Course Objective 2: Physiological changes that occur in spec…
Course Objective 2: Physiological changes that occur in specific diseases Restless leg syndrome is caused in part due to dopaminergic, adenosine, & GABA neurotransmission dysfunction. Obstructive sleep apnea (OSA) is caused by collapse of the oral airway with cessation of breathing. Insomnia is caused by hyperarousal of the thalamus, amygdala, &anterior cingulate Shift work sleep disorder (SWSD) = characterized by insomnia and excessive sleepiness affecting people whose work hours overlap with the typical sleep period Delayed sleep phase syndrome (DSPS) = a delay in rhythms of sleep and temperature cycles, is caused by mutation of a gene involved in the rhythmicity of neurons of the SCN Parasomnias = abnormal behaviors such as nightmares or sleepwalking that occur during sleep Insomnia = recurring problems in falling or staying asleep Acute and chronic stress patho: In chronic stress, elevated glucocorticoids and insulin levels redistribute stored calories to the abdominal region, where fat tissue can begin generating glucocorticoids locally. The NP student did not realize how time consuming school would be, so they have been extremely stressed trying to working full-time, studying, and caring for their family. This chronic stress over the past year has impacted the NP student’s ability to learn course content due to cortisol decreasing hippocampus synaptic plasticity. Selye’s theory suggests that our body has an adaptational response to stressors, for example stress on the neurological system can lead to amyloid and tau deposits which can lead to which disease? Alzheimer’s disease A patient with chronic psychological stress is found to have elevated levels of pro-inflammatory cytokines and signs of cognitive decline. The nurse practitioner explains that stress may be affecting the brain’s immune system. Microglia become activated during stress, increasing cytokine production and potentially compromising the BBB. The NP student knows that acute stress in a female of child-bearing age can often lead to delayed ovulation What are the 3 stages of Selye’s General Adaptation Syndrome (GAS)? Alarm; Resistance; Exhaustion Sleep Patho A 48-year-old man has recently been diagnosed with obstructive sleep apnea with an apnea-hypopnea index of 21.2/hr. He presents to the clinic for follow-up because he tried CPAP in the sleep laboratory and felt uncomfortable with it. He asks what the potential risks would be to his health if he chose to forego treatment. What advice should the NP give him? Untreated obstructive sleep apnea has an increased risk of mortality due to cardiovascular events including myocardial infarction and stroke. Untreated obstructive sleep apnea raises nocturnal blood pressure, and treatment with CPAP can lead to drop in blood pressure. Untreated obstructive sleep apnea is associated with a sevenfold increased risk of automobile accidents. Untreated obstructive sleep apnea has an increased risk of depression. A 47 year old female presents to the NP complaining of “creepy crawlies” all over legs when she tries to sleep. She feels exhausted as the sensation is preventing her from getting a good night’s rest. The NP suspects restless leg syndrome and knows there is likely dopaminergic dysfunction involved in this disorder. The FNP is a seeing a 25-year-old man who comes to the clinic because of daytime sleepiness for the past 3 months. He is working in a banking office and just dozes off at his desk. His coworkers have woken him up a few at work, and he does not even recall falling asleep. He also says his daytime naps are increasing in frequency. He describes these naps as a “sudden desire to fall asleep, sometimes involuntarily”. He sleeps on average 7-8 hours a night. His lab work shows no abnormalities and no anemia. The FNP had already ordered a sleep study 2 months ago, and that showed no sleep apnea. The FNP suspects his symptoms are related to low levels of which of the following orexin (hypocretin). The presentation is suggestive of narcolepsy, which theories attribute to low levels of orexin or hypocretin, a wake-promoting neurochemical. Chronic, unrelenting stress and sleep deprivation can increase a patient’s cancer risk through which of the following THREE mechanisms: oxidative stress leading to DNA mutations, immune suppression of NK cells, and increased cytokine release and inflammation. A 48-year-old man with a body mass index of 28.9 kg/m2 is diagnosed with obstructive sleep apnea with 42 apneic events per hour and a minimum oxygen saturation of 78%. Which best describes the pathogenesis of this condition? Transient episodes of pharyngeal collapse Nurses who have worked night shifts for over 10 years show an epigenetic age approximately 3 years older than those who have never worked night shifts. This difference is partly due to changes in DNA methylation