NUR 606 Week 9 Discussion 1 Question-Based Discussion—Team B (General Neurologic Dysfunction)

Value: 100 points

Due: To facilitate scholarly discourse, create your initial post by Day 3, and reply to at least two of your classmates, on two separate days, by Day 7.

Gradebook Category: Discussions

Initial Post

It is understood that thoughtful responses to your topic question(s) will take some time and thought. Please organize your thoughts before creating your initial post.

Based on your assigned team, create an initial post by answering all questions in your team’s case study, making sure to address all components of all questions.

By Day 3, post your initial response to your assigned part of the case study as a reply to the appropriate discussion thread. Please be sure to number the questions addressed and include all components of each question in your response. Each initial response must have a reference, including at least two scholarly references other than your textbook or course materials. Your post should comprehensively address the questions posed.

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Team B

Week 9 Discussion Team B Worksheet (Word)

General Neurologic Dysfunction

In some neurologic disorders, postsynaptic membrane permeability is increased. Does this make the neuron more easily stimulated or less excitable? Using pathophysiology, explain why.
Cholinergic drugs are often used to help correct neurologic pathologic processes. Briefly describe where a cholinergic drug acts and how it affects the postsynaptic receptors. Give two examples of its possible effects on function.
Describe two possible areas of CNS damage that might cause flaccid paralysis. What signs and symptoms would a patient with this condition exhibit?
There are many different conditions that can cause increased intracranial pressure (ICP); identify two. What are the early signs and symptoms of increased ICP? What will you look for in a patient to help determine if they have increased ICP?
Describe how vital signs change from early increased ICP to later stages.
Which is more critical: a lesion in the brainstem or in the cerebral hemisphere? Using pathophysiology, explain why.

Replies

Select posts from two peers that addressed a case study from a different team than you. For example, students from Team A reply to one post from Team B and one post from Team C. Each reply must use at least one scholarly reference other than your textbook.

Thinking about your population-specific NP track and anticipated practice area:

Describe a patient you might encounter where you could apply the information learned in your peer’s post.
What “signs” and “symptoms” would you expect this patient to exhibit? Identify at least four, describe the finding, and classify each as subjective or objective data.

Please refer to the Grading Rubric for details on how this activity will be graded.

Posting to the Discussion Forum

Select Add a new discussion topic.
Type your topic in the subject line.
Create your post.
Select Post to Forum.

General Neurologic Dysfunction

1. In some neurologic disorders, postsynaptic membrane permeability is increased. Does this make the neuron more easily stimulated or less excitable? Using pathophysiology, explain why.

“The postsynaptic membrane is the membrane that receives a signal (binds neurotransmitter) from the presynaptic cell and responds via depolarization or hyperpolarization” (Uniprot, n.d.). When the postsynaptic membrane permeability increases, sodium ions flow into the cell space, thus depolarizing it with a degenerating action potential (VanMeter & Hubert 2018 p.334). This makes neurons more easily stimulated and excitable.

2. Cholinergic drugs are often used to help correct neurologic pathologic processes. Briefly describe where a cholinergic drug acts and how it affects the postsynaptic receptors. Give two examples of its possible effects on function.

Cholinergic medications are drugs that “act upon the neurotransmitter acetylcholine, the primary neurotransmitter within the parasympathetic nervous system (PNS)” (Pakala Brown & Preuss 2021). These kinds of medications fall into two different categories direct acting in indirect-acting cholinergic drugs. Direct-acting cholinergic drugs work by binding to and activating the muscarinic receptors (Pakala Brown & Preuss 2021). At the same time, indirect cholinergic drugs increase the availability of acetylcholine at the cholinergic receptors (Pakala Brown & Preuss 2021). One example of the cholinergic drug effect is in ophthalmology, where Carbachol induces miosis to reduce intraocular pressure in the treatment of glaucoma (National Center for Biotechnology Information, 2021). Carbachol mimics the effect of acetylcholine on both the muscarinic and nicotinic receptors (National Center for Biotechnology Information, 2021). Another example of a cholinergic drug is Bethanechol, which is used in urology cases. Bethanechol is used to treat non-obstructive urinary retention (National Center for Biotechnology Information, 2021). The drug is a muscarinic agonist with no nicotinic effects (National Center for Biotechnology Information, 2021).

3. Describe two possible areas of CNS damage that might cause flaccid paralysis. What signs and symptoms would a patient with this condition exhibit?

There are many possible areas of the central nervous system when damage can cause flaccid paralysis. “Damage to the upper motor neurons in the posterior zone of the frontal lobe of the cerebral cortex or the corticospinal tracts in the brain inferences with voluntary movement, which can cause paralysis on the opposite side of the body” (VanMeter & Hubert 2018 p.339). Another area that can cause flaccid paralysis is anterior spinal artery syndrome, in which the anterior spinal artery is blocked (BrainandSpinalCord.org, 2021). Some signs and symptoms of flaccid paralysis are a progression of paralysis, onset of fever, diminished muscle tone, sensory loss, cramps, or tingling of palms and soles of the feet, bladder dysfunction, and respiratory insufficiency (BrainandSpinalCord.org, 2021).

4. Many different conditions can cause increased intracranial pressure (ICP); identify two. What are the early signs and symptoms of increased ICP? What will you look for in a patient to help determine if they have increased ICP?

Two causes of increased intracranial pressure (ICP) could be a brain hemorrhage and cerebral edema. Some early signs and symptoms include severe headache, vomiting, papilledema. By assessing their pupils and vital signs, you can determine if somebody has increased intracranial pressure with the additional symptoms of a severe headache and vomiting. When looking through the eye’s pupil at the retina with the optical nerve, there is swelling of the part of the optic nerve inside the eye (optic disc) (NIH, 2016).

5. Describe how vital signs change from early increased ICP to later stages.

Systematic blood pressure rises and slows heart rate during the early stages of increased intracranial pressure (ICP) (VanMeter & Hubert 2018 p.342). Some later vital sign changes of ICP are a decrease in blood pressure, decrease in heart rate, decrease in respiratory rate (VanMeter & Hubert 2018 p.343). Moreover, ICP continues severe ischemia in neurological death prevent circulation control which results in the decrease in blood pressure and decreasing heart rate (VanMeter & Hubert 2018 p.343).

6. Which is more critical: a lesion in the brainstem or the cerebral hemisphere? Using pathophysiology, explain why.

A lesion on the brainstem is more critical as it may affect motor and sensory fibers resulting in widespread impairment (VanMeter & Hubert 2018 p.338). This is called an infratentorial lesion. The brainstem is a bundle of nerves, and this can affect “respiratory and circulatory function in the level of consciousness may be impaired by a small lesion in this area” (VanMeter & Hubert 2018 p.338).

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References

BrainandSpinalCord.org. (2021). Flaccid Paralysis. Retrieved October 25, 2021, from https://www.brainandspinalcord.org/flaccid-paralysis/

National Center for Biotechnology Information (2021). PubChem Compound Summary for CID

5831, Carbachol. Retrieved October 25, 2021, from https://pubchem.ncbi.nlm.nih.gov/compound/Carbachol.

National Center for Biotechnology Information (2021). PubChem Compound Summary for CID

2370, Bethanechol. Retrieved October 25, 2021 from https://pubchem.ncbi.nlm.nih.gov/compound/Bethanechol.

NIH. (2016). Papilledema | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. Nih.Gov. Retrieved October 25, 2021, from https://rarediseases.info.nih.gov/diseases/7318/papilledema

Pakala RS, Brown KN, Preuss CV. Cholinergic Medications. [Updated 2021 Aug 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538163/

Uniprot. (n.d.). Postsynaptic cell membrane. Uniprot.Org. Retrieved October 25, 2021, from https://www.uniprot.org/keywords/628

VanMeter, K. C., & Hubert, R. J. (2018). Gould’s pathophysiology for the health professions. (6th ed.). Elsevier Saunders.

890 words

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NUR 606 Week 9 Discussion 1 Question-Based Discussion—Team B (General Neurologic Dysfunction)