(Summary) MDC 4 NUR2755 FINAL EXAM, Updated 2024, With Complete Solution.

(Summary) MDC 4 NUR2755 FINAL EXAM, Updated 2024, With Complete Solution. Alzheimer's Mild Stage -Forgets names; misplaces household items -Has short-term memory loss and difficulty recalling new information -Shows subtle changes in personality and behavior Alzheimer's Moderate Stage -Is disoriented to time, place, and event -Has difficulty driving and gets lost -Incontinent -Psychotic behaviors, such as delusions, hallucinations, and paranoia -Episodes of wandering, trouble sleeping Alzheimer's Late Stage -Totally incapacitated; bedridden -Totally dependent in ADLs -Has agnosia -Hallucinations -Incontinence -Difficulty eating Apraxia Difficulty with motor planning to perform tasks or movements Aphasia Inability to speak or understand language Anomia Inability to recall the names of everyday objects Agnosia Loss of sensory comprehension, including facial recognition Alzheimer's diagnostics -No laboratory test can confirm the diagnosis of AD -Definitive diagnosis is made on the basis of brain tissue examination at autopsy, which confirms the presence of neurofibrillary tangles and neuritic plaques Alzheimer's medications Cholinesterase inhibitors- Donepezil, galantamine NMDA receptor antagonists- Memantine Parkinson's symptoms -Slow, shuffling, and propulsive gait -RESTING tremors -Muscle rigidity -Bradykinesia/akinesia (loss of ability to move muscles voluntarily) -Mask Like face -Drooling -Postural instability Parkinson's diagnostics -Diagnosis typically made based on manifestations, their progression, and by ruling out other disease -Analysis of CSF may show a decrease in dopamine levels Parkinson's medications Carbidopa/Levodopa (Sinemet) Parkinson's surgical interventions Stereotactic pallidotomy or thalamotomy Migraine triggers -Caffeine -Red wine -MSG -Foods high in tyramine (aged cheeses, cultured food like yogurt) Migraine abortive therapy Acetaminophen, ibuprofen, naproxen, triptans, ergotamine derivatives Migraine preventative therapy Beta blockers, calcium channel blockers, antiepileptics, Botox Migraine surgical treatment Trigeminal nerve resection Aura symptoms -Visual disturbances -Flashing lights/lines/spots -Numbness of lips or tongue -Acute confused state -Aphasia -Vertigo -Unilateral weakness* -Offensive smell -"Deja vu" feeling Multiple sclerosis clinical manifestations -Muscle weakness and spasticity -Intention tremors (tremor when performing an activity) -Diplopia (double vision) -Nystagmus (an involuntary condition in which the eyes make repetitive uncontrolled movements) -Depression/labile Multiple sclerosis diagnosis MRI of the brain and spinal cord demonstrates the presence of plaques in at least 2 areas Multiple sclerosis medications -Baclofen -Disease-modifying therapies -Interferon beta-1a and beta-1b -Corticosteroids Meningitis clinical manifestations -Nuchal rigidity -Kernig Sign -Brudzinski Sign -Decreased level of consciousness -Photosensitivity Kernig Sign Resistance and pain with extension of the client's leg from a flexed position Brudzinski Sign Flexion of the knees and hips occurring with deliberate flexion of the client's neck Meningitis diagnostics Lumbar puncture Appearance of CSF: cloudy (bacterial) or clear (viral) Prevention of meningitis Meningococcal vaccine Droplet precautions -Private room -Stay at least 3 feet away from the patient unless wearing a mask -Patients who are transported outside the room should wear a mask -Health care personnel should wear gloves, gown, and mask Tonic-clonic seizure Generalized seizure in which the patient loses consciousness and has both stiffening of the muscles (tonic) and rhythmic jerking of the extremities (clonic) Tonic seizure Clients suddenly lose consciousness and experience sudden increased muscle tone, loss of consciousness, and have autonomic manifestations Clonic seizure Only the clonic phase is experienced (rhythmic jerking of the extremities) Myoclonic seizure Lasting only seconds, myoclonic seizures consist of brief jerking or stiffening of the extremities, which can be symmetrical or asymmetrical Atonic or akinetic seizure Characterized by a few seconds in which muscle tone is lost Complex partial seizure -Seizures associated with automatisms (behaviors that the client is unaware of, such as lip smacking or picking at clothes) -Can cause loss of consciousness Simple partial seizure Seizure where consciousness is maintained Seizure diagnostics -Electroencephalogram (EEG) -CT/MRI Seizure interventions -Turn the patient on their side -Remove objects that may injure the patient -Suction as needed -Oxygen -Padded side rails -IV access (saline lock) -Bed in lowest position -Nothing in mouth -Loosen or remove restrictive clothing Seizure medications -Lorazepam or diazepam IV push to stop a seizure (4 mg over a 2 minute period) -Phenytoin (therapeutic range 10 to 20 mcg/ml) Earliest sign of increased intracranial pressure Decreased level of consciousness Increased intracranial pressure early signs -EARLIEST SIGN: Decreased level of consciousness -Restlessness -Changes in speech -Confusion -Headache -Nausea and vomiting → projectile Increased intracranial pressure late signs -Pupillary changes → can mean herniation -Cranial nerve dysfunction -Ataxia -Cushing's triad (very late sign) Increased intracranial pressure interventions -Low stimulation -Semi-fowlers → 30 degrees -Head in neutral position -Do not cluster activities -Suction only as needed -Teach patient not to cough or blow their nose -Dim lighting -Stool softeners -Do not bend or bare down Increased intracranial pressure treatment IV mannitol given through a filter because it crystallizes at room temperature Cushing's triad Severe hypertension, widened pulse pressure (difference between the systolic and diastolic blood pressure), bradycardia, irregular respirations Pulse pressure Difference between systolic and diastolic pressure Ischemic stroke Caused by the occlusion of a cerebral artery by either a thrombus or an embolus. Thrombotic stroke Occur secondary to the development of a blood clot on an atherosclerotic plaque in a cerebral artery that gradually shuts off the artery and causes ischemia distal to the occlusion Embolic stroke Caused by an embolus traveling from another part of the body to a cerebral artery. Blood to the brain distal to the occlusion is immediately shut off causing neurologic deficits or a loss of consciousness to instantly occur. Hemorrhagic stroke Occur secondary to a ruptured artery or aneurysm. The prognosis for a client who has experienced a hemorrhagic stroke is poor due to the amount of ischemia and increased ICP caused by the expanding collection of blood. Patients will complain of the "worst headache of my life". Alexia Inability to understand written words Stroke diagnostics A non-contrast computed tomography (CT) scan (WITHOUT CONTRAST) is the initial diagnostic test and should be performed within 25 minutes from the time of client arrival to the emergency department Homonymous hemianopsia interventions -Instruct them to use a scanning technique (turning head from the direction of the unaffected side to the affected side) when eating and ambulating -Rotate their plate so that they can see it -Talk to them on their good side Ischemic stroke treatment -Give thrombolytics within 4.5 hours of initial manifestations -Low-dose aspirin is given within 24-48 hours following an ischemic stroke to prevent further clot formation Stroke prevention -Smoking cessation -Heart-healthy diet rich in fruits and vegetables and low in saturated fats -Regular activity, including planned exercise; example: walking at least 30 minutes most days of the week -Reduction in alcohol consumption -Reduction of salt in diet Post-stroke feeding interventions -An RN should provide the initial feeding and intervene if choking occurs. Some clients require an eating environment without distractions to prevent choking. -Chin tuck when swallowing -Watch for pocketing -Put food on the unaffected side -Aid cannot feed unless they are stable -Do not rush the patient while they are eating Decorticate posturing Hands towards the CORE Decerebrate posturing Hands OUT ("to celebrate")