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137 Cards in this Set
- Front
- Back
What is the definition of pain?
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-unpleasant sensory and emotional experience with actual or potential tissue damage
-pain is what the patient says it is and when the patient says it is occuring |
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Somatic pain can be broken down into what to subtypes?
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Superficial and deep
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Superficial pain is from the _____ and is well localized, sharp and (clearly/poorly) located
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-skin
-clearly |
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Deep pain is from the _____ (many) and is dull, aching, throbbing, cramping and (clearly/poorly) localized?
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-bone, ligaments, blood vessels and muscles
-poorly |
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Visceral pain is located where and results from what?
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location: deep tissues or organs and surrounding structures
results from: stretching or ischemia |
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Visceral pain characteristics?
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-deep, boring, diffuse, poorly defined, referred to a distant location
-associated with ANS |
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Neuropathic pain comes from?
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peripheral receptors, afferent fibers in periphery or CNS
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Neuropathic pain characteristics?
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-shooting, burning, stabbing, cutting, tingling
-hard to treat, phantom pain |
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What is acute pain?
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a biologically necessary physiologic response that provokes an escape/ protection reaction
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Chronic pain has no useful ______ purpose and it lasts longer than ___ months
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biological
6 |
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Cancer pain can be _____, ____ or a combo of both.
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acute, chronic
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Referred pain originates at a visceral site but is perceived as originating in a part of the body wall that is innervated by ____ entering the same segments of the nervous system.
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neurons
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Pain threshold is defined as?
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the point at which a stimulus is perceived as painful
*almost equal from person to person |
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What is pain tolerance defined as?
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max intensity or duration of pain that a person is willing to endure before the person wants something done about the pain
-caries a lot depending on genetic, cultural, psychological and familial factors |
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What are the 3 basic stimuli that activate specific pain receptors?
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-mechanical
-thermal -chemical |
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some examples of mechanical stimuli are?
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-pressure
-brushing -pinch -prick |
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Examples of thermal stimuli are?
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-hot
-cold |
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examples of chemical stimuli are?
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-exogenous
-endogenous -tissue damage -inflammation -vascular epithelial cells -immune cells |
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Nociceptors are?
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pain receptors
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the two peripheral afferents are?
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-A delta fibers
-c fibers |
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A delta fibers are _____ making them fast and responsible for ____ pain.
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-myelinated
-acute |
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C fibers are _____ and responsible for _____ pain.
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-unmyelinated
-chronic |
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Chemicals released in response to pain are?
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-glutamate
-NE -substance P |
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pain pathways to the cortex involve?
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-second-order neurons
-third- order neurons |
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Second order neurons process _____ info and communicate with various reflex networks and sensory pathways in the spinal cord and travel to the ______.
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-nociceptive
-thalamus |
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third order neurons ____ pain info to the cortex where is is perceived. both _____ and _____ areas.
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-project
-primary and associative |
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The central processing of pain information includes the __________ cortex, the ________________ ____________, and the ____________ stem centers
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The central processing of pain information includes the SOMATOSENSORY cortex, the LIMBIC SYSTEM, and the BRAIN stem centers
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Pain information is perceived and interpreted in this part of the brain
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-somatosensory cortex
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Pain is transmitted to the ________________ cortex
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-SOMATOSENSORY cortex
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The ____________ ____________ experiences the emotional components of pain
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-limbic system
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This part of the central processing of pain information in the brain recruits autonomic nervous system responses
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-brain stem centers
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The somatosensory cortex, the limbic system, and the brain stem centers are all part of the ____________ ____________ ___________.
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-all part of the TOTAL PAIN EXPERIENCE
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Periaqueductal gray area
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-inhibits brain impulses; stimulates and the pain subsides; part of the descending modulatory pathway
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The endogenous analgesic center is located in the _____ __________
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mid brain
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__________________ __________________ _______________ in the medulla sends inhibitory signals to __________ horn neurons in the spinal cord
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-Nucleus raphe Magnus
-dorsal horn |
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Signals from the PAG area sends signals to the spinal cord which goes to the ___________ horn
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posterior horn
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Pain signals from the PAG area go to the spinal cord then to the posterior horn that increase or decrease the amount of ___________ __________ from nociceptors
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***action potentials
--therefore OPENING or CLOSING the gate |
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If the "gate" is opened....
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-more action potentials from nociceptors
-more pain |
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If the gate is closed...
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-less action potentials
-feel less pain |
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PAG
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serotonin tricyclics work here
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Prostaglandins _______________ the pain signal
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INCREASE
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Opioids ____________ the pain signal
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DECREASE
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Opioids ________ the gate at the posterior horn
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**close
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Substances that will stimulate pain receptors mainly are these
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Prostaglandins
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Prostaglandins formed from this pathway
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Arachidonic Acid
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NSAIDs block _____ __ receptors
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COX 1
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Vioxx (rarely used now due to s/e) and Celebrex block these receptors
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COX II
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Morphine like drugs are derived from _______ and can be __________ or synthetic
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-opium
-natural or synthetic |
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Morphine acts on receptors in spinal cord and causes
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-epidural analgesia
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Morphine acts on receptors in brain stem and causes
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respiratory depression
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Morphine acts on receptors in the GI tract and causes
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constipation
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Morphine acts on receptors in the brain directly and/or releasing ___________ which are ____________ ____________ like substances
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-endorphins
-endogenous morphine like substances |
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Amitriptyline is in this drug class
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tricyclic antidepressant
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Tricyclic antidepressants increase the amount of ______________ in PAG
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serotonin
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TCAs are great for this type of pain
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neuropathic pain
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Neurontin is this type of medication
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antiseizure medication
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Neurontin suppresses the spontaneous ____________ of __________
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-firing of neurons
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Three dosing schedules for pain
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1. PCA
2. fixed 3. PRN |
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Best way to treat pain
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PCA
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2nd best way to treat pain
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Fixed
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Why is PRN a problem in treating pain?
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-experience pain, need more drugs, more prone to side effects
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Pain and Clinical Sequelae: Ventilation
Pain>>Splinting >>> altered respiratory pattern and effort >> _________ lung capacity >> ________ airway clearance >> retention of secretions >> (develop this airway disease) >> DECREASE PaO2 |
-splinting >> altered resp pattern and effort >> DECREASED lung capacity >> INEFFECTIVE airway clearance >> retention of secretions >> DEVELOP PNA
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Pain>>Splinting >> altered respiratory pattern and effort >> decreased lung capacity >> __/__ abnormalities >> shunt >> __/__ mismatch >> atelectasis >> decrease Pa O2
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V/Q abnormalities
V/Q mismatch |
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Pain increases vasopressin, _______, aldosterone, and _________ which leads to fluid retention in the __________ and ___________ in preload, this eventually leads to tachycardia
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renin, angiotensin
in the kidneys increase in preload |
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Pain and Perfusion....
Pain activates the _______________ nervous system and causes increase afterload and tachycardia.....this increases ____________ demand leading to myocardial ischemia |
SNS
myocardial demand |
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Pain and Perfusion...
Pain activates the SNS which vaso-_________ and ______________ regional blood flow and ____________ wound healing |
vasoconstricts
decreases decreases |
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Pain and Perfusion..
Pain may make a person immobile leading to venous ________ place the patient at and ___________ risk of DVT |
stasis
increased |
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T/F Chronic pain requires it's own form of treatment
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True
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T/F does chronic pain has a significance
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False-no significance
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Phantom pain
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"original tissue injury may resolve but the pain lingers"
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The ANS controls __________________ body functions
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involuntary
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What is the main center for the control of the ANS
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hypothalamus
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PNS
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-conserve, restore energy, "feed and breed"
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SNS
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mobilizes when the organism is being threatened, "fight or flight"
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Humans are Homeotherms what does this mean?
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As part of homeostasis we keep a constant temp: 36.0°C - 37.5 °C (97 °F - 99.5 °F )
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_________________in general is the purposeful maintenance of a stable internal environment by coordinated physiologic processes that oppose change
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Homeostasis
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The way by which the organism opposes the change is the ___________________________. This includes: (3)
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the feedback mechanism:
1. Sensors that detect a change 2. Center that compares the data to a set point 3. Mechanisms that return the parameter within the values of the set point |
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Thermoregulatory Control Loop involves (3)
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Receptors
Hypothalamus Effector mechanisms |
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Thermoregulatory Control Loop Receptors
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Temperature-sensitive ion channels thru-out body, receive/integrate thermal inputs from internal/external sensors
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In relation to thermoregulation, where would deviations be detected around a set point?
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Hypothalamus: The processing center; “thermostatic comparer”
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Thermoregulatory Control Loop Effector mechanisms
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Initiate compensatory responses to correct deviation; also voluntary mechanisms
Core temps > 41° C (105.8° F) or < 34° C (93.2° F) -> impaired thermoregulation |
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Temperature is regulated by ____________ ____________mechanisms and is a balance between: (two things)
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nervous feedback;
1. Increased heat production and heat conservation 2. Decreased heat production and increased elimination |
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Name 2 Mechanisms of Heat Production
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Hypothalamic stimulation of shivering
SNS stimulation |
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Heat production and SNS stimulation
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Epi, NE shift body metabolism to heat production from energy generation (brown fat) especially important in infants
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________________stimulation of shivering: physiology and effectiveness
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Hypothalamic stimulation of shivering
Gradual increase in muscle tone Rapid muscle oscillations (shivering) Increases heat production 4 to 5 times the norm |
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Three Mechanisms of Heat Conservation; and how they work
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1. SNS activation: Intense skin vasoconstriction conserves the heat in the core
2. Abolition of sweating: Decreases evaporation at skin level 3. Behavioral control: Physical activity, Dressing, Moving close to a heat source |
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Mechanisms of Heat Loss: (5) and explain each
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1. Radiation: Loss through infrared rays to cooler surfaces nearby; turn the temp down in the room.
2. Conduction; Loss through contact with cooler surfaces: cooling blankets. 3. Convection: Loss through air movement around the body 4. Evaporation: 0.5 calorie is lost for each mL of water evaporate; Important in hot temperatures 5. Behavioral control: turn on the AC, turn on fan etc. |
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Fever is elevation in body temperature that is caused by ____________-induced (upward/downward) displacement of the _____ ______ of the ________________ thermoregulatory center
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Elevation in body temperature that is caused by cytokine-induced upward displacement of the set point of the hypothalamic thermoregulatory center
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Fever is Caused by a number of ____________and substances called, __________ _____________
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Fever is Caused by a number of microorganisms and substances, “exogenous pyrogens”
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Exogenous pyrogens induce ____cells to produce _____-producing mediators, called “endogenous pyrogens.” Interleukins (IL-1, IL-6), TNF-α (tumor necrosis factor) act on the ______________.
This causes: ______________. |
Exogenous pyrogens induce host cells to produce fever-producing mediators, “endogenous pyrogens” - Interleukins (IL-1, IL-6), TNF-α act on hypothalamus
This causes fever. |
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exogenous pyogens include:
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bacteria, viruses, exotoxins etc.
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Describe the fever mechanism in relation to set point:
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We have a normal set point ie: 37 C. First, exogenous pyrogens affect host cells... (at this point we are infected and experience prodromal symptoms, but do not have fever)... these infected host cells (macrophages, endotheilial cells) then produce endogenous pyrogens... these endogenous pyrogens then act on the hypothalamus and change the set point... This causes shivering because our current temp (37) is much lower than the new set point: 38+, so we shiver so we can get our core temp all the way up to our new set point of 38+.
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3 Beneficial Effects of a Fever
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1) "cook" the poisons
2) Enhance immune function 3) Inhibit microbial growth ex: if microbes grow best at 97 degrees, increasing the temp to 102 degrees will inhibit the microbes from growing as well |
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Below which temperature may a fever be beneficial?
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40 degrees Celsius or 104 degrees Fahrenheit
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A fever enhances immune function by....
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increasing mobility & activity of WBCs
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A fever can kill __________________ and has adverse effects on their ________________.
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A fever can kill MICROORGANISMS and has adverse effects on their GROWTH.
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High temperatures decrease the serum levels of which 3 elements?
What are these elements needed for? |
1) zinc
2) iron 3) cooper **these elements are needed for replication** |
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When someone has a fever, the body switches to which 2 forms of energy metabolism?
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1) Lipolysis
2) Proteolysis *body switches from glycolysis to lipolysis & proteolysis, depriving microbes from food sources* |
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Lysosomal breakdown prevents _____________ ___________ and enhances __________ and __________ function.
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Lysosomal breakdown prevents VIRAL REPLICATION and enhances MACROPHAGE and NEUTROPHIL function.
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5 Harmful Effects of a Fever
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1) Increased basal metabolic rate
2) Rigors 3) Hypotension 4) Increase in cardiac output & heart rate 5) Temperatures over 40 degrees may not enhance immune function. |
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For every degree increase in body temperature, what percentage of the basal metabolic rate increases?
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13%
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Rigors increase the basal metabolic rate by what percentage?
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400%
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What are the 2 causes of hypotension associated with fever?
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1) vasodilation
2) relative & absolute Hypovolemia -sweating --> evaporate too much water |
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2 Situations when a Fever should be Treated
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1) Fever is NOT the origin of an illness
2) Fever is the response to an illness. |
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Remember to treat the ________________________, not the ___________________.
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Remember to treat the ILLNESS, not the FEVER.
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________________ temperatures may be beneficial.
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HIGHER temperatures may be beneficial.
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2 Considerations when deciding whether to treat a fever or not
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1) Individual patient's physiologic status
ex: older person --> increased HR from fever --> chest pain --> beneficial to give Tylenol/reduce fever 2) Evaluate benefits/risks for each patient **make decision based on patient, NOT on temperature** |
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(True or False). Infants and young children have increased immune function.
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FALSE
Infants and young children have DECREASED immune function. |
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What brain structure is not fully functional in children?
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hypothalamus
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Most frequent cause of fever in children is....
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bacterial infections
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___________ increases in temperature might indicate a ______________ infection in children.
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SMALL (slight) increases in temperatures might indicate a SERIOUS infection in children.
*Treat early with antibiotics* |
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4 Signs of Toxicity in Children with a Fever
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1) Lethargy
2) Cyanosis 3) Poor feeding 4) Labored breathing |
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(True or False) Baseline temperatures in the elderly tend to be lower.
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True
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How many degrees above baseline temperature would suggest a fever in an older adult?
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2 degrees Fahrenheit
*Consider fever with increase of 2 degrees Fahrenheit above their baseline* |
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In 20% to 30% of the elderly, their infection will not produce a ....
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fever
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4 Signs & Symptoms of Infection in the Older Adult
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1) Worsening mental status
2) Decreased function 3) Weakness 4) Fatigue |
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3 Abnormal Physiologic Process that Make it Difficult for Older Adults to Manifest with a Fever
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1) Blunted response by the hypothalamus
2) Altered release of endogenous pyrogens 3) Failure of vasoconstriction & shiver |
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In the elderly with a fever and/or infection, _______________ therapy should be started promptly.
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In the elderly with a fever and/or infection, ANTIBIOTIC therapy should be started promptly.
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Hypothermia is defined as a core temperature less than .....
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35 degrees Celsius or 95 degrees Fahrenheit
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2 Causes of Hypothermia
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1) Accidental
2) Controlled hypothermia |
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2 Examples of Accidental Hypothermia
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1) Spontaneous decrease in core temp (ex: cold environment)
2) Submersion hypothermia **children have better survival --> diving reflex |
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When is controlled hypothermia instituted ....
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post cardiac arrest
**decrease oxygen requirements by brain cells** |
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3 Risk Factors for Hypothermia
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1) Infants
2) Elderly 3) Predisposition |
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Why are infants at an increased risk for hypothermia?
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*high ratio of surface area to body mass
-high surface area allows for more heat to escape, esp. from the head- |
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6 Factors that place the Elderly at an Increased Risk for Hypothermia
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1) inadequate heating
2) malnutrition 3) decreased fuel for heat generation 4) loss of body fat 5) ETOH & sedatives might dull mental awareness 6) inhibit shivering |
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3 Conditions that Predispose people to Hypothermia
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1) CV disease
2) Cerebral vascular disease 3) Hypothyroidism |
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8 Neurological Manifestations of Hypothermia
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1) poor coordination
2) stumbling 3) slurred speech 4) irrationality 5) amnesia 6) hallucinations 7) pupil dilation 8) stupor --> death |
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2 Manifestations of the Skin with Hypothermia
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1) blueness
2) puffiness |
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Hypothermia leads to a decrease in _________________ rate and _______________ and __________________ functions.
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Hypothermia leads to a decrease in METABOLIC rate, and CARDIAC and RESPIRATORY functions.
**decreased respiratory rate** |
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With cold diuresis, fluid shifts _______________ the core and is interpreted by the brain as ________________________.
The body responds with ___________________ ___________________ that results in __________________. |
With cold diuresis, fluid shifts TOWARDS the core and is interpreted by the brain as HYPERVOLEMIA.
The body responds with INCREASED DIURESIS that results in DEHYDRATION. |
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Major Cause of Death in Hypothermia
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V-fib
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3 Mechanisms for Re-Warming a Hypothermic Individual
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1) Passive external
2) Active external 3) Active core |
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2 Examples of Passive External Mechanisms for Rewarming
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1) blankets
2) warm fluids |
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2 Examples of Active External Mechanisms for Rewarming
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1) heating pads
2) Bair-Hugger |
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3 Examples of Active Core Mechanisms for Rewarming
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1) Warm IVFs
2) Warm oxygen 3) Extracorporeal Circulation |
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Rewarming collapse is a collapse of the __________ ___________ and ___________ __________ due to the rapid return of cold, acidic blood from the periphery to the center.
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Rewarming collapse is a collapse of the BLOOD PRESSURE and CARDIAC OUTPUT due to the rapid return of cold, acidic blood from the periphery to the center.
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Over how many hours should a person who underwent therapeutic hypothermia s/p cardiac arrest be rewarmed?
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12-24 hours
**to prevent massive vasodilation** |