PATHO NURS611 Exam 2 - Maryville University Question and Answers

PATHO NURS611 Exam 2 - Maryville University Question and Answers Contributing factors for stroke diabetes, HTN, high cholesterol , heart disease, PVD, polycythemia and thrombocytopenia, a-fib, postmenopausal hormone therapy, hight Na/low K intake, smoking, physical inactivity, obesity, chronic sleep deprivation, African Americans (2xs likely then whites), and hereditary. What is the most common location of a stroke? Middle cerebral artery What is the single greatest risk factor for stroke? Uncontrolled hypertension Contralateral hemiparesis (hemiplegia) Paresis/paralysis of the upper and lower extremities on one side, the opposite side of the brain is affected (ex= injury to L brain = R side s/s) Guillain-Barre Syndrome An autoimmune disease triggered by a preceding bacterial or viral infection. *Weakness occurs and usually plateaus or improves by the 4th week in 90% of cases, After weakness plateaus, strength improves over a period of days to months, with the majority of individuals reaching activity levels similar to their predisease state. What percent of individuals require ventilator support in Guillain-Barre syndrome? 10-30% *respiratory weakness leads to need for ventilatory support S/S of Guillain-Barre syndrome (d/t cranial nerve) chewing, swallowing, and coughing Multiple Sclerosis Chronic inflammatory disease involving degeneration of CNS myelin, scarring or formation of plaque, and loss of axons. MS is caused by an autoimmune response to self-antigens in genetically susceptible individuals. What is "clinically isolated syndrome: or first demyelinating event for multiple sclerosis? Is a single episode of neurologic dysfunction lasting greater than 24 hours that can be a prelude to MS. What is the central component of the pathogenic model of multiple sclerosis? Demyelination of nerve fibers in the CNS Multiple sclerosis is best described as a? CNS demyelination possibly from an immunogenetic virus. MS and Guillain-Barre syndrome are similar in that they are both? a result from demyelination by an immune reaction MS prognosis 90% present with a relapsing, remitting course and 10% with a primary progressive course. *90% develop a progressive course in 10 to 20 years after the onset of the disease. *Once walking problems develop, disease progression occurs quickly regardless of disease type Progression of MS As the disease progresses, inflammatory changes in the CNS increase, and loss of brain volume progresses more rapidly. The demyelination disrupts sodium, calcium, and potassium ion channels. Activated microglia and macrophages release nitric oxide and free radicals. Myasthenia Gravis is a chronic ___A___ disease characterized by antibodies attacking ___B___ receptors that act at the neuromuscular junction. A. Autoimmune B. Acetylcholine Acetylcholine a neurotransmitter that, among its functions, triggers muscle contraction Myasthenia Gravis usually has what type of an onset? Insidious First clinical manifestations of Myasthenia gravis may first appear during pregnancy, during the postpartum period, or in conjunction with the administration of certain anesthetic agents. Hallmark symptoms are exertional fatigue and weakness that worsens with activity, improves with rest, and recurs with resumption of activity. The individual often complains of fatigue after exercise and has a recent history of recurring upper respiratory tract infections. The muscles of the eyes, face, mouth, throat, and neck usually are affected first. The extraocular (eye) muscles and the levator muscles are most affected. Manifestations include diplopia, ptosis, and ocular palsies. Later signs of the disease progression for Myasthenia Gravis The muscles of facial expression, mastication, swallowing, and speech are the next most involved. Respiratory distress and difficulty breathing. Strabismus deviation of one eye from the other when a person is looking at an object, loss of binocular vision Diplopia Double vision Mystagmus Involuntary unilateral or bilateral rhythmic movement of the eyes and can occur in infants or adults Amblyopia (lazy eye) a reduction or dimness of vision related to altered development of the visual cortex and is the most common cause of childhood monocular blindness Individuals with myasthenia gravis begin to have ___A___ which leads to chronic respiratory infections. microaspirations Ptosis drooping of eyelids Clinical manifestations of Parkinson disease are caused by a deficit in which of the brain's neurotransmitters? Dopamine Parkinson Disease -The pathogenesis of primary PD is unknown - Several PD genes have been identified -The primary pathology is degeneration of the basal ganglia, loss of dopaminergic pigmented neurons in the substantia nigra -Dopamine loss in other brain areas include the brainstem, thalamus, and cortex Characteristic appearance of Parkinson disease -resting tremor, pill-rolling tremor -bradykinesia/ akinesia (poverty of movement) , rigidity (muscle stiffness) - Postural abnormalities - facial muscles smoothed out and almost immobile -Wide-eyed, unblinking, staring expression - Saliva frequently drools from the corners of the slightly open mouth. - The skin of the face is frequently greasy. - The gait is pathognomonic: the individual walks with slow, short, shuffling steps; the arms are flexed, abducted, and held stiffly at the side; and the trunk is bent slightly forward. What is the balance like for a PD patient? The person may break into a run spontaneously or when pushed forward or backward. Because of the disorder of postural fixation, the tendency is to fall to the side. Postural instability, sleep disorders, and difficulty concentrating are some of the most depressing symptoms for people with PD. Tremors at rest, rigidity, akinesia, and postural abnormalities are a result of the atrophy of neurons in the brain's: Substantia nigra that produces dopamine Parkinson disease is a degenerative disorder of the brain's: Basal ganglia In Parkinson disease the basal ganglia influences the hypothalamic function to produce which clinical manifestations? Inappropriate diaphoresis, gastric retention, & urinary retention, and constipation *The basal ganglia influences hypothalamic function (autonomic and neuroendocrine) through pathways connecting the hypothalamus with the basal ganglia and cerebral cortex. Chronic pain Neuropathic pain is chronic pain initiated or caused by a primary lesion or dysfunction in the nervous system and leads to long-term changes in pain pathway structures (neuroplasticity) and abnormal processing of sensory information. There is amplification of pain without stimulation by injury or inflammation. Acute pain clinical signs Increased pulse rate, elevated blood pressure, increased respiratory rate, diaphoresis, dilated pupils Chronic pain clinical signs Response patterns vary; fewer overt signs (adaptation) Neuropathic pain Often described as burning, shooting, shock-like, or tingling. It is characterized by hyperalgesia, increased sensitivity to a normally painful stimulus (touch, pressure, pinprick, cold, and heat), or allodynia, the induction of pain by normally nonpainful stimuli. Migraines are typically seen in _____ compared to ______. Women Men Migraines - Slow to rapid - Throbbing - Aura - Prodromal with vomiting - can be genetic Cluster Headache/Proximal Hemicrania Age of onset: young adulthood, middle age Gender: me Family history: No Onset & evolution: rapid Time course: Clusters in time Quality: steady Location: Orbit, temple, cheek Associated features: Lacrimation (tears), rhinorrhrea (runny nose), Horner syndrome (smaller pupil, drooping eyelid, & little to no sweating on affected side) Tension Type Headache Age of onset: young adulthood, middle age Gender: not sex-specific Family history: Yes Onset & evolution: slow to rapid Time course: episodic, may become constant Quality: steady Location: variable Associated features: None What hormone peaks in the morning when we wake up? Cortisol Obstructive Sleep Apnea syndrome (OSAS) Disorder of breathing during sleep related to upper respiratory collapse (obstruction) that is associated with reduced blood oxygen saturation and hypercapnia. List major risk factors for OSAS Obesity, male sex, older age, and postmenopausal status (not on hormone therapy) in women What is the Apnea Hypopnea Index (AHI)? The typical classification of the severity of this disease uses the Apnea Hypopnea Index (AHI). This index represents how many apnea (total airway closure) or hypopnea (partial airway closure) episodes occur per night—the number of which is then divided by the night's total sleep time to give an average number of apnea or hypopnea episodes per hour. Sleep deprivation and women Premenstrual women may be protected from sleep-disordered breathing because the female hormone progesterone is a respiratory stimulant. Women have different symptoms than men such as insomnia, restless legs, depression, nightmares, palpitations, and hallucinations. Sleep deprivation and the obese Obese individuals often have a short, thick neck; pharyngeal airway collapse; impaired respiratory mechanics; and depressed respiratory control, particularly during sleep. Sleep deprivation and men The longer pharyngeal airway in males also may contribute to increased risk for OSAS. Men are more likely to report snoring and apneic episodes. What is the most commonly diagnosed sleep disorder? Obstructive sleep apnea What are some effects of excessive cortisol on the body? Arthritis, decreased immune system, decreased metabolism, depression, HTN, chronic fatigue, sleep deprivation, migraines, tunnel vision, acid reflux disease, hostility, hunger What happens in sleep deprivation? The circadian rhythm is disrupted and the cortisol influx/release is messed up. This causes cortisol to be released at the wrong time and causes blood pressure to increase. Increase blood glucose levels. Detrimental influences on immune system function (increase in proinflammatory cytokines). Decreased activity of parasympathetic neurons.