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 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)
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 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)
