MDC4 Exam 01 - MDC4 Exam 1 Study Guide PDF

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MDC4 Exam 1 Study Guide...

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MDC4 Exam 01 Module 1 Ch 39, 40 Module 2 Ch. 41 Module 3 Ch. 38, 18 Module 4 Ch. 09 

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Migraines o S/S: episodic, head pain that is throbbing and unilateral, photophobia, osmophobia, steady ache to violent throbbing. o Trigger Foods: caffeine, red wine and monosodium glutamate (MSG) o New onset of migrane and doctor wants a CT with contrast- ask if allergic to shellfish, seafood, iodine MOA of Ergotamine Tartrate o May be taken at the start of the headache. o May take up to 6 tablets in 24 hours. o Acts by constricting the cerebral blood vessels Stages of Alzheimer’s o Early (Mild)- First Symptoms up to 4 years  Independent ADLs  Denies presence of symptoms  Forgets names; misplaces household items  Has short-term memory loss and difficulty recalling new info  Has mild impaired cognition and problems with judgement.  Often has decreased sense of smell o Middle (Moderate)- 2 to 3 years  Has impairment of all cognitive functions  Demonstrates problems with handling money and finacnes  Disoriented to time, place and event  Possibly depressed and/or agitated  Increasingly dependent in ADLs  Psychotic behaviors, delusions, hallucinations and paranoia  Has episodes of wandering; trouble sleeping o Late (severe)  Completely incapacitated; bedridden  Totally depending in ADLs  Has loss of mobility and verbal skills  Possibly has seizures and tremors  Has agnosia Parkinson’s Disease o S/S: tremor, muscle rigidity, bradykinesia, or akinesia (slow movement/no movement) and postural instability. o Levodopa  Used for improving muscle control, allowing more normal movements of the body  Side effects: orthostatic hypotension, hallucinations, sleepiness, drowsiness  Give drug before meals to increase absorption. And change positions slowly. Multiple Sclerosis- chronic disease caused by immune, genetic and/or infectious factors that affects the myelin and nerve fibers of the brain and spinal cord. o S/S: intention tremors, muscle weakness and spasticity, fatigue, dysmetria, dysphagia, vertigo o Baclofen: helps relieve muscle spasms  Side effects:

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Guillain-Barre- acute inflammatory disorder that affects the axons and./or myelin of the PNS o S/S: ascending symmetrical muscle weakness, respiratory compromise, loss of bowel and bladder control, ataxia, pain (cramping), facial weakness, dysphagia, diplopia, difficulty speaking, tachycardia o Health history: exposure to virus o What will kill them? Respiratory failure (top concern) o Nursing Considerations:  Emergency Interventions- ABCs  Airway management is PRIORITY!  Aspiration precautions (HOB up 45/assess swallowing ability/suction equipment)  Managing cardiac dysfunction  Cardiac monitor/VS trends  Hypertension- beta blocker/nitroprusside  Hypotension- IVFs and flat  Bradycardia- atropine  Respiratory function- assess q1-2 hrs in acute phase  Preventing complications of immobility  PT/OT/ST- address self-care deficits  Manage pain- PCA (opiates), Neurontin  Psychosocial support- assess/educate patient and family o Treatment:  Plasmapheresis- 3-4 treatments  Removes antibodies destroying myelin sheaths  Nurse: education/weights before and after; manage IV and monitor for complications  IV immunoglobulin- safer and immediately available  Nurse- assess for Side effects (chills, fever, myalgia, headache)  Start slow and increase if patient tolerates it Myasthenia Gravis o S/S: proximal to distal muscle weakness, ptosis/diplopia, dysphagia, fatigue, respiratory compromise o Nursing Management  Gas exchange priority- chest physiotherapy  Promote mobility- schedule tests/activity early in day/rest periods/ assist  Avoid the use of sedatives, magnesium, tranquilizing drugs and morphine because these drugs can cause respiratory or cardiac depression. Increase muscular weakness. o Medications  Cholinesterase Inhibitor Drugs- 1st line management  Pyridostigmine (mestinon, Regonol)  Doses vary day by day  Take with food to avoid GI side effects. o Myasthenic crisis- EMERGENCY SITUATION  Rapid onset of dysphagia, ptosis, diplopia, and respiratory distress  Nursing: maintain airway; hold cholinesterase inhibiting drugs What condition resembles a stroke but isn’t? o Seizures (Epilepsy)- abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change of LOC, motor or sensory ability and/or behavior. o Priority Precautions: lay on left side, adequate airway, padded rails o Active: suction and O2; bedrails up and padded, IV access, give Ativan/lorazepam o Lorazepam- may be given to stop the clusters to prevent the development of status epilepticus. Glasgow Coma Scale

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o Scoring system for the neuro-trauma client o Assess three client responses  Best eye response  Best verbal response  Best motor response o Low=3; high 15 o Severe 8 or less o Moderate 9-12 o Mild 13-15 What is autonomic Dysreflexia o Sometimes referred to as autonomic hyperreflexia o A potentially life-threatening condition in which noxious visceral or cutaneous stimuli cause a sudden, massive, uninhibited reflex sympathetic discharge in people with high-level spinal cord injury Strokes “Brain Attacks”- caused by an interruption of perfusion to any part of the brain that results in infarction (cell death) o Transient Ischemic Attack- indications you’re going to have a stroke, a high risk of a stroke. o Ischemic Strokes  Caused by the occlusion of a cerebral or carotid artery by either a clot (thrombus) or dislodged clot (embolus) o Hemorrhagic strokes  Vessel integrity is interrupted and bleeding occurs into the brain tissue.  Treatment: vitamin K, fresh frozen plasma, and surgery o Effects of CVA  3 types of aphasia Broca’s- expressive o Management- using communication board or clipboard for writing if able  Wernicke’s- receptive  Global- both types o Treatment  Thrombolytic therapy  Neuroprotective drugs  Surgery  Carotid artery angioplasty with stenting  Endarterectomy  Extracranial-intracranial bypass o Drug Management  tPA- tissue plasminogen activator  must be giving within the first 3 hours of symptom onset;  first must know the time of CVA onset. ICU for close monitoring  Side effects:  Contraindications: hypertension, bleeding, stroke onset greater than 3 hours. o Safe feeding practices to teach Stroke Patients (SATA)  eat in upright position and swallow with head and neck slightly flexed.  Tuck chin to swallow to prevent aspiration  Small bites with food  MS diet- pureed, watch the affected side for food pocketing  Sit up right 90 degrees  DO NOT use straws Increased Intracranial Pressure- most at risk during first 72 hours after onset of stroke.

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o Normal: 10-15 o Ways to Test : ICP monitoring device o S/S:  Adults: headache or change in LOC  Infants: irritability, lethargy, poor feeding, may have a bulge of fontanel o Managing ICP  Positioning- HOB elevated 30 degrees, limit to 1 pillow to keep head and neck midline to prevent compression of the jugular veins, limit hip flexion  Activity management- distribution of care procedures over a longer time frame to decrease oxygen demand  Airway management- suctioning only when indicated since ETT suctioning can increase ICP  Hyperventilation- not recommended with TBI because it decreases perfusion  Bowel management- stool softeners or laxatives are recommended to prevent constipation and associated increased ICP  No excessive fluid intake  Monitor for CSF leakage- instruct patient to avoid blowing nose and putting anything into ears o Contraindication: lumbar puncture o Cushing’s Triad Very late sign  Severe hypertension- increase systolic  Widened pulse pressure  Bradycardia  Change in respiratory pattern Surgical Pre-Op teaching o Ensuring informed consent is signed  Surgeon obtains signed consent before sedation and/or surgery  Nurse clarifies facts and dispels myths about surgery  Nurse not responsible for providing detailed information about procedure.  If patient has additional questions at any time, the surgeon should be called and asked to come back and speak with the patient. o NPO- patient not to ingest anything by mouth for 6 to 8 hours before surgery  Decreases risk for aspiration  Give patients written/oral directions to stress adherence  Surgery can be canceled if instructions not followed o Stating an understanding of preop preps (skin preparation, bowel preparation) o Demonstrating correct use of exercises and techniques to be used after surgery for the prevention of complications (splinting the incision, using an incentive spirometer, performing leg exercises, ambulating as early as permitted) Types of Anesthesia/Sedation/Blocks o Complications: malignant hyperthermia, overdose, unrecognized hypoventilation, problems with specific anesthetic agents, intubation problems o Treatment of complications:  Establish open airway  Give oxygen  Notify surgeon  Fast-acting barbiturate is usual tx  Epinephrine for unexplained bradycardia o General inhalation:  Most controllable method; suppresses CNS activity and results in unconsciousness.  Post-op nausea and shivering common

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o General Intravenous  Rapid and pleasant induction  Contraindicated in presence of liver and kidney disease  Increased cardiac and respiratory depression o Balanced  Minimal disturbance to physiologic function  Can be used with older and high-risk patients o Regional or Local: spinal, epidural, nerve block  Local anesthetic agent injected around major nerves or the spinal cord to block sensation and pain form limited part of the body  Field block- series of injections around the operative field; most commonly used for chest procedures, hernia repair, dental surgery and some plastic surgeries  Nerve block- injection of the local anesthetic agent into or around one nerve or group of nerves in the involved area; most commonly used for limb surgery or to relieve chronic pain  Spinal anesthesia- injection of an anesthetic agent into the cerebrospinal fluid in the subarachnoid space  Epidural anesthesia- injection of an agent into the epidural space Malignant Hyperthermia- acute, life threatening complication; begins with skeletal muscle expose to specific agent o Causes increased metabolism, calcium levels in muscle cells. o S/S: tachycardia, skin mottling, cyanosis, myoglobinuria (monitor urine output for blood or myoglobin), rise in end tidal carbon dioxide, elevated temperature o Nursing Interventions  Intubate, ventilate and administer dantrolene sodium IV at 2-3mg/Kg repeat as needed.  ABG- administer sodium bicarb for metabolic acidosis  Implement active cooling techniques: iced saline, cooling blanket, ice packs, ice normal saline lavage  Place patient on cardiac monitor How long do you surgical Scrub? o 3-5 minutes , followed by a rinse. o Rinsing, hands and arms are positioned so water runs off the arms. Evisceration o Total separation of all wound layers and protrusion of internal organs through the open wound o Contact surgeon IMMEDIATELY and patient returns to the OR o Apply a warm, moist normal saline sterile dressing while waiting for further orders Dehiscence o Partial or complete separation of the outer wound layers, sometimes described as “splitting open of the wound” o Seen most often between 5 and 10 days after surgery S/S of Pulmonary Embolism o Dyspnea o Cyanosis o Tachycardia What does “postictal” mean? o Referring to the time immediately after the seizure o Atonic seizure- sudden loss of muscle tone, lasting for seconds, followed by postictal (after the seizure) confusion....