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MEDSURG | Part 2 Neuro Disorders
Season 2
Published 5 months ago
Description
🧠 HIGH-YIELD NEURO NURSING STUDY GUIDE ⚡ This guide hits the 20% of neuro content that gives you 80% of your clinical edge—rapid, focused, and straight to what matters in exams and practice.
🩸 Trauma & ICP
- Mild TBI: GCS ≥13, minor capillary bleed.
- Mod/Severe TBI: GCS 9–12/≤8. Watch for Cushing’s Triad 🚨 (↑BP, ↓HR, irregular resp). ➤ Manage w/ mannitol or hypertonic saline, maintain airway, avoid hypoxia.
- Epidural Hematoma: ⚠️ Lucid interval, then coma. Ipsilateral dilated pupil → immediate surgery.
- Basilar Skull Fx: Raccoon eyes, Battle sign, CSF leak. Prevent infection w/ IV ABX.
🧬 Cerebrovascular Emergencies
- Ischemic Stroke: Sudden neuro deficit. “Time = Brain.” ➤ rtPA within 4.5 h 🕐, thrombectomy up to 24 h if eligible. ➤ Maintain BP ≤185/110 mmHg if thrombolytics planned.
- Hemorrhagic Stroke: Often hypertensive. High early mortality. Manage ICP, avoid anticoags.
- Dysphagia Precaution: Keep NPO until swallow eval—aspiration kills faster than stroke.
🦠 CNS Infections
- Bacterial Meningitis: Fever + nuchal rigidity + petechial rash 🚨 ➤ Draw cultures → start IV ABX + dexamethasone STAT.
- Viral Encephalitis (HSV): Hallucinations, confusion → IV Acyclovir immediately.
⚡ Seizures
- Tonic-Clonic: Protect airway, pad rails, do NOT restrain or put anything in mouth. ➤ Document onset, duration, postictal phase.
- Status Epilepticus: ≥5 min seizure → IV/IM Lorazepam or Midazolam STAT. Watch for aspiration, cardiac arrest, cerebral edema.
- Todd Paresis: Temporary weakness post-seizure (not stroke!).
💊 Anticonvulsants
- Phenytoin: Check levels, CBC, LFTs. Gingival hyperplasia → oral care.
- Carbamazepine: No grapefruit juice. Risk: dizziness, rash, bleeding.
- Valproic Acid: ⚠️ Liver toxicity, bleeding, pregnancy danger.
🧍♂️ Chronic Neuro Disorders
- Parkinson’s: ↓Dopamine. Tremor, rigidity, bradykinesia. ➤ Carbidopa/Levodopa = gold standard. Teach “on/off” periods. ➤ Avoid excess Vit B6 & tyramine (if on MAO-B inhibitors).
- Myasthenia Gravis: Weakness worse w/ exertion. ➤ Give anticholinesterase meds on time, monitor resp status.
- Multiple Sclerosis: Demyelinating autoimmune flare-ups. ➤ Avoid heat, infection, fatigue. Corticosteroids for exacerbations.
💣 Red-Flag Drugs & Contraindications
- Triptans: 🚫 in CAD, HTN, PVD.
- Antiseizure meds: Never stop abruptly → rebound SE.
- Anticholinesterase OD: Cholinergic crisis (drooling, bradycardia, weakness).