NUR2755 / NUR 2755 Exam 1 Blueprint (Latest 2021 / 2022): Multidimensional Care IV / MDC 4, Study Guides, Projects, Research of Nursing

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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: CHRONIC, Slow Insidious Onset, Irreversible, Progressive, Degenerative disease that eventually causing complete disorientation and total dependence on others for care.

If utilizing 3 stages: Stage 1 or Early Dementia = 3 & 4, Stage 2 or Middle Dementia = 5 & 6, Stage 3 or Late Dementia = 7. There are NO discernable signs in Stage 1 or 2. Risk = Age, Female, Genetics & Family History.

• Stages
• Safety Considerations
• Caregiver support
• Orientation vs validation
• Routines Parkinson’s
• Fall Prevention intervention
• Dealing with clinical manifestations Migraines
• Triggers
• Aura
• Abortive vs. preventative therapy Multiple Sclerosis - Medications - Teaching Meningitis
• Tier 2 precautions: Droplet

• LP (teaching
• Complication: increase ICP Seizures
• Types of seizures
• Aura, postictal
• Seizure precautions
• Status Epilepticus: what is it? Interventions.
• Medication teaching, DMV
• Increased ICP: Remember Change in LOC. Lumbar puncture: For increased ICP or possible Infection. Keep HOB elevated 30 degrees if just ICP question. With Lumbar puncture position = LLR, contraindications, post-care - Clinical manifestations (early vs. late) - Interventions/meds - Brain herniation - Cushing’s triad Stroke
• TIAs
• Predisposing factor(s): Modifiable vs. nonmodifiable
• Stroke prevention
• Types: ischemic vs. hemorrhagic-know clinical manifestations and possible interventions
• Symptoms: know left vs right and manifestations
• Fibrinolytic therapy

• Complications: o Increased ICP
• Thrombolytic therapy
• Risk for aspiration: Evaluation, interventions Traumatic Brain Injury
• Complications o Increased ICP o CSF Leakage: interventions, testing o Bleeding: epidural, subdural ▪ Treatment Brain Death - Diagnosis - Organ donation Brain Tumors
• Primary vs. secondary
• Treatment Spinal Cord Injury
• Risk Factors
• Interventions
• Level of the injury
• Complications o Autonomic dysreflexia: prevention and treatment

Myasthenia Gravis

- Diagnosis: Tensilon test - Complications

o Cranial nerves

o Myasthenic vs. cholinergic crisis

- Medications

Guillain-Barre

• Progression
• Causes

o Virus

• Complications/interventions

Bell’s Palsy

- r/o stroke - Clinical manifestations - Meds

Trigeminal Neuralgia

Preoperative

• Consents

o Implied

o Informed

o Minors

• Pre-op checklist

o Labs

o NPO status

• Teaching
• Pre-op meds
• Safety

Intraoperative

• Types of Surgeries
• Types of anesthesia and considerations
• Staff members and responsibilities
• Malignant Hyperthermia: Interventions, Dantrolene
• Safety: Infection prevention, fire safety, instruments

Postoperative

• Recovery
• Prevention of complications (VTE, Pneumonia, atelectasis, hypovolemic shock)
• Drains (management)
• Complications/interventions:

o Dehiscence

o Evisceration

• Pain management

o PCA

o Complications

Understand: Delegation, prioritization and therapeutic communication

Medications: (Therapeutic Effect, Side effects, Nursing Considerations)

Drug Class: Diuretics Mannitol Furosemide Spironolactone

Drug Class: Triptan sumatriptan eletriptan naratriptan

Drug class: Ergotamine cafergot (Ergotamine) Dihydroergotamine (DHE)- Migranal Midrin almotriptan

Antiseizures meds : Phenytoin Fosphenytoin Carbamazepine Valproic acid Gabapentin Pregabalin Levetiracetam Topiramate

Cholinesterase Inhibitor: Pyridostigmine

Immunosuppressive drugs or corticosteroids

Baclofen

Drugs for Parkinson’s: Sinement Levodopa MAOI Inhibitors Benztropine

Drugs for Alzheimer’s: Cholinesterase inhibitors Memantine SSRIs Antipsychotics

Diagnostics: know nursing considerations

• Plain CT
• CT with contrast
• MRI
• Glasgow Coma Scale: Scores, areas evaluated
• Lumbar puncture: position, contraindications, post-care

Laboratory Values

Electrolytes Value Comments

Na+ 136 - 145 mEq/L

K+ 3.5- 5 mEq/L

Ca++ 9.0-10.5 mg/dL

Mg 1.3-2.1 mg/dL

CBC

Hgb Men 14-18 g/100 ml, Women 12 - 16 g/100 mL

Hct Men^42 - 52%, Women 37 - 47%

WBC 5,000-10,000/mm

Cardiac

Platelets 150,000-400,

PT PT = 11 - 12.5 sec (Rx 2 - 3 times)

aPTT 30 - 40 sec (Rx 1.5- 2 times)

INR 0.7-1.1 (Rx 2 - 3 times)

Renal

BUN 10 - 20 mg/dL

Creatinine 0.6 - 1.2 mg/dL

Urine Specific Gravity 1.005-1.

Dosage Calculation:

1. Order: infuse 1 L of NS over 8 hours. mL/hr
2. Order: Heparin 2,000 units SQ 6 hours. Available: Heparin injection 5,000 units /mL. mL/dose
3. Order Heparin 12units/kg/hr. Available Heparin 25,000units/250 mL. The client is 189 pounds. mL/hr

Answers:

1. 125

Vocab:

Agnosia - inability to recognize common or everyday objects (like a fork or hairbrush).

Apraxia - is an effect of neurological disease. It makes people unable to carry out everyday movements and gestures.

Aphasia – is a disorder that results from damage to areas of the brain that produce and process language. It can affect your ability to speak, write and understand language. Provide pictures or a communication board

Bradykinesia - slowness of movements and reflexes (such as that caused by Parkinson's disease or antipsychotic drugs). Give extra time to these patients.

Proprioception - is the sense of body position.

Prosopagnosia - inability to recognize the faces of familiar people.