lOMoAR cPSD| 47061011
MDC 4 – Examination 1 Blueprint
Iggy Chapter old book: Neurological-42, 43, 44, 45. Perioperative- 14, 15, 16
New Edition = Iggy Chapters 39, 40, 41, 38, 18 & 9
For all conditions you must understand the Pathophysiology, Clinical manifestations
including labs/diagnostics, Possible problems (nursing Diagnosis), interventions and client
teaching.
Alzheimer’s: AD is a type of dementia that causes progressive brain atrophy and shrinkage that contributes to loss of
function, disorientation, and death from immobility or choking.
● Stages:
Mild Moderate Severe
● Independence with ADLS ● ● Completely incapacitated
● Forgets names and may Has impairment of all cognitive and bedridden.
misplace household objects. ● functions. ● Total ADL dependence.
● Denies presence of Demonstrates difficulty ● Loss of mobility and verbal
symptoms ● handling money or finances. skills
● Short-term memory loss and Disoriented to time, place and ● Seizures and tremors are
difficulty recalling new ● event. common.
information. ● May be depressed or agitated. ● Has agnosia: inability to
● Small changes in personality ● Dependent on ADLS identify people and
and behavior. Visuospatial deficits and objects.
● Loses initiative and less difficult driving and often gets
involved social relationships. ● lost.
● Decreased performance Speech and language difficulty
when stressed. ● and may be less talkative.
● Cannot travel alone Aphasic and may not use
● vocabulary correctly.
● Decreased sense of smell.
Psychotic manifestations may
● be present.
Episodes of wandering and
trouble sleeping may occur.
● Safety Considerations
○ Environment: remove dangerous objects or throw rugs, lights in the environment, no stairs,
elevators or exits, must be structured and changes introduced gradually, place items in the
same places each time.
○ Give walks to reduce wandering and maintain a sleeping schedule.
○ Cognition and memory: Offer varied environmental stimulation, use short directions when
explaining activities or communicating, have consistency, memory techniques and stimulating
the memory.
○ Communication: may need nonverbal aids, short and clear sentences, may need to reinforce
what you say, do not argue with clients.
, lOMoAR cPSD| 47061011
○ Promote self-care and independence with ADLS.
○ Nutrition: provide optimal intake of folate, VB12, C and E, may need finger foods.
● Caregiver support
○ Will need education and instruction about coping with their loved ones' manifestations. Must
be warned that their loved one may one day not be able to remember who they are.
○ May need to assist the patient with coping and ADLs.
○ Refer to social work for home health care or respite therapy.
● Orientation vs validation
○ Orientation Therapy uses a calendar or clock to assist with client orientation. These clients often
lose the ability to recognize day and time.
○ Validation Therapy assists with acknowledging the client's feelings and validating client
concerns. This helps to not argue with the patient and use reinforcement for ideals.
● Routines
○ Will help with clients remembering where certain objects are located, when it is time to eat,
and for toileting.
● Meds: memantine, Cholinesterase inhibitor (donepezil), SSRIs (sertraline, paroxetine), antipsychotics.
Parkinson’s: a progressive neurodegenerative disorder that affects dopamine producing neurons in the brain. Leads to
not enough dopamine.
● Fall Prevention intervention
○ Assist patients with movement.
○ Clear environment of dangerous items.
○ Give patients time to complete movements and rest periods.
○ Give patient movement devices for ambulation.
○ PT/OT
● Dealing with clinical manifestations
○ 4 Characteristics: tremors, muscle rigidity, bradykinesia, akinesia, postural instability.
○ Other manifestations: fatigue, changes in handwriting, decreased manual dexterity, stooped
posture, slow monotone speech, pill-rolling movements of fingers, orthostatic hypotension,
flushing ,sweating, incontinence, mask like expression, difficulty chewing and drooling.
Migraines: a condition where a client has recurrent episodic attacks of head pain that serve no protective purpose.
Can be with or without an aura.
● Triggers: o Foods: red wine, caffeine, alcohol, MSG, chocolate, yeast, cheese, lunch meat, hot dogs, smoked
meats, ice cream, yogurt, marinated foods.
o Cigarettes o
Contraceptives o
Hypertension
● Aura: an alteration in vision, smell, hearing or emotions prior to a headache or seizure starting. It can develop
over minutes to hours and will subside when the headache resolves.
● Abortive vs. preventative therapy: o Abortive: purpose is to alleviate pain during aura or soon after the
headache begins.
, lOMoAR cPSD| 47061011
▪ Use: acetaminophen. NSAIDS, caffeine, antiemetics, triptans,
ergotamine (severe, take up to 6
tabs in 24 hours- acts by contrictting the cerebral blood vessels).
o Preventative: purpose is to be
given if HA occurs more than 2x a week, interferes with ADLS or not relieved.
▪ Use: NSAIDS,beta blocker and calcium channel blockers, topamax, nortriptlyine.
▪ REMEMBER: Never suddenly stop beta blockers; ergotamine constricts blood vessels, calcium
channel blockers used prevention only
Multiple Sclerosis: a chronic autoimmune disease affecting the myelin sheath and conduction pathway of the CNS and
can cause neurologic disability.
● Medications
o Interferon beta 1a and 1b: immune modulators: can cause flu like manifestations. Treats relapses. o
Gkatriamer: simulates myelin basic protein and blocks damaging T cells. o Pyrimidine synthesis
inhibitors. o Steroids: decrease inflammation. o Muscle relaxants such as dantrolene and baclofen to
treat spasms. o Carbamazepine: for numbness and tingling. o Stool softener o Anticholinergics o BB
and benzo for ataxia. o Medications to combat fatigue: amantadine, pemoline. Will decrease fatigue.
● Teaching o Discuss coping and sources for support
o Bladder care: increase fluids, prevent UTIs, assist with elimination with self cath,
pacemaker or crede maneuver, need voiding time schedule with gradual increase.
o Cognitive: reorient as needed and place objects in the same areas.
o May need a communication board if dysarthria (slurred speech) present. o Vision: eye
patches, scanning techniques. o Stretching muscles. o Plan rest periods
o Safe environment o PT/OT/ST o Avoid overexertion, stress, extreme temp, infected
people.
Meningitis: Inflammation of the meninges surrounding the brain and spinal cord.
● Tier 2 precautions: Droplet
● Important S/S: nuchal rigidity, positive kernigs and brudzinskis sign
● LP (teaching) give abx prior, CT scan prior o Keep patient lying flat for several hours and monitor the site to
decrease risk of post LP HA or CSF leakage.
o Can tell client activities are able to be resumed after this period of rest.
● Complication: increase ICP
● Intervention: sit HOB up 30 degrees
Seizures: abrupt, abnormal, excessive, and uncontrolled electrical discharge of neurons within the brain that can
cause alterations in the level of consciousness and/or changes in motor and sensory ability and/or behavior.
● Types of seizures
Generalized Partial Complex Partial Simple Partial
MDC 4 – Examination 1 Blueprint
Iggy Chapter old book: Neurological-42, 43, 44, 45. Perioperative- 14, 15, 16
New Edition = Iggy Chapters 39, 40, 41, 38, 18 & 9
For all conditions you must understand the Pathophysiology, Clinical manifestations
including labs/diagnostics, Possible problems (nursing Diagnosis), interventions and client
teaching.
Alzheimer’s: AD is a type of dementia that causes progressive brain atrophy and shrinkage that contributes to loss of
function, disorientation, and death from immobility or choking.
● Stages:
Mild Moderate Severe
● Independence with ADLS ● ● Completely incapacitated
● Forgets names and may Has impairment of all cognitive and bedridden.
misplace household objects. ● functions. ● Total ADL dependence.
● Denies presence of Demonstrates difficulty ● Loss of mobility and verbal
symptoms ● handling money or finances. skills
● Short-term memory loss and Disoriented to time, place and ● Seizures and tremors are
difficulty recalling new ● event. common.
information. ● May be depressed or agitated. ● Has agnosia: inability to
● Small changes in personality ● Dependent on ADLS identify people and
and behavior. Visuospatial deficits and objects.
● Loses initiative and less difficult driving and often gets
involved social relationships. ● lost.
● Decreased performance Speech and language difficulty
when stressed. ● and may be less talkative.
● Cannot travel alone Aphasic and may not use
● vocabulary correctly.
● Decreased sense of smell.
Psychotic manifestations may
● be present.
Episodes of wandering and
trouble sleeping may occur.
● Safety Considerations
○ Environment: remove dangerous objects or throw rugs, lights in the environment, no stairs,
elevators or exits, must be structured and changes introduced gradually, place items in the
same places each time.
○ Give walks to reduce wandering and maintain a sleeping schedule.
○ Cognition and memory: Offer varied environmental stimulation, use short directions when
explaining activities or communicating, have consistency, memory techniques and stimulating
the memory.
○ Communication: may need nonverbal aids, short and clear sentences, may need to reinforce
what you say, do not argue with clients.
, lOMoAR cPSD| 47061011
○ Promote self-care and independence with ADLS.
○ Nutrition: provide optimal intake of folate, VB12, C and E, may need finger foods.
● Caregiver support
○ Will need education and instruction about coping with their loved ones' manifestations. Must
be warned that their loved one may one day not be able to remember who they are.
○ May need to assist the patient with coping and ADLs.
○ Refer to social work for home health care or respite therapy.
● Orientation vs validation
○ Orientation Therapy uses a calendar or clock to assist with client orientation. These clients often
lose the ability to recognize day and time.
○ Validation Therapy assists with acknowledging the client's feelings and validating client
concerns. This helps to not argue with the patient and use reinforcement for ideals.
● Routines
○ Will help with clients remembering where certain objects are located, when it is time to eat,
and for toileting.
● Meds: memantine, Cholinesterase inhibitor (donepezil), SSRIs (sertraline, paroxetine), antipsychotics.
Parkinson’s: a progressive neurodegenerative disorder that affects dopamine producing neurons in the brain. Leads to
not enough dopamine.
● Fall Prevention intervention
○ Assist patients with movement.
○ Clear environment of dangerous items.
○ Give patients time to complete movements and rest periods.
○ Give patient movement devices for ambulation.
○ PT/OT
● Dealing with clinical manifestations
○ 4 Characteristics: tremors, muscle rigidity, bradykinesia, akinesia, postural instability.
○ Other manifestations: fatigue, changes in handwriting, decreased manual dexterity, stooped
posture, slow monotone speech, pill-rolling movements of fingers, orthostatic hypotension,
flushing ,sweating, incontinence, mask like expression, difficulty chewing and drooling.
Migraines: a condition where a client has recurrent episodic attacks of head pain that serve no protective purpose.
Can be with or without an aura.
● Triggers: o Foods: red wine, caffeine, alcohol, MSG, chocolate, yeast, cheese, lunch meat, hot dogs, smoked
meats, ice cream, yogurt, marinated foods.
o Cigarettes o
Contraceptives o
Hypertension
● Aura: an alteration in vision, smell, hearing or emotions prior to a headache or seizure starting. It can develop
over minutes to hours and will subside when the headache resolves.
● Abortive vs. preventative therapy: o Abortive: purpose is to alleviate pain during aura or soon after the
headache begins.
, lOMoAR cPSD| 47061011
▪ Use: acetaminophen. NSAIDS, caffeine, antiemetics, triptans,
ergotamine (severe, take up to 6
tabs in 24 hours- acts by contrictting the cerebral blood vessels).
o Preventative: purpose is to be
given if HA occurs more than 2x a week, interferes with ADLS or not relieved.
▪ Use: NSAIDS,beta blocker and calcium channel blockers, topamax, nortriptlyine.
▪ REMEMBER: Never suddenly stop beta blockers; ergotamine constricts blood vessels, calcium
channel blockers used prevention only
Multiple Sclerosis: a chronic autoimmune disease affecting the myelin sheath and conduction pathway of the CNS and
can cause neurologic disability.
● Medications
o Interferon beta 1a and 1b: immune modulators: can cause flu like manifestations. Treats relapses. o
Gkatriamer: simulates myelin basic protein and blocks damaging T cells. o Pyrimidine synthesis
inhibitors. o Steroids: decrease inflammation. o Muscle relaxants such as dantrolene and baclofen to
treat spasms. o Carbamazepine: for numbness and tingling. o Stool softener o Anticholinergics o BB
and benzo for ataxia. o Medications to combat fatigue: amantadine, pemoline. Will decrease fatigue.
● Teaching o Discuss coping and sources for support
o Bladder care: increase fluids, prevent UTIs, assist with elimination with self cath,
pacemaker or crede maneuver, need voiding time schedule with gradual increase.
o Cognitive: reorient as needed and place objects in the same areas.
o May need a communication board if dysarthria (slurred speech) present. o Vision: eye
patches, scanning techniques. o Stretching muscles. o Plan rest periods
o Safe environment o PT/OT/ST o Avoid overexertion, stress, extreme temp, infected
people.
Meningitis: Inflammation of the meninges surrounding the brain and spinal cord.
● Tier 2 precautions: Droplet
● Important S/S: nuchal rigidity, positive kernigs and brudzinskis sign
● LP (teaching) give abx prior, CT scan prior o Keep patient lying flat for several hours and monitor the site to
decrease risk of post LP HA or CSF leakage.
o Can tell client activities are able to be resumed after this period of rest.
● Complication: increase ICP
● Intervention: sit HOB up 30 degrees
Seizures: abrupt, abnormal, excessive, and uncontrolled electrical discharge of neurons within the brain that can
cause alterations in the level of consciousness and/or changes in motor and sensory ability and/or behavior.
● Types of seizures
Generalized Partial Complex Partial Simple Partial
