Schmerler- Patho Neuro Part 2

Front 1

____ is the expert on pain and all pain is "___" even if the cause is unknown.

Back 1

patient, real

Front 2

Elderly reports of pain may be _____.

Back 2

atypical

Front 3

MDs and RNs are notorious for _____treatment of pain mgmt.

Back 3

under

Front 4

Definition of pain

Back 4

unpleasant sensory and emotional experience associated w actual or potential tissue damage, what pt says whenever they say it is occurring

Front 5

This is a biologically necessary physiologic response that provokes and escape/protection reaction

Back 5

acute pain

Front 6

This is a type of pain whose source is the skin, and is well-localized, sharp, clearly located

Back 6

somatic superficial

Front 7

This type of pain comes from bone, ligaments, blood vessels, and muscles; can be characterized as dull, aching, throbbing, cramping, and poorly localized

Back 7

deep somatic

Front 8

This type of pain comes from deep tissues or organs and surrounding structural tissues, results from stretching, distension or ischemia; described as deep, boring, diffuse, poorly defined, frequently referred to as a distant location, assoc. w/ autonomic symptoms

Back 8

visceral pain

Front 9

This type of pain comes from peripheral receptors, afferent fibers in periphery or CNS; described as shooting, burning, stabbing, cutting, tingling, hard to treat, "phantom"

Back 9

neuropathic

Front 10

This type of pain has autonomic symptoms, warns of tissue injury, and is usually temporary

Back 10

acute pain

Front 11

These are the consequences of which type of pain? escape from source of injury, protection of injured site

Back 11

acute pain

Front 12

This type of pain has no useful biological purpose, less physiologic correlation, and lasts> 6 months

Back 12

chronic pain

Front 13

with This type of pain, the original tissue injury may resolve but the pain lingers so the cause may not be clear; pain takes on a disease status of its own, requiring its own form of treatment

Back 13

chronic pain

Front 14

These are consequences of what type of pain: worsened
quality of life, relationships, mood, suicide potential

Back 14

chronic pain

Front 15

This type of pain cand be acute, chronic, or a combo of the 2, and has the same consequences as chronic pain

Back 15

cancer pain

Front 16

This type of pain originates at a visceral site but is perceived as originating in a part of body wall that is innervated by neurons entering the same segment of the nervous system (dermatome)

Back 16

referred pain

Front 17

This is the point at which a stimulus is perceived as painful, and is almost equal from person to person

Back 17

pain threshold

Front 18

This is the max intensity or duration of pain that a person is willing to endure before the person wants something done about it; varies a lot depending on genetics, culture, psychological and familial factors

Back 18

pain tolerance

Front 19

3 stimuli that activate specific pain recepors

Back 19

mechanical, thermal, chemical

Front 20

These are examples of what type of pain stimuli: pressure, brushing, pinch, prick

Back 20

mechanical

Front 21

These are examples of what type of pain stimuli: hot and cold

Back 21

thermal stimuli

Front 22

These are examples of what type of pain stimuli: exogenous and endogenous (tissue damage, inflamation, vascular epithelial cells, immune cells)

Back 22

chemical stimuli

Front 23

Other name of pain receptor

Back 23

nociceptor

Front 24

2 typs of peripheral afferent nociceptors

Back 24

A delta fibers: myelinated, fast, acute pain
C fibers: not myelinated, chronic pain

Front 25

These 3 neurotransmitters play a part in pain signaling

Back 25

glutamate, NE, substance P

Front 26

These neurons process nociceptive info, communicate w various reflex networks and sensory pathways in the spinal cord and travel to the thalamus (some sensation)

Back 26

second-order neurons

Front 27

These neurons project pain info to the cortex where ti is perceived both primary and associative areas

Back 27

third-order neurons

Front 28

In the somatosensory cortex, pain info is ____ and ____.

Back 28

perceived and interpreted

Front 29

In the limbic system, a person experiences the _____ components of pain.

Back 29

emotional

Front 30

Brain stem centers recruit ____ system responses to pain.

Back 30

autonomic nervous system

Front 31

What pathway does this describe?
somatosensory cortex --> hypothalamus --> periaqueductal gray --> locus coeruleus --> A5 cell group --> nucleus raphe magnus --> lateral reticular nucleus --> dorsolateral funiculus --> spinal dorsal horn

Back 31

descending modulatory pathway

Front 32

The ____ _____ center in the midbrain modulates the pain experience

Back 32

endogenous analgesic center

Front 33

This type of neuron modulates pain experience

Back 33

pontine noradrenergic neurons

Front 34

______ in the medulla sends inhibitory signals to dorsal horn neurons in the spinal cord.

Back 34

nucleus raphe magnus

Front 35

This is the endogenous analgesic center that serotonin tricyclics act upon. Pain signals increase w _____ release and decrease with ______ release.

Back 35

PAG (periaqueductal gray),
prostaglandins increase, endogenous opioids decrease

Front 36

This type of pain originates at a visceral site but is perceived as originating in a part of body wall that is innervated by neurons entering the same segment of the nervous system (dermatome)

Back 36

referred pain

Front 37

This is the point at which a stimulus is perceived as painful, and is almost equal from person to person

Back 37

pain threshold

Front 38

This is the max intensity or duration of pain that a person is willing to endure before the person wants something done about it; varies a lot depending on genetics, culture, psychological and familial factors

Back 38

pain tolerance

Front 39

3 stimuli that activate specific pain recepors

Back 39

mechanical, thermal, chemical

Front 40

These are examples of what type of pain stimuli: pressure, brushing, pinch, prick

Back 40

mechanical

Front 41

This is the site of pain modulating circuits

Back 41

spinal cord and dorsal horn

Front 42

This is the site of perception and meaning of pain

Back 42

somesthetic association cortex

Front 43

This is the site of discrimination, location and intensity of pain

Back 43

primary somesthetic cortex

Front 44

Nociceptive stimuli comes in via one of these 2 fibers:

Back 44

a delta (Fast) or c (Slow)

Front 45

Ventilatory consequences of pain:

Back 45

splinting leads to altered resp pattern and effort, decreased lung capacity -->
1. ineffective airway clearance (cough) --> retention of secretions --> pneumonia --> decr PaO2
2. V/Q abnormalities --> shunt --> VQ mismatch and diffusion defect --> atelectasis --> decr PaO2

Front 46

This is the site of pain modulating circuits

Back 46

spinal cord and dorsal horn

Front 47

This is the site of perception and meaning of pain

Back 47

somesthetic association cortex

Front 48

This is the site of discrimination, location and intensity of pain

Back 48

primary somesthetic cortex

Front 49

Nociceptive stimuli comes in via one of these 2 fibers:

Back 49

a delta (Fast) or c (Slow)

Front 50

This is the site of pain modulating circuits

Back 50

spinal cord and dorsal horn

Front 51

Ventilatory consequences of pain:

Back 51

splinting leads to altered resp pattern and effort, decreased lung capacity -->
1. ineffective airway clearance (cough) --> retention of secretions --> pneumonia --> decr PaO2
2. V/Q abnormalities --> shunt --> VQ mismatch and diffusion defect --> atelectasis --> decr PaO2

Front 52

This is the site of perception and meaning of pain

Back 52

somesthetic association cortex

Front 53

This is the site of discrimination, location and intensity of pain

Back 53

primary somesthetic cortex

Front 54

This is the site of pain modulating circuits

Back 54

spinal cord and dorsal horn

Front 55

This is the site of pain modulating circuits

Back 55

spinal cord and dorsal horn

Front 56

Nociceptive stimuli comes in via one of these 2 fibers:

Back 56

a delta (Fast) or c (Slow)

Front 57

This is the site of perception and meaning of pain

Back 57

somesthetic association cortex

Front 58

This is the site of perception and meaning of pain

Back 58

somesthetic association cortex

Front 59

Ventilatory consequences of pain:

Back 59

splinting leads to altered resp pattern and effort, decreased lung capacity -->
1. ineffective airway clearance (cough) --> retention of secretions --> pneumonia --> decr PaO2
2. V/Q abnormalities --> shunt --> VQ mismatch and diffusion defect --> atelectasis --> decr PaO2

Front 60

This is the site of discrimination, location and intensity of pain

Back 60

primary somesthetic cortex

Front 61

This is the site of discrimination, location and intensity of pain

Back 61

primary somesthetic cortex

Front 62

This is the site of pain modulating circuits

Back 62

spinal cord and dorsal horn

Front 63

Nociceptive stimuli comes in via one of these 2 fibers:

Back 63

a delta (Fast) or c (Slow)

Front 64

Nociceptive stimuli comes in via one of these 2 fibers:

Back 64

a delta (Fast) or c (Slow)

Front 65

Ventilatory consequences of pain:

Back 65

splinting leads to altered resp pattern and effort, decreased lung capacity -->
1. ineffective airway clearance (cough) --> retention of secretions --> pneumonia --> decr PaO2
2. V/Q abnormalities --> shunt --> VQ mismatch and diffusion defect --> atelectasis --> decr PaO2

Front 66

Ventilatory consequences of pain:

Back 66

splinting leads to altered resp pattern and effort, decreased lung capacity -->
1. ineffective airway clearance (cough) --> retention of secretions --> pneumonia --> decr PaO2
2. V/Q abnormalities --> shunt --> VQ mismatch and diffusion defect --> atelectasis --> decr PaO2

Front 67

This is the site of perception and meaning of pain

Back 67

somesthetic association cortex

Front 68

This is the site of discrimination, location and intensity of pain

Back 68

primary somesthetic cortex

Front 69

Nociceptive stimuli comes in via one of these 2 fibers:

Back 69

a delta (Fast) or c (Slow)

Front 70

Ventilatory consequences of pain:

Back 70

splinting leads to altered resp pattern and effort, decreased lung capacity -->
1. ineffective airway clearance (cough) --> retention of secretions --> pneumonia --> decr PaO2
2. V/Q abnormalities --> shunt --> VQ mismatch and diffusion defect --> atelectasis --> decr PaO2

Front 71

How does pain influence perfusion to alter DVT risk?

Back 71

pain --> immobility --> venous stasis --> incr risk of DVT

Front 72

What are the infusion consequences and clinical sequelae of pain?

Back 72

pain leads to incr vasopressin, renin, aldosterone and angiotensin release --> incr fluid retention in kidneys --> incr preload --> tachycardia

Front 73

Describe consequences of perfusion and its cardiac sequelae?

Back 73

pain --> SNS activation --> incr afterload and tachycardia --> incr myocardial demand --> myocardial ischemia

Front 74

With chronic pain, the original tissue injury may resolve but...

Back 74

the pain lingers

Front 75

Describe consequences of perfusion and its cardiac sequelae?

Back 75

pain --> SNS activation --> incr afterload and tachycardia --> incr myocardial demand --> myocardial ischemia

Front 76

____ meets pain needs better than fixed schedule or PRN admin.

Back 76

PCA

Front 77

Describe the consequences of pain regarding perfusion with wound healing?

Back 77

pain --> SNS activation --> vasoconstriction --> decr regional blood flow --> decr wound healing

Front 78

____ maintains homeostasis of internal environment toether w the endocrine system and controls involuntary body functions.

Back 78

ANS

Front 79

This system links control centers of brain wtih internal organs and secretory cells.

Back 79

ANS

Front 80

____ is the major center for ANS control.

Back 80

hypothalamus

Front 81

What emotional effects are shown through ANS responses?

Back 81

palpitations, blushing, sweating, dry mouth

Front 82

This branch of NS is for conserving and restoring energy, "feed and breed"

Back 82

PNS

Front 83

This branch of NS mobilizes when the organism is being threatened, "fight or flight"

Back 83

SNS

Front 84

____ is the major center for ANS control.

Back 84

hypothalamus

Front 85

The somatic nervous system releases ____ directly at skeletal muscle site

Back 85

ACh

Front 86

What emotional effects are shown through ANS responses?

Back 86

palpitations, blushing, sweating, dry mouth

Front 87

This branch of NS is for conserving and restoring energy, "feed and breed"

Back 87

PNS

Front 88

How does pain influence perfusion to alter DVT risk?

Back 88

pain --> immobility --> venous stasis --> incr risk of DVT

Front 89

This branch of NS mobilizes when the organism is being threatened, "fight or flight"

Back 89

SNS

Front 90

With chronic pain, the original tissue injury may resolve but...

Back 90

the pain lingers

Front 91

The somatic nervous system releases ____ directly at skeletal muscle site

Back 91

ACh

Front 92

____ meets pain needs better than fixed schedule or PRN admin.

Back 92

PCA

Front 93

____ is the major center for ANS control.

Back 93

hypothalamus

Front 94

____ is the major center for ANS control.

Back 94

hypothalamus

Front 95

What emotional effects are shown through ANS responses?

Back 95

palpitations, blushing, sweating, dry mouth

Front 96

What emotional effects are shown through ANS responses?

Back 96

palpitations, blushing, sweating, dry mouth

Front 97

This branch of NS is for conserving and restoring energy, "feed and breed"

Back 97

PNS

Front 98

____ maintains homeostasis of internal environment toether w the endocrine system and controls involuntary body functions.

Back 98

ANS

Front 99

This branch of NS is for conserving and restoring energy, "feed and breed"

Back 99

PNS

Front 100

This system links control centers of brain wtih internal organs and secretory cells.

Back 100

ANS

Front 101

This branch of NS mobilizes when the organism is being threatened, "fight or flight"

Back 101

SNS

Front 102

This branch of NS mobilizes when the organism is being threatened, "fight or flight"

Back 102

SNS

Front 103

The somatic nervous system releases ____ directly at skeletal muscle site

Back 103

ACh

Front 104

The somatic nervous system releases ____ directly at skeletal muscle site

Back 104

ACh

Front 105

In the SNS, ACh acts on the adrenal medulla to cause

Back 105

epi release at various organ sites

Front 106

In the SNS, ACh can act on the postsynaptic ganglion to initiate ____ Release at various organs or ____ release at the sweat glands.

Back 106

NE, ACh

Front 107

In the PNS, ACh can be released at the postsynaptic ganglion to cause ____ release at various organs

Back 107

ACh

Front 108

_____ is secreted by cholinergic nerve endings and broken down by cholinesterase.

Back 108

ACh

Front 109

Cholinergic receptors respond to ____. There are these 2 types:

Back 109

ACh,
muscarinic (organs)
nicotinic (ganglions)

Front 110

PNS promotes ___ heart rate, ____bronchi, and _____ visceral functions related to digestion.

Back 110

decreased, constricts, increased

Front 111

PNS activation causes stimulation of vagus in the GI tract, causing...

Back 111

increased peristalsis and secretion, relaxation of sphincters.

Front 112

Stimulation of the sacral PNS causes..

Back 112

contraction of urinary bladder and rectum, facilitates general erection

Front 113

2 types of adrenergic receptors

Back 113

alpha adrenergic (1 and 2)
beta adrenergic (1 and 2)

Front 114

Stimulation of this receptor causes :
incr contractility of heart and BP, mydriasis, bladder and prostate contraction

Back 114

alpha 1

Front 115

Sympathetic stimulation of this receptor causes decr BP (decr NE) and decr GI tone and motility

Back 115

alpha 2

Front 116

Sympathetic stimulation of this receptor causes incr cardiac contractility, incr HR, incr renin and angiotensin, incr BP.

Back 116

beta 1

Front 117

Sympathetic stim of this receptor causes decr GI tone and motility, bronchodilation, relaation of uterine smooth muscle, activation of glycogenolysis and incr blood sugar, dilation of skeletal vessels, gluconeogenesis, lipolysis

Back 117

beta 2

Front 118

Normal human temp range

Back 118

36-37.5 C
97-99.5 F

Front 119

This is the purposeful maintenance of a stable internal environment by coordinated physiologic processes that oppose change

Back 119

homeostasis

Front 120

The way by which the organism opposes change to maintain homeostasis

Back 120

feedback mechanism

Front 121

In feedback mechanism, _____ detect change, ____ compares data to a set point, and ______ return the parameter within the values of the set point.

Back 121

sensors, center, mechanisms

Front 122

In the thermoregulatory control loop, These are temp sensitive ion channels throughout the body that receive and integrate thermal inputs from internal/external sensors

Back 122

receptors

Front 123

In the thermoregulatory control loop, this is the processing center, thermostatic comparer, deviations are detected around a set point

Back 123

hypothalamus

Front 124

In the thermoregulatory control loop, these initiate compensatory responses to correct deviation, also voluntary mechanisms

Back 124

effector mechanisms

Front 125

Impaired thermoregulation occurs when temp exceeds ____ or goes below ____.

Back 125

41 C/105.8 F,
34 C/93.2 F

Front 126

Temp is regulateed by nervous feedback mechanisms and is a balance between....

Back 126

incr heat production and heat conservation,
decreased heat production and incr elimination

Front 127

_______stimulates shivering, in which there is a gradual increase in muscle ____, leading to rapid muscle _____, increasing heat production 4-5 x the norm.

Back 127

hypothalamus, tone, oscillations

Front 128

When the SNS is stimulated, epi and norepi shift body metabolism from _____ generation (brown fat- esp important in infants) to ____ production

Back 128

energy generation, heat production

Front 129

Mechanisms of heat conservation:

Back 129

1. sns activation (intense skin vasoconstriction conserves heat in core)
2. abolition of sweating (Decr evaporation at skin level)
3. behavioral control (physical activity, dressing, moving close to heat source)

Front 130

5 mechanisms of heat loss

Back 130

radiation, conduction, convection, evaporation, behavioral control

Front 131

This heat loss occurs through infrared rays to cooler surfaces nearby

Back 131

radiation

Front 132

This heat loss is through contact w cooler surfaces

Back 132

conduction

Front 133

This heat loss is through air movement around the body

Back 133

convection

Front 134

This heat loss is 0.5 calorie lost for each mL of H20 that goes into the air, important in hot temps

Back 134

evaporation

Front 135

This is an elevation in body temp that is caused by cytokine-induced upward displacement of the set point of the hypothalamic thermoregulatory center

Back 135

fever mechanism

Front 136

Fever mechanism is caused by a number of microorganisms and substances called

Back 136

exogenous pyrogens

Front 137

Exogenous pyrogens induce _____ cells to produce fever-producing mediators called ______ (acts on IL-1 and IL-6) and _____ (acts on hypothalamus).

Back 137

host, endogenous pyrogens, TNF alpha

Front 138

During fever, ____ release by the hypothalamus causes change in the set point.

Back 138

prostaglandin

Front 139

Fevers cause vasoconstriction and shivering, leading to increase in _____ to new set point.

Back 139

core temp

Front 140

3 stages of febrile episode

Back 140

1. chill
2. plateau
3. defervescence

Front 141

Beneficial effects of fever

Back 141

"cook" the poisons, not harmful when benlow 40 C/104 F, enhances immune function (incr mobility and activity of WBCs), inhibits microbial growth/kills microbes, higher temp decr serum zinc, iron and copper needed for replication, body switches from glycolysis to lipolysis and proteolysis (deprives food source), lysosomal breakdown prevents viral replication, enhances neutrophil and macrophage fcn

Front 142

Deleterious effects of fever

Back 142

incr BMR 13% per degree up, rigors incr BMR 400%, hypotension, incr CO and HR, temp over 40 doesnt enhance immune function

Front 143

When to treat a fever

Back 143

fever is not origin of illness, it is the response to an illness- treat the illness not the fever, higher temps can be beneficial, so decisions should be made on individual basis, evaluate benefits vs risks

Front 144

____ have decreased immune function and organisms can be more virulent.

Back 144

infants and children

Front 145

In children, the ____ is not fully functional. The most frequent cause of fever is _____.

Back 145

hypothalamus, bacterial infections

Front 146

In children, slight incr in rectal temp may indicate _____. Signs of toxicity include: ____. start abx. promptly

Back 146

a serious infection,
lethargy, cyanosis, poor feeding, labored breathing

Front 147

In the elderly slight temp elevations may be serious because

Back 147

their baseline temps are lower

Front 148

Consider fever with elderly temp increase of

Back 148

2 F above baseline

Front 149

In 20-30% of elderly there is no fever. So s/s of infection include ____. start abx promptly!

Back 149

worsening mental status, decr function, weakness, fatigue

Front 150

Hypothermia can be considered a core temp less than

Back 150

35 C/ 95 F

Front 151

2 types of hypothermia

Back 151

accidental (spontaneous decr in cord temp due to cold environment, submersion hypothermia, children have better survival-diving reflex)

controlled (post cardiac arrest)

Front 152

infant risk factors for hypothermia

Back 152

high ratio of surface area to body mass (3x that of adult)

Front 153

elderly risk factors for hypothermia

Back 153

inadequate heating, malnutrition decr fuel for heat generation, loss of body fat, ETOH and sedatives might dull mental awareness --> inhibiting shiver

Front 154

Factors that may predispose someone to hypothermia

Back 154

cardiovasc dx, cerebral vascular dx, hypothyroidism

Front 155

What are the manifestations of hypothermia?

Back 155

poor coordination, stumbling, slurred speech, irrationality, amnesia, hallucinations, blueness, puffiness, pupil dilation, decr RR, irregular pulse, stupor

Front 156

Hypothermia causes a _____ in metabolic rate, cardiac and resp functions.

Back 156

decrease

Front 157

During hypothermia, ______ causes fluid shifts toward the core, which are interpreted by the brain as ______, increasing diuresis and dehydration.

Back 157

cold diuresis, hypervolemia

Front 158

The decrease in insulin activity during hypothermia causes

Back 158

hyperglycemia

Front 159

Major cause of death w hypothermia is

Back 159

vfib

Front 160

Treatments for hypothermia

Back 160

rewarming, support of vital functions, prevention and treatment of complications

Front 161

Treatments for hypothermia

Back 161

rewarming, support of vital functions, prevention and treatment of complications

Front 162

Methods of rewarming the hypothermic patient

Back 162

passive external (Blankets, warm fluids orally)
active external (heating pad, bair hugger)
active core (warm IVF, warm O2, extracorporeal circulation)

Front 163

Methods of rewarming the hypothermic patient

Back 163

passive external (Blankets, warm fluids orally)
active external (heating pad, bair hugger)
active core (warm IVF, warm O2, extracorporeal circulation)

Front 164

This is a collapse of the BP and cardiac output due to rapid return of the cold, acidic blood from the periphery to the center

Back 164

rewarming collapse

Front 165

This is a collapse of the BP and cardiac output due to rapid return of the cold, acidic blood from the periphery to the center

Back 165

rewarming collapse