NURS 6501 - Advanced Pathophysiology

Final Exam Review Guide (Weeks 7-11)

• Structure and Function of the Cardiovascular and Lymphatic Systems

• Pathophysiological changes related to Pain, Temperature Regulation, Sleep,

and Sensory Function

• How does patient characteristics such as racial and ethnic variables impact

altered physiology?

• How does the pathophysiology of spinal injuries impact patients?

• What is the impact of patient characteristics on disorders and altered

physiology.

Common Neurological and MS disorders and the pathophysiological nature of

these issues in adults and children:

Concepts of Neurological and Musculoskeletal Disorders

Stroke

• Cerebrovascular disease is the most frequently occurring neurologic

disorder. Any abnormality of the blood vessels of the brain is referred to as

cerebrovascular disease includes vessel wall abnormalities and vascular

malformations, thrombotic or embolic occlusion, and increased blood

viscosity or clotting.

• Cerebrovascular disease causes

o ischemia with or without infarction and hemorrhage.

o The common clinical manifestation is a cerebrovascular accident

(CVA) or stroke syndrome.

o Hypertension is the greatest risk factor followed by other

preventable risks.

• CVAs are classified according to the pathophysiology and include

ischemic (thrombotic, embolic, and hypoperfusion), lacunar (small vessel

disease), and hemorrhagic strokes.

• Ischemic strokes result from interruption in brain-blood flow with a core

of irreversible ischemia and necrosis or infarction that appears pale (white

infarct).

o The zone around the infarction has reversible ischemia, is called

the ischemic penumbra, and can regain neurologic function,

particularly with thrombolytic treatment.

o Leaking blood vessels can develop in the infarcted area, resulting

in a hemorrhagic transformation (a red infarct) that can be

exacerbated by thrombolytic therapy.

o Reperfusion injury can occur with ischemic stroke.

• Intracerebral hemorrhagic stroke is primarily associated with vessel

disease related to hypertension.

• Subarachnoid hemorrhage is associated with ruptured aneurysms,

arteriovenous malformations (AVMs), or cavernous angioma.

o Subarachnoid hemorrhage is bleeding into the subarachnoid space

commonly associated with intracranial aneurysms, AVM, and

hypertension. The expanding hematoma increases ICP,

compresses brain tissue, reduces cerebral perfusion, disrupts the

bloodbrain barrier, and causes inflammation and neuronal death.

Secondary brain injury follows. Seizures and hydrocephalus can

accompany neurologic deficits.

Multiple sclerosis

• MS is a chronic inflammatory disease involving degeneration of CNS

myelin in genetically susceptible individuals.

• The cause is unknown and autoreactive T and B cells recognize myelin

autoantigens and produce myelin-specific antibodies triggering

inflammatory demyelination with loss of oligodendrocytes and plaque

formation leading to disruption of nerve conduction.

• The clinical manifestations of MS involve different types: relapsingremitting, primary progressive, secondary progressive, and progressiverelapsing.

Transient Ischemic Attack

• A transient ischemic attack is a transient episode of neurologic dysfunction

resulting from focal cerebral ischemia with risk for progressing to stroke.

Myasthenia gravis

• Myasthenia gravis results from a defect in nerve impulse transmission at

the neuromuscular junction with generalized, ocular, or neonatal subtypes.

Autoantibodies, complement deposits, and membrane attack complex

destroy the acetylcholine receptor (AChR) sites, causing decreased

transmission of nerve impulses, leading to muscle weakness, including

ocular and systemic muscles. There can be childhood and adult onset.

Headache

• Migraine is an episodic disorder whose marker is headache lasting 4 to

72 hours.

o Migraine is classified as a headache with and without aura and

chronic migraine (migraines 15 days in a month for more than 3

months).

o Migraine may be precipitated by a triggering event.

o The aura is associated with cortical spreading depression, which

initiates the release of neurotransmitters, particularly CGRP, that

stimulate vasodilation in the trigeminal vascular system,

inflammation, and sensitization of pain receptors. Glutamate is

increased and serotonin is decreased.

• Cluster headaches (trigeminal autonomic cephalalgia) occur in

episodes several times during a day for a period of days at different times

of the year, primarily in men.

o The pain is unilateral, intense, tearing, and burning and associated

with ptosis, lacrimation, reddening of the eye, and nausea. The

cause of trigeminal activation is unknown.

o There is sympathetic nervous system underactivity and

parasympathetic overactivity with trigger events similar to migraine.

The two forms are acute and chronic

o Chronic paroxysmal hemicranias are a cluster-type headache that

occurs 4 to 12 times per day for 20 to 120 minutes in both men and

women.

o There is sympathetic activity different from that in cluster headache,

as it is relieved with indomethacin. 40.

• Tension-type headache (TTH) is the most common type of headache.

o Both central and peripheral pain mechanisms are associated with

the etiology.

o The headache is bilateral, with the sensation of a tight band around

the head. The pain may last for hours or days.

o There are acute and chronic forms.

Seizure disorders

• Seizures represent abnormal, excessive hypersynchronous discharges of

cerebral neurons with transient alterations in brain function.

• Seizures may be focal or generalized.

• The categories of seizures include genetic, structural, metabolic, immune,

infectious, and unknown