NURS 611 – ADVANCED PATHOPHYSIOLOGY
Study Guide Questions for Exam 2
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Central Nervous System- Brain & spinal cord
I.Brain
*Ability
... [Show More] to reason, function intellectually, express personality & mood, perceive & interact with the environment
A.Forebrain (telencephalon: cerebral hemispheres & diencephalon: interbrain)
a.Cerebral cortex (largest portion of the brain)
b.Basal ganglia (several nuclei)
c.Cerebral cortex: outer layer of neurons (grey matter) that receive, integrate, store & transmit info & white matter (beneath the cerebral cortex) composed of myelinated nerve fibers
Telencephalon
Frontal lobe (central sulcus): future planning, self-management, decision-making
*Speech & language issues (Broca’s area: helps put thoughts into words), ability to speak, understand language, produce speech aka aphasia & dysphagia
*Motor skills (primary motor cortex) such as coordinate voluntary movements (walking & running)
*Comparing objects
*Forming memories (long-term)
*Empathy
*Personality
*Reward-seeking behavior & motivation (dopamine-sensitive neurons)
*Attention, selective attention
Parietal lobe: somatic sensory input (storage, analysis, interpretation of
sensory stimuli)
*Touch, temperature, vibratory sense
*Hemiplegia
*Differentiate between right & left
*Difficulty with reading, writing & math
*Apraxia
Occipital lobe: primary visual cortex
*Homonomous hemianopia
Temporal lobe: primary auditory cortex
*Receptive aphasia or dysphagia (Wernicke’s area: sensory speech, responsible for reception & interpretation of speech
* Memory consolidating issues
*Hearing: auditory agnosia, verbal agnosia, illusions & hallucinations
*Memory, emotion & behavior: loss of short & long term memory, aggressive behavior, lack of interest (depression)
*Seizures, vertigo, abnormal perception of time, disturbances of smell & taste
Corpus callosum: bundle of myelinated fibers that connects the two cerebral hemispheres
Basal ganglia (contains substantia nigra): coordination of voluntary movements, cognitive & emotional function
Extrapyramidal system: motor control system that causes involuntary reflexes, has a stabilizing effect on motor control
Limbic System (group of interconnected structures located between the telencephalon & diencephalon):
mediates emotion, long-term memory, behavioral responses, visceral reaction to emotion, motivation, mood, feeding behaviors, biologic rhythms, sense of smell
⟶ Amygdala
⟶ Hippocampus
⟶ Fornix
⟶ Hypothalamus
Diencephalon
Thalamus: major integrating system for afferent (sensory) stimuli to the cerebral cortex
*Relay center for info from basal ganglia & cerebellum to the appropriate motor area
*Cortical processing for interpretation
Hypothalamus: maintain constant internal environment & implement behavioral patterns
*Autonomic (sympathetic & parasympathetic NS) nervous system function, regulate body temperature, endocrine function- hormone synthesis, adjust emotional expression
B.Midbrain
Superior colliculi: voluntary & involuntary visual motor movements (eyes to track moving objects)
Inferior colliculi: similar motor activities; involve movements affecting the auditory system
Tegmentum (composed of the red nucleus & substantia nigra): Red nucleus- receives ascending sensory info from the cerebellum, substantia nigra-
synthesizes dopamine (PD)
C.Hindbrain (metencephalon & myelencephalon) Metencephalon
Cerebellum: two lobes; reflexive, involuntary fine-tuning of motor control, maintaining balance & posture through
extensive neural connections with the medulla
* Ipsilateral (same side) control of the body (contrast to cerebral cortex)
Pons: transmits info from the cerebellum to the brainstem between the two cerebellar hemispheres
*Nuclei of the 5th to the 8th cranial nerves
Myelencephalon (Medulla oblongata) Lowest portion of brainstem
*
*Reflex activities such as HR, RR, BP, coughing, sneezing, swallowing & vomiting
*Nuclei of cranial nerves 9th to 12th
II.Spinal cord
*Transmit long motor & sensory tracts that originate in the brain and synapse with cell bodies in gray matter of the spinal cord before exiting to the body
*Somatic & autonomic reflexes, motor pattern control centers, sensory & motor modulation
*Divided into sections: 8 cervical, 12 thoracic, 5
lumbar, 5 sacral & 1 coccygeal
Peripheral Nervous System
*Nerves outside the CNS
*Somatic NS controls voluntary muscle movement (efferent nerves) and sensory info (afferent nerves)
*Cranial & spinal nerves
Autonomic Nervous System
*Regulates involuntary function of internal organs
*Part of the efferent division of the PNS
*Separated by two divisions: sympathetic nervous system & parasympathetic nervous system
Parasympathetic & Sympathetic NS
➢Body organs are innervated by these two nervous systems
➢The two divisions cause opposite responses
(Ex: sympathetic stimulation of the GI tract causes peristalsis, whereas parasympathetic stimulation peristalsis)
➢Release acetylcholine via cholinergic transmission
I.Parasympathetic Nervous System: conserves/stores energy and the body’s resources
➢Parasympathetic activity promotes rest & tranquility
➢HR and enhanced visceral functions leading to digestion
➢Lacks the generalized & widespread response of the sympathetic system, specific parasympathetic fibers are activated to regulate particular functions
II.Sympathetic Nervous System: Promotes responses that are concerned with the protection of the individual
➢Responds to stress by preparing the body to defend itself “fight or flight”
➢Sympathetic stimuli blood glucose, temperature & BP
*Regulation of vasomotor tone is considered the single most important function
➢Postganglionic sympathetic fibers release norepinephrine (adrenaline) & thus are considered to function by adrenergic transmission
➢Action of catecholamines (epinephrine, norepinephrine, dopamine) varies with the type of neuroreceptor stimulated;
released by adrenal medulla (resembles sympathetic NS
➢Dopamine is a precursor of NE and
Epinephrine, synthesized by substantia nigra
➢Mobilizes energy stores, and decreases the release of insulin
➢Redistributes blood flow: increases to muscles (flight) and lungs, decreases to GI & integumentary
Traumatic Brain Injury: can be classified as focal or diffuse
-Primary brain injuries are caused by the direct impact or injury
➢Focal: specific, involving one area of the brain. Direct impact
Ex: Scalp laceration, skull fracture, contusions, hemorrhage: epidural, subdural, intracerebral, subarachnoid
➢Diffuse: involving more than one area of the brain.
Ex: Hypoxia, meningitis, encephalitis, and damage to blood vessels
- Swelling, commonly seen after TBI can lead to dangerous increases in intracranial pressure (ICP)
➢Increased ICP can cause collateral dysfunction such as diabetes insipidus (ADH not secreted thus polyuria)
Autonomic hyperreflexia (Dysreflexia): [Show Less]