MEDSURG | Part 2 Neuro Disorders

🧠 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).