nur 2755 nur2755 exam 1 multidimensional care iv mdc 4 exam 1 concept guide 20212022 rasmussen
multidimensional care iv exam 1
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Rasmussen College
NUR2755 Multidimensional Care IV (NUR2755)
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MDCIV EXAM 1 CONCEPT GUIDE
Neuro
Migraine signs/symptoms, medications and action of meds, dietary restrictions
o S/S
o Mild migraine:
Acetaminophen, NSAIDS (ibuprofen and naproxen)
Excedrin migraine has acetaminophen, ASA, and caffeine (causes
vasoconstriction)
o Severe migraine:
Triptan preparations
Sumatriptan (Imitrex)
Ergotamine preparations
Cafergot
Dihydroergotamine (DHE)
Isometheptene and dichloralphenazone combo (Midrin)
o Migraine WITH aura
1st/Prodromal:
Several hours to days before onset
Irritability, depression, food cravings, diarrhea, constipation, frequent
urination
Aura develops over several minutes and lasts no longer than 1 hour
2nd:
Severe, incapacitating, throbbing, intensifies over several hours, N/V,
drowsiness, and vertigo
3rd (4-72 hours):
Dull HA, pain and aura subside, muscle aches, contraction of head and neck
muscles, physical activity worsens and client might sleep
o Migraine w/OUT aura
“Common” migraine
Pain is aggravated by physical activity
Unilateral, pulsating pain with one or more s/s
Photophobia, phonophobia, nausea, vomiting
Lasts 4-72 hours
Often occurs in the morning, during stress, with premenstrual tension, or fluid
retention
o Atypical Migraine
Also called “status migrainous”
Lasts longer than 72 hours
Migrainous infarction:
Neuro symptoms are not reversed within 7 days
Ischemic infarct noted on neuroimaging (stroke after migraine)
Unclassified:
Any headache that does not fulfill all the criteria
o MEDS
o Given if headache occurs more than twice a week, interferes with ADLs
NSAIDS
, MDCIV EXAM 1 CONCEPT GUIDE
Beta-blockers and calcium channel blockers reduce the activity of hyperactive
excitable neurons
Beta-adrenergic: Propranolol and timolol
Calcium channel blocker: Verapamil
Antiepileptic: Topiramate
Onabotulinumtoxin A: Used for chronic migraines, injected into specific areas for
5 treatment cycles
o
Seizure, phases and treatment, interventions
o TYPES
o Tonic
Stiffening and rigidity of muscles especially arms and immediate loss of
consciousness
Lasts 30 seconds or several minutes
Bite tongue or become incontinent, confusion and lethargy
o Clonic
Rhythmic jerking/relaxing of all extremities, follows tonic (Tonic-clonic seizure)
Muscle contraction and relaxation
o Myoclonic
Brief twitches, jerking, or stiffening of extremities, can occur in one area or in
groups, lasts just a few seconds, contractions may be symmetric or asymmetric
o Atonic
Sudden loss of muscle tone lasting a few seconds, followed by postictal
confusion
May cause pt to fall
Most resistant to drug therapy
o Postictal
After the seizure, brain is recovering, may last minutes to hours
o MEDS
o Antiepileptic drugs (AED)
Carbamazepine (Carbatrol, Tegretol, others)
Phenytoin (Dilantin, Phenytek)
Valproic acid (Depakene)
Oxcarbazepine (Oxtellar, Trileptal)
Lamotrigine (Lamictal)
Gabapentin (Gralise, Neurontin)
Topiramate (Topamax)
o Phenobarbital
o Introduced one at a time & doses adjusted until they med(s) control seizures
o Want therapeutic levels without major side effects
o DURING SEIZURE INTERVENTIONS
Position pt. to provide a patent airway.
Protect from injury. Move furniture away, hold head in lap if on the floor
Suction secretions (If your patient has a hx of seizures, you should have the
suction READY
Turn to side (drain oral secretions and avoid aspiration)
, MDCIV EXAM 1 CONCEPT GUIDE
Loosen restrictive clothing.
Do not attempt to restrain the client.
o AFTER SEIZURE INTERVENTIONS
Maintain side-lying position
Suction and oxygen as needed
Check vital signs and assess for injuries.
Perform neurological checks.
Allow patient to rest if necessary.
Reorient and calm the patient, who might be agitated or confused.
DO NOT restrain
The patient my become incontinent
Determine if they experienced an aura, which can indicate the origin of seizure
in the brain.
Contraindication for CT with contrast
o Reaction to contrast agent
o Pregnancy
o Treatment of thyroid disease w/ radioactive iodine
o Use of metformin
o Anti-inflammatory meds
o Diuretics
o Chronic or acutely worsening renal disease
Parkinson’s signs and symptoms, treatment, medications, nursing interventions, clinical
manifestations
o STAGES
1/Initial: Unilateral limb movement, minimal weakness
2/Mild: Mask like face, slow shuffling gait
3/Moderate: Postural instability
4/Severe: Akinesia (loss of motor function
5/ Worse stage
o S/S
Nervous system disfunction
Fatigue
Changes in handwriting
Decreased manual dexterity
Stooped posture
Slow, shuffling fait
Slow, monotonous speck
Tremors/pill-rolling tremor of the fingers
Bradykinesia, akinesia
Orthostatic hypotension, flushing, diaphoresis
Bowel and bladder dysfunction
Muscle rigidity
Cogwheel: rhythmic interruption
Plastic: Mildly restrictive
Lead pipe: total resistance
Mast like: Wide open, fixed, staring eyes
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