pain, sleep, temp, and sensory function Flashcards
what is pain?
active tissue damage. sensory info as a through, emotion, feeling
- no correlation between amount of tissue damage and amount of pain
nociceptive pain
- nociceptor receptors
- sharp, distinct pain
- triggers nociceptors (pain receptors)
- somatic: joints, muscle, skin
- visceral: organs (tumors/obstruction). fewer nocireceptors. broad, referred pain
neuropathic
- pain without a stimulus
- nociceptive can lead to neuropathic
- central: central or peripheral NS
- peripheral: neuropathies (DM/GB disease)
Large A Fibers
- initial, immediate, sharp pain
- a stab or cut
- myelinated fibers travel fast impulses
small c fibers
- prolonged, dull pain, achy, persistent
- non-myelinated, slower impulses
good side of pain
analgestic: we produce these pain-relievers ourselves
* Endorphins: exercise, runner’s high
- neuropeptides that inhibit transmission of pain impulses in the spinal cord and brain by binding to opiod receptors
- Enkephalin: less potent than endorphins
- weaker anelgestic but more potent and longer lasting than morphine
- dynorphin: inhibits but can also INCITE pain
nociceptors
- “free nerve ending”
- dermis, muscle, joints, viscera
- respond to chemical, mechanical, and thermal stimuli
- large A/delta fibers - detect touch, vibration, thermal and sharp pain
- small c/unmyelinated - long-lasting dull pain
nociception pain pathway
- transduction - tissue damage releases substances that bind to nociceptors and activate small C fibers
- transmission - from small c fibers –> spinal cord –> brain stem –> thalamus –> cerebral cortex
- perception - in the cerebral cortex detect pain.
- modulation - inhibit or control pain. brain releases endorphins down spinal cord
- transduction
- tissue damange
- sensitizing substances - prostaglandins, bradykinis, substance p (all cause pain)
- action potential - wave of depolarization
- SMALL C starts action potential
- Transmission
tissue damange –> spinal cord –> brain stem and thalamus –> cerebral cortex
- Perception
awareness of pain
- modulation
endogenous - from within body
- inhibition of nociceptive impulses SMALL C
- brain stem (endorphins, serotonin) –> spinal cord (block signals at spinal cord)
- norepinephrine stops anticipated pain
pain - gate control theory
- small c fibers - pain (diffuse, burning, aching, itches). = open pain gate –> heat pad, itching, etc. stimulates large A
- Large A - touch, vibration, thermal inhibition of pain = close pain gate = exogenous modulation
- large A beats nocicpetors to stimulus and blocks pain
endogenous vs exogenous pain
endogenous = down spinal cord. (still nociceptors)
exogenous = outside of body, rubbing, itching, heat (still nociceptors)
acute pain
- immediate, harmful alert, acute anxiety
- tissue damage, self-limiting, ends with healing
- SOMATIC: superficial, sharp, well-localized
- VISCERAL: referred pan, decreased nociceptors. internal organs, abdoment, skeletal, poorly localized. nausea and vomiting, hypotension, restlessness and shock
referred pain
pain in one location referrs pain to another areas associated with it
chronic pain
chronic inflammation/injury
- greater than 3 months
- related to tissue damage, inflammation or injury of nervous system
a) intermittent = comes and goes, chronic migraines
b) persistent = continual, lumbago. sacrolumbar pain
c) neuropathic - brain’s perception of pain - hyperalgesia = hypersensitibity to stimuli
- allodynia - perception of pain w/o stimuli (fibromyalgia)
Fever
- means presence of a foreign body
- resetting of hypothalamic thermostat
- heat = muscle contractions
- exogenous pyrogens (endotoxins) = increase in hypothalamus temperature control
- endogenous pyrogens = mast, basophils. body processes
BENEFITS: kills pathogenic microorganisms (denaturing and inhibiting) & incrases reactions and pathways in cells that may increase dense mechanisms)
hyperthermia
high body temp
- NOT mediated by pyrogens, no resetting of the hypothalamic set point
- nerve damage at 105
- death at 109
- heat cramps = increase in sweating, pulse, blood pressure, electrolyte loss
- Heat exhaustion = dizziness, wekaness, nausea, confusion, syncope
- heat stroke = cerebral edema, degeneration of CNS, necrosis and death
malignant hyperthermia
rare, inherited muscle disorder
- anesthesia
- precipitated by inhaled anesthetics and neuromuscular blocking agents. increase o2 and lactic acid
- incrased muscle contractions, body temp
hypothermia
body temp below <35 c
- decreases response and reactions
- produces depression of CNS and resp systems, vasoconstriction, microcirculation, coagulation and ischemic tissue damage
- severe - ice crystals form within the cells and rupture and death
Sleep
temporary state of restful unconsciousness with spontaneous arousal
- two main stages:
- REM: 60-90 mins, dreams. awake, very active brain
- non-REM: stages 1-4, deep restful sleep. 6-8 hours for deep, restful sleep
sleep disorders
- insomnia: inability to fall or stay asleep
- sleep disordered breathing
- obstructive sleep apnea = obese, overweight
- nocturnal paroxysmal dyspnea = shortness of breath, postural dependent (CHF)
- Hypersomnia: too much sleep
- primary hypersonmnia - no root cause
- secondary hypersomnia - something induces it. drugs, meds.
visual dysfucntion
from cranial nerves III (oculomotor), IV (cochlear), VI (abducens)
* strabismus: lazy eye. cases diplopia (double vision)
* Nystagmus: eyes shaking or twitching
CAUSES: inner ear, cerebellum, CN, drugs, retinal disease, cerbical cord disease
alterations in refractions
- myopia: nearsightedness (long eye ball, focus in front of the retina) can’t see far, only near
- hyperopia - farsigntedness (focus behind retina, fat eye ball). can’t see close, only far
- astigmatism: uneven corneal curvature (no single retinal focus). blurry vision
the ear
cochlear = hearing vestibules = balance
ear infections
- otis externa: outside of tympanic membrane
- infection of outer ear
- prolonged moisture exposure and bacteria (swimmers ear)
- otitis media: infants and children
- acute - pain, fever, inglamed tympanic membrane with middle ear fluid
- tubes
ear - proprioceptive dysfuction
- vestibular nystagmus: eyeball movement, overstimualtino of semicircular canals ( spin way too fast)
- Vertigo: spining senstation to inflammation of semicircular canals. meniere’s disease. neuro disorders, changes in elevation, pressure on inner ear by tumor)
aphasia
loss of language and speech, basic communication
- CVA/stroke, brain tumor, infection, head injury, dementia
- symptom of brain damage, not a disease itself
boca area
mouth, motor speech
wernickie’s area
sensory, understanding speech and written word
4 categories of aphasia
- anomic/amnesia aphasia: can’t come up with name/word.
- expressive aphasia: damage to brocas area. difficulty conveying thoughts through speech or writing
* ischemia, damage to brocas area - receptive aphasia: bilateral, difficulty in understanding spoken or written language. wernickie
* ischemia, damage to wernickie area - global aphasia: most severe. both broca and wernickie. lose comprehension and expression of speech
* damage to both brocas and wernickie
cognition
full consciousness: awareness of self and environment
- arousal: state of awareness. mediated by RAS. consciousness
- thought: all cognitive functions. awareness of self, enviro, afective state/mood
decorticate posturing
flexed arms up
- severe brain damage symptom
- symptoms contralateral to lesion
- damage to cortical tract
decerebrate posturing
extended arms and adducted
- damage to upper brainstem and has worse prognoses that decorticate.
- symptoms are ipsilateral (same side)
- upper brainstem
brain stem death
never recover nor maintain internal homeostasis
- midrbain, medulla, pons
- affects vital reflexes (breathing, heart rate, BP)
- vegetative state - on life support
cerebral brain death
coma survivors
- can breath, heart beat
- minimal conscious state
- locked-in syndrom = lack of expression cannot speak or write but can totally understand speech and written word
seizures
- Partial: only part of the brain affected
- focal and unilateral
- Generalized: bilateral, symmetic
- absence: spacing out for a few minutes
- tonic clonic: ridig and relaxed state, convulsice, grand mal
- epileptic: chronic reoccurrence of grand mal/tonic clonic
Increase Intracranial Pressure (ICP)
- Hydrocephalaus: excess fluid within cranial vault, subarachnoid space, or both
- interference in CSF flow. decreased reabsorption, increased fluid production, or obstruction.
- infancy through adulthood
Coup Countercoup Injury
coup = initial impact
countercoup = secondary response
- stretch and pull brain tissue and neurons
- shreds veins and nerves
cerebral concussion
- chemical injury with loss of ATP
- scary of neurons
most common type of TBI
- micro tearing of brain tissue
- 2/3 of head injury deaths
- no major broken blood vessels
- no active bleeding, no LOC
* damages neurons, chemical injury with ATP Loss
- brain heals by scarring
- confusion, amnesia, dizziness, fatigue, change in personality
Brain Trauma
- contusion/hematoma
- brain bleed
- broken blood vessels
- direct contract (severe blunt trauma)
Epidural Hematoma
- arterial bleeds
- b/n scull and dura
- BBB doesn’t break
- lucid interval - no there symptoms but headache
- fast bleed
- blunt trauma, car accident
Subdural hematoma
- venous bleed
- below dura but above pia
- slow bleed
- most common and most fatal
- increased ICP = lack of o2, hypoxia
- BBB is broken = leukocytes and macrophages, inflammation, liquify brain tissue
- elderly alcoholics - slips and falls
- shaken baby syndrome
Intracerebral hematoma
- small arteries/veins
- inside brain tissue/hemisphere
- slow
- produces symptoms quicker - decreased cognition, LOC, confusion
- loss of BBB = liquefactive necrosis
- penumbra = self limiting bleed
- little to no change in ICP, bleeding doesn’t spread
- CVA
spinal cord trauma
- quadriplegia - cervical and down damaged
- paraplegia - below t1
- hemiplegia - stroke, half of body affected
degenerative disc disease
herniated nucleus pulposis
- dorsal pinching = dull achy pain/shooting pain
- ventral pinching = muscle weakness and pain
circle of willis
collateral flow in brain. if there is damage or blockage in area still all areas can receive blood
CVA/stroke
most frequent neuro disorder
- ischemia = infarction. death of brain tissue
- hemorrhage
- > 65 years
- > men
- > african americans
inflammation of the CNS
- meningitis: infection of the meninges
1. bacterial: pia mater, arachnoid, subarachnoid, ventricles and CSF - systemic blood stream or direct extension from an infected area
2. aspetic: viral meningitis - enterovirus, mumps, herpes simplex, west nile, influenza
3. fungal: chronic, less common - Encephalitis: infection of the brain
- caused by arthropod-borne viruses and herpes simplex type 1
Degenerative Diseases
- dimentia
- mild cognitive impairment
- alzheimers disease
- parkinsons
- amyotrophic lateral sclerosis
- multiple sclerosis
- gullain-barre
- senility: decreased cognitive function
- dementia, mental impairment of elderly
- MCI - loss of memory, recognition, mental calculations, mental pressing
AD – Alzheimer’s Disease
Initial symptoms = memory loss (dementia); secondary (later) = motor function loss
Has strong genetic component
Tau tangles and Amyloid plaques inhibit brain neuron transmission = neurons deteriorate/degenerate = brain atrophy
PD – Parkinson’s Disease
Initial symptoms = motor function loss; secondary (later) = memory loss (dementia)
Loss of dopamine production/release
Dopamine balances (counteracts) Acetylcholine (AcH) (think muscle contraction…)
Loss of inhibition by dopamine causes more action by AcH = muscle TREMORS
ALS – Amyotrophic Lateral Sclerosis (Lou Gehrig’s)
Primary symptom = muscle weakness
Degeneration of somatic motor neurons (loss of voluntary skeletal muscle control)
Rapidly progressive - leads to respiratory failure and death
- normal intellectual and sensory function until death
MS – Multiple Sclerosis
Primary symptom = muscle weakness
Demyelination of CNS neurons
Autoimmune disease = cyto t’s damaging oligo’s
Slower degeneration than ALS
GB – Guillan Barre
Primary symptom = muscle weakness
Demyelination of PNS neurons
From infection (usually EBV virus)
- acute peripheral neuropathy results in limb weakness.. progress in days to weeks
- ## demyelination of peripheral neurons
MD – Muscular Dystrophy
Primary symptom = muscle weakness
Muscle protein (dystrophin) problem (=musculoskeletal, not really neuro problem)
Duchenne MD = Most common in kids
Myotonic MD = most common in adults
MG – Myasthenia Gravis
Primary symptom = muscle weakness
Autoimmune disease = Ab to AcH receptor = blocks/destroys = low muscle function
