NUR 170
EXAM 2 STUDY GUIDE
Concepts Of Medical–Surgical Nursing
Galen College of Nursing
, lOMoARcPSD|51648332
2Parkinson’s Disease
Parkinson’s Disease: Caused by degeneration of the substantia nigra, results in too little dopamine and too
much acetylcholine so you have an imbalance
Symptoms:
o Tremor
o Slow shuffling of gait
o Muscle rigidity
o Bradykinesia (slow movement)
o Mask like face
o Drooling (sialorrhea)
o Difficulty swallowing
Care:
- Monitor swallowing, food intake, thicken food, sit up right to eat, have suction available,
encourage ROM (range of motion) & exercise, help with ADLS as needed..
Medications:
o Levodopa carvadopa (Sinemet) - Increases dopamine
o Benztropine anticholinergic that decreases acetylcholine.
Communication board:
o Speech difficulties & voice problems are common in these people. This is because it affects
nerves & muscles that affect your speech like the larynx (voice box), throat, resp muscles,
roof of mouth, tongue & lips, facial muscle movement,, areas of the brain that control
hearing and affect voice & speech processing .
o PT may experience softened voice or reduced volume in voice, speaking in unchangeable
pitch (monotoned). Having hoarse or strained voice, breathiness in voice, run out of air while
speaking, trouble clearly and easily pronouncing speech, loss of facial expression.
o Can use pen and paper if possible, or alphabet board to point to first letter of word being
said, spell word with board or use gestures.
Increase calorie intake:
• Dyskinesia: extra movements which can be a side effect of Levodopa Carvadopa (Sinemet) resulting in
excessive energy consumption, you burn more calories leading to weight loss,, so you need to increase
intake of calories to maintain weight & for energy..
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Drooling:
• Keep chin up & lips closed when not speaking or eating, swallow often, especially before speaking, ask
speech therapist about exercises to strengthen up muscles, avoid sugary foods that can cause more saliva
to develop,, ask about medications that help with decreasing saliva such as anticholinergics like
glycopyrrolate and scopolamine and benzhexol hydrochloride..
Fall risk:
• Due to poor balance, freezing, stooped posture (causes forward falls).
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Epilepsy/Seizures
Seizure
• Uncontrolled electrical impulses of neurons.
Epilepsy
• Chronic seizures.
Care for pt experiencing a seizure:
• Prime objective when caring for a pt experiencing a seizure is to prevent injury, keep a patent airway,
and if possible, turn pt to their side to prevent aspiration if they vomit. DO NOT force anything into mouth
or airway once a seizure has begun. Airway takes priority. Reducing stimuli will not help once a seizure has
begun. Can also have aura
Medications (Seizure meds are taken lifelong):
o Phenytoin (10 - 20mcg//mml safe dose)) - an antiseizure hydantoin. Side effects include
drowsy & dizziness. Adverse reactions include steven Johnson's syndrome. Do not take if
pregnant. Do not take with herbals, or anticoagulants, monitor serum blood levels and liver
enzymes, take with foods high in calcium.
o Lorazepam – Sedative that is used to treat seizures, like epilepsy, can be used before
surgery and medical procedures to relieve anxiety. Can cause paranoid or suicidal ideation,
impair memory, judgement & coordination. Combining with other substances like alcohol
can lead to slow breathing/death.
o Gabapentin – Anticonvulsant prescribed to prevent recurrent seizures. Sudden withdrawal
can result in status epilepticus.
o Diazepam – 1st line for continuous seizures. Do not give with CNS depressant, will make
more tired.
EEG:
• Records brain waves between seizures called interictal brain waves. Electrodes are attached to scalp with
a paste like substance or cap. Does not always show past abnormalities. Can show abnormalities even if
seizure does not occur during the test. Helps diagnose seizure types.
Safety:
• Important to prevent injury. Make sure environment is safe as possible. Pad bed rails, have suction in the
room, never put anything in their mouths once they are seizing, DO NOT restrain someone seizing.
Downloaded by Benjamin Luca ()
EXAM 2 STUDY GUIDE
Concepts Of Medical–Surgical Nursing
Galen College of Nursing
, lOMoARcPSD|51648332
2Parkinson’s Disease
Parkinson’s Disease: Caused by degeneration of the substantia nigra, results in too little dopamine and too
much acetylcholine so you have an imbalance
Symptoms:
o Tremor
o Slow shuffling of gait
o Muscle rigidity
o Bradykinesia (slow movement)
o Mask like face
o Drooling (sialorrhea)
o Difficulty swallowing
Care:
- Monitor swallowing, food intake, thicken food, sit up right to eat, have suction available,
encourage ROM (range of motion) & exercise, help with ADLS as needed..
Medications:
o Levodopa carvadopa (Sinemet) - Increases dopamine
o Benztropine anticholinergic that decreases acetylcholine.
Communication board:
o Speech difficulties & voice problems are common in these people. This is because it affects
nerves & muscles that affect your speech like the larynx (voice box), throat, resp muscles,
roof of mouth, tongue & lips, facial muscle movement,, areas of the brain that control
hearing and affect voice & speech processing .
o PT may experience softened voice or reduced volume in voice, speaking in unchangeable
pitch (monotoned). Having hoarse or strained voice, breathiness in voice, run out of air while
speaking, trouble clearly and easily pronouncing speech, loss of facial expression.
o Can use pen and paper if possible, or alphabet board to point to first letter of word being
said, spell word with board or use gestures.
Increase calorie intake:
• Dyskinesia: extra movements which can be a side effect of Levodopa Carvadopa (Sinemet) resulting in
excessive energy consumption, you burn more calories leading to weight loss,, so you need to increase
intake of calories to maintain weight & for energy..
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Drooling:
• Keep chin up & lips closed when not speaking or eating, swallow often, especially before speaking, ask
speech therapist about exercises to strengthen up muscles, avoid sugary foods that can cause more saliva
to develop,, ask about medications that help with decreasing saliva such as anticholinergics like
glycopyrrolate and scopolamine and benzhexol hydrochloride..
Fall risk:
• Due to poor balance, freezing, stooped posture (causes forward falls).
Downloaded by Benjamin Luca ()
, lOMoARcPSD|51648332
Epilepsy/Seizures
Seizure
• Uncontrolled electrical impulses of neurons.
Epilepsy
• Chronic seizures.
Care for pt experiencing a seizure:
• Prime objective when caring for a pt experiencing a seizure is to prevent injury, keep a patent airway,
and if possible, turn pt to their side to prevent aspiration if they vomit. DO NOT force anything into mouth
or airway once a seizure has begun. Airway takes priority. Reducing stimuli will not help once a seizure has
begun. Can also have aura
Medications (Seizure meds are taken lifelong):
o Phenytoin (10 - 20mcg//mml safe dose)) - an antiseizure hydantoin. Side effects include
drowsy & dizziness. Adverse reactions include steven Johnson's syndrome. Do not take if
pregnant. Do not take with herbals, or anticoagulants, monitor serum blood levels and liver
enzymes, take with foods high in calcium.
o Lorazepam – Sedative that is used to treat seizures, like epilepsy, can be used before
surgery and medical procedures to relieve anxiety. Can cause paranoid or suicidal ideation,
impair memory, judgement & coordination. Combining with other substances like alcohol
can lead to slow breathing/death.
o Gabapentin – Anticonvulsant prescribed to prevent recurrent seizures. Sudden withdrawal
can result in status epilepticus.
o Diazepam – 1st line for continuous seizures. Do not give with CNS depressant, will make
more tired.
EEG:
• Records brain waves between seizures called interictal brain waves. Electrodes are attached to scalp with
a paste like substance or cap. Does not always show past abnormalities. Can show abnormalities even if
seizure does not occur during the test. Helps diagnose seizure types.
Safety:
• Important to prevent injury. Make sure environment is safe as possible. Pad bed rails, have suction in the
room, never put anything in their mouths once they are seizing, DO NOT restrain someone seizing.
Downloaded by Benjamin Luca ()
