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Neurotransmitters Excitatory – adrenaline – nagpapabilis Inhibitatory – cholinergic – nagpapabagal Dopamine is found in neurological – specifically at the basal ganglia. Cerebral cortex – is the highest center of the brain that occupies most of the brain and plans the movement of the body. Thalamus – relay center of the brain. Basal ganglia – “Ramp generator”, initiates movement of the body. Drug of choice: Dopamine Levodopa (L-dopa) Sinemet – combination of dopamine and L-dopa Anticholinergic Ethiology – the cause of Parkinson’s disease is unknown. Risk Factors: Hereditary Oxidative agent inhalation -manganese -magnesium Troma S/Sx: 1. Rigidity – heaviness and stiffness of the body. a. Cog wheel – continuous b. Lead – pipe – with catch 2. Resting tremor – “Postural tremor” – starts from pin – rolling – 4-7 oscillations/sec. 3. Bradyknesia – slowness of movement. 4. Postural instability – “Stoop posture” or “Kyphotic” (Most disabling symptom). 5. Festinating “Shuffling gait”. 6. End – bloc – freezing phenomenon. 7. Micrographia – small handwriting 8. Dysphagia – difficulty in swallowing 9. Dysarthria – lowered voice volume a. Hypophonia 10. Mask face – no facial expressions / no eye blinking. 11. Seborrhea – increase oil in scalp 12. Sialorrhea – Increase salivation 13. Anxiety / depression – mngt: family support Exercise: Frenkel’s exercise – tandem walking Diet – no strict diet Adapting home environment Support group General mng’t: Consciously lift your feet to avoid shuffling Avoid prolonged standing w/ feet closed together Avoid pivot turning instead use U-turn pattern. If balance is the problem when standing or walking use a cane or a quad cane. Never carry object on both hands Swing both hands freely when walking
Don’t try to do things at once Postural hypotension – immediate blood pooling. Diabetes Diabetes Mellitus diabetes insipidus Diabetes Mellitus Type 1 – IDDM – Insulin dependent diabetes mellitus Type 2 – NIDDM – Non Insulin dependent diabetes mellitus. Type 3 – Upon pregnancy. - is a chronic disorder of the carbohydrates metabolism -carbohydrates – converted to sugar (Glucose) Glucose – active sugars (10%) Glycogen – Inactive sugar (90%) -Protein – converted to amino acids -Lipid / fat – glycerol + fatty acids - Disease in Pancreas cells called Langerhan’s o Alpha – glucagon o Beta – insulin (70 – 120 dl/mg) o Delta Type 1 – IDDM - Juvenile DM - can start before 20 Y/O - absolute deficiency in insulin - Rapid on set. - Auto – immune Type 2 – NIDDM - 90% has this type of diabetes. - gradual (Slow) - associated w/ obesity -aged over 40 - mild or high glucose in blood Triad of DM – 3 P’s Polydipsia – Increase in water intake Polyuria – increase in urination Polyphagia – increase in food intake S/Sx: Blindness – diabetic retinopathy because of diabetic neuropathy. Lymph amputation Complication: 1. Ketoacidosis a. Complication – diabetic coma i. Polydipsia ii. Polyuria iii. Polyphagia b. Neusea – urge to vomit / dizziness. c. Abdominal pain / rigidity d. Fruity odor of breath e. Weakness and paralysis (weakness – paresis, plegia – paralysis – total absence of strength). f. Muscle wasting – atrophy
g. Dehydration – soft eyeball h. Hypotension / shock i. Coma / stupor 2. Neuropathy 3. Hypertension 4. Hypoglycemia a. Excess insulin intake b. Omitting of meal c. Over exertion d. Nutrition and fluid imbalance S/Sx: Headache / weakness / irritability / muscular uncoordination. Diaphoresis – excessive sweating. Pallor – or pale / tachycardia / thread pulse. Neusea, loss of appetite (anorexia) / hunger / malaise – general body weakness) Visual disturbance – “Diplopia” Alteration of consciousness / memory loss / confusion / hallucination. Generalized seizures. Interventions 1 glass of orange juice / 1 or 2 candies. For unconscious patient use glucose paste Glucagon Use diabetic ID card. Mng’t: Exercise Diet (time, quatity, content) Drug / medication – (insulin – injection, glucogon – oral) o Site of injection Abdomen Buttock Deltoid Parascapular Thigh Arm Multiple sclerosis – Demyelination of nerve cells Plaque formation caused be demyelination (“Gliosis”) Function of neuron – convey and transmit Axon – takes electrical impulses away from the cell body Dendrite takes electrical impulses towards the cell body. Ethiology – unknown cause Factors: 1. High temperature climate 2. More than 40 Y/O 3. More than 15 yrs. living in high temperature climate. 4. High socio economic class. Neuropraxia – damage of nerve (naipit). Axonotmesis – laceration of the nerves Special test for MS – Lhermittes sign. Triad of MS 1. Scanning speech 2. Intention tremor 3. Nystagmus – involuntary oscillatory movement of the eyeball. Myasthenia gravis – see photocopy for more info. Traumatic Brain Injury Causes:
1. Motor vehicular accidents – less than 25 Y/O. 2. Fall – elderly 3. Interpersonal violence 4. Pedestrian accident Risk factor: 1. Alcoholism 2. Pre – injury personal disturbance 3. Family discord 4. Anti – social behavior Classification: A. According to type of injury a. Open TBI - open wound – skull/scalp b. Close TBI B. According to severity a. Mild i. S/Sx: 1. Headache 4. Emotional irritability 2. Vertigo 5. Mental disturbance 3. Fatigability b. Moderate i. S/Sx 1. Concussion c. Severe i. Acceleration of the brain – upward movement of the brain. ii. Deceleration of the brain – downward movement of the brain, may result to temporary blindness – Amourosis fugax iii. Deformation – rotating of the brain along its axis 1. DAI – Diffuse axonal injury, may lead to death. 2. Blunt trauma – pinalo 3. Coup injury 4. Counter coup injury d. According to structure damage i. Primary head injury 1. Scalp injury a. Mng’t: i. Apply pressure to bleeding, open wound on the scalp. ii. Do not attempt to remove foreign, or penetrated object. iii. Uncomplicated wounds are anesthetically cleansed and sutured. 2. Skull fracture a. Linear fracture – hair line fracture b. Penetrated fracture – i.e Bullets c. Depressed d. Basilar i. S/Sx: 1. There is a CSF flow into the ear. 2. There is damage to various cranial nerves 3. Blood behind eardrum 4. Periorbital ecchymosis – bruises around eyes. 5. Battle’s sign – bruises around mastoid. 3. Brain Injury a. Concussion b. Contusion
Problems after TBI 1. Fracture a. Unexpected swelling b. Deformity c. Pain 2. Seizure a. Depressed fracture b. Intracranial hematoma c. Early seizure d. Prolonged disturbance of consciousness i. Drugs: 1. Phenytoin 2. Phenobarbital 3. Carbomazipin 4. Valprovic acid 3. Hydrocephalus a. Triad of hydrocephalus i. D – dementia – pagiging makakalimutin ii. A – Ataxia – gait disturbance (lakad lasing) iii. I – incontinence 4. Hypertension a. Causes: i. Occult (Naiipit) – Intracranial pressure ii. Hypothyroidism iii. Increased intracranial pressure iv. Renal (kidney) and adrenal abnormality v. Injury to brainstem / hypothalamus vi. Cardiopulmonary disorder 1. Test for TBI a. Glasgow coma scale i. 1 – 8 out of 15 – severe and in state of coma ii. 9 – 12 – moderate iii. 13 – 15 mild TBI Aneurysm Note: Artery – carries oxygenated blood Vein – carries unoxygenated blood Nerves – supplies oxygen to muscles Capillaries Arteriole Aneurysm – is caused by weakening of the blood vessels. Caused by: Arterioslerosis Atherosclerosis Note:* Sclerosis – hardening Nerves must be elastic Types of Aneurysm Saccular – ballooning on 1 side of the blood vessel. Fusiform – ballooning on both side of the blood vessel. Pseudoaneurysm – ballooning outside of the blood vessel. Ethiology – unknown cause.
Risk factor: a) Old age e) Hypertension b) Family history f) Smoking c) Genetic factor g) Dm d) Hyperlipidemia (increase fats in blood) h) Male Sites of Aneurysm 1. Abdominal aortic aneurysm – could be result of a trauma a. S/Sx: i. Abdominal pain ii. Lower back pain that radiates to the groin 2. Cerebral aneurysm – trauma / High blood pressure a. S/Sx: i. Sudden severe headache iv. Visual disturbance ii. Neusea v. Loss of consciousness iii. Vomiting 3. Common iliac – pregrancy / infection a. S/Sx: i. lower back pain that radiates from buttocks to groin. 4. Femoral and popliteal – trauma a. S/Sx: i. Pain starts from groin that radiates in to the back of the knee. Diagnose: CT scan (Computer tomography) 2D echo MRI (Magnetic resonance imaging) Audiogram Treatment is: 1. Based on age, overall health, medical history. 2. Extent of disease 3. S/Sx 4. Tolerance on medication 5. Expectations on the course of the disease. Treatment option: 1. Control or modifying risk factor 2. Medication 3. Surgery Dementia – is a neurological disorder resulting to decline of intellectual function and memory loss. Ex. Alzheimer’s disease – is an atrophy of the brains cells. S/Sx: of Alzheimer’s disease 1. Sundowning – memory loss at sunset. S/Sx of Dementia: Stage 1: - last 1-3 years o Poor recent memory / poor judgement o Impaired acquisition of new information o Mild anomia (state of not caring) o Personality changes o Irritability / apathetic / depressed o Slow reaction to time Stage 2 – 2-10 years o Memory loss (both past & recent) Anterograde
Retrograde o Judgement impaired Stage 3 – 8 – 12 years o Severe impairment of all cognitive function o Physical impairment Unsteadiness Repeated falls Reduced mobility Loss of ability to oneself o Complete disorientation to time o Bed ridden o Patient grunts and/or moans
Treatment: Provide safe environment Handrails, signage
SPINAL CORD INJURY – SCI Notes:* Medulla oblongata – end part of the brain Foramen magnum – Spinal cord exits from foramen magnum. Spinal cord is 42 – 45cm (21-23 inches) Aside from CSF there is a protective membrane Protective membrane: Pia matter – innermost covering – most delicate Meninx (singular) Arachnoid matter – middle Meninges (plural) Dura matter – outermost – toughest End level of Spinal cord – inferior of L1, superior of L2 [(L1L2) – adult], [(L2-L3) – child]
Resembles horse tail called cauda equina
Eonus medullaris Tapering end Single, long, cylindrical (Filum terminale)
*C1 C2 C3 – phrenic nerve – supplies diaphram – for inhalation (respiration). Causes: Collission (Vehicular) Falls Diving Gunshot wound Diseases i.e – Pott’s disease – TB of the bone / spine Classification of SCI 1. Complete – no sensory & motor function 2. Incomplete – there is preservation of function
Types of Incomplete SCI 1. Anterior cord syndrome a. No motor function, preserved sensory motor b. Caused by flexion injury 2. Posterior cord syndrome a. No sensory function, preserved motor function b. Commonly seen in Tabes dorsalis i. Wide base gait c. Absent proprioception and vibration 3. Central cord syndrome – common in cervical injury a. Coused by whiplash injury b. Hyperextention of the neck c. Spared both sensory and motor (not totally loss) 4. Brown seguard Syndrome a. Hemisection of the spinal cord – one sided b. Gunshot wound / stab wound c. Loss of motor, proprioception anf vibratory sense on the same side, associated with contralateral loss of pain and temperature. 5. Cauda equine lesion a. Bowel and bladder incontinence 6. Sacral sparing a. Spared sensation of the lower extremities 7. Root scape – naiipit ang ugat. Clinical manifestation Spinal shock o Period of areflexia (No reflex) / flaccidity (lantang gulay) no sensory function. Resolves within 24 hours, confirmed when the bulbocavernosus reflex\ Motor deficit o Weakness or paralysis may lead to atrophy and later to contracture Spasticity – increase muscle tone. Complete or spared sensation Autonomic dysfunction Respiratory dysfunction Bladder / bowel dysfunction Sexual dysfunction Secondary complication Pressure sore / pressure ulcer Autonomic disreflexia – level above T6 Postural Hypotension – “Orthostatic hypotension” – immediate blood pooling Heterotrophic ossification – develops in 1-4 months o Osteogenic formation of soft tissue / soft tissue masformation Signs Erythema Swelling Pain Loss of motion Contractures – shortening of the muscle length Deep venous thrombosis – formation of clot / thrombus in vein. o Ex: peripheral vascular disease o C/I (Contradictions) of PVT Exercise (ankle pumping)
Massage Indications: Anti – thrombotic stocking
Cerebrovascular accident (Shock) – Any sudden focal, neurological disorder of the brain. Causes: 1. Blood clot a. Types: i. Embolus – travelling clot ii. Thrombus – stationary clot 2. Fat embolism 3. Hemorhage Types of Strokes 1. Thrombotic stroke – most common form or type of stroke. a. 40% of stroke cases are thrombotic b. Large blood vessels are affected c. S/Sx: Heaviness, headache 2. Embolic stroke a. 30% of stroke cases are embolic b. Small and medium blood vessels are affected. c. Distal blood vessels 3. Lacunar – pure motor, pure sensory a. Small blood vessels are affected 4. Hemorrhage – most catastrophic type of stroke. a. Nausea b. Dizziness c. Increased intracranial pressure d. Abrupt (Biglaan). S/Sx: 1. Drowsy but no loss of consciousness 2. Paralysis or weakness 3. Difficulty in swallowing and chewing – dysphagia 4. Incontinence 5. Dysarthria – lowered voice volume 6. Ataxia – gait disturbance (lakad lasing) 7. Aphasia - is a disorder caused by damage to the parts of the brain that control language. 8. Loss or spared sensation (paresthesia) Independent in activities of daily living Mobility Transfer Personal hygiene AIDS – Acquired Immunodeficiency Syndrome, is a sexually acquired disease. - is a profound cellular immune system dysfunction. Causative agents: Kaposis sarcoma Pneumocystis carimii pneumonia – invades the mononucleus phagocytes Incubation period: AIDS - 10 – 12 years before it is diagnosed HIV - 1-3 months – detection of HIV virus Note:
Types of WBC Neutrophil Eosinopil Basophil Monocyte Lymphocytes o T – fights o B – produce Antibody Phagocytes – (Kumakain). Stationary Moving Predisposing factors 1. Male homosexual – anal is most likely the route of infection. 2. Drug users – i.e. Shared needles of drug injection. 3. Hemophilia – problems with blood clotting. 4. Screening test is done using blood. MOT: 1. Intimate sexual intercourse 2. Exposure to infected blood (blood transfusion) 3. Perinatal transmission – mother to baby. Mechanism of Transmission 1. Blood 2. Semen 3. Vaginal secretion 4. Saliva 5. Urine tears *3,4,5 – in large amount General Assessment 1. Rapid unexpected weight loss 2. Swollen lymph nodes 3. Fever, or night sweat 4. Chronic diarrhea 5. Unexplained & prolonged fatigue 6. Cough & dyspnea – Shortness of breath 7. Fungal infection in the mouth (candidiasis / thrush) 8. Rush with reddish brown rushes Intervention: No known cure Family intervention Medical Prevention is focused on pneumocystis carimii Weight patient everyday Check stool (no diarrhea) Inspect areas of infection Suicidal tendencies Paranoid Management Needs individual counseling (Psychiatrist) Prevent recurrence Provide proper skin care, hygiene Proper nutrition Sites of Ulcer 1. Sacrum
2. Heals 3. Trochanter (hips) 4. Ischium Sites of Pulse 1. Temporal – Sintido 2. Carotid pulse – leeg 3. Apical – puso 4. Brachial – braso 5. Radial – wrist 6. Femoral – singit 7. Popliteal – alak-alakan 8. Dorsalis pedis- ankle 12 Cranial nerves Note: S – Sensory M – motor B – both S and M 1. Olfactory - S 2. Optic - S 3. Oculomotor - M 4. Trochlear - M 5. Trigeminal - B 6. Abducens - M 7. Facial - B 8. Vestibulocochlear - S 9. Glossopharyngeal - B 10. Vagus - B 11. Spinal accessory - M 12. Hypoglossal - M Parts of the skull and functions of the brain pertaining to the location Frontal – emotion / cognition / behavior / speech / motor function. Parital – sensation Temporal – hearing / judgement Occipital - vision Amourosis fugax – temporary blindness. Periorbital ecchymosis – bruises around eyes. Battle’s sign – bruises around mastoid. Medulla Oblongata – controls our heart. Alzheimer’s disease – atrophy of the brains cells. Pott’s disease – TB of the bone / spine Spasticity – increase muscle tone Dysarthria – lowered voice volume Dysphagia – difficulty in swallowing Nausea – urge to vomit dyspnea – Shortness of breath candidiasis / thrush - Fungal infection in the mouth Aphasia - is a disorder caused by damage to the parts of the brain that control language. Paresthesia – Loss or spared sensation CSF – Cerebrospinal fluid – 80-150 ml or in some books – 100-180 ml. COMA – not uttering understandable words, no motor response, cannot open eyes, is a state of unconsciousness, lasting more than 6 hours.
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