Pathophysiology of the Nervous System - Case Study Example

Pathophysiology of the Nervous System: Case Analysis Student’s Name: Course/Number: Instructor’s Name Institution Date Assignment is due: Table of Contents Table of Contents 2 Introduction 2 Key Clinical Signs 4 Differential diagnosis 4 Tetanus 4 Pathophysiology of tetanus 5 Paramedic clinical practice intervention 6 Critique of intervention 7 Epilepsy 7 Pathophysiology underlying epilepsy 8 Paramedic clinical practice interventions 9 Critique of interventions 10 Meningitis 10 Pathophysiology of meningitis 11 Paramedic clinical practice intervention 12 Critique of the intervention 12 Conclusion 13 Introduction The human nervous system is a complex control system for responding to its environment. The nervous system controls processes like breathing, production of digestive enzymes, perception and memory among other human body processes[Bri03]. The disorders of the nervous system may impede the proper functioning in areas with the neural mesh. Pathophysiology of the nervous system regards to the research of the disruption of normal mechanical, physical as well as biochemical functions as a result of an illness or arising from abnormal syndrome [Car08]. This paper aims at providing a case analysis on the nervous system disorders. The case analysis involves a 24 year old male. The patient is on the floor with his arms tight and curled towards his chest, his head back, back arched, and his eyes are rolled back with a fixed gaze. The patient’s mouth is open and the facial muscles seem to be pulled back tight. The issues that will be discussed following the case analysis include the major clinical signs of the case, differential diagnoses and their justifications, the existing management practices in regard to the disorder. Other issues include a critique on the proof in support of the management practices and the pathophysiology related to the diagnoses of the illness in the case provided. There is need for quick and accurate determination of the condition affecting the case for rapid interventions to safe life. These issues have been chosen due to their importance in providing detailed evidence for the handling of the patient’s condition. Key Clinical Signs There are major signs that have been noted in the case provided: 1. The patient is on the floor with his arms tight 2. Arms are curled towards his chest 3. The head faces backward 4. The back is arched 5. Eyes have rolled back with a fixed gaze 6. The mouth is open 7. Facial muscles seem to be tightly pulled back Differential diagnosis Based on the symptoms observed three possible diagnoses include: 1. Epilepsy 2. Tetanus 3. Meningitis Tetanus Tetanus is caused by contaminated wounds through Clostridium tetani which is a bacterium that produces a toxin that inhibits the release of certain inhibitory neurotransmitters, thus causing the nervous system to malfunction[Pat09]. Cases with early tetanus infection will experience mild spasm in the jaw muscles which might lock the jaws leading to respiratory paralysis and consequently might cause death[Mic04]. Pathophysiology of tetanus Tetanus causing bacteria is an obligate anaerobe which forms spores. These spores have the tendency to withstand high thermal temperatures, desiccation and disinfectants. In this form the C. tetani may be in a state of inactivity in the soil, house dust, animal intestines and human feces, but remain infectious for more than 40 years[Voh03]. When the spores enter the body tissues through the wounds, it is capable of persisting for several months. Under certain favorable conditions the spores thrive and produce toxins called tetanospasmin which cause the clinical manifestation of tetanus[JTS04]. The toxin spread to all the nervous system through the lymphatic and vascular circulation. Tetanospasmin is believed to be the most potent toxin known[JTS04]. The neurons which are responsible for releasing gamma-aminobutyric acid (GABA) and glycine, which are inhibitory neurotransmitters enzymes, are specifically sensitive to the toxin- tetanospasmin[Jef02]. This toxin inhibits the release of the neurotransmitters inhibitors, leading to failed inhibition of electrical stimulation of sensory stimulation. Consequently results in contractions of the muscles as exhibited by a tetanic spasm. The early signs of facial alteration and neck and back stiffness are due to the toxic in the peripheral nerves which is the first to supply the toxin to the central nervous system[Jef02]. The case under analysis exhibited signs of early tetanus manifestation as a result of peripheral nerve intoxication with tetanospasmin. Thus causing the patient’s hands to tighten and arching of the back[JTS04]. Paramedic clinical practice intervention Emergency intervention for tetanus case is the treatment of the muscle cramp, control respiratory and metabolic complication, prevention of spread of the toxin and to eradicate the source of tetanus. Some of the drugs that a paramedic can administer to treat muscle cramp, stiffness, and tetanus convulsion may include sedative-hypnotic agents, muscles relaxants such as diazepam, general anesthetics, and neuromuscular blocking agents[JTS04]. The paramedic can also use Antibiotics such as penicillin, clindamycin, erythromycin, or metronidazole to prevent the multiplication of the C. tetani,and halt the production and secretion of toxins. Due the risk of reflex cramp, the patient should be provided with dark and quiet environment. Due to muscle rigidity and sedation, and other secretions in the body of the patient there is high risk of aspiration of gastric elements getting into the lungs leading to reduced ability to cough. Under this condition early establishment of secure airways is crucial prior to laryngeal abstraction occurs. When the patient experiences Tetanus spasms, metabolic rate increase, thus the patient should receive adequate nutritional support to enhance the patient’s chances of survival [WHO10]. The sedatives used to control the muscle spasm may lead to respiratory depression[JTS04]. Therefore, mechanical ventilation should be used or the sedative doses be adjusted to prevent respiratory failure. Critique of intervention The prolong administration of sedatives or overdose may cause slurred speech, unsteady gesture poor mental judgment and may also slow the certain reflexes in the body. Large dose may lead to unconsciousness and death[Car08]. Over the years tetanus infection has been prevented using vaccines. The vaccine injected brought in different side effects. Some of the common side effects of the vaccine injections ussually are the general pain felt in the area where the patient has received injection. According to research over 75% of the people injected with the tetanus vaccines shot experienced this pain[Car08]. Some other adverse effects of the vaccines include the numbness in the arm after receiving the injection. Some people complain of a swelling in the injected area In some rare situation injected people have been noted to experience dangerous effects like seizure, and others have experience brain damages or went into coma immediately after the tetanus shot injection. Some patients have developed severe allergies to the vaccine and the injected area show a rash or a swelling. Bad reaction can make a person feel dizziness, difficulty in breathing and wheezing. Extreme reaction can cause the person to collapse, or experience ‘fit’[Jef02]. Epilepsy A convulsion sometimes referred to as seizure, or 'fit' is an anomalous condition that is caused by sudden shift in the electrical task of the cells in the head or electrical storm in the brain[Car081]. The repeated pattern of convulsion or seizure is referred to epilepsy. There are different types of epilepsy based on the type of seizure experienced[Car081]. So far researchers have not been able to pin point specific causes of epilepsy but it is believed to be caused genetic factors, continued brain disease and as a result of brain cells malfunction due to other diseases like Down syndrome[Car11]. Analysis our case the patient appear to be suffering from Grand mal seizure which affect patients of all age group and can be diagnosed by sudden loss of consciousness (Grey, 2011; Mbuba et al., 2008), and the patient may fall to the ground, the muscles stiffen and experience a rapid pulsation and dilated pupils. The patient with this condition also experience violent jerking of the muscles and eyes roll in the head. Pathophysiology underlying epilepsy The nervous system controls all the other process within the body and this relies on the communication of the several neurons meshed in the body. The chemical signals and electrical impulses conveying electrical information over the numerous body parts such as the brain and the rest of the nervous system[Cha05]. A minimum difference in electrical charge is noticed when a neuron becomes activated. This uneven charge is referred to as an action potential and is as a result of the concentration of ions (atoms or molecules with unbalanced charges) through the cell membrane. The action potential moves very quickly along the axon. The neuronal communication is also regulated by the release of excitatory or inhibitory neurotransmitters usually sent from an axon through the synaptic space between the neurons and are picked up by the dendrites of a different neuron. The nervous system will be activated with an excitatory neurotransmitter into action whereas an inhibitory neurotransmitter will prevent activity [Car08]. A seizure is stimulated when more than required excitatory neurotransmitters are given off, or less than required inhibitory transmitters are given off, both of which leads to brain malfunction and consequently cause increased flow of energy through the brain, leading to coma and contractions of the muscles [Car08]. Paramedic clinical practice interventions The immediate action for an emergency case of epilepsy is to ensure there is good ventilation and ensure there is no objects that can fall on the patient of sharp objects that can bruise or cut the patient[Ken09]. Use a soft material underneath the head to avoiding straining the patient unnecessarily[Voh03]. The mouth of the patient should be free of any obstruction and nothing should be administered through the mouth when the patient is experiencing seizures. The medical practitioner should ensure the patient privacy by shielding the patient from other people[Ken09]. The medical practitioner might inject the patient with anti-seizure drugs to suppress the seizure. Once the patient condition recovers the patient should be examined and oxygen should be administered to reduce the cell anaerobic respiration which result in more toxin in the cells[van04](NH et al., 2009). Check the patient medical history. Critique of interventions Epilepsy has been associated with a lot of complications which lessen the quality of life of the patient but its treatment intervention also have a number of adverse effects to patients such as the alteration of the cognitive functioning and mood swings[Mic04] Patients who have undergone prolong antiepileptic drugs (AEDs) treatment have a high tendency of developing atherosclerosis which is characterized by the hardening of the arteries [Pel05]. Prolonged use of valproate in women may increase the risk of anatomical birth defects[Car081]. Children born by mothers who were using valproate during pregnancy shows reduced IQs level by an average of six to nine points compared to other children with no valproate exposure [Bri03] Meningitis This (Meningitis) is caused as a result of infection in the tough layer in the brain surrounding the brain and the spinal code called the meninges. Meningitis can be caused by the following: micro-organism such viruses, fungi, bacteria; environmental toxins and reaction of medications[Cha05] When these causal agents get into the brain, they are separated from the immune system. As the body attempt to fight the infection the blood vessels is perforated and permit white blood cells and enter protective body particles into the meninges and the brain[van04]. As a result this causes swelling in the meninges and so leads to blood flow to parts of the brain being reduced. The case under analysis might be having of severe meningitis as a result of delayed medical intervention and therefore the patient is experiencing such meningitis complications such us seizure and brain damage[Hus00]. Pathophysiology of meningitis The human brain is protected from the body’s immune system by the meninges membrane which is located between the bloodstream and the brain[S1605]. This prevents the body immune system from acting on itself. When organisms get entry into the brain they are separate from the immune system by the meninges thus allowing the organism to spread[Wan05]. When the body tries to fight the organism the blood vessels swell up causing the white blood cells to leak out in to the brain which is as a result of the porosity in the swollen region of the blood vessels[Fou04]. This process cause brain inflammation and as a result reduced blood circulation to the brain. Depending on the severity of the micro-organisms, the swelling may confined to the subarachnoid space. In less severe infection the pial is left intact[Fou04], while in severe forms the pial barrier is broken resulting in parenchyma infection. Increase micro-organism numbers increase the inflammatory cells, which induce disruptions in the membrane transmission and increased vascular and membrane permeability resulting in changes in PH lactate and the glucose levels in patients[Hus00]. Insufficient blood supply to the brain may result to anaerobic metabolism which contributes to increased lactate concentration and hypoglycorrhachia[Bri03]. If the condition is not controlled early transient neuronal dysfunction or permanent neural injury may occur. Paramedic clinical practice intervention The first intervention an emergency medic should perform is to examine the case carefully and assess the severity of the infection and also determine the type of the microorganism if it’s a viral, fungal or bacteria. Careful assessment will also aid in determining the type of interventions to administer on the patient [Fou04]. The next step is to monitor and stabilize the blood circulation [All04]. If the patient show signs of shock or hypotension drugs should be administered first, crystalloid infusion should be done until the patient is euvolemic[All04]. The most appropriate approach to follow during emergency situations is to treat systemic complications. If the patient shows some signs of seizure, precaution should be taken and seizure treatment procedures are followed. For such cases IV medication like lorazepam, phynytion or fosphenytion should be administered, as prolonged seizure may cause brain damage [Fou04]. Airway protection procedures should be observed for patients with abnormal mental condition. For alert patients in stable condition who have normal vital signs, administer oxygen, establish IV access, and transport them rapidly to the hospital. Critique of the intervention According to Braun and Anderson (2008), performance of lumber puncture in all patients suspected with meningitis is a positive potential for disaster in the patient. The cases of resistance towards the treatment are very scarce; though close to ten percent of individuals tend to develop antibodies towards the toxin, hence causing treatment to become inefficient. In several patients, the antibodies reduce as the treatment progresses to be administered[Jan09]. The antibodies can be removed in cases where the treatment method is the only applicable way of curing the patient (Brooks 2008, p. 10). By halting the injections for a number of years the antibodies could fade away in several patients and the treatment becomes active again. There are other types of the injection being developed to be used on patients who develop complete resistance when the drug is administered in their bodies. Some of the medical interventions can cause adverse effects of patients for example the use of Amphotericin may cause nephrotoxicity, causes vomiting, hepatoxicity and neurotoxicity. This may be as a result of accumulation of the Amphotericin dose in the body[Jan09]. Use of Liposomal Amphotericin B may cause acute infusion and related infections which might include hypoxia, abdominal pain among other complications[S1605]. According to Sheehan and Marcellin (2009), under emergency situations treatment of meningitis with steroids may help prevent seizures, but use of steroids may cause stomach bleeding, increase blood sugar, and may also alter the capability of the body to recover from other types of infections which are not bacteria. Conclusion In the case provided, the symptoms of the patient have been used to discuss the possible disorder that he could be suffering from. This came to the conclusion that the patient might be suffering from one of the following: tetanus, epilepsy or meningitis[Voh03]. Chronic conditions of from the infections exhibit unusual body movement and postures as noted in the patient. At emergency situation the medical practitioner should try and lower the level of the complication/condition of the patient. Further test should be done to isolate each case and come up with a precise infection the patient is suffering from. For the case in study exhibited complication should be dealt with to increase the chance of survival before taking the patient for further medical help. There are various treatment methods available for handling the disorder, which include physical intervention, use of drugs or surgery. However, there is no treatment method that has been proven to be completely effective to date in treating the disorders. References Bri03: , (Briar & Lasserson, 2003), Car08: , (Braun & Anderson, 2008), Pat09: , (Guilfoile & Babcock, 2009), Mic04: , (Scheld et al., 2004), Voh03: , (Vohra, 2003), JTS04: , (Seaman, 2004), Jef02: , (Myers et al., 2002), WHO10: , (WHO, 2010), Car08: , (Braun & Anderson, 2008), Car081: , (Mbuba et al., 2008), Car11: , (Mbuba, 2011), Cha05: , (Chavez-Bueno & McCracken, 2005), Ken09: , (NH et al., 2009), van04: , (Beek et al., 2004), Pel05: , (Pellock et al., 2005), Bri03: , (Briar & Lasserson, 2003), Hus00: , (Hussein AS, 2000), S1605: , (Chavez-Bueno & North, 2005), Wan05: , (Wang et al., 2005), Fou04: , (Foundation, 2004), Fou04: , (Foundation, 2004), All04: , (Tunkel et al., 2004), All04: , (Tunkel et al., 2004), Jan09: , (Sheehan & Marcellin, 2009), .  Read More