Pain, temp, mh

Phases of pain

Transduction, Transmission, Perception, Modulation

Myelinated A-delta fibers

transmission is fast and causes reflex withdrawal of affected body part from stimulus before pain sensation is perceived.

Unmyelinated C polymodal fibers

Slow transmission of pain signals conveying dull, aching, or burning sensations.

Pain threshold

Lowest intensity of pain that a person can recognize.

Pain tolerance

Greatest intensity of pain that an individual can endure.

Somatic pain

Arises from joints, muscle, bone, and skin.

Visceral pain

Transmitted by C fibers and arises from internal organs and body cavities. Pain is poorly localized as a result of the fewer number of nociceptors. Pain is aching, gnawing, throbbing, or intermittent in quality.

Neurogenic pain

Result of primary lesion or dysfunction in the nervous system, often chronic and characterized by burning, shooting, shock-like, or tingling sensations.

Referred pain

Pain in an area removed from its point of origin, supplied by the same spinal segment as the actual site.

Pediatric pain

Nociceptor system is functional by 20-24 weeks' gestation.

Phases of sleep

Rapid eye movement (REM) sleep and Non-rapid eye movement (NREM) sleep.

NREM sleep

N1 - light sleep, N2 - longest stage, N3 - slow-wave sleep.

REM sleep

Paradoxical sleep with vivid dreaming, occurs every 90 minutes, beginning after 1−2 hours of sleep

Insomnia

Inability to fall or stay asleep.

Obstructive sleep apnea syndrome

disorder of breathing during sleep, related to an upper airway obstruction associated with reduced blood oxygen saturation and hypercapnia.

Restless leg syndrome

Unpleasant sensations at rest, worse in the evening or at night.

Obesity hypoventilation syndrome

Due to leptin resistance.

Acute pain

Protective mechanism, alerts to immediate harm, lasts less than 3 months. Sympathetic nervous notable. Tachycardia, hypertension, diaphoresis, dilated pupils. Anxiety.

Chronic pain

Lasts at least 3 months, poorly understood, does not respond to usual therapy. May cause behavioral and psychologic changes, such as depression and anxiety. Suffering usually increases with time.

Neuroplasticity

Maintenance of pain, brain's ability to form and reorganize synaptic connections in response to learning or experience.

Temperature regulation

Controlled by the hypothalamus, heat distributed by circulatory system, produced by metabolism and muscle tone and contraction.

Fever

Temporary resetting of the hypothalamic thermostat, aids infectious response. Kills many organisms. Decreases the serum levels of iron, zinc, and copper. Deprives bacteria of food. Promotes lysosomal breakdown and auto destruction of cells. Increases lymphocytic transformation and phagocyte motility.

Tissue hypothermia

slows chemical reactions; increases blood viscosity and slows blood through the microcirculation; facilitates blood coagulation; stimulates vasoconstriction.

Accidental hypothermia

Result of sudden immersion in cold water or prolonged exposure to cold. Passive or active rewarming can be used.

Therapeutic hypothermia

ATP is preserved. Is used to slow metabolism and preserve ischemic tissue during surgery, especially brain surgery.

Conductive hearing loss

Cannot be conducted through the middle ear.

Sensorineural hearing loss

can be caused by ototoxic drugs. Impaired organ of Corti or its central connections. Presbycusis: age-related hearing loss Mixed hearing loss.

Schizophrenia patho

Genetic predisposition. Monozygotic twins concordance rate: 30%–50%. Dizygotic twins or siblings concordance rate: 12%. Likely involvement of several genes located on different chromosomes. Prenatal and perinatal vulnerability factors. Exposure to prenatal infection; prenatal nutritional deficiencies; perinatal complications, such as birth defects and neonatal hypoxia; and upbringing in an urban environment. Neuroanatomic alterations. Enlargement of lateral and third ventricles; widening of frontocortical fissures and sulci. Reduction in the thalamus (may cause positive symptoms) and temporal lobe areas. Loss of cortical tissue. Low levels of reelin in the prefrontal cortex and hippocampus. Neurotransmitter alterations. Alteration of brain dopamine pathways. Glutamate hypothesis: under activation of glutamate receptors (acts on the N-methyl-d-aspartate [NMDA] receptor subtype).

Positive Schizophrenia symptoms

Frequently occur during a psychotic episode when the individual loses touch with reality and experiences something that should be absent. Hallucinations: perceptions are experienced without an external stimulation of the sense organs. Delusions: false beliefs are persistent. Disorganized behavior is exhibited. Disorganized speech: formal thought disorder; poverty of speech. Disorganized or bizarre behaviors.

Negative Schizophrenia symptoms

Characterized by disruptions in normal emotional states and expressions. Cognitive symptoms. Problems with thought processes. Inability to perform daily tasks requiring attention and planning. Negative dimensions. Flattened Affect- near absence of facial expressions or emotions. Anhedonia-cannot experience emotions like pleasure or pain and feel detached from environment. Alogia-absence of speech and the ability to answer questions or express themselves. Avolition-not able to complete simple goals or tasks like bathing or dressing.

Classifications

Bipolar I - depression with mania, Bipolar II - depression with hypomania.

PTSD

persistent dysregulation of fear-based memory system. DSM 5 needs 6 symptoms: reexperience, avoidance, negative cognitions, and mood and arousal.

Depression patho

Neurochemical dysregulation. Deficits in norepinephrine, dopamine, and/or serotonin, leading to depression. Mania: elevated concentrations of monoamines. thyroid

Depression symptoms

Unremitting feelings of sadness and despair. Dysphoric mood. Sleep disturbances. Loss of appetite and body weight. Reduced interest in pleasurable activities and interpersonal relationships. Decreased concentration. Restlessness and agitation. Feelings of worthlessness and guilt. Suicidal thoughts.

Transduction

begins when tissue is damaged by exposure to chemical, mechanical, or thermal noxious stimuli and is converted to electrophysiologic activity

Transmission

conduction of pain impulses along the
A and C fibers into the dorsal horn of the spinal cord and eventually to the reticular formation, hypothalamus, thalamus, and limbic system

Perception

is the conscious awareness of pain (in the brain)

Modulation

process of increasing or decreasing transmission of pain signals throughout the nervous system

Segmental inhibition

A-beta fibers stimulated and impulses arrive at same spinal level as A-delta or C fiber impulses. Inhibitory interneuron. Decreases pain transmission.

Heat loss

Vasodilation

Heat conservation

vasoconstriction

Pediatric temperature

Infants produce sufficient body heat (brown fat) but are unable to conserve the heat produced. Small body size and high body surface-to-weight ratio. Inability to shiver. Thin subcutaneous layer. Must keep warm.

Aging considerations

Blood circulation and vasoconstriction/vasodilator responses are slowed. Metabolic rate is decreased. Shivering is decreased and ineffective. Sweating and the perceptions of heat and cold are decreased.