Chapter 15 Notes - Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function PDF

Preview

Summary

Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function...

Description

Chapter 15: Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function Dementia  









Progressive failure of __________________________ that is not caused by an impaired level of consciousness Losses: o Orientation o _________________ o Language o Judgement o _______________________ o Behavioral changes Causes: o Neuron __________________________ o Atherosclerosis o ______________ o Genetic predisposition o _______________________ o Slow growing viruses Evaluation: o Hard to determine the cause o ____________, ________________, and _________________________ work ups should be done Treatment o Whatever it takes to keep the patient ___________________________ and assist them with the task they are unable to perform o Family support Neuro Vital Signs o Oriented to ________________________, _____________________, _________________

Alzheimer Disease 





Three forms of Alzheimer o __________________, _________________, and _________________________ o Nonhereditary (sporadic, late onset) Theories o Mutation for encoding _______________________________________________ o Alteration in _________________________________________ o Loss of neurotransmitter stimulation of __________________________________ o Caused by _____________________________________________ Neurofibrillary tangles





 



Senile plaques o Plaques build up in the __________________________________ Clinical manifestations are progressive: o Forgetfulness o ___________________________ o Disorientation o Confusion o Lack of ____________________ o Decline in abstraction, problem solving, and judgement Diagnosis is made by ruling out other causes of dementia Thought to be caused by degeneration of ______________________________________ with loss of _____________________________ o Loss of acetylcholine results in:  Decreased memory and ______________________  Loss of other cognitive functions Treatment: o To help patient ___________________ for the impaired cognitive function o Cholinesterase inhibitors given

Seizures     





Syndrome versus disease Sudden, ________________ alteration of brain function caused by an ________________, _________________, ____________________ discharge of cerebral neurons Motor, sensory, autonomic, or psychic signs Brief alteration in the brain’s electrical functions Convulsion o Tonic-clonic (jerky, contract-relax) movement associated with some seizures o ___________________: no underlying cause can be found Etiologic factors: o _____________________________ o Congenital malformations o Genetic predisposition o Perinatal injury; postnatal trauma o _____________________________ o Infection o Brain tumor o Vascular disease o Substance abuse o Other causes include: _______________________, fatigue or lack of sleep, emotional and physical ____________, large amount of water ingestion, _________________, use of stimulant drugs or withdraw from depressant drugs (alcohol), ___________________________, loud noises, certain music or even some odors. Types of seizures o Classified by:





 __________________________________  Site of origin  EEG correlates  Response to therapy o ___________________________ Partial seizures o Begin _________________ o Simple, complex, secondary generalized Generalized seizures o Absent, myoclonic, clonic, tonic-clonic, atonic  Clonus: ____________________________________ contraction and relaxation of a muscle. These movements _______________ be stopped by restraining or repositioning the arms and legs.  An absence seizure causes a short period of ________________________ or staring into space. Like other seizures, they are caused by _______________ activity in a person’s brain.  Also called _________________________  Myoclonic seizures are ___________________, ____________________ jerks of a muscle or a group of muscles.  “Myo”: ___________________  “clonus”:_________________________________________  Usually don’t last more than a second or two  Clonic: __________________ reflex activity with __________________ muscular contractions and relaxations in rapid succession. These seizures are rare.  Tonic-Clonic: the jerking is preceded by _____________. Sometimes these seizures start with joking alone. These seizures tend to last for _________________________________________.  Atonic: “without tone”, so in these seizures, muscles suddenly _______________________.  Eyelids may droop, head may nod, and the person may drop things and often falls to the ground.  Often called _______________________ or __________________  Typically last ___________________________  Often start in childhood yet last into adulthood

Oxygen Consumption During Seizure Activity     

__________ more oxygen is consumed Cerebral oxygen supply is ___________________________________ ______________________ is also depleted ______________________ accumulates in the brain Continues prolonged seizure will cause brain injury and _____________________ damage

Seizures 



Prodromal o Comes about _______________ before the seizure o Nauseated, irritated, do not feel well Aura

  





o Comes ___________________________ o Warning sign of a seizure, can be a weird smell, flashing lights in your eyes, sound that isn’t actually there Tonic Phase o Contraction Clonic Phase o Relaxation Postictal Phase o End of seizure o Groggy, waking up, may defecate Evaluation and diagnosis: o Health history o ____________________________________ o Serum and urine test to identify potential causes of seizures  _____________________  _____________________ o X-rays and testing the _______________________________ to test for neurological causes of the seizures o EEG used to assess the type of seizures and where in the brain the activity is coming from o Documentation Treatment: o Identifying and controlling the cause o _______________________________ o Drug test to measure drug levels

Increased Intracranial Pressure (IICP)  



Caused by an ____________________ in intracranial content o Tumor growth, ________________, excessive __________, or hemorrhage The cranial vault contains three things: o _____________________________ o _______________________ o _________________________________ o When any of these components increase, the other two must compensate. If they do not compensate, you get ___________________________________ To lower ICP, we being _______________________ and it is then absorbed by the ____________________________.

Cerebral Spinal Fluid Production  



CSF: clear, ___________________ fluid in the ___________________________, subarachnoid space, and the spinal cord Functions: o ______________________________________________ o ________________________________ o ___________________________________ Between _____________________ circulating at any given time o If number goes up, we are adding pressure, thus increasing our ICP

  

Product/function of _________________________ It is reabsorbed through the ___________________________________ Normal ICP: ____________________________________

Cerebral Edema  

Increase in the fluid (_____________________________________________) within the brain Types: o __________________________  Caused by ______________________________ of the capillary walls of the brain. Plasma proteins lead out into the interstitial tissue in the brain bringing water with them. o __________________________  Toxins directly affect the cells of the brain causing them to ___________________________________________________. Water follows the sodium into the cell, causing the cells to swell o __________________________  Occurs when the CSF cannot get _____________________ so that there is more CSF than needed causing the increase in ICP.  __________________________

Hydrocephalus  











Excess fluid within the _________________________________, _______________________________, or both Caused by interference in CSF flow o ___________________________________ (clogging of the arachnoid villi) o Increased fluid production o Obstruction within the ___________________________________ Noncommunicating hydrocephalus o Caused by _____________________________ through the ventricles. o Seen mostly in ___________________ o Internal o Intraventricular Communicating (_____________________________) hydrocephalus o Caused by defect in _______________________ o Seen mostly in ___________________ Patho: o Obstruction of CSF flow causes ___________________________ and ____________________________________ causing atrophy of the cerebral cortex and degeneration of ______________________________ (lies under the cerebral cortex and consist of myelinated nerve fibers) Acute Hydrocephalus o Acute Increased Intracranial Pressure o Develops over a few minutes to a few hours o Usually secondary to ____________________________ o ICP increases and may cause ____________________________________ o Acute swelling of the brain tissues Normal-pressure hydrocephalus





o Increased size of the ___________________ without increased pressure o Has ________________________________  Declining memory and cognitive function  Incontinence  You cannot control your __________________________________  Dementia Diagnosis o Physical exam o CT and MRI of the head Treatment o Surgical removal of the obstruction o _____________  Ventriculoperitoneal shunt o Diuresis

Parkinson Disease (disorder of ________________) 











Severe degeneration of the _________________________ (corpus striatum) involving the _______________________________________________________ o Loss of dopamine producing neurons o Parkinsonian tremor, rigidity, ________________________ o Postural disturbances o _______________________________________________________ o Cognitive-affective symptoms Primary Parkinson’s is the actual disease o Presents after the age of __________ o More prevalent in ______________ o Major leading cause of _____________________________ in people over 60 Secondary parkinsonism o Presents with symptoms of parkinsonism but is caused by __________________________  Head trauma, __________________, cancers, _________________________, toxins, and drugs.  If caused by drugs (neuroleptic, antiemetic, and antihypersensitive) is usually reversible Causes o Unknown. o Viral and toxins have been linked Patho o _____________________ is an inhibitory neurotransmitter. With lack of dopamine and an increase of ___________________ (excitatory neurotransmitter), you get hypertonic tremors and rigidity. o Over decades, __________________ may develop secondary to plaque formation in the cerebral cortex Clinical Manifestations o _________________________ o Rigidity (muscle stiffness) o Bradykinesia (slow movement)/ akinesia (no movement) o Poor posture

o _____________________ (poor pronunciation of words suet to muscle of speech not working) o _____________________ (disruption of language either understanding it or using it) o Poor balance----- they adapt a gait to prevent them from falling (short accelerating steps) 





Autonomic neuroendocrine symptoms o Secondary to increased ____________________________ not checked by dopamine which has an ____________________ action o Inappropriate diaphoresis o _______________________________ o Drooling o Gastric retention o _______________________ o Urinary retention o Depression Diagnosis o Based on history and physical exam o First, they exclude secondary causes o No specific diagnostic test Treatment o Treat symptoms o Assist them to adapt with _________________: activities of daily living o Medications to decrease ______________ (side effects are so bad that they are only given late in the disease)...