
depolarization or hyperpolarization of a receptor, action potential generation propagation CNS processing, and then perception.
Caudo equina
the filum terminale and the ventral and dorsal roots caudal to the conus medullaris
In an adult, the conus medullaris is found at about
L1
