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Questions and Answers
What is the primary focus of alterations in cognitive systems?
What is the primary focus of alterations in cognitive systems?
Which factor is most critical in cerebral hemodynamics?
Which factor is most critical in cerebral hemodynamics?
How do alterations in cognitive systems manifest in motor function?
How do alterations in cognitive systems manifest in motor function?
What is a potential consequence of disrupted cerebral hemodynamics?
What is a potential consequence of disrupted cerebral hemodynamics?
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Which of the following can be a cause of cognitive system alterations?
Which of the following can be a cause of cognitive system alterations?
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What is the most critical clinical index of nervous system function?
What is the most critical clinical index of nervous system function?
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What are the three components that contribute to intracranial pressure (ICP)?
What are the three components that contribute to intracranial pressure (ICP)?
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Which of the following is NOT a sign of a Stage 2 increase in intracranial pressure?
Which of the following is NOT a sign of a Stage 2 increase in intracranial pressure?
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Which of the following is NOT a factor that can lower the threshold for seizures?
Which of the following is NOT a factor that can lower the threshold for seizures?
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What is a paroxysmal event associated with abnormal electrical discharges of neurons in the brain?
What is a paroxysmal event associated with abnormal electrical discharges of neurons in the brain?
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Which of the following is NOT considered to be a characteristic of a preictal phase?
Which of the following is NOT considered to be a characteristic of a preictal phase?
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What is a potential complication of seizures?
What is a potential complication of seizures?
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Which type of dementia is characterized by amyloid plaques and beta tangles?
Which type of dementia is characterized by amyloid plaques and beta tangles?
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Which of the following is a common complication of Parkinson’s disease?
Which of the following is a common complication of Parkinson’s disease?
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What is the underlying cause of Guillain-Barré syndrome?
What is the underlying cause of Guillain-Barré syndrome?
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What is the characteristic pattern of muscle weakness associated with Guillain-Barré syndrome?
What is the characteristic pattern of muscle weakness associated with Guillain-Barré syndrome?
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Amyotrophic lateral sclerosis (ALS) primarily affects the brain.
Amyotrophic lateral sclerosis (ALS) primarily affects the brain.
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Cushing's triad is a sign of increased intracranial pressure.
Cushing's triad is a sign of increased intracranial pressure.
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Hydrocephalus is a condition where there is too much cerebrospinal fluid in the brain.
Hydrocephalus is a condition where there is too much cerebrospinal fluid in the brain.
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Parkinson's disease is a result of a lack of acetylcholine in the brain.
Parkinson's disease is a result of a lack of acetylcholine in the brain.
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What is the term for a generalized tonic-clonic seizure that lasts more than 5 minutes or recurs more than once without regaining consciousness?
What is the term for a generalized tonic-clonic seizure that lasts more than 5 minutes or recurs more than once without regaining consciousness?
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What is the term for a state of muscle contraction with excessive tone that occurs during the ictal phase of a seizure?
What is the term for a state of muscle contraction with excessive tone that occurs during the ictal phase of a seizure?
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What is a clinical characteristic of the postictal phase after a seizure?
What is a clinical characteristic of the postictal phase after a seizure?
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What is a common clinical manifestation of delirium that can be particularly alarming?
What is a common clinical manifestation of delirium that can be particularly alarming?
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Match the following terms with their descriptions:
Match the following terms with their descriptions:
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Study Notes
Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function
- Nursing 302 course material
- Discussion covers cognitive function, cerebral blood flow, and motor function.
Alterations in Arousal
- Five key neurological function patterns crucial for evaluation:
- Level of consciousness
- Breathing pattern
- Pupillary reactions
- Oculomotor responses
- Motor responses
- These patterns help gauge the extent of brain dysfunction.
- Brain Death: Total brain death; irreversible damage; brain cannot maintain homeostasis.
- Cerebral Death: Irreversible coma; permanent brain damage; brainstem can maintain homeostasis.
Level of Consciousness
- The essential clinical index of nervous system function.
- Alert and oriented individuals demonstrate the highest level of consciousness.
- If awake, begin with conversation, introducing yourself and observing patient reactions.
- Use orientation questions (A+O x3) about person, place, date/time to evaluate awareness.
- If unconscious or unable to speak, assess vital signs first, followed by neuro-vital signs using the Glasgow Coma Scale (GCS).
Levels of Altered Consciousness
- Confusion: Impaired judgment and decision-making.
- Disorientation: Beginning loss of awareness, especially to time and place; memory difficulties.
- Lethargy: Limited spontaneous movement and speech, easily aroused by normal stimuli, possibly oriented x3.
- Obtundation: Mild-to-moderate reduction in arousal, limited responsiveness to the environment. Falls asleep without stimulation; minimally responsive to questions.
- Stupor: Deep sleep or unresponsiveness; only arouses with vigorous stimulation; often withdraws or grabs at stimuli.
- Coma: No verbal response to external environment; no response to stimulation. Light coma might have purposeful movements on stimulation, while deep coma does not.
Early, Late, and Terminal Signs of Altered LOC
- Early: Compensatory mechanisms intact; variable signs such as focal findings (speech, vision), papilledema, vomiting, headaches, and seizures.
- Late: Compensatory mechanisms failing; unilateral or bilateral pupil changes; ineffective breathing patterns; abnormal motor responses (decorticate or decerebrate).
- Terminal: Decompensation; bilaterally fixed and dilated pupils; respiratory arrest; absence of motor response. Signs such as hypertension, bradycardia, and hyperthermia are common at this stage.
Patterns of Breathing
- Breathing patterns help evaluate brain dysfunction and coma.
- Assess rate, rhythm, and pattern.
- Normal rhythm is regular; irregular rhythms may indicate changes.
- Cheyne-Stokes respiration involves periods of apnea followed by rapid breathing.
- Kussmaul respiration is characterized by increased rate and depth.
Pupillary Changes & Oculomotor Responses
- Assess pupillary changes to indicate brainstem dysfunction.
- Pupils equal, round, reactive to light, and accommodation (PERRLA) is normal.
- Certain medications, including opiates, can cause pinpoint pupils.
- Oculomotor responses (resting, spontaneous, reflexive eye movements) reflect brain function at various levels.
- Doll's Eyes phenomenon assesses brain stem function.
Motor Responses
- Motor responses help evaluate brain dysfunction and identify the most severely damaged side of the brain.
- Purposeful movements, including obeying commands, indicate adequate function.
- Inappropriate generalized movement means that the cortex is losing inhibition.
Alterations in Awareness
- Awareness encompasses cognitive function, including self-awareness, environmental awareness, moods, selective attention, and memory.
- Amnesia is memory loss, ranging from temporary (after a seizure) to permanent (dementia). Retrograde amnesia is difficulty remembering past events, while anterograde amnesia is difficulty forming new memories.
- Executive attention deficits involve problems with sustained attention, working memory, goal setting, and following instructions.
Data Processing Deficits
- Agnosia: Difficulty recognizing objects, often tactile, visual, or auditory.
- Dysphasia: Impairment of language comprehension or production; aphasia is the most severe form. There is inability to communicate through expressive (Broca's) and receptive (Wernicke's) language.
Acute Confusional States - Delirium
- Delirium is a hyperactive confusional state, often associated with autonomic nervous system overactivity.
- The condition typically develops over 2-3 days and is a medical emergency, requiring identification of the underlying cause.
- Symptoms include restlessness, insomnia, tremors; hallucinations; incoherent conversations; tachycardia; and diaphoresis.
- Diagnosis involves a thorough history and physical exam, along with lab tests, imaging, and CSF analysis. Treatment aims to address the primary cause.
Delirium vs Dementia
- Both result in impaired mental function, but differ in onset and reversibility.
- Delirium involves sudden onset with fluctuating symptoms that typically resolve when the underlying cause is addressed. Dementia is a progressive and irreversible decline in cognitive abilities.
Dementia
- Acquired deterioration in intellectual processes; progressive failure of many cerebral functions.
- Mechanisms vary: neuron degeneration, brain tissue compression/trauma, atherosclerosis, or genetic predisposition.
- Losses include orientation, memory, language, judgment, and decision-making. Differences in various types of dementia are highlighted.
Alzheimer's Disease
- A progressive neurodegenerative disease accounting for a significant portion of dementia cases.
- Two forms: familial (early onset) and sporadic (late onset).
- Pathological markers include extracellular neuritic plaques with amyloid beta protein accumulation and neurofibrillary tangles (tau protein).
- Clinical manifestations in early stages: memory loss, difficulty performing familiar tasks, difficulty learning, and concentration problems. Later progression involves deterioration in hygiene, communication difficulties, problem-solving issues, and difficulty with coordination and verbal expression.
Seizures
- Paroxysmal events caused by abnormal electrical discharges of neurons.
- Epilepsy is a seizure disorder without an underlying treatable cause. Convulsion refers to the tonic-clonic (jerky, alternating contract-relax) movements.
- Disorders that can trigger seizures include metabolic issues, congenital defects, prenatal/postnatal trauma, infections, brain tumors, and vascular issues. Alcohol or drug use or withdrawal can also be triggers.
- Factors that can lower seizure threshold: Hypoglycemia, fatigue, lack of sleep, stress, fever, excessive water ingestion, constipation, and antipsychotic and depressant medication usage or withdrawal.
- During a seizure, there are phases that can be observed including preictal, ictal, and postictal.
Increased Intracranial Pressure (ICP)
- Intracranial pressure, (ICP), is the pressure exerted by the combined brain tissue, blood, and cerebrospinal fluid (CSF). The pressure can increase due to various causes and manifest as neurological symptoms.
- Increased ICP can occur when the pressure of these components in the brain is unable to be displaced elsewhere in the cranium.
- Causes of elevated ICP: tumors, swelling (edema), excess cerebrospinal fluid (CSF) or bleeding (hemorrhage).
- Clinical symptoms of elevated ICP are typically progressive, such as confusion, restlessness, drowsiness, and changes in pupil size and breathing.
Hydrocephalus
- Hydrocephalus is an excess of cerebrospinal fluid (CSF) within the brain's ventricles, subarachnoid space, or both.
- Causes include decreased reabsorption, increased fluid production, and obstruction of the CSF flow pathways.
- Clinical manifestations can be varied, ranging from subtle unsteady gait issues, incontinence, and changes in memory to more acute symptoms of increased intracranial pressure.
Alterations in Muscle Tone
- Hypotonia: Decreased muscle tone; passive movement with minimal resistance.
- Hypertonia: Increased muscle tone; resistance to stretching of muscles.
Alterations in Movement
- Hyperkinesia: Excessive purposeless movements (e.g., spasms, tics, tardive dyskinesia, Tourette syndrome).
- Hypokinesia: Decreased movement (e.g., Akinesia, bradykinesia, Parkinson's Disease).
Parkinson's Disease
- Progressive neurodegenerative disease affecting the basal ganglia and characterized by dopamine deficiency.
- Clinical manifestations include tremor (pill-rolling), rigidity, bradykinesia/akinesia, and postural disturbances.
- Common complications: falls, aspiration pneumonia, UTIs and skin breakdown due to immobility. Treatment focuses on medication and physical therapy.
Guillain-Barre Syndrome (GBS)
- Rapidly progressive, acute, demyelinating autoimmune disorder affecting peripheral nerves.
- Symptoms typically begin with tingling and numbness and progress to muscle weakness, paralysis, and potential respiratory distress.
- It arises post viral or bacterial infection, and recovery is often complete for most people.
- Treatment involves supportive measures and physical therapy.
Amyotrophic Lateral Sclerosis (ALS)
- Progressive neurodegenerative disease affecting motor neurons in the brain and spinal cord.
- Results in muscle weakness, atrophy, spasticity, and eventual loss of motor function, affecting speech, swallowing and breathing.
- Treatment involves control of symptoms and providing emotional support. Drug therapy is often employed to decelerate disease progression. Tracheostomy and mechanical ventilation are used to maintain breathing.
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Description
This quiz explores the relationship between cognitive system alterations and cerebral hemodynamics. Participants will delve into how changes in these systems can affect motor function and identify critical factors that can lead to disruptions. Gain a deeper understanding of the consequences of such disruptions on overall cognitive health.
