NR 507
Week 7 Part 1, 2 & 3
Discussion Responses
Behavioral, Neurologic, and Digestive Disorders
,Week 7: Behavioral, Neurologic, and Digestive Disorders - Discussion Part
One
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Discussion
This week's graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease
states. (PO 1)
2
Differentiate the epidemiology, etiology, developmental considerations,
pathogenesis, and clinical and laboratory manifestations of specific
disease processes. (PO 1)
3
Examine the way in which homeostatic, adaptive, and compensatory
physiological mechanisms can be supported and/or altered through
specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic
processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and
disease states. (PO 1, 4)
Discussion Part One (graded)
You are at the local mall and you see a patient who appears to be homeless by his physical
appearance and you witness the person “walk 50 feet to a table sit down, and after 5 seconds he
gets up and walks to a tree and urinates on it” He repeats this action 5 times apparently oblivious
to his surroundings. When the police come he ignores them as if they aren’t there. Later, you go
to work and sitting in exam room 3 is the same person! Now, he is your patient, when you talk to
him he has no recollection of his behavior by the mall.
, • What is your differential diagnosis?
• What tests do you order?
• An MRI comes back and there seems to be a lesion in the temporal lobe does this change
your differential? The EEG also comes back with unusual excitatory activity. What is your
definitive diagnosis? In retrospect did anything bias your first differential?
Responses
Rechel DelAntar 6/12/2016 12:44:25 PM
Differential Diagnosis
Hello professor and Class,
Differential Diagnosis
This is a case of a patient who was previously seen in the mall looking homeless in physical
appearance who exhibits repetitive movement such as “walking to a table, sitting up, walking to a tree
and urinating” oblivious to the people around him and his surroundings. Upon initial exam he has no
recollections of previous events. Based on this history, we may consider:
Seizures = specifically Complex Focal seizure (temporal or psychomotor seizure)with a simple partial
onset followed by impairment of consciousness. In this type of seizure, the patient is able to interact
with the environment with a purposeful, although inappropriate movement. Most characteristic event of
this type of seizure is the automatism; common examples of automatisms are lip smacking, chewing,
facial grimacing, swallowing movements, and patting, picking, or rubbing oneself or one’s clothing. The
body may stiffen but the patient will continue to perform complex activities of which they are involved in
such as driving. Witnesses may not recognize that anything is wrong. Temporal lobe seizures generally
last 11 seconds to 8 minutes (average 2 minutes) and are followed by several minutes of postictal
confusion (McCance, K.L., 2013).
Diagnostic testing = Laboratory studies have to be done to rule out potential causes or triggers to
seizures. MRI of the brain can be performed to check if structural lesions are causing the seizure event
and is helpful in assessing temporal seizures. Temporal lobe seizures commonly result from damage to
specific areas in that part of the brain. This can be due to a head injury, infection, or damage to a portion
of the temporal lobe due to lack of oxygen, brain tumors, genetic syndromes, or lesions of any sort.
Many of these problems also produce brain-tissue scarring called mesial temporal sclerosis. EEG within
24 hours is more sensitive for diagnosing epileptiform abnormalities as it is able to localize seizure focus.
Brain cells communicate with each other and produce our consciousness, thoughts, and actions by
electrochemical processes. Certain patterns of electrical activity disrupt this normal function of the brain
and spread in abnormal patterns within the brain. This process can be seen on an EEG (Walter, B.,
2013).
With the patient’s MRI results coming back with temporal lobe lesion and an EEG reading of
unusual excitatory activity, my differential diagnosis remains the same. The results support the
diagnosis. In retrospect, the patient’s inability to recollect his actions made me think that he was not in
control of his actions and also reminded me of post ictal stage of seizure when patients were unable to
recall the seizure event is what gave bias to my differential diagnosis.
References:
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The
biologic basis
for disease in adults and children (7th ed.). St. Louis, MO: Mosby.
Walter, B. (2013). Bradley’s neurology in clinical practice (6th ed.). Philadelphia, PA: Elsevier,
Saunders.
Instructor Brown reply to Rechel DelAntar 6/14/2016 2:23:24 PM
RE: Differential Diagnosis
What symptoms are possible with right vs. left side lesion?
, Rechel DelAntar reply to Instructor Brown 6/14/2016 10:20:29 PM
RE: Differential Diagnosis
Hello Professor and Class,
Right side vs. Left side lesion
The brain is the control center for all human activity, including vital processes
(breathing and moving) as well as thinking, judgment, and emotional reactions. Brain lesions
can be caused by injury, infection, exposure to certain chemicals, problems with the immune
system, and more. Typically, their cause is unknown. Symptoms experienced by the patient
vary depending on the location, type and size of the lesion. The brain is divided into two halves
(hemispheres). The left half controls movement and sensation in the right side of the body, and
the right half controls movement and sensation in the left side. Therefore, damage to the right
side of the brain may cause movement problems or weakness on the body's left side. For
majority of the population, the left half of the brain is responsible for verbal and logical functions
including language (listening, reading, speaking, and writing), thought and memory involving
words. Patients with this type of lesion will exhibit right side weakness, aphasia, slow speech and
decreased attention span. The right half is responsible for nonverbal and intuitive functions such
as putting bits of information together to make up an entire picture, recognizing oral and visual
patterns and designs (music and art), and expressing and understanding emotions. Patients
with this type of lesion will exhibit left sided weakness, will have difficulty with complex
communication such as difficulty identifying relevant information, inability to interpret body
language and relevant information. They tend to be very literal in their interpretation of things
and situations. Left hemispheric damage may produce a right hemianopsia or quadranopsia.
They have flat affect and at times are impulsive (Novack, T., n.d.). Right Hemispheric damage
may not only produce a left homonymous hemianopsia or quadranopsia, but it may also produce
a severe attention disorder to the left side called left hemispatial inattention or visual neglect.
Spatial orientation, body position and nonverbal communications may become impaired in some
individuals. Emotional and behavioral problems may occur. Thinking skills may be effected.
Meanwhile, many patients will be unaware of the full extent of their impairment. They may even
deny they have a problem (Manasco, H., 2014).
References:
Manasco, H. (2014). Introduction to neurogenic Communication Disorders.
Burlington, MA: Jones and Bartlett Learning.
Novack, T. (n.d.). Understanding TRI part 2: Brain Injury Impact on Individual
Functioning. Retrieved from http://www.msktc.org/tbi/factsheets/
Understanding-TBI/Brain-Injury-Impact-On-
Individuals-Functioning.
Brittany Heller 6/12/2016 1:51:25 PM
AD
"Alzheimer disease is a neurodegenerative disorder of uncertain cause and pathogenesis that
primarily affects older adults and is the most common cause of dementia" ( Wolk & Dickerson, 2016, p.
1). AD typically affects patients older than 60 years and is rarely occurs in less than 60 (Wolk &
Dickerson, 2016, p. 1). Some have suggested that there is a mutation in genes that alter beta-amyloid
protein production and metabolism (Wolk & Dickerson, 2016, p. 1). Genes that are mutated include
APP, PSEN1, and PSEN2 (Wolk & Dickerson, 2016, p. 1). AD also had three common areas of cortical
thinning patterns that were observed which are the medial temporal, diffuse, and patietal dominant
atrophy subtypes (Hwang, Kim, Jeon, Lee, HOne, Roh, Lee, Koh, & Noh, 2016, p. 1). The thinning of the
cortical areas may suggest a predictive pattern in the pathophysiology of AD. Memory impairment is the
most common symptom of AD. "Executive dysfunction and visuospatial impairment are often present
Week 7 Part 1, 2 & 3
Discussion Responses
Behavioral, Neurologic, and Digestive Disorders
,Week 7: Behavioral, Neurologic, and Digestive Disorders - Discussion Part
One
Loading...
Discussion
This week's graded topics relate to the following Course Outcomes (COs).
1 Analyze pathophysiologic mechanisms associated with selected disease
states. (PO 1)
2
Differentiate the epidemiology, etiology, developmental considerations,
pathogenesis, and clinical and laboratory manifestations of specific
disease processes. (PO 1)
3
Examine the way in which homeostatic, adaptive, and compensatory
physiological mechanisms can be supported and/or altered through
specific therapeutic interventions. (PO 1, 7)
4 Distinguish risk factors associated with selected disease states. (PO 1)
5 Describe outcomes of disruptive or alterations in specific physiologic
processes. (PO 1)
6 Distinguish risk factors associated with selected disease states. (PO 1)
7 Explore age-specific and developmental alterations in physiologic and
disease states. (PO 1, 4)
Discussion Part One (graded)
You are at the local mall and you see a patient who appears to be homeless by his physical
appearance and you witness the person “walk 50 feet to a table sit down, and after 5 seconds he
gets up and walks to a tree and urinates on it” He repeats this action 5 times apparently oblivious
to his surroundings. When the police come he ignores them as if they aren’t there. Later, you go
to work and sitting in exam room 3 is the same person! Now, he is your patient, when you talk to
him he has no recollection of his behavior by the mall.
, • What is your differential diagnosis?
• What tests do you order?
• An MRI comes back and there seems to be a lesion in the temporal lobe does this change
your differential? The EEG also comes back with unusual excitatory activity. What is your
definitive diagnosis? In retrospect did anything bias your first differential?
Responses
Rechel DelAntar 6/12/2016 12:44:25 PM
Differential Diagnosis
Hello professor and Class,
Differential Diagnosis
This is a case of a patient who was previously seen in the mall looking homeless in physical
appearance who exhibits repetitive movement such as “walking to a table, sitting up, walking to a tree
and urinating” oblivious to the people around him and his surroundings. Upon initial exam he has no
recollections of previous events. Based on this history, we may consider:
Seizures = specifically Complex Focal seizure (temporal or psychomotor seizure)with a simple partial
onset followed by impairment of consciousness. In this type of seizure, the patient is able to interact
with the environment with a purposeful, although inappropriate movement. Most characteristic event of
this type of seizure is the automatism; common examples of automatisms are lip smacking, chewing,
facial grimacing, swallowing movements, and patting, picking, or rubbing oneself or one’s clothing. The
body may stiffen but the patient will continue to perform complex activities of which they are involved in
such as driving. Witnesses may not recognize that anything is wrong. Temporal lobe seizures generally
last 11 seconds to 8 minutes (average 2 minutes) and are followed by several minutes of postictal
confusion (McCance, K.L., 2013).
Diagnostic testing = Laboratory studies have to be done to rule out potential causes or triggers to
seizures. MRI of the brain can be performed to check if structural lesions are causing the seizure event
and is helpful in assessing temporal seizures. Temporal lobe seizures commonly result from damage to
specific areas in that part of the brain. This can be due to a head injury, infection, or damage to a portion
of the temporal lobe due to lack of oxygen, brain tumors, genetic syndromes, or lesions of any sort.
Many of these problems also produce brain-tissue scarring called mesial temporal sclerosis. EEG within
24 hours is more sensitive for diagnosing epileptiform abnormalities as it is able to localize seizure focus.
Brain cells communicate with each other and produce our consciousness, thoughts, and actions by
electrochemical processes. Certain patterns of electrical activity disrupt this normal function of the brain
and spread in abnormal patterns within the brain. This process can be seen on an EEG (Walter, B.,
2013).
With the patient’s MRI results coming back with temporal lobe lesion and an EEG reading of
unusual excitatory activity, my differential diagnosis remains the same. The results support the
diagnosis. In retrospect, the patient’s inability to recollect his actions made me think that he was not in
control of his actions and also reminded me of post ictal stage of seizure when patients were unable to
recall the seizure event is what gave bias to my differential diagnosis.
References:
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The
biologic basis
for disease in adults and children (7th ed.). St. Louis, MO: Mosby.
Walter, B. (2013). Bradley’s neurology in clinical practice (6th ed.). Philadelphia, PA: Elsevier,
Saunders.
Instructor Brown reply to Rechel DelAntar 6/14/2016 2:23:24 PM
RE: Differential Diagnosis
What symptoms are possible with right vs. left side lesion?
, Rechel DelAntar reply to Instructor Brown 6/14/2016 10:20:29 PM
RE: Differential Diagnosis
Hello Professor and Class,
Right side vs. Left side lesion
The brain is the control center for all human activity, including vital processes
(breathing and moving) as well as thinking, judgment, and emotional reactions. Brain lesions
can be caused by injury, infection, exposure to certain chemicals, problems with the immune
system, and more. Typically, their cause is unknown. Symptoms experienced by the patient
vary depending on the location, type and size of the lesion. The brain is divided into two halves
(hemispheres). The left half controls movement and sensation in the right side of the body, and
the right half controls movement and sensation in the left side. Therefore, damage to the right
side of the brain may cause movement problems or weakness on the body's left side. For
majority of the population, the left half of the brain is responsible for verbal and logical functions
including language (listening, reading, speaking, and writing), thought and memory involving
words. Patients with this type of lesion will exhibit right side weakness, aphasia, slow speech and
decreased attention span. The right half is responsible for nonverbal and intuitive functions such
as putting bits of information together to make up an entire picture, recognizing oral and visual
patterns and designs (music and art), and expressing and understanding emotions. Patients
with this type of lesion will exhibit left sided weakness, will have difficulty with complex
communication such as difficulty identifying relevant information, inability to interpret body
language and relevant information. They tend to be very literal in their interpretation of things
and situations. Left hemispheric damage may produce a right hemianopsia or quadranopsia.
They have flat affect and at times are impulsive (Novack, T., n.d.). Right Hemispheric damage
may not only produce a left homonymous hemianopsia or quadranopsia, but it may also produce
a severe attention disorder to the left side called left hemispatial inattention or visual neglect.
Spatial orientation, body position and nonverbal communications may become impaired in some
individuals. Emotional and behavioral problems may occur. Thinking skills may be effected.
Meanwhile, many patients will be unaware of the full extent of their impairment. They may even
deny they have a problem (Manasco, H., 2014).
References:
Manasco, H. (2014). Introduction to neurogenic Communication Disorders.
Burlington, MA: Jones and Bartlett Learning.
Novack, T. (n.d.). Understanding TRI part 2: Brain Injury Impact on Individual
Functioning. Retrieved from http://www.msktc.org/tbi/factsheets/
Understanding-TBI/Brain-Injury-Impact-On-
Individuals-Functioning.
Brittany Heller 6/12/2016 1:51:25 PM
AD
"Alzheimer disease is a neurodegenerative disorder of uncertain cause and pathogenesis that
primarily affects older adults and is the most common cause of dementia" ( Wolk & Dickerson, 2016, p.
1). AD typically affects patients older than 60 years and is rarely occurs in less than 60 (Wolk &
Dickerson, 2016, p. 1). Some have suggested that there is a mutation in genes that alter beta-amyloid
protein production and metabolism (Wolk & Dickerson, 2016, p. 1). Genes that are mutated include
APP, PSEN1, and PSEN2 (Wolk & Dickerson, 2016, p. 1). AD also had three common areas of cortical
thinning patterns that were observed which are the medial temporal, diffuse, and patietal dominant
atrophy subtypes (Hwang, Kim, Jeon, Lee, HOne, Roh, Lee, Koh, & Noh, 2016, p. 1). The thinning of the
cortical areas may suggest a predictive pattern in the pathophysiology of AD. Memory impairment is the
most common symptom of AD. "Executive dysfunction and visuospatial impairment are often present
