MDC 4 Final Exam Concept Guide
FINAL
• A: airway/ cervical spine
• Jug trans maneuver: suspected cervical neck injury
• Head tilt: no spinal injury/ no hurt neck
• Cervical spine precautions: log roll pt with 4 or more ppl, avoid jaw thrust and head tilt
for opening airway, maintain strict bed wrest (do NOT elevate pts head on pillows)
• B: breathing
• Look at effort (fast or slow) *low/high RR*
• Pneumothorax
• Asymmetrical movement: one side is moving more than other
• Diminished breath sounds on affected side
• Absent breath sounds in affected area
• Decreased sp02
• Distended neck veins
• Tx: chest tube
• Tension pneumothorax:
• EMERGENCY: entire lung has collapsed
• Tracheal deviation (if tension puff toward the good side)
• No breath sounds
• Tx: needle thoracostomy first and THEN the chest tube
• First goal: reinflate the lung
• Flail chest: Paradoxical chest movement
• Seesaw chest movement
• Tx: mechanical vent (intubate) first, PEEP next
• C: circulation
• Assess BP, HR, Pulses, quality of pulse, capillary refill, signs of perfusion, urinary
output, LOC
• Intervention:
• Pacemaker externally
• IV Fluids
• ABCDE
• checking neuro status
• GLASCOW coma scale
• Best motor response, best verbal response, eye-opening response
▪ NOT PAIN RESPONSE
• 3-15, anything less than 8 is a coma
• Don’t expose them to the cold due to Hypothermia
• Hypothermia Tx: warm with friction
• MED ERROR:
• Assess Patient & Don’t Leave Patient, Watch for S/S
• I.E Too Much BP Medication, Watch BP
• Report It and Call Dr.
• RACE (fire)
• R: rescue
• A: alert/ call 911
• C: contain/ close doors and windows behind you
• E: exit/ extinguish
1. Alzheimer: Slow progressive irreversible brain disease
• Clients with Alzheimer’s Disease can present with:
, MDC 4 Final Exam Concept Guide
Clients do not die of Alzheimer’s. They die WITH Alzheimer’s.
EARLY stage: minor memory loss, long term memory and reasoning is typically
intact, forget where common items are kept
MODERATE stage: wandering, anger, incontinence, visuospatial deficits
1. Risk for safety concerns
LATE/ SEVERE stage: dependent in all ADLs
• Alzheimer’s is not curable. Meds are used to manage the symptoms.
• May slow down the progression but cannot reverse.
• Patient comes in with Alzheimer’s. What can we do to decrease agitation and
confusion?
Routine! If we need to change their environment, we want to bring familiar
objects to the hospital to try to mimic their normal environment as much as
possible. Keep a routine day to day to give the patient some structure.
Validation. Never fight with the patient. What they are saying is their reality.
Exercise during the day can help them sleep better and if they sleep better,
they have less confusion.
2. Meningitis
• Bacterial meningitis is highly fatal
If bacterial, start on abx as soon as possible.
• Pt. can develop ICP (also a complication of strokes)
Reduce the risk of ICP: Elevate head of bead as high as tolerated to reduce the
pressure going to the head
• S/S: Nuchal rigidity, headache, photosensitivity
Droplet precautions as soon as patient presents with these symptoms.
3. GBS acute inflammatory disease, seen after exposure to viral infections (2-4 wks)
• Often associated with recent infection
• Tx: IV immune globulin is used to increase production of acetylcholine antibodies
• S/S: A patient with weakness and tingling in feet and legs and spreads to the upper body,
ascending paralysis
• Monitor: Respiratory system: May need to be intubated to support their airway as
paralysis ascends upward.
4. Parkinson’s affects nervous system
• Huntington's Vs. Parkinson’s: Often Mistaken for Each Other, HD Has Choreiform or
Jerky Movements
• Chronic disease
Concerns: falls, aspiration if trouble swallowing
Not curable
Meds to treat and possible slow progression
• S/S
Tremors, Shuffling, Can Be One Sided - Progress to Both Sides Do Tasks Slowly
(More Concentration)
Small Handwriting Freezing
Masked like faces (mild stage)
Difficult Chewing/Swallowing Orthostatic Hypotension Soft Speech
Urinary Incontinence
Bradykinesia (slow movement)
Muscle righty (Levodopa will improve this)
Shuffling gait/ postural instability (mild stage)
• Labs
, MDC 4 Final Exam Concept Guide
CSF May have Low Dopamine
MRI or SPECT To Rule Out Other Brain Conditions
1. MRI shows post stroke cerebellum damage: s/s is balance impairment
• Drugs
Sinement- Carbadopa/Levadopa (Stimulate Dopamine Receptors) COMT
Inhibitor-Entacapone (Prolong Action of Levodopa)
MAOIS-Rasagiline Mesylate (Increase Dopamine Concentration)
Dopamine Receptor Agonists- Bromocriptine Mesylate (Promote Dopamine
Release)
Antiviral-Amantadine
• Surgical Treatment
Stereotactic Pallidotomy- Destroy a Portion of the Globus Pallidus, and Thereby,
Decrease Patients' Muscle Rigidity from Parkinson's Disease
DBS-Uses Electrical Stimulation to Modulate These Control Centers Deep to the
Surface of the Brain, Improving Communication Between Brain Cells. This
Helps to Reduce Symptoms Such as Tremor, Slowness, and Stiffness.
5. Myasthenic Gravis
• Patho
Autoimmune Disease Muscle Weakness
• Types
Ocular- Eyes
Generalized- Throughout Body
• Causes
Distorted Acetylcholine Receptors Hyperplasia of Thymus Gland
• Physical Assessment
Post Infection, Pregnancy Anesthesia Period of Exacerbation
Temp Weakness After Vaccine, Menstruation,
Change in Temp
Worsening of Symptoms with Repetitive Movement
Drooping Eyelids
Dysphagia
Voice Weakens with Use
Lack of Meds, give a Med and See if It Helps
• Labs
Thyroid Function SPEP
AChR Antibodies Chest Xray/Ct RNS
EMG
Tensilon Test
MuSK Antibodies
• Drugs
Cholinesterase Inhibitors-Pyridostigmine Immunosuppressant-Methotrexate,
Rituximab, Steroids IVIG for Acute Treatment
1. TOO MUCH cholinesterase inhibitor meds: CHOLINERGIC CRISIS
6. MS: Immune system eats the protective covering of nerves making it difficult for nerves and
muscles to communicate
• Autoimmune response causes demyelination and axonal nerve damage in the brain
• Progressive relapsing ms (prms): Includes frequent relapsed with only partial recovery
• Multiple sclerosis risk factors
, MDC 4 Final Exam Concept Guide
Female, 20-40 years old
May show up with different signs and symptoms depending on which area is
affected c. Could be autoimmune. Can put them on immunosuppressants or
corticosteroids which puts them at risk for infection.
Treat symptoms, if they have depression, give antidepressants, if they have
incontinence, give them straight cath, or indwelling catheter. If function
incontinence, educate about elastic waist bands.
Give them support because this is a chronic disease and they need to know how
to manage their disease at home. Educate about periods of exacerbation. Know
what can cause these exacerbation (infection, weather—being overheated)
• Aggravators
Fatigue, stress, overexertion, temps
• S/S
Muscle Weakness and Spasticity
Fatigue
Intention Tremor
Dysmetria (Inability to Direct Movement)
Numbness
Ataxia-Decreased Coordination
Dysarthria
Dysphagia
Diplopia
Nystagmus (involves involuntary eye movements; horizontally or vertically)
Tinnitus/Hearing loss
Cognitive Changes
Depression
• Lab
CSF-Elevated Protein, Myelin Basic Protein IgG Bands
MRI-Brain or Spinal Cord Plaques
• Drugs
Preventative:
1. Avonex, Betaseron, Copaxon, Acute-Steroids and Baclofen
A Client with MS is taking Baclofen (antispasmodic), What Is This Rx for?
Muscle Spasms and mobility
7. Seizures: one finding can be nonprogressive compensatory stage of hypovolemic shock
• Patho
Seizure - Sudden Uncontrolled Electrical Discharge of Neurons
Epilepsy = 2 or More Seizures; a disruption of the brain that interrupts normal
activity
Potential causes for seizures:
1. Severe head injury or stroke
2. Severe infections and high fever
3. Complication caused by diabetes
• Generalized Seizures Types: involve both cerebral hemispheres
Tonic-Clonic
Tonic
Clonic
Myoclonic
FINAL
• A: airway/ cervical spine
• Jug trans maneuver: suspected cervical neck injury
• Head tilt: no spinal injury/ no hurt neck
• Cervical spine precautions: log roll pt with 4 or more ppl, avoid jaw thrust and head tilt
for opening airway, maintain strict bed wrest (do NOT elevate pts head on pillows)
• B: breathing
• Look at effort (fast or slow) *low/high RR*
• Pneumothorax
• Asymmetrical movement: one side is moving more than other
• Diminished breath sounds on affected side
• Absent breath sounds in affected area
• Decreased sp02
• Distended neck veins
• Tx: chest tube
• Tension pneumothorax:
• EMERGENCY: entire lung has collapsed
• Tracheal deviation (if tension puff toward the good side)
• No breath sounds
• Tx: needle thoracostomy first and THEN the chest tube
• First goal: reinflate the lung
• Flail chest: Paradoxical chest movement
• Seesaw chest movement
• Tx: mechanical vent (intubate) first, PEEP next
• C: circulation
• Assess BP, HR, Pulses, quality of pulse, capillary refill, signs of perfusion, urinary
output, LOC
• Intervention:
• Pacemaker externally
• IV Fluids
• ABCDE
• checking neuro status
• GLASCOW coma scale
• Best motor response, best verbal response, eye-opening response
▪ NOT PAIN RESPONSE
• 3-15, anything less than 8 is a coma
• Don’t expose them to the cold due to Hypothermia
• Hypothermia Tx: warm with friction
• MED ERROR:
• Assess Patient & Don’t Leave Patient, Watch for S/S
• I.E Too Much BP Medication, Watch BP
• Report It and Call Dr.
• RACE (fire)
• R: rescue
• A: alert/ call 911
• C: contain/ close doors and windows behind you
• E: exit/ extinguish
1. Alzheimer: Slow progressive irreversible brain disease
• Clients with Alzheimer’s Disease can present with:
, MDC 4 Final Exam Concept Guide
Clients do not die of Alzheimer’s. They die WITH Alzheimer’s.
EARLY stage: minor memory loss, long term memory and reasoning is typically
intact, forget where common items are kept
MODERATE stage: wandering, anger, incontinence, visuospatial deficits
1. Risk for safety concerns
LATE/ SEVERE stage: dependent in all ADLs
• Alzheimer’s is not curable. Meds are used to manage the symptoms.
• May slow down the progression but cannot reverse.
• Patient comes in with Alzheimer’s. What can we do to decrease agitation and
confusion?
Routine! If we need to change their environment, we want to bring familiar
objects to the hospital to try to mimic their normal environment as much as
possible. Keep a routine day to day to give the patient some structure.
Validation. Never fight with the patient. What they are saying is their reality.
Exercise during the day can help them sleep better and if they sleep better,
they have less confusion.
2. Meningitis
• Bacterial meningitis is highly fatal
If bacterial, start on abx as soon as possible.
• Pt. can develop ICP (also a complication of strokes)
Reduce the risk of ICP: Elevate head of bead as high as tolerated to reduce the
pressure going to the head
• S/S: Nuchal rigidity, headache, photosensitivity
Droplet precautions as soon as patient presents with these symptoms.
3. GBS acute inflammatory disease, seen after exposure to viral infections (2-4 wks)
• Often associated with recent infection
• Tx: IV immune globulin is used to increase production of acetylcholine antibodies
• S/S: A patient with weakness and tingling in feet and legs and spreads to the upper body,
ascending paralysis
• Monitor: Respiratory system: May need to be intubated to support their airway as
paralysis ascends upward.
4. Parkinson’s affects nervous system
• Huntington's Vs. Parkinson’s: Often Mistaken for Each Other, HD Has Choreiform or
Jerky Movements
• Chronic disease
Concerns: falls, aspiration if trouble swallowing
Not curable
Meds to treat and possible slow progression
• S/S
Tremors, Shuffling, Can Be One Sided - Progress to Both Sides Do Tasks Slowly
(More Concentration)
Small Handwriting Freezing
Masked like faces (mild stage)
Difficult Chewing/Swallowing Orthostatic Hypotension Soft Speech
Urinary Incontinence
Bradykinesia (slow movement)
Muscle righty (Levodopa will improve this)
Shuffling gait/ postural instability (mild stage)
• Labs
, MDC 4 Final Exam Concept Guide
CSF May have Low Dopamine
MRI or SPECT To Rule Out Other Brain Conditions
1. MRI shows post stroke cerebellum damage: s/s is balance impairment
• Drugs
Sinement- Carbadopa/Levadopa (Stimulate Dopamine Receptors) COMT
Inhibitor-Entacapone (Prolong Action of Levodopa)
MAOIS-Rasagiline Mesylate (Increase Dopamine Concentration)
Dopamine Receptor Agonists- Bromocriptine Mesylate (Promote Dopamine
Release)
Antiviral-Amantadine
• Surgical Treatment
Stereotactic Pallidotomy- Destroy a Portion of the Globus Pallidus, and Thereby,
Decrease Patients' Muscle Rigidity from Parkinson's Disease
DBS-Uses Electrical Stimulation to Modulate These Control Centers Deep to the
Surface of the Brain, Improving Communication Between Brain Cells. This
Helps to Reduce Symptoms Such as Tremor, Slowness, and Stiffness.
5. Myasthenic Gravis
• Patho
Autoimmune Disease Muscle Weakness
• Types
Ocular- Eyes
Generalized- Throughout Body
• Causes
Distorted Acetylcholine Receptors Hyperplasia of Thymus Gland
• Physical Assessment
Post Infection, Pregnancy Anesthesia Period of Exacerbation
Temp Weakness After Vaccine, Menstruation,
Change in Temp
Worsening of Symptoms with Repetitive Movement
Drooping Eyelids
Dysphagia
Voice Weakens with Use
Lack of Meds, give a Med and See if It Helps
• Labs
Thyroid Function SPEP
AChR Antibodies Chest Xray/Ct RNS
EMG
Tensilon Test
MuSK Antibodies
• Drugs
Cholinesterase Inhibitors-Pyridostigmine Immunosuppressant-Methotrexate,
Rituximab, Steroids IVIG for Acute Treatment
1. TOO MUCH cholinesterase inhibitor meds: CHOLINERGIC CRISIS
6. MS: Immune system eats the protective covering of nerves making it difficult for nerves and
muscles to communicate
• Autoimmune response causes demyelination and axonal nerve damage in the brain
• Progressive relapsing ms (prms): Includes frequent relapsed with only partial recovery
• Multiple sclerosis risk factors
, MDC 4 Final Exam Concept Guide
Female, 20-40 years old
May show up with different signs and symptoms depending on which area is
affected c. Could be autoimmune. Can put them on immunosuppressants or
corticosteroids which puts them at risk for infection.
Treat symptoms, if they have depression, give antidepressants, if they have
incontinence, give them straight cath, or indwelling catheter. If function
incontinence, educate about elastic waist bands.
Give them support because this is a chronic disease and they need to know how
to manage their disease at home. Educate about periods of exacerbation. Know
what can cause these exacerbation (infection, weather—being overheated)
• Aggravators
Fatigue, stress, overexertion, temps
• S/S
Muscle Weakness and Spasticity
Fatigue
Intention Tremor
Dysmetria (Inability to Direct Movement)
Numbness
Ataxia-Decreased Coordination
Dysarthria
Dysphagia
Diplopia
Nystagmus (involves involuntary eye movements; horizontally or vertically)
Tinnitus/Hearing loss
Cognitive Changes
Depression
• Lab
CSF-Elevated Protein, Myelin Basic Protein IgG Bands
MRI-Brain or Spinal Cord Plaques
• Drugs
Preventative:
1. Avonex, Betaseron, Copaxon, Acute-Steroids and Baclofen
A Client with MS is taking Baclofen (antispasmodic), What Is This Rx for?
Muscle Spasms and mobility
7. Seizures: one finding can be nonprogressive compensatory stage of hypovolemic shock
• Patho
Seizure - Sudden Uncontrolled Electrical Discharge of Neurons
Epilepsy = 2 or More Seizures; a disruption of the brain that interrupts normal
activity
Potential causes for seizures:
1. Severe head injury or stroke
2. Severe infections and high fever
3. Complication caused by diabetes
• Generalized Seizures Types: involve both cerebral hemispheres
Tonic-Clonic
Tonic
Clonic
Myoclonic
