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What is the pathophysiology of schizophrenia?
- Dopamine hypothesis:Dysfunction in neurotransmission > dopamine activation involving the midbrain, cortex and limbic system.
- Altered brain structure hypothesis:Volume reduction affecting the amygdala, frontal, and temporal lobes, hippocampus, thalamu relays have been noted. Ventricular enlargement is common. Reduced lateralization and altered lateralization.
What are the positive symptoms of schizophrenia?
- Hallucinations; visual, auditory, olfactory
- Disorganised speech
- Bizarre and unpredictable behaviour
What are the negative symptoms?
- Social withdrawal
- Limited affect
- Normal thoughts and behaviours are absent or diminished.
What are the cognitive symptoms?
- Poor executive functioning - unable to understand info and use this to make a decision.
- Poor communication
- Trouble focussing or paying attention
- Memory problems
- Unable to utilise new information.
Are things a person can experience that no one else is experiencing. Can affect any of the senses.
Fixed false beliefs. No amount of evidence can change them to make patients believe they are false. Not logically - frequently bizarre.
Define thoughts disorder?
Disorganised thinking. Unusual/dysfunctional thought processes/way of thinking. Trouble linking thoughts in a logical way or organising thoughts-fast disorganised speech-jumping rapidly from topic to topic.
Define movement disorders?
Agitated body movements-pacing, repetitive movements/actions
What is the medication for schizophrenia?
What is the mode of action?
Blocks dopamine receptors in the brain and controls psychotic symptoms.
What are the side effects of antipsychotics?
- Drowsiness, dry mouth, increased heart rate,
- urinary retention, constipation, blood pressure decreases, extrapyramidal
- symptoms can begin 5-30 days after initiation of antipsychotic therapy these
- symptoms can include; pseudoparkinsonism, akathisia (feeling of restlessness
- and the urge to move), dystonia (prolonged muscle contractions with twisting,
- repetitive movements) and tardive dsykinesia (involuntary movements).
Nursing interventions for antipsychotics?
- Monitor vital signs.
- Remain with client while medication is being
- taken as some clients hide them under their tongue to avoid taking them.
- Administer oral does with food or milk
- to decrease gastric irritation.
- Administer by IM route deep into muscle,
- because drug irritates fatty tissue. Do
- not inject into subQ tissue.
- Check blood pressure for marked decrease 30 minutes after drug is injected.
- Observe for EPS and report these
- promptly to the health care provider.
- Record urine output. Urinary retention
- may result.
- Monitor serum glucose levels.
What is the pathopyhsiology of parkinsons disease?
Cells in the substania nigra and putamen of striatum become impaired or die, decreasing the amount of dopamine available resulting in the symptoms.
What are the signs and symptoms of Parkinsons disease?
- Tremor at rest
- Akinesia (absent of movement)
- postural changes
- gait disturbances
- difficulty initiating voluntary movement
- marked slowness of movement
- festinating gait (involuntary acceleration)
What medication is used for Parkinsons Disease?
Sinemet (Levodopa and carbidopa)
Mode of action of sinemet?
- Levodopa passes into the BBB and is converted to dopamine and therefore increases dopamine concentrations in the brain.
- Carbidopa does not cross the BBB, prevents the breakdown of levadopa before reaching the BBB. This allows lower doses of levodopa to be used and decreases the side effects.
Side effects of sinemet?
- Light headedness (from drop in BP)
- Dry mouth
- Mood swings
- Urine and sweat may turn red
- Chest pain
What are two important assessments needed for parkinsons patients?
- Falls assessment
- Swallow assessment
What is the role of dopamine in the brain?
Chemical messenger produced in the brain. Works with acetylcholine to transmit messages from the brain to the body. Especially important in coordination of movement.
What is the on/off phenomenon?
Abrupt and unpredictable changes in mobility when taking levadopa. On=able to move, off=immobile. Can switch between in a brief period of time.
What is the pathophysiology of asthma?
Chronic condition causing inflammation, hyper-reactivity, narrowing of the airways (obstructive/bronchoconstriction/mucus production/mucus plugging). Reversible.
What is the structure in the lungs primarily responsible for gas exchange?
Common signs and symptoms of asthma?
- Coughing – which may worsen at night
- Chest tightness
- Shortness of breath
- Difficulty speaking (in more severe attacks)
- Blueness around the mouth (in more severe attacks).
What is the role of Beta2 adrenergic receptors?
Dilates smooth muscle in bronchioles and coronary arteries increasing blood flow to the heart and air flow to the lungs. Concentrated in the lungs.
What is a MI?
MI results from reduced blood flow through one of the coronary arteries. This causes myocardial ischemia, injury and necrosis.
The pathophysiology of MI?
MI results from occlusion of one or more of the coronary arteries. Occlusion can stem from atherosclerosis, thrombosis, platelet aggregation, or coronary artery stenosis or spasm.
What are the pre-disposing factors of MI?
- Family Hx
- Amphetamine use
- High carb, sat fat and salt diet.
Complications of MI?
- Cardiogenic shock
- Heart failure
- Ventricular aneurysms
- Personality changes
- MI results from prolonged ischemia
- MI results from prolonged ischemia to the myocardium with irreversible cell damage and muscle death. Functionally, the MI causes:
- Reduced contractility with abnormal wall motion.
- Altered left ventricle compliance
- Reduced stroke volume.
- Reduced ejection fraction
- Elevated left ventricle end-diastolic pressure.
What are the signs and symptoms?
- Persistent crushing substernal pain that may radiate to the left arm, jaw, neck or shoulder blades.
- Feeling of impending doom
- N and V
- Cool extremities
What is heart failure?
- When the myocardium cant pump effectively enough to meet the body's metabolic needs, heart failure occurs. Usually left-sided heart failure occurs first.
- Classified:high or low output, acute or chronic, left or right sided, forward or backward.
Pathophysiology of heart failure?
May result from a primary abnormality of the heart muscle (ie infarction) that impairs ventricular function and prevents the heart from pumping enough blood.
Predisposing factors of heart failure are:
- Pulmonary embolism
- Heart defects
- Constrictive pericarditis
Complications of heart failure are:
- Na and H20 may enter lungs causing pulmonary oedema.
- Decreased perfusion to the brain, kidneys, and other major organs, can cause them to fail.
- MI due to 02 demands of heart not being met.
Signs and symptoms of heart failure are:
- Neck vein enlargement
- Noctural dyspnea
- Unexplained weight gain
- Chest tightness
- Fluid retention
Streptococcus pneumoniae signs and symptoms?
- The main symptoms of pneumonia are:
- Cough (green, yellow, bloodstained sputum)
- Sharp or stabbing chest pain worsened by deep breathing or coughing
- Rapid, shallow breathing
- Shortness of breath
- Excessive sweating and clammy skin
- Loss of appetite
- Excessive fatigue
- Confusion, especially in older people
What is empyema?
- Occurs in the cavity between the lung and the pleural space.
- The infected fluid can build up putting pressure on the lungs, causing shortness of breath and pain.
- Risk factors include recent pulmonary conditions including bacterial pneumonia.
- Upper respiratory tract infection
- serotypes (bacteria)
- Spread-droplet infection