Patho Exam 6 Flashcards
Generalized seizure: Absence seizures
occurs in children, staring spells that last a few seconds
Causes of seizures
unknown
cerebral trauma
cerebral lesions
metabolic/nutritional disorders
decorticate response
mummy pose
flexion of arms, wrists, and fingers with adduction in upper extremities
neurogenic shock
form os distributive shock caused by the loss of the brainstem and higher center control of the sympathetic nervous system. Causes hypotension due to vasodilation.
serotonin
mood neurotransmitter
mood, appetite, social behavior, sexual drive, sleep, reminiscence, learning, and GI mobility
ACh
learning neurotransmitter
recollection, concentration, attention, muscular activities, thinking, and mood
cause of seizures in infants
infection and exposure to toxins in utero
Alzheimer’s pathology and risk factors
unknown cause
early neuronal degeneration in the hippocampus
followed by degeneration of neurons in cerebral cortex
intracellular neurofibrillary tangles
extracellular amyloid and tau plaques
risk factors related to age and family history
Parkinson’s etiology
Common onset age in 70s
More common in men
treatment of
ischemic stroke
hemorrhagic stroke
IS: minimizing infarct size and preserving neurologic function
HS: BP management, ICP monitoring and management
cause of seizures in elderly
stroke, Alzheimer’s, and tumors
classic symptoms of an acute subdural
headache, drowsiness, restlessness, agitation, and confusion
Receptive aphasia: transcortical motor/sensory
motor=nonfluent
sensory=fluent
loss of parasympathetic control
bradycardia and loss of the cardiac accelerator reflex
Receptive aphasia: word deafness
hears noise instead of words
generalized seizure
entire brain surface involved, including the thalamus and RAS. Loss of consciousness
main neurotransmitter for the PNS
ACh
prodoma
early sign of seizure. Headache, malaise, depression. May occur hours to days before seizure
treatment for meningococcal
rifampin
Cause of seizures in neonates
infection, congenital defect, premature
Epidural bleed
An artery is the source
Only 1-2% of bleeds
90% have skull fracture
temporal fossa
middle meningeal artery
can result in uncal herniation
coup (focal) injury
contra coup (polar) injury
coup is impact with surface
contracoup is the brain rebounding against the skull
Generalized seizure: tonic-clonic
jerking of many muscles
Receptive dysphasia: sensory/wernicke’s
trouble understanding what has been said to them
supratentorial vs infratentorial herniation
supra-brain tissue moves through tentorial notch
infra- tissue moves through the foramen magnum
What causes secondary ischemia?
edema
Generalized seizure: myoclonic
single or several jerks
Clinical manifestations of increasing ICP
headache, vomiting, altered level of consciousness, blurry vision, edema of optic disk, reduced pupillary response.
partial seizure: simple
no visible change
reperfusion injury
oxygen reenters cell after ischemia and produces reactive oxygen product similar to free radicals. Cell membranes undergo lipid peroxidation with formation of arachidonic acid which creates more free radicals.
Receptive aphasia: anomic
difficulty with word-finding, or naming items
partial seizure with secondary genrealization
starts simple but goes to generalized
cause of seizures in children
brain tumors, fevers, development
signs and symptoms of systemic bacterial infection involving meninges
severe headache, photophobia, nuchal rigidity
decrease in LOC, cranial nerve palsies, focal deficits
primary vs secondary spinal cord injuries
primary: injury related to immediate trauma of the spinal cord
secondary: injury is a result of ischemia, inflammatory response, edema, and other cellular activities that create lesions
Parkinson’s complications
-weakness and akinesia
-dementia/neuropsych issues
-dysphagia
-orthostatic hypotension
-sleep disorders
tonic
muscle contraction with excessive muscle tone. Stiffness, incontinence, epileptic cry, and back arched. Excitatory spread to the subcortical, thalamic, and brain stem and loss of consciousness.
Parkinson’s clinical manifestations
slowing down in initiation and execution of movement
increased muscle tone/rigidity
tremor at rest
gait disturbance
partial seizure
restricted to one hemisphere
Numbers for mild, moderate, and severe of GCS
mild: 13-15
moderate: 9-12
severe: 3-8
Clinical manifestations of Alzheimers
short term memory loss, long term memory loss intact
decline in ability to perform ADLs
decline in ability to swallow
dyphasia
impaired comprehension of words, language, symbols, written or verbal
Stroke sequelae
initial muscle flaccidity or paralysis, recovery of motor neurons starts with muscle rigidity
sensory disturbances occur in same locations as motor paralysis and may involve neglect or visual impairment
broca aphasia- poor articulation and sparse vocabulary
wernicke aphasia- word salad
part of brain damaged dictates cognitive impairments
partial seizure: complex
change in consciousness
Health history items for parkinson’s nursing assessment
excessive salivation
dysphagia
weight loss
difficulty with movements, falls, loss of dexterity
constipation
incontinence
diffuse pain
depression/mood swings
hallucinations
agnosia
Loss of the ability to identify objects or people.
Receptive aphasia: global
non-fluent
Pathophysiology of Parkinson’s
degeneration of dopamine-producing neurons in substantia nigra
disrupts dopamine-ACh balance in basal ganglia
Reduced dopamine affects posture, support, and voluntary motion
dementia
-cause
-types
-loss of cognitive and functional intellect
-gradual decrease over months or years
-caused by stroke, metabolic, toxins, and demyelination
-85% alzheimer’s type dementia
-other is multiinfarct dementia
Subdural bleed
venous source
10-20% of TBI
acute 48 hours
chronic- weeks to months
tearing of bridging veins
acute can result in herniation
Receptive aphasia: conduction
inability to repeat words or phrases they have heard
aphasia
common cause
Loss of comphrehension and production of language, spoken or written. Can either not speak or speak with word salad.
Related to stroke that involves middle cerebral artery.
loss of impulses from the temperature regulatory center
unable to sweat below level of injury
cause of seizures in young adults/adults
unknown or drugs/alcohol
tumors
delirium
usually related to drug/toxin/metabolic disease process
sudden onset or gradual over a few days
loss of vigilance
Cerebral perfusion pressure
60-100gHg
Epi
Fight or Flight
Increased HR, tear production, and BP.
Aura
a partial seizure that proceeds a generalized seizure, feel strange. Hallucinations, dizzy, numbness, confusion, and distorted emotions
What causes primary ischemia?
blood clot
autonomic dysreflexia
full bladder or constipation common cause
hypertension, bradycardia, headache, upper body flushing, and lower body vasoconstriction.
status epilepticus
continuous series of seizures with no recovery between seizures
postical
period immediately after seizure which can last for hours. Confusion, drowsiness, hypertension, weakness, headache, nausea, etc
Causes of increased ICP
increased brain tissue volume:
tumor, hemorrhage, infection, edema, ischemia, and necrosis
increased cerebrospinal fluid:
hydrocephalus and pseudotumor
Increased blood volume:
increased right atrial pressure, dural sinus thrombosis, high arterial PaCO2, Acidosis
dopamine
pleasure neurotransmitter
enthusiasm, cognition, recollection, awareness, decision-making, and sleep control.
decerebrate response
all four extremeties in rigid extension, pointed toes, and turned out arms. Signals a worsening in condition, herniation.
clonic
alternating contraction and relaxation of muscles, blinking eyes, frothy saliva. associated with inhibitory neurons stopping the seizure
expressive aphasia/broca’s
non fluent, can’t find the word
Three hallmark symptoms of Parkinson’s
-Tremor: initially minimal, more prominent at rest and is aggravated by stress. Pill rolling.
-Rigidity: jerky movements, sustained muscle contraction, soreness, fatigue, and pain.
-Bradykinesia: slow movement, loss of autonomic movement such as blinking, swallowing saliva, and facial expressions.
Generalized seizure: Atypical absence
myoclonic jerks, automatisms with staring spell
Parkinson’s symptoms
tremors, unsteady gait, and instability
bradykinesia
akinesia
NorEpi
Increase HR and blood flow, increased RR, increased strength and performance
main neurotransmitters for the SNS
epi and norepi
treatment of increased ICP
decrease swelling- diuretics (mannitol)
control hypertension- nitroprusside
control bleeding
control pain and anxiety- profenol, morphine, and benzo
maintain tissue perfusion- oxygen
Generalized seizure: atonic
falls down
GABA
Calming neurotransmitter
Calms neurons in brain and CNS
relaxation, decreased stress, and stable mood
