Patho exam 3

what is sensory perception

process of neural, sensory, endocrine and integumentary systems'

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involves receiving and interpreting environmental stimuli,and depends on normal sensory receptors, an intact reticular activating system (RAS), and functional nervous pathways to the brain

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The nurse is responsible for the assessment of sensory perception functioning, as well as implementing treatment or altering the client's plan of care when dysfunction is present.

what are the exemplars of this lecture

pain and stres

what is the central nervous system

brain and spinal cord

what is the peripheral nervous system

neural tissues outside of CNS

what are nerves

bundles of axons extend from CNS

afferent division

neurons that transmit action potentials from sensory organs to CNS

carries info to CNS

What is efferent neurons

carry info away from CNS

2 parts: autonomic and somatic

what is the somatic nervous system

transmit action potentials to skeletal muscle

what is the autonomic nervous system

transmit Action potentials from CNS to smooth involuntary muscles

parasympathetic and sympathetic

what is the parasympathetics division

regulates resting and nutrtion related function such as digestion and urination

what is the sympathetic division

controls the strength of the heart beat and BP

stimulate liver to release more glucose in the blood, providing quick energy for flight fight and response when stressed, frightened , or angry

what is the role of the autonomic nervous system to stress

direct role in physical response to stress

parasympathetic, and autonomic nervous system

what is the normal vs abnormal process of sensory perception

sensory perception can be disrupted, inadequate, or abnormal due to alterations in integumentary system or factors affecting senses such as medication effects, nerve damage.

Alterations in individual perceptions, life experiences which lead to cognitively and emotionally manage internal and external situations, availability of resources and support

what are the interrelated concepts of sensory perception

cognition: one interprets environmental stimuli which effects coping

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nutrition: tissue integrity, leads to decreases senses, and sensory and motor neurons to cause pain

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mobility

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tissue integrity

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intracranial regulation: damage to nerve and traumatic brain injury can lead to dysfunction of sensory and motor pathways.

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SCI

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perfusion: increased in fight or flight

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oxygenation: rapid breathing,

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immunity and metabolism: endocrine system is activated, increased glucose and cortisol, slowed down gastric, immune function suppressed with cortisol

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infection

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interpersonal relationships cognition, mood and affect, safety: sensory perception is overloaded

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functional ability

what are good outcomes of sensory perception

quality of life, senses intact

what are poor outcomes of sensory perceptions

decreased QOL

sensory disruption (hearing, vision, smell,taste, touch)

depression, anxiety, suicide, and lack of self care

unsuccessful relationships

immunosuppression

cardio gastrointestinal disorders

what assessment should take place for sensory perception

HR, BP, electrodermal

hormone levels

cortisol level

CN

senses - hearing level, visual acuity

integumentary system intact

taste (sweet, salt, sour, bitter), olfactory (odor sensed)

affect

communication

ADLs

what is stress

non-specific response of the body to any demand made upon it

normal part of life

general principle of stress: a general adaptive response in order to cope with the altered homeostasis

what happens when the sympathetic nervous system signals the adrenal gland

release of hormones NE and cortisol

this is the release of the endocrine system

what does increased cortisol level do

cortisol is a steroid

physiological or physically stressed increased cortisol

inflammatory response plus immunosuppression increase risk for infection

What is the epidemiology of sensory perception

acute vs chronic

can lead to various stress related disorders- e.g PTSD

What population are at risk

everyone is at risk

especially for work related or serious live events

What is the etiology of sensory perception (acute vs chronic)

acute: good= short term protection from infections

chronic: immunosuppression= at risk for infections

what are the two types of stress

eustress and distress

what is a stressor

sensory stimuli that elicits a stress response. A challenging demand on the body that arouses a response from multiple organ systems.

What is adaptation?

respond to challenges of physical or psychological homeostasis and help return to a balanced state

What is coping?

emotional and behavioral responses used to manage stress to physiological and psychological homeostasis

what does our adaptive ability depend on

conditioning factors such as

age and health status, gender, pre existing health condition, life experiences, and social support

what are ways the body can respond to stress

cope and adapt

What is GAS

general adaption syndrome

for long term stress

Alarm, Resistance, Exhaustion

what is the alarm stage of GAS

SNS and adrenal gland stimulate "fight or flight"

immediate response to stress

SAM and HPA access initially kick in

What is the resistance stage if GAS

body selects most effective channels of defense -homeostasis - adaptation - HPA axis is sustained

release of cortisol is here, not during alarm (cortisol)

extensive cortisol release for a long time leads to exhaustion

GAS ends here when stress subside, and parasympathetic nervous system is able to kick and and maintain homeostasis

what is the exhaustion stage of GAS

stress continue

resources are depleted - stress overwhelms body

high levels or hormone and chemical secretion

stress overwhelms body to defend itself, systemic dysfunction occurs such as copmorised immune system and organ dama

During this stage, an individual commonly feels rundown, unable to cope, depressed, anxious, and physically ill.

what McEwen's Long term stress theory

talks about allostatic load

what allows allostasis load to accumulate

repeated stressful experiences

inability to adapt to stress

prolonged reaction to stress

inadequate response to a stressor

what is allostasis

a dynamic state of balance that changes according to exposure to stressors

what is Allostatic load and what are its causes

stress

can be caused SODH, physiological stressors, major life events

the wear and tear on body systems caused by stress reactions

does not show physiological symptoms

what is Allostatic overload

stressed out

stress exceeds body's ability to adapt =pathophysiological disorder

how is stressed managed with good habits vs bad habits(allostasis theory)

picture

What are 3 body systems involved in stress perception?

Neuroendocrine

immune system

adrenal land

what are the neural and endocrine pathways of stress

Brain sensory regions

this occurs during the alarm stage

SAM- sympathetics, adrenal, medulla for acute stress

HPA axis- hypothalamus, pituitary, adrenal is for chronic stress

what are the brain sensory regions for stress

amygdala, cerebral cortex, and hypothalamus

SAM pathway: alarm stage

activates hypothalamus, which activates sympathetic nervous system which increased glucose and oxygen to brain and muscle

sympathetic nervous system activates adrenal medulla which releases epinephrine which triggers fight or flight response to increase HR, BP, and dilated pupils

HPA pathway

hypothalamus released cortical-tropin releasing factors (CRF) stimulating pituitary gland to release ACTH stimulating the adrenal cortex to produce corticosteroids which stimulate the liver to release energy(glucose) and suppress the immune system

what are the brains sensory regions

Amygdala, cerebral cortex, hypothalamus

what is the HPA axis

CRF = anterior pituitary gland to secrete ACTH and posterior pituitary gland to secrete ADH (Resistance stage)

ACTH travels through bloodstream to adrenal cortex where corticotropin increases cortisol production

what are hormones for adrenal gland stimulation

cortisol, epinephrine, and aldosterone

what is cortisol

mobilizes glucose, fat and amino acids which then enhances muscle strength, and has potent anti-inflammatory response, diminishes immunity, therefore making infection more probable with chronic use

what is epinephrine

gives fight or flight response

increases HR, BP, vasoconstriction, bronchodilation

what is aldosterone

Na+ water reabsorption, K+ excretion to increase BP

what is the immune stage

immunosuppression (Exhaustion stage or allostatic overload )

What mental health diseases can be caused by stress

acute stress disorder

PTSD

release of cortisol and chemical means can induce lasting changing in parts of the brain involved in stress response

changes overtime can affect memories and future response to stress

what body systems can stress impact in terms of physical health

GI, SNS, Immune system

What diseases does stress cause in SNS?

due to activate of sympathetic nervous system

increased hr and RR can worsen respiratory diseases

COPD, asthma, exacerbations; Myoinfractional

what diseases does stress cause in the immune system?

inflammatory response, aggravate lupus, MS;

immunosuppression= infection risk

what diseases does stress cause in the GI system

worsen inflammatory bowel disorders, peptic ulcers, reflux

due to relaxation of GI activity from sympathetic activity

how does stress effect vaccines

decreases the response to vaccination, which produced lower levels of antibodies

how does stress affect the elderly

decreased immune response =increased infection risk and poor wound healing; increased risk for anxiety and depression

how does stress affect children

exposure to stressful situations =neurologic and cognitive development implications (increased anxiety and impaired decision making)

how does stress affect pregnancy

high stress = low fetal birth and preterm birth and post partum anxiety and depression

what is the treatment for stress

lifestyle changes

Stress management programs

Psychotherapy

Alternative medicine

Pharmacology

what are lifestyle changes that can reduce stress

reduce caffeine intake

engage in yoga

increase exercise

ensure sufficient sleep

achieve proper nutrition

humor

what is afferent neurons

are sensory nerves that carry pain, temperature, touch, proprioception, vibration, andpressure sensations into the spinal cord.

A-delta or C fibers

what are A-delta fibers

small in diameter and myelinated.

carry sharp, easilzed localized pain sensation

These fibers conduct impulses rapidly and cause the first, short-lived acute experience of pain.

glutamate is involved in the rapid neural transmission of acute pain associated with A-delta fibers

quick, intense

what are C fibers

smaller in diameter and unmyelinated.

carry diffuse, achy pain sensation

These fibers conduct impulses slowly and cause longer lasting, persistent dull pain.

throbbing, chronic

what are Efferent neurons

motor nerves; these neurons exit the spinal cord through the ventral horn and travel to the muscles of the body

what is simple reflex arc

An afferent neuron carries sensory impulses into the dorsal horn of the spinal cord;

The afferent neuron connects with an interneuron in the substantia gelatinosa of the spinal cord;

The interneuron connects to an efferent neuron that exits via the ventral horn and enacts motor activity.

what are nociceptors

Nerve fibers that respond to noxious stimuli;

respond to breakdown product in injured tissue, which can be chemical, mechanical or thermal

Found in the skin, muscle, connective tissue,bone, circulatory system, and abdominal, pelvic, and thoracic viscera;

Afferent neurons, which are nociceptors, carry the sensations of touch, temperature, vibration, proprioception, and pain into the dorsal horn of the spinal cord

what is the spinothalamic tract

* sensory, not motor

crosses over immediately

feel on left, activated and feels pain and temperature on right side

e.g see stroke on one side of the brain, effects will show on the opposite side

directs sensory neural impulses from the spinal cord up through the brainstem to the hypothalamus and upper regions of the brain cortex;

The axons of the spinothalamic tract cross over to the other side of the spinal cord before their arrival in the brain.

what are neurotransmitters

Excitatory or inhibitory chemical mediators that are released from one neuron to stimulate another;

Example: dopamine, serotonin, norepinephrine, Gamma amino-butyric acid (GABA);

Excitatory NTs: acetylcholine and norepinephrine;

Inhibitory NTs: serotonin, dopamine, GABA

what are endogenous opioids

Natural analgesic neurochemicals that inhibit pain sensation;

Endogenous opioids include endorphins,
enkephalins, and dynorphins;

Endogenous opioids bind to and inhibit receptors in the axons of incoming C and A-delta fibers, which carry pain signals of nociceptors from the periphery.

what is addiction

it is characterized by behavior that includes one or more of the following

Impaired control over drug use

Compulsive use of drug

Continued use despite harm from using the drug

Craving of the drug

what is tolerance

a state of adaptation in which chronic exposure to a drug causes gradual decreasing results over time

what is physical dependence

a state of adaptation manifested by a drug withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, or administration of an antagonist.

what is homeostasis

he state of steady internal, physical, and chemical conditions maintained by living systems.

This is the condition of optimal functioning for the organism

what is pain

An unpleasant sensation that can range from mild, localized discomfort toagon

leading cause for work absenteeism

what is epidemiology for pain

difficult to define

what are the population at risk for pain

increase with age

what is the etiology for pain

acute: tissue injury

chronic: ongoing tissue injury (Musculoskeletal, neuro, psychological, local,or generalized)

what is the pathway of pain

transduction

transmission

modulation

pain perception (localization, intensity)

pain perception (suffering, emotion)

interpretation

behavior

what is transduction

Afferent neurons: Nociceptors -Neurochemicals

Prostaglandins- enhance pain because there cause inflammation

-Action potentials generated by active pain receptors when they travels into the spinal cord along sensory portions of peripheral nerves

once AP reach spinal cord, nerve tracts cross over and ascend contralateral. which is spinal-thalamic tract. sends signals back to effected body region

prostaglandins are made at site of injury or injection

what is transmission

A-delta (Glutamate - amplify) andC-fiber

what is modulation

pain theories - GCT and Neuromatrix


endorphins, Enkephalins: neuropeptides, natural pain killers,



GABA (inhibit): released when channels are open and inhibit glutamate and pain

what is perception

interpretation of pain

why is the severity of pain unpredictable

pain has both psychological and physioloigcal

what are the pain therioes

gate control and neuromatrix

What is the gate control theory?

pain may be though of as being controlled by a gate in the central nervous system

when the gate is open,pains enstation is allowed through

activity in the pain fibers (nociceptive nurse impulses) open the gate

transduction process: uses neurochemicals to stimulate specialized pain receptors in peripheral nerve endings called nociceptors

activity in other sensory nerves(endorphins released), meds, hot/cold therapy closes the gase

what is the neuromatrix theory

Matrix of neurons in the brain is capable of generating pain (& other sensations) in the absence of signals from sensory nerves -Accounts for phantom pain

what is acute pain

BP, P, RR increase

range mild to severe, < 3months

decreases over time

anxiety, confusion, agitation

what is chronic pain

Pain does not go away

> 3 months

withdrawal, decreased physical movement, fatigue

what is cutaneous pain

superical somatic pain

what is deep somatic pain

Poorly localized

injuries/disorders affecting bones, joints, muscles, skin, or structures composed of connective tissues

what is visceral pain

Deep, acute pain arising from an internal organs that are diseased/injured

Not well localized

May be referred to another area

what is referred pain

Pain in an area is removed or distant from its point of origin; Can be acute or chronic.

what is phantom pain

Perceptions that an individual experiences relating to a limb or an organ that is not physically part of the body.

can equipment measure pain

not accurately

what are the physiological stressor of pain

cell damage

what is the psychological stressor of pain

anxiety

depression

past pain experience

environmental condition

hospitalization

what is the spiritual and developmental stressor of pain

spritual: degree of faith

developmental: age and copng mechanism

what is the aging and perception of pain

pain threshold increases and Pain tolerance decreases

Alteration in the metabolism of drugs and metabolites occurs