NURS 210 MED SURG FINAL EXAM WITH
COMPLETE SOLUTIONS
Total Patient Care Model - ANSWER 12 hour shift
Functional Nursing - ANSWER Task approach delegated by RN to individual
Team Nursing - ANSWER RN is team leader
Primary Nursing - ANSWER 24 hr management and coordination
Nurse Care Manager - ANSWER Does all the above. Bad for hospital financial
rating
CVA (stroke) - ANSWER Blood rich o2 not reaching brain cells
TIA - ANSWER warning signs of stroke
Cerebral Anoxia - ANSWER - oxygen deprivation to the brain
- 10+ mins of it = irreversible changes, RISK FOR ASPIRATION
Ischemic Stroke - ANSWER (80-90%) sudden blood loss to brain
Thrombotic Stroke (plaque rupture) - ANSWER sx progressively worse as
infraction and edema increase over 72 hrs. LOC decreases within first 24 hrs
Embolic Stroke (clot broke traveling) - ANSWER - Sudden severe sx 72 hrs.
Headache.
- Criteria -CT, norm BG, INR, Platelets, BP <185/110
- Tx TPA 3-4 1/2 hrs of onset to dissolve clot
- TPA ex Activase, Retavase
Hemorrhagic Stroke - ANSWER - HTN (220+) Aneurysm, head trauma
- Sudden (mins to hrs), due to ongoing bleeding, seizure common
- TX NO TPA, it increases bleeding
- R/F: Afib, smoking, DM, 65+, HTN, obesity, physically inactive
- Risk for increased ICP within first 72 hrs = increased BP, decreased
HR/RR/LOC, nausea/vomiting,
- NO HEPARIN
Seizures - ANSWER excessive discharge of neurons
, Epilepsy - ANSWER chronic seizures
Tonic - ANSWER stiff, rigid muscle
Clonic - ANSWER spasms followed by relaxation
Tonic-clonic - ANSWER + Aura
Absent - ANSWER Daydreaming (common in peds patients)
Atonic - ANSWER loss of muscle tone, legs give out
Simple/Complex - ANSWER - Simple: conscious, aware of what is happening
- Complex: unconscious, not aware, frozen in place
Status Epilepsy - ANSWER - prolonged seizure. longer than 5-10 min
- Turn on side, maintain airway, document before/during/after, pad rails,
suction/o2 at beside
- Do not restrain
- TAKES MEDS AT SAME TIME DAILY
- no alcohol, caffeine
Alzheimer's - ANSWER - neurons disease, brain shrinks, memory lost
- MAINTAIN DAILY ROUTINE
- Mild-Mod: Donepezil can slow HR
- Mod-Severe: Memantine (Namenda) cause dizziness, headache, confusion
Multiple Sclerosis (MS) - ANSWER - No communication between neurons
- sensory/cognitive/motor problems
- Inflammation/scarring from attack myelin sheath, immune mediated.
- MAINTAIN SAFE ENVIROMENT
Parkinson's disease - ANSWER - Decreased dopamine, increased cholinergic
- Maintain/promote mobility
- Resting tremors, hypertonia, bradykinesia, pill rolling, mask-like face, drooling,
monotone voice
- Dyskinesia- unwanted movement, lower dose to start. Namenda
- Dystonia: painful muscle contraction
-Freezing gait: sudden inability to walk for 1+ min
Falls: related to freezing, abnormal gait, hypotension, fiber, soft easy to chew
food, 2L water/day
Parkinson's disease MEDS - ANSWER -Dopaminergic: ropinirole, relieve
tremors= drowsiness
COMPLETE SOLUTIONS
Total Patient Care Model - ANSWER 12 hour shift
Functional Nursing - ANSWER Task approach delegated by RN to individual
Team Nursing - ANSWER RN is team leader
Primary Nursing - ANSWER 24 hr management and coordination
Nurse Care Manager - ANSWER Does all the above. Bad for hospital financial
rating
CVA (stroke) - ANSWER Blood rich o2 not reaching brain cells
TIA - ANSWER warning signs of stroke
Cerebral Anoxia - ANSWER - oxygen deprivation to the brain
- 10+ mins of it = irreversible changes, RISK FOR ASPIRATION
Ischemic Stroke - ANSWER (80-90%) sudden blood loss to brain
Thrombotic Stroke (plaque rupture) - ANSWER sx progressively worse as
infraction and edema increase over 72 hrs. LOC decreases within first 24 hrs
Embolic Stroke (clot broke traveling) - ANSWER - Sudden severe sx 72 hrs.
Headache.
- Criteria -CT, norm BG, INR, Platelets, BP <185/110
- Tx TPA 3-4 1/2 hrs of onset to dissolve clot
- TPA ex Activase, Retavase
Hemorrhagic Stroke - ANSWER - HTN (220+) Aneurysm, head trauma
- Sudden (mins to hrs), due to ongoing bleeding, seizure common
- TX NO TPA, it increases bleeding
- R/F: Afib, smoking, DM, 65+, HTN, obesity, physically inactive
- Risk for increased ICP within first 72 hrs = increased BP, decreased
HR/RR/LOC, nausea/vomiting,
- NO HEPARIN
Seizures - ANSWER excessive discharge of neurons
, Epilepsy - ANSWER chronic seizures
Tonic - ANSWER stiff, rigid muscle
Clonic - ANSWER spasms followed by relaxation
Tonic-clonic - ANSWER + Aura
Absent - ANSWER Daydreaming (common in peds patients)
Atonic - ANSWER loss of muscle tone, legs give out
Simple/Complex - ANSWER - Simple: conscious, aware of what is happening
- Complex: unconscious, not aware, frozen in place
Status Epilepsy - ANSWER - prolonged seizure. longer than 5-10 min
- Turn on side, maintain airway, document before/during/after, pad rails,
suction/o2 at beside
- Do not restrain
- TAKES MEDS AT SAME TIME DAILY
- no alcohol, caffeine
Alzheimer's - ANSWER - neurons disease, brain shrinks, memory lost
- MAINTAIN DAILY ROUTINE
- Mild-Mod: Donepezil can slow HR
- Mod-Severe: Memantine (Namenda) cause dizziness, headache, confusion
Multiple Sclerosis (MS) - ANSWER - No communication between neurons
- sensory/cognitive/motor problems
- Inflammation/scarring from attack myelin sheath, immune mediated.
- MAINTAIN SAFE ENVIROMENT
Parkinson's disease - ANSWER - Decreased dopamine, increased cholinergic
- Maintain/promote mobility
- Resting tremors, hypertonia, bradykinesia, pill rolling, mask-like face, drooling,
monotone voice
- Dyskinesia- unwanted movement, lower dose to start. Namenda
- Dystonia: painful muscle contraction
-Freezing gait: sudden inability to walk for 1+ min
Falls: related to freezing, abnormal gait, hypotension, fiber, soft easy to chew
food, 2L water/day
Parkinson's disease MEDS - ANSWER -Dopaminergic: ropinirole, relieve
tremors= drowsiness
