NUR 2755 Multidimensional Care IV
Exam 1 Blueprint
Iggy Chapter: Neurological-42, 43, 44, 45. Perioperative- 14, 15, 16
For all conditions you must understand the Pathophysiology, Clinical manifestations
including labs\/diagnostics, Possible problems (nursing Diagnosis), interventions and
client teaching.
Alzheimer\u2019s: microscopic changes of the brain \u2013 neurofibrillary tangles, neurotic plaques, beta
amyloid
\uf0b7 Stages: steady and gradual decline of cognitive, mobility, and ADL function from milk
through severe stages; patients usually die from complications of immobility
o Early (Stage 1): First symptoms up to 4 years
\uf0a7 Independent in ADLs
\uf0a7 Denies presence of symptoms
\uf0a7 Forgets names; misplaces household items
\uf0a7 Has short-term memory loss and difficulty recalling new information
\uf0a7 Shows subtle changes in personality and behavior
\uf0a7 Loses initiative and is less engaged in social relationships
\uf0a7 Has mild impaired cognition and problems with judgment
\uf0a7 Demonstrates decreased performance, especially when stressed
\uf0a7 Unable to travel alone to new destinations
\uf0a7 Often has decreased sense of smell
o Middle (Stage 2): 2-3 years
\uf0a7 Has impairment of all cognitive functions
\uf0a7 Demonstrates problems with handling or unable to handle money and
finances
\uf0a7 Is disoriented to time, place, and event
\uf0a7 Is increasingly dependent in ADLs
\uf0a7 Has visuospatial deficits: has difficulty driving and gets lost
\uf0a7 Has speech and language deficits: less talkative, decreased us of
vocabulary, increasingly nonfluent, and eventually aphasic
\uf0a7 Incontinent
\uf0a7 Psychotic behaviors such as delusions, hallucinations, and paranoia
\uf0a7 Has episodes of wander; trouble sleeping
o Late (Stage 3)<\/p>\n\n\n\n
\uf0a7 Completely incapacitated; bedridden
\uf0a7 Totally dependent in ADLs
\uf0a7 Has loss of mobility and verbal skills
\uf0a7 Possibly has seizures and tremors
\uf0a7 Has agnosia (loss of sensory comprehension including facial recognition)
\uf0b7 Etiology: UNKNOWN
o Increased age over 65 years
o Female more prone
o Down syndrome
o TBI
o African Americans and Hispanics
\uf0b7 Safety Considerations
o Prevent injury, wandering, or falls: ID badge or bracelet
o Aggressiveness, especially verbal and physical abusive tendencies: keep patient
busy with structured activities
o Rapid mood swings
o Increased confusion at night or when light is not adequate or in excessively
fatigued patients
o Remove or secure all potentially dangerous objects
o Seizure precautions
o Environment must be uncluttered, consistent, and structured
o When in hospital, avoid the use of restraints including side rails, frequent
surveillance, toileting every 2 hours
\uf0b7 Caregiver support
o Teach caregivers to be aware of their own health and stress levels
o Respite care: give caregivers a break
o Prevent elder abuse
o When a problem behavior occurs, divert patient to another activity; minimize
excessive stimulation
o Alzheimer\u2019s association
\uf0b7 Orientation vs validation
o Orient to time, place, and person during early stages
\uf0a7 Does not work for moderate or severe AD \u2013 use validation instead to
prevent agitation
o Validation: recognizes and acknowledges the patient\u2019s feelings and concerns
\uf0b7 Routines
o Establish a daily routing and follow it as much as possible
o Explain changes in routine to the patient before they occur, repeating the
explanation immediately before the changes take place
o Establish exercise program to maintain mobility for as long as possible and to
prevent complications of immobility<\/p>\n\n\n\n
o Encourage to be as independent as possible in ADLs
\uf0b7 Medication Therapy
o Cholinesterase inhibitors \u2013 delay destruction of ACh
o NMDA receptor antagonist \u2013 blocks excess glutamate
o Antidepressants (SSRI) \u2013 no tricyclics because of side effects
o Psychotropic drugs \u2013 reserved for hallucinations, last resort and should be lowest
dose possible
Parkinson\u2019s
\uf0b7 Pathophysiology: progressive neurodegenerative disorder. Chronic, terminal disease
caused by degeneration of substantia nigra cells in the basal ganglia of the brain
causing decreased dopamine, which normally functions to promote voluntary muscle
and sympathetic nervous system control
o Symptoms: tremor (in upper extremity), muscle rigidity (cogwheel, plastic, lead
pipe), bradykinesia (slow movement\/no movement), postural instability
\uf0a7 Emotional changes
\uf0a7 Speech changes
\uf0a7 Bowel and bladder changes
\uf0a7 Slow and gradual decline (10-20 years) \u2013 usually die from complications of
immobility
\uf0b7 Etiology: environmental and genetic factors, exposure to chemicals and metals, older
than 40, familial tendency
o Primary disease: cause not known, but could be a combination of genetic and
environmental factors
\uf0a7 Male
\uf0a7 Over 40 years
\uf0a7 Family history
o Secondary disease: caused by antipsychotic drugs or another condition such as
brain tumor or trauma
\uf0b7 Stages
o Initial stage: unilateral limb involvement, minimal weakness, hand and arm
trembling
o Mild stage: bilateral limb involvement, masklike face, slow and shuffling gait
o Moderate disease: postural instability, increased gait disturbance
o Severe disability: akinesia, rigidity
o Stage 5: complete ADL dependence
\uf0b7 Fall Prevention intervention
\uf0b7 Dealing with clinical manifestations
o Decreased mobility related to muscle rigidity, tremors, and postural\/gait changes
\uf0a7 Exercise, PT
\uf0a7 Surgical: stereotactic pallidotomy, deep brain stimulation
o Impaired cognition due to neurotransmitter changes in the brain<\/p>\n\n\n\n
NUR 2755 Multidimensional Care IV
Exam 2 Blueprint
Burns \u2013 thermal, chemical, smoke inhalation, electrical, cold thermal
\uf0b7 Risk factors
o Older adults heal more slowly than young adults
o Preexisting cardiovascular, respiratory, and renal disease cause for poorer
prognosis
o Diabetes mellitus contributes to poor healing and gangrene
o Physical debilitation: alcoholism, drug abuse, malnutrition
o Concurrent fractures, head injuries, or other trauma also lead to poor prognosis
\uf0b7 Electrical burns \u2013 result from coagulation necrosis caused by intense heat generated
from an electrical current
o May result from direct damage to nerves and vessels causing tissue anoxia and
death
o Severity depends on amount of voltage, tissue resistance, current pathways,
surface area, duration of the flow
o Current that passes through vital organs will produce more life-threatening
sequelae than current passing through other tissue
o Electrical sparks may ignite the patient\u2019s clothing, causing a combination of
thermal and electrical injury
o Severity of injury can be difficult to assess as most damage is beneath the skin
(iceberg effect)
o At risk for dysrhythmias, severe metabolic acidosis, myoglobinuria
\uf0b7 Chemical burn \u2013 acids, alkalis, organic compounds
o Pre hospital care
\uf0a7 Brush solid particles off the skin
\uf0a7 Water lavage
\uf0a7 Remove clothing over chemical burn ASAP
\uf0a7 Tissue destruction may continue up to 72 hours after a chemical injury
\uf0a7 Identify chemical for specific treatment
\uf0a7 Monitor for systemic toxicity
o Alkali burns are hard to manage because they cause protein hydrolysis and
liquefaction \u2013 damage continues after alkali is neutralized
o Injuries to skin, respiratory system, liver, kidney, eye (severe corneal scarring)
\uf0b7 Smoke inhalation injuries \u2013 result from inhalation of hot air or noxious chemicals<\/p>\n\n\n\n
o Causes damage to respiratory tract
o Major predictor of mortality in burn victims \u2013 need to be treated quickly
o Carbon monoxide poisoning displaces oxygen
\uf0a7 Hypoxia
\uf0a7 Carboxyhemoglobinemia
\uf0a7 Death
o Inhalation injury above the glottis
\uf0a7 Thermally produced, hot air, steam, or smoke
\uf0a7 Mucosal burns of oropharynx and larynx
\uf0a7 Mechanical obstruction can occur quickly
o Inhalation injury below the glottis
\uf0a7 Injury is related to length of exposure to smoke or toxic fumes
\uf0a7 Pulmonary edema may not appear until 12 to 24 hours after the burn \u2013
acute respiratory distress syndrome
\uf0b7 Assessment \u2013 Expected laboratory values \u2013 stages
\uf0b7 Treatment \u2013 Fluids – skin grafts – Fluid overload S&S
\uf0b7 Phase of Burn Injury management
o Prehospital care
\uf0a7 Remove the person from the source of the burn and stop the burning
process
\uf0a7 Rescuer must be protected from becoming part of the incident
\uf0a7 Electrical injuries \u2013 remove patient from contact with source
\uf0a7 Chemical injuries \u2013 brush soli particles off the skin and water lavage
\uf0a7 Small thermal burns \u2013 cover with clean, cool, tap water dampened towel
\uf0a7 Large thermal burns \u2013 airway, breathing, and circulation
\uf0b7 Do not immerse in cool water or pack with ice
\uf0b7 Wrap in clean, dry sheet or blanket
\uf0b7 Remove burned clothing
o Emergent\/Resuscitative Phase \u2013 required to resolve the immediate problems
resulting from injury, usually lasts 24-48 hours
\uf0a7 Fluid loss and edema formation and continues until fluid mobilization and
diuresis begin
\uf0a7 Fluid and electrolyte shifts
\uf0b7 Greatest threat is hypovolemic shock caused by a massive shift of
fluids out of blood vessels as a result of increased capillary
permeability
\uf0b7 Colloidal osmotic pressure decreases resulting in more fluid shifting
out of the vascular space into the interstitial spaces
\uf0b7 Net result of the fluid shift is intravascular volume depletion \u2013
edema, decreased BP, increased pulse
\uf0b7 Normal insensible loss: 30-50 ml\/hr<\/p>\n\n\n\n
\uf0b7 Severely burned patient 200-400 ml\/hr
\uf0b7 RBCs are hemolyzed by a circulating factor released at the time of
the burn
\uf0b7 Thrombosis
\uf0b7 Elevated hematocrit
\uf0a7 Immunologic changes
\uf0b7 Burn injury causes widespread impairment of the immune system
because the skin barrier is destroyed
\uf0b7 Decreased circulating levels of immunoglobulins
\uf0b7 WBC changes
\uf0a7 Cardiovascular system
\uf0b7 Dysrhythmias and hypovolemic shock, edema, ischemia, necrosis,
paresthesia, gangrene
\uf0b7 Impaired microcirculation and increased viscosity -> sludging
\uf0a7 Respiratory system
\uf0b7 Upper respiratory tract injury causes edema formation and
mechanical airway obstruction and asphyxia
\uf0b7 Inhalation injury
o Direct insult at the alveolar level
o Interstitial edema
o Patient may not exhibit signs during first 24 hours
\uf0b7 Pneumonia
\uf0b7 Pulmonary edema
\uf0a7 Urinary system
\uf0b7 Decreased blood flow to kidneys causes renal ischemia
\uf0b7 Acute tubular necrosis
\uf0a7 Nursing management
\uf0b7 Fluid therapy
o One or two large-bore IV lines
o Type of fluid replacement based on size\/depth of burn, age,
and individual consideration
o Parkland (Baxter) formula
o Colloidal solutions
\uf0b7 Airway management: early endotracheal intubation, escharotomies
of the chest wall, fiberoptic bronchoscopy, humidified air and 100%
oxygen
\uf0b7 Wound care
o Should be delated until a patient airway, adequate
circulation, and adequate fluid replacement have been
established<\/p>\n\n\n\n
NUR 2755 Multidimensional Care IV
Final Exam Blueprint
Neuro 25%
1) Alzheimer\u2019s
a. Stages
b. Safety considerations
c. Caregiver support
i. Assess the needs of the caregiver and provide realistic expectations
ii. Respite care
d. Orientation vs Validation
i. Orientation for mild AD
ii. Validation for moderate or severe AD \u2013 recognizes and
acknowledges the patient\u2019s feelings and concerns
e. Routines: establish a daily routine
2) Parkinson\u2019s: decreased dopamine which normally functions to promote voluntary
muscle and sympathetic nervous system control
a. Clinical manifestations: tremor, muscle rigidity, bradykinesia, postural
instability
b. Fall prevention intervention
3) Meningitis
a. S\/S: nuchal rigidity, fever, flu-like symptoms
b. Tier 2 precautions: droplet
c. Lumbar puncture teaching
i. Keep patient lying flat for several hours
ii. Complications: headache, CSF leakage
d. Complication: increase ICP can lead to herniation of the brain and death \u2013
treat with mannitol
e. Kernig (knee extension is painful) & Brudzinski (neck flexion leads to knee
flexion) signs
4) Seizures<\/p>\n\n\n\n
a. Types
i. Atonic: sudden loss of muscle tone, confusion afterwards, lasts a
few seconds, resistant to medications
ii. Myoclonic: brief jerking of extremities, lasts a few seconds
iii. Tonic: abrupt increase of muscle tone, lost of consciousness,
autonomic changes (apnea, dysrhythmia, incontinence, drooling),
lasts 30 seconds to several minutes
iv. Clonic: muscle contraction and relaxation that lasts several minutes
v. Tonic-clonic: stiffness and loss of consciousness to jerking
extremities that lasts 2-5 minutes<\/p>\n\n\n\n
NUR 2755 Multidimensional Care IVExam 1 BlueprintIggy Chapter: Neurological-42, 43, 44, 45. Perioperative- 14, 15, 16For all conditions you must understand the Pathophysiology, Clinical manifestationsincluding labs\/diagnostics, Possible problems (nursing Diagnosis), interventions andclient teaching.Alzheimer\u2019s: microscopic changes of the brain \u2013 neurofibrillary tangles, neurotic plaques, betaamyloid\uf0b7 Stages: steady and gradual decline of cognitive, mobility, and ADL function […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-117213","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/117213","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=117213"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/117213\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=117213"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=117213"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=117213"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}