MULTIDIMENSIONAL CARE 4 EXAM 1 STUDY GUIDE TO SUCCESS (MDC4 EXAM 1)

MULTIDIMENSIONAL CARE 4 EXAM 1 STUDY GUIDE TO SUCCESS, FULLY COVERED WITH TOPICS YOU MUST KNOW IN ORDER TO PASS YOUR MDC4 EXAM 1MDC 4 – Examination 1 Blueprint Iggy Chapter: Neurological-42, 43, 44, 45. Perioperative- 14, 15, 16 For all conditions you must understand the Pathophysiology, Clinical manifestations including labs, Possible problems (nursing Diagnosis), interventions and client teaching. Alzheimer’s: This is the most common type of Dementia that affects people older than 65  StagesMild stage- Independent in ADLS Denies presence of symptoms Forgets names and misplaces household items Has short term memory loss and difficulty recalling new information Subtle changes in personality Decrease performance especially when stressed Decreased sense of smell Middle or Moderate stage- Has impairment of all cognitive function Demonstrates problem with handling or unable to handle finances. Disoriented to place time and event Possibly depressed or agitated Is increasingly dependent In ADLs Has difficulty driving and gets lost Incontinent Has episodes of wandering and trouble sleeping Severe or stage three Completely bedridden Totally dependent in ADLs Has loss of mobility and verbal skills Has agnosia- Inability to recognize faces.  Safety – The nurse will prevent in injury or accident as well as elder abuse  Caregiver care- Respite care  Orientation vs validation- Orientation therapy is used for patients who are in the mild stage of Alzheimer’s disease to orientate them to the environment  While Validation therapy is used for patient with moderate or severe stage of Alzheimer’s disease, this is used to acknowledge the patient’s feelings and concerns.  RoutinesParkinson’s Disease- This is a progressive neurogenerative disease, it is a debilitating disease affecting mobility.  Manifestations  Tremor  Muscle rigidity  Bradykinesia with rigidity  Postural instability  Depression  Drooling with slurred speech Expressionless, fixed gaze (mask-like  Fall Prevention intervention- Priority Problems:  Decreased mobility (and possible self-care deficit) related to muscle rigidity, tremors, and postural instability  Potential for decreased self-esteem related to impaired cognition, tremors, and self-care deficit  Medication  Dopamine agonists (stimulate dopamine receptors)  Most effective early  Apomorphine, pramipexole, ropinarole  Sinemet (most common) combo of levodopa-carbidopa  COMT inhibitors (prolong action of levodopa)  Entacapone  MAOIs (increase dopamine concentration)  Rasagiline mesylate  Dopamine receptor agonists (promote release of dopamine, later in disease)  Bromocriptine mesylate  Antiviral (anti-Parkinson benefits)  Amantadine Surgical management for Parkinson • Stereotactic pallidotomy Probing first, then scarring if probing successful • DBS Electrodes implanted into brain, generator like a pacemaker   Dealing with clinical manifestations Migraines- Migraine headaches are painful, unilateral, and throbbing in nature. The headache is associated with symptoms such as nausea, photophobia, phonophobia, and visual changes. The symptoms can last up to 72 hours. There may be known triggers such as stress, red wine, caffeine, and monosodium glutamate (MSG). If the client identifies a possible trigger, then the client is taught to avoid the suspected trigger. This therapy is known as trigger avoidance therapy. Migraine headaches may be associated with an aura such as a sensation or a visual change alerting the client that a headache is imminent. The approach to therapy is abortive and preventive therapy. Abortive therapy is most affective when administering the prescribed medication during the aura or shortly after the headache has begun. Preventative therapy is used to suppress the onset of headaches that can occur as frequently as twice a week  Triggers- pickled foods, chocolate, wine/beer, cultured food/dairy, nuts/butters, onions, tomatoes, caffeine, Beans, banana, citrus fruits, monosodium glutamate Aura- sensation or a visual change alerting the client that a headache is imminent.  Abortive - Acetaminophen (APAP), Ibuprofen (Motrin) NSAIDs, Naproxen (Naprosyn), Migraine HA tablets that contain caffeine, Triptan preparations  sumatriptan (Imitrex)  eletriptan (Relpax)  naratriptan (Amerge)  almotriptan (Axert)  Ergotamine preparations  cafergot (Ergotamine)  Dihydroergotamine (DHE)- Migranal  Midrin     vs. preventative therapy Beta Blockers  propranolol (Inderal)  Timolol Calcium Channel Blocker  verapamil (Calan) Antiepileptic drugs  topiramate (Topamax) Tricyclic antidepressant  nortriptyline (Pamelor)  onabotulinumtoxinA (Botox)  Multiple Sclerosis  Medications  Teaching • Meningitis= Inflammation of meninges of brain and spinal cord  Droplet-requirements- Surgical mask and proper hand hygiene  Causes  Bacterial, viral most often, can be fungal, protozoal, sterile (cancer, drugs)  Direct introduction: penetrating trauma, ruptured brain abscess, basilar skull fracture, infection in eye, ear, nose, mouth  Meningococcal meningitis is highly contagious, high mortality rate • Decreased or changed LOC. Disorientation to person, place, year • Nuchal rigidity, Brudzinski, Kernig’s signs • Pupil reaction & eye movements: Photophobia, nystagmus, abnormal eye movements