Neurogenic Diabetes Insipidus
Swelling commonly seen after traumatic brain injury (TBI) can lead to dangerous increases in intracranial pressure. This
... [Show More] increase can push on the pituitary leading to decreased ADH secretion = polyuria.
Parasympathetic Nervous System
Mediated by acetylcholine; controls rest and digest; conserves energy and the body's resources; controls everyday metabolism
Sympathetic Nervous System
Mediated by catecholamines (epi and norepi); prepares the body for fight or flight; mobilizes energy stores --> releases insulin; redistributes blood flow - increased to muscles, decreased to GI/integumentary
Focal brain injury
Specific lesions that are observable on imaging; epidural or subdural hemorrhage
Diffuse brain injury
Injuries involving widespread areas of the brain; may be difficult to detect and define because damage is often microscopic; hypoxia is the number 1 cause; other causes include meningitis or encephalitis
Autonomic Dysreflexia (below the lesion)
Faulty control of sweating because the hypothalmus is unable to regulate body heat due to SNS damage; pale, cool skin
Autonomic Dysreflexia (general)
A complication occurring in a person who has a spinal cord injury above T6
Autonomic Dysreflexia (above the lesion)
Paroxysmal hypertension (up to 300 mmHg systolic), piloerection, and sweating with flushing of the skin; headache, bradycardia
Delirium
Acute onset, short duration; often associated with UTI, resolves with treatment; attention and orientation are impaired; patient can be agitated, disorganized, and have hallucinations
Dementia
Usually insidious with chronic slow decline; attention and orientation are often intact early in the progression; no overt behavioral signs early
Alzheimer Disease
Leading cause of dementia; greatest risk factors are age and family history; specific diagnosis is made by postmortem examination
Stroke (incidence)
Two times higher in blacks than whites; tends to run in families; most common are ischemic
Stroke (Risk Factors)
Hypertension, Insulin resistance and diabetes mellitus, High total cholesterol or low high-density lipoprotein (HDL) cholesterol level, elevated lipoprotein-A level, Heart disease and peripheral vascular disease, Polycythemia and thrombocythemia, Atrial fibrillation, Postmenopausal hormone therapy, High sodium intake, >2300 mg; low potassium intake, <4700 mg, Smoking, Physical inactivity, Obesity BMI >30, Chronic sleep deprivation
Right-sided homonymous hemianopsia
Visual field loss to the side of the vertical midline. In this case left-sided peripheral vision will be intact, but right side is lost
Middle cerebral artery stroke s/s
Contralateral hemiparesis or hemiplegia (upper extremities greater than lower); expressive disorder with anomia (inability to name objects); nonfluent aphasia, comprehension defects; Cheyne-Stokes respirations
Guillain-Barre
An autoimmune disease that is preceded by an infection; with the outbreak of Zika, there has been an increase in cases; weakness plateaus around week 4 in most cases and strength can be regained
Guillain-Barre (picture)
Multiple Sclerosis
Chronic inflammatory disease involving degeneration of myelin; there is usually a clinically isolated syndrome with a single episode of neurologic dysfunction (often follows pregnancy)
Multiple Sclerosis (Clinical manifestations)
Initially 90% of patients present with relapsing/remitting course that progresses over 10-20 years; 10% present with primary progressive course; once walking problems develop, disease progression occurs quickly.
Multiple Sclerosis (Picture)
Myasthenia Gravis
A chronic autoimmune disease mediated by acetylcholine receptor antibodies that act at the neuromuscular junctions
Myasthenia Gravis (Clinical Manifestations)
Exertional fatigue that improves with rest; history of recurrent respiratory infections; diplopia, ptosis, and ocular palsies; facial droop, flat affect; difficulty chewing and swallowing
Parkinson's Disease (characteristic appearance)
Resting tremor, pill-rolling tremors, bradykinesia/akinesia (poverty of movement), rigidity. A wide-eyed, unblinking, staring expression; shuffling steps; arms flexed, held stiffly at the side; trunk is bent forward
Acute Pain
Transient, sudden onset; Clinical signs: Increased pulse rate, elevated blood pressure, increased respiratory rate, diaphoresis, dilated pupils
Chronic Pain
Prolonged and persistent; few overt s/s due to adaptation; most common form is persistent low back pain
Glaucoma
Leading cause of visual impairment and blindness; family history is a risk factor; increased introcular pressure causes optic nerve degeneration
Open-angle Glaucoma
Most common; obstruction is in the aqueous flow
Closed-angle Glaucoma
The iris pushes into the lens, blocking aqueous flow
Cardinal Signs of Inflammation
Edema, warmth, redness, and pain
Edema
Vasodilation causes slower blood velocity which increases local blood flow; increased flow and capillary permeability result in leakage of plasma and swelling
Warmth and redness
Increased concentration of RBC at the site of inflammation; chemotactic factor effects the inflammatory response by directing leukocytes to the inflamed area
Pain
Physiologic response that allows us to know when damage is done
Inflammatory response
One main purpose is to prevent infection of the injured tissue
Phagocytosis
Opsonization, engulfment, fusion with lysosomal granules, destruction of the target
Opsonization
Phagocytes recognize the target and adhere to it
Resolution
When cellular damage occurs and it is minor with no significant complications; it is possible for the injured tissues to return to normal structure and function
Humoral immunity
Mediated by B-lymphocytes; works in the bodily fluids before an infectious agent has entered the cell; antibody circulates in the blood and binds to antigens on infectious agents
Cellular Immunity
T cells differentiate during an immune response and develop the ability to react directly with antigens on infectious agents
Types of T cells
Some stimulate other leukocytes through contact or through cytokine secretion; others develop into T-cytotoxic cells that kill targets
Immune deficiency and T-lymphocytes
A patient with this problem needs screening for malignancy
Active Immunity
Produced by the individual after exposure; either naturally occurring or via vaccines
Passive Immunity
Occurs when preformed antibodies are transferred from a donor to the recipient; naturally occurring as the mother passes antibodies to her breastfed baby or passive via immunotherapy
IgG
The most abundant class of immunoglobulins; They constitute 80% to 85% of those circulating in the body and account for most of the protective activity against infections
IgA
Molecules found in bodily secretions; there is a secretory piece that is attached inside mucosal epithelial cells; may function to protect these immunoglobulins against degradation by enzymes also found in the secretions
IgM
The largest of the immunoglobulins. It is the first antibody produced during the initial, or primary, response to antigen.
IgE
The least concentrated of any of the immunoglobulin classes in the circulation; it appears to have very specialized functions as a mediator of many common allergic responses
Antibodies
Protect the host from bacterial invasion; bind to toxins produced by bacteria and prevent their interaction with cells; neutralizes the bacteria's biologic effects
Routes of antigen administration
Each route stimulates a different lymphocyte containing tissue, resulting in different types of cellular and humoral immunity
Type I hypersensitivity
Mediated by antigen-specific IgE and the products of tissue mast cells; causes most common allergies; anaphylaxisis
Type II hypersensitivity
Characterized by a specific cell or tissue being targeted; antibodies bind to antigens on the cell surface
Grave's disease
Type II hypersensitivity reaction; autoantibody binds to and activates receptors for TSH receptors which control the production thyroxine by the thyroid; In this way the antibody stimulates the thyroid cells to produce thyroxine.
Alloimmune reaction to ABO-mismatched blood
Type II hypersensitivity reaction; Because individuals with type O blood lack both types of [Show Less]