MDC 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
• Stages-
Mild 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.
• Routines-
Parkinson’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
• 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)
•
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
• Stages-
Mild 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.
• Routines-
Parkinson’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
• 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)
•
