Week 12 & 13 Endocrine and Neural Function PDF

Hand Hygiene BSN213 Pathophysiology Endocrine & Neural Function Sem. 2 – Week 12 &13 2023/ 2024 Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, o...

Hand Hygiene BSN213 Pathophysiology Endocrine & Neural Function Sem. 2 – Week 12 &13 2023/ 2024 Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Outline Disorders of the Pituitary Gland ✓Hypopituitarism ✓Hyperpituitarism Diabetes Mellitus Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 2 fchs.ac.ae Endocrine System Hand Hygiene Complex messaging and control system. Uses hormones secreted by glands located throughout the body. Hormones are classified or described based on action, source, or chemical structure. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Pituitary Gland Hand Hygiene Roughly the size of a pea Located at the base of the brain Divided into two part—the anterior and posterior pituitary gland Referred to as the master gland Secretes several hormones: TSH, growth hormone, adrenocorticotropic hormone (ACTH), follicle-stimulating hormone, luteinizing hormone, prolactin melanocytestimulating hormone, antidiuretic hormone, and oxytocin Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Figure 10.F03: The pituitary gland. (a) A cross section of the brain showing the location of the pituitary and hypothalamus. (b) The structure of the pituitary gland. Releasing and inhibiting hormones travel via the portal system from the hypothalamus to the anterior pituitary, where they affect hormone secretion. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Hypopituitarism A condition in which the pituitary gland does not produce enough of some or all its hormones. Causes: congenital defects, cerebral or pituitary trauma, autoimmune conditions, tuberculosis, pituitary tumors, sarcoidosis, and hypothalamic dysfunction Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 7 fchs.ac.ae Hand Hygiene Hypopituitarism Can cause: Dwarfism: short stature caused by deficient levels of growth hormone, somatotropin, or somatotropinreleasing hormone Diabetes insipidus (DI): excessive fluid excretion in the kidneys caused by deficient antidiuretic hormone levels Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 8 fchs.ac.ae Diabetes Insipidus Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 9 fchs.ac.ae Hypopituitarism Hand Hygiene Manifestations: ✓fatigue, headache, cessation of menstruation, ✓infertility (in women), decreased libido, low tolerance for stress, muscle weakness, nausea, constipation, ✓weight loss or gain, anorexia, abdominal discomfort, ✓cold sensitivity, visual disturbances, loss of body or facial hair, joint stiffness, hoarseness, facial puffiness, ✓ thirst, excess urination, hypotension, short stature, and delayed growth and development Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 10 fchs.ac.ae Hyperpituitarism Hand Hygiene The pituitary gland secretes excessive amounts of one or all the pituitary hormones. Most caused by tumors that secrete hormone or hormonelike substances. Can cause: Gigantism: tall stature caused by excessive growth hormone prior to puberty Acromegaly: increased bone size caused by excessive growth hormone in adulthood Syndrome of inappropriate antidiuretic hormone (SIAH): increased renal water retention caused by excessive antidiuretic hormone Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 11 fchs.ac.ae Hand Hygiene Hypopituitarism Dwarfism Gigantism Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org A. Marion Bull/Alamy B. © Bettina Cirone / Science Source 12 fchs.ac.ae Hyperpituitarism Hand Hygiene Hyperprolactinemia: excessive prolactin that results in menstrual dysfunction and galactorrhea Cushing’s syndrome: excessive cortisol that results from the increased ACTH levels Hyperthyroidism: hypermetabolic state caused by excessive thyroid hormones from increased TSH Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 13 fchs.ac.ae Hyperpituitarism Hand Hygiene Manifestations: headache, visual field loss or double vision, excessive sweating, hoarseness, galactorrhea, sleep apnea, carpal tunnel syndrome, joint pain and stiffness, muscle weakness, and paresthesia Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 14 fchs.ac.ae Hand Hygiene Hyperpituitarism Cushing’s Syndrome Condition of excessive amounts of glucocorticoids Causes: iatrogenic from ingestion of glucocorticoid medications, adrenal tumors that secrete glucocorticoids, pituitary tumors that secrete ACTH and cortisol, and paraneoplastic syndrome Manifestations: ✓ obesity (especially around the trunk), “moon” face, ✓ “buffalo hump,” muscle weakness, delayed growth and ✓ development, acne, purple striae, thin skin that bruises easily, ✓ delayed wound healing, osteoporosis, hirsutism, ✓ insulin resistance, hypertension, edema, hypokalemia, mood changes, and psychosis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 15 fchs.ac.ae Signs and symptoms of Cushing’ syndrome Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 16 fchs.ac.ae Cushing’s Syndrome Hand Hygiene Figure 10.F12: Cushing’s disease before and after treatment. (a) Full, rounded face (“moon face”) prior to treatment. (b) Normal facial appearance after treatment. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Courtesy of Leonard V. Crowley, MD, Century College. 17 fchs.ac.ae Hyperpituitarism Hand Hygiene SIADH (Syndrome of Inappropriate Antidiuretic Hormone) - Opposite of diabetes Insipidus. - Instead of large fluid losses, persons with SIADH may have water intoxication due to fluid retention. - Diagnosis rests on the presence of hyponatremia with a normal and expanded plasma volume. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 18 fchs.ac.ae Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 19 fchs.ac.ae Diabetes Mellitus (DM) Hand Hygiene DM is a group of metabolic disease characterized by elevated levels of glucose in the blood (Hyperglycemia) Resulting from 1. Defects in insulin secretion 2. Insulin action 3. both Prevalence is increasing Impaired insulin production or action results in abnormal carbohydrate, protein, and fat metabolism because of the glucose transportation issue. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 20 fchs.ac.ae Hand Hygiene Classification of DM 1. 2. 3. 4. Type I DM: Insulin dependent DM (IDDM): Absent of Insulin Due to destroyed Beta-cells that produces insulin hormone Acute onset, before age 30, 5-10% of DM patients has this type Type II DM: Non-Insulin dependent DM (NIDDM): Decrease sensitivity of insulin ( insulin resistance) or decrease production of insulin represent 90-95% of Diabetic patients Gestational diabetes mellitus (GDM) Diabetes Mellitus associated with other conditions or syndrome Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 21 fchs.ac.ae Hand Hygiene Functions of Insulin Transports and metabolizes glucose for energy Stimulates storage of glucose in the liver and muscle as glycogen Signals the liver to stop the release of glucose Enhances the storage of dietary fat in adipose tissue Accelerates transport of amino acids into cells Inhibits the breakdown of stored glucose (Inhibit), protein, and fat (Inhibit glucogenolysis & gluconeogenesis) Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 22 fchs.ac.ae Hand Hygiene INSULIN FUNCTION When we eat, food is broken down into chemicals and glucose enters bloodstream. In response to elevated serum glucose, beta cells of pancreas secrete insulin into bloodstream. Insulin combines with insulin receptors on cell wall (activating glucose transporters) allowing glucose to enter cell. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 23 fchs.ac.ae Hand Hygiene INSULIN FUNCTION Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 24 fchs.ac.ae Hand Hygiene Diabetes Mellitus - DM  Three P’s: ▪ Polyuria ▪ Polydipsia ▪ polyphagia  Fatigue  Weakness  Sudden vision changes  Tingling or numbness in the hands or feet  Dry skin  Sores that slow to heal and recurrent infection  Type 1 may have sudden weight loss, nausea, vomiting, and abdominal pain if DKA has developed Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 25 fchs.ac.ae Hand Hygiene Type 1 Diabetes Previously called insulin-dependent and juvenile-onset Develops when the body’s immune system destroys pancreatic beta cells Must have insulin Usually strikes children and young adults, although disease onset can occur at any age Exact cause unknown, but most likely a viral or environmental trigger in genetically susceptible people that causes an autoimmune reaction Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 26 fchs.ac.ae Hand Hygiene Type 1 Diabetes Type I DM is characterized by lymphocytic infiltration of the endocrine pancreas specifically in the Islets of Langerhans. This inflammatory infiltration, termed Insulinitis, appears to be primarily composed of T-cells. Inflammation leads to progressive and selective destruction of insulin-producing islet beta cells. Insulin levels progressively decline and may reach complete absence. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 27 fchs.ac.ae Type 2 Diabetes Hand Hygiene Previously called non–insulin-dependent and adult-onset. In adults, type 2 accounts for about 90–95% of all newly diagnosed cases. Usually begins as insulin resistance. The pancreas gradually loses its ability to produce insulin. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 28 fchs.ac.ae Type 2 Diabetes Hand Hygiene Risk factors: advancing age, obesity, family history of DM, history of gestational diabetes, impaired glucose metabolism & physical inactivity. Usually managed initially with oral antidiabetic medications that increase insulin production and action. As the condition progresses, supplemental insulin is often necessary as pancreatic production declines. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 29 fchs.ac.ae Hand Hygiene Pathophysiology of Type II DM Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 30 fchs.ac.ae Hand Hygiene Acute complications of DM Hypoglycemia Diabetic ketoacidosis (DKA) Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 31 fchs.ac.ae Hand Hygiene Hypoglycemia Hypoglycemia (insulin reaction): when the blood glucose falls to less than 50 to 60 mg/dl (2.7 to 3.3 mmol/L) Causes: too much medication, too little food, or excessive exercise. Clinical Manifestations: - Adrenergic symptoms: Sweating, tremor, tachycardia, palpitation, nervousness and hunger - CNS symptoms: inability to concentrate, headache, lightheadedness, confusion, numbness of the lips and tongue, slurred speech, emotional changes, double vision…. Sever hypoglycemia lead to loss of consciousness; Hypoglycemic unawareness. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 32 fchs.ac.ae Hand Hygiene Diabetic ketoacidosis (DKA) Caused by an absence or markedly inadequate amount of insulin this result in disorder in the metabolism of CHO, protein, and fat. Causes: 1. Decreased or missed dose of insulin. 2. illness 3. Undiagnosed and untreated diabetes Clinical features: 1. Hyperglycemia 2. Dehydration and electrolyte loss 3. Acidosis Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 33 fchs.ac.ae Pathophysiology of DKA Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 34 Hand Hygiene fchs.ac.ae Hyperglycemic hyperosmolar Nonketotic Syndrome (HHNS) Hand Hygiene Hyperglycemia and hyperosmolarity predominate, with alteration of awareness; ketosis is minimal or absent Cause: Lack of effective insulin (insulin resistance). Clinical manifestation: hypotension, profound dehydration, tachycardia, alteration in awareness, hemiparesis. Management  Rehydration  Insulin administration  Monitor fluid volume and electrolyte status Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 35 fchs.ac.ae Hand Hygiene Long-Term Complications of Diabetes 1. Macrovascular complications 2. Microvascular complications 3. Neuropathic changes Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 36 fchs.ac.ae Hand Hygiene Long-Term Complications of Diabetes 1.    Macrovascular disease: changes in the medium to large blood vessels Blood vessels walls thicken, sclerose, and become occluded by plaque (atherosclerosis). May happened due to other diseases Coronary artery disease, Cerebrovascular disease, and peripheral vascular disease are the three main types of Macrovascular. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 37 fchs.ac.ae Hand Hygiene DM complication Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 38 fchs.ac.ae Hand Hygiene Long-Term Complications of Diabetes 2. Microvascular complications (Diabetic Retinopathy and Nephropathy) - Unique to DM Capillary basement membrane thickening of the retina (microangiopathy) and kidneys (Nephropathy) Proliferative retinopathy is characterized by the proliferation of new blood vessels growing out of the retina into the vitreous which are prone to bleeding. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 39 fchs.ac.ae Hand Hygiene Long-Term Complications of Diabetes  Nephropathy: microvascular changes in the kidney. The kidney’s filtration mechanism is stressed allowing blood protein to leak into the urine as a result, pressure in the blood vessels of the kidney increases. this increase in the pressure stimulates the development of Nephropathy. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 40 fchs.ac.ae Hand Hygiene Long-Term Complications of Diabetes 3. Neuropathic changes:  Group of disease that affect all types of nerves, including peripheral (sensorimotor), autonomic, and spinal nerves Demyelination of the nerves (result in disruption of conduction).  Peripheral neuropathy Autonomic neuropathies Hypoglycemic unawareness Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 41 fchs.ac.ae Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 42 fchs.ac.ae Hand Hygiene Neural Function Outlines Cerebrovascular Accident Seizure Meningitis Multiple Sclerosis Myasthenia Gravis 4/27/2024 Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org BSN213 Pathophysiology 43 fchs.ac.ae Cerebral Vascular Accident (CVA) Hand Hygiene Also known as a stroke or brain attack. An interruption of cerebral blood supply. Ischemic damage is permanent. Causes: total vessel occlusion (e.g., thrombus, embolus, or plaque) or cerebral vessel rupture (e.g., cerebral aneurysm, arteriovenous malformation, or hypertension) Major types of CVA Ischemic strokes are the most common. Hemorrhagic strokes are the most fatal. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Pathophysiology- CVA Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org Hand Hygiene fchs.ac.ae Hand Hygiene Cerebral Vascular Accident Complications: neurologic deficits and death Additional risk factors: physical inactivity, obesity, hypertension, smoking, hypercholesterolemia, diabetes mellitus, atherosclerosis, oral contraceptive usage, excessive alcohol consumption, and illicit drug use. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Manifestations Muscle weakness or paralysis of the face, arm, or leg (usually unilateral) Unilateral paresthesia Aphasia or receptive aphasia Dysphagia Hand Hygiene Dysgraphia Difficulty reading Vision issues (e.g., diplopia, nystagmus, and partial or complete loss of vision) Headaches may be present with hemorrhagic strokes because of increasing ICP. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Manifestations Changes in sensation (e.g., touch, pain, temperature, pressure, hearing, and taste) Change in levels of consciousness Personality, mood, or emotional changes Confusion Hand Hygiene Agnosia (inability to recognize or identify sensory stimuli) Ataxia Vertigo or dizziness Incontinence of bowel or bladder Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Transient Ischemic Attack (TIA) A temporary episode of cerebral ischemia that results in symptoms of neurologic deficits Also called mini strokes because these neurologic deficits mimic a cerebral vascular accident (CVA) or stroke except that these deficits resolve within 24 hours (1–2 hours in most cases) May occur singly or in a series Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Seizure Disorder Hand Hygiene Seizure: transient physical or behavior alteration that results from an abnormal electrical activity in the brain Causes: altered membrane ion channels, altered extracellular electrolytes, and imbalanced excitatory and inhibitory neurotransmitters Can occur secondary to trauma, hypoglycemia, electrolyte disorders, acidosis, infection, tumors, or chemical ingestion (e.g., medications, illicit drugs, and alcohol) Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Seizure Disorder Hand Hygiene Epilepsy: seizure disorder resulting from spontaneous firing of abnormal neurons; characterized by recurrent seizures for which there is no underlying or correctable cause Complications: brain damage, traumatic brain injury, aspiration, mood disorders, and status epilepticus (seizures that last longer than 20 minutes or subsequent seizures occur before the individual has fully regained consciousness) Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Seizure Disorder Hand Hygiene Two broad categories: ✓Focal or partial ✓Generalized. Not all can be easily defined as either focal or generalized. Some begin as focal seizures but then spread to the entire brain. Other people may have both types of seizures but with no clear pattern. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 53 fchs.ac.ae Focal/Partial Seizure Hand Hygiene Occurs in just one part of the brain Varies depending on the area of the brain affected Usually lasts just a few seconds. Some people may experience auras (unusual sensations just prior to an impending seizure) that are actually simple focal seizures in which the person maintains consciousness. Seizure characteristics tend to be similar with every seizure. Can easily be confused with other disorders (e.g., migraine headaches, narcolepsy, syncope, and psychiatric disorders). Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Focal/Partial Seizure Hand Hygiene Simple focal seizure: individual remains conscious but experiences unusual feelings or sensations that can take many forms (e.g., sudden and unexplainable feelings of joy, anger, sadness, or nausea; hear, smell, taste, see, or feel things that are not real) Complex focal seizure: individual has changes in or loss of consciousness, producing a dreamlike experience; may display strange, repetitious behaviors (e.g., blinking, twitching, moving their mouth, walking in a circle) called automatisms Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Generalized Seizures Hand Hygiene Abnormal neuronal activity on both sides of the brain May cause loss of consciousness, falls, or massive muscle spasms Absence seizure: (previously called petit mal seizure): individual may appear to be staring into space and/or have jerking or twitching muscles Tonic seizure: causes stiffening of muscles of the body, generally those in the back and extremities Clonic seizure: causes repeated jerking movements of muscles on both sides of the body. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Generalized Seizures Hand Hygiene Myoclonic seizure: causes jerks or twitches of the upper body, arms, or legs Atonic seizure: causes a loss of normal muscle tone; will fall down or may drop his or her head involuntarily Tonic–clonic seizure (previously called grand mal seizure): causes stiffening of the body and repeated jerks of the arms and/or legs as well as loss of consciousness Postictal period: just after the seizure, the individual may be confused, fatigued, and fall into a deep sleep Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Meningitis Inflammation of the meninges, usually resulting from an infection. CSF may also become affected. Causes: bacteria (e.g., Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae), viruses (e.g., enterovirus, measles, influenza, and herpes), tumors, and allergens. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Meningitis Hand Hygiene Risk factors: being less than 25 years of age living in a community setting pregnancy working with animals immunodeficiency. Cornerstone of meningitis prevention Vaccinations including those for H. influenzae, pneumococcal, and meningococcal infections Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Pathophysiology Invasion of infectious agents to the meninges through the blood or nearby structures or by direct access (e.g., wounds) or indirect access triggers the inflammatory process leading to swelling of the meninges increases ICP. 4/27/2024 Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org BSN213 Pathophysiology 60 fchs.ac.ae Meningitis Hand Hygiene Can be self-limiting (viral) or life-threatening (acute bacterial). Complications: permanent neurologic damage, seizures, hearing loss, blindness, speech difficulties, learning disabilities, behavior problems, paralysis, renal failure, adrenal gland failure, shock, and death Manifestations: fever, chills, mental status changes, nausea, vomiting, photophobia, severe headache, stiff neck (meningismus), agitation, bulging fontanel, decreased consciousness, opisthotonos (abnormal positioning that involves rigidity and severe arching of the back with the head thrown backward), poor feeding or irritability in children, tachypnea, and rash. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Myasthenia Gravis (MG) Hand Hygiene Autoimmune condition in which acetylcholine receptors are impaired or destroyed by IgG autoantibodies, leading to a disruption of normal communication between the nerve and muscle at the neuromuscular junction. This disruption causes weakness of the voluntary skeletal muscles because of inadequate nerve stimulation. Muscle weakness typically increases during periods of activity and improves after periods of rest. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Myasthenia Gravis Hand Hygiene Muscles that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often, but not always, involved. The muscles that control breathing and neck and limb movements may also be affected. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Neuromuscular Junction Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Pathophysiology Circulating antibodies Cross linking or destruction of acetylcholine receptors Decreased no. Of Ach receptor sites at the neuro muscular junction Decreased Ach molecule attachment and stimulation of muscle contraction Decreased transmission of impulses -→ easy fatigability and muscle weakness Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Myasthenia Gravis Hand Hygiene The exact trigger is unclear, but the thymus gland is thought to play a role. Factors that can worsen and cause a myasthenic crisis: fatigue, illness, stress, extreme heat, alcohol consumption, and certain medications (e.g., betablockers, calcium channel blockers, quinine, and some antibiotics). Myasthenic crisis: potentially life-threatening complication that occurs when the muscles become too weak to maintain adequate ventilation. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Myasthenia Gravis - Manifestations Breathing difficulty Dysphagia Difficulty climbing stairs, lifting objects, or rising from a seated position Dysarthria Drooping head Facial paralysis or weakness Fatigue Hoarseness or changing voice Eye and vision issues (e.g., diplopia, ptosis, blurred vision, and difficulty maintaining gaze) Dysphonia (voice impairment ) Therefore, RISK of choking + aspiration Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Multiple Sclerosis (MS) Hand Hygiene Debilitating autoimmune condition that involves a progressive and irreversible demyelination of brain, spinal cord, and cranial nerves. Damage occurs in diffuse patches throughout the nervous system and slows or stops nerve impulses. This impairs the conduction of signals in the affected nerves, causing impairment in sensation, movement, cognition, or other functions depending on which nerves are involved Progression of the damage varies. Symptom onset usually occurs between 20 and 40 years of age. Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Multiple Sclerosis - Manifestations Vary depending on the degree of damage and the specific nerves affected. Characterized by remissions and exacerbations. Exacerbations may last for days to months. Fever, hot baths, sun exposure, and stress can trigger or worsen these episodes. May progress without remissions. Complications: epilepsy, paralysis (most often the legs), and depression Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Multiple Sclerosis - Manifestations Fatigue Loss of balance Muscle spasms Paresthesia or abnormal sensation in any area Problems moving arms or legs Weakness in one or more arms or legs Unsteady gait Lack of coordination Tremor in one or more arms or legs Constipation and stool leakage Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae Hand Hygiene Multiple Sclerosis - Manifestations Urinary frequency, urgency, hesitancy, or incontinence Vision issues (e.g., diplopia and vision loss) Decreased attention span, poor judgment, and memory loss Difficulty reasoning and solving problems Dizziness Hearing loss Sexual dysfunction Slurred speech Dysphagia Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z. © 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae