Neuro Basics
A nurse is assessing a client with suspected hypoxia. Which organ is MOST sensitive to oxygen deprivation?
Brain
Neurons cannot store oxygen → begin dying in ~5 minutes → “time is brain.”
Name the two major classifications of stroke.
Ischemic (clot-based, ~87%) and Hemorrhagic (vessel rupture, ~13%)
Ischemic strokes are further divided into thrombotic (clot forms locally in atherosclerotic vessel) and embolic (clot travels from elsewhere — #1 source: atrial fibrillation → cardioembolic stroke). This distinction is critical because tPA is used for ischemic strokes but is absolutely contraindicated in hemorrhagic strokes — giving it would worsen bleeding and be fatal.
Name the three priority nursing actions during an active tonic-clonic seizure.
(1) Protect from injury (pad side rails, clear environment); (2) Position on side (lateral) to prevent aspiration; (3) Time the seizure — note characteristics and sequence of events. Do NOT put anything in the mouth.
Common misconception: nurses should NEVER insert anything into the mouth during a seizure — jaw clenching can fracture teeth and the patient cannot 'swallow their tongue.' Lateral positioning prevents aspiration of secretions. Timing is critical — >5 minutes = status epilepticus → medications required. Post-ictal: maintain airway, assess for injuries, allow rest, reorient gently.
A patient presents with shuffling gait, masked facial expression, and resting tremor. Identify the disorder.
Parkinson’s disease
↓ dopamine → TRAP symptoms (Tremor, Rigidity, Akinesia (absence of movemnt) or Ataxia (poor muscle control), Positural instability.)
An injury at or above C4 is life-threatening because it affects this essential function.
Breathing (respiratory function)
Define status epilepticus
Status epilepticus = seizure >5 minutes OR recurrent seizures without return to baseline (first-line: IV lorazepam)
Status epilepticus is a neurological emergency with mortality up to 20% if untreated. ABCs first. IV access immediately. Benzodiazepines enhance GABA → stop seizure in ~80% of cases if given early. Response rate drops dramatically after 30 minutes. Second-line agents control ~60% of benzo-refractory cases. Refractory status (>30 min) requires propofol/pentobarbital coma with intubation and continuous EEG monitoring.
State the priority nursing position for a patient with elevated ICP, including the exact degree of elevation.
HOB at 30°, head and neck in neutral midline alignment — avoid hip flexion, head rotation, and Trendelenburg.
30° HOB promotes venous drainage via the jugular veins → lowers ICP. Any head/neck rotation or flexion compresses the jugular veins and RAISES ICP. Hip flexion raises intra-abdominal/intrathoracic pressure → impairs venous drainage. These positioning requirements apply continuously, including during nursing care procedures — nurses must maintain alignment even when turning patients.
A patient with a spinal cord injury above T6 is at risk for this life-threatening hypertensive emergency.
Autonomic dysreflexia = life-threatening uncontrolled sympathetic response to a noxious stimulus below the injury; occurs in SCI at T6 and above.
The brain cannot inhibit the sympathetic nervous system (descending control is severed). Any stimulus below T6 triggers massive, uncontrolled SNS activation → severe hypertension, bradycardia (baroreceptor reflex), flushing/diaphoresis above injury, pallor below. BP can exceed 200/100 mmHg. Without treatment → stroke, MI, or death.
This neurodegenerative disease affects both upper and lower motor neurons, leading to progressive paralysis while cognition remains intact.
ALS
UMN + LMN involvement → hallmark.
This device is used immediately after spinal injury to prevent movement and further damage.
Cervical collar (C-collar)
Maintains spinal alignment.
An excess of excitatory neurotransmitters like glutamate can lead to this neurological condition characterized by uncontrolled electrical activity.
Seizures
Overstimulation → neuronal firing → seizures.
A patient suddenly develops right-sided weakness and difficulty speaking. Which side of the brain is most likely affected?
Left hemisphere
Left brain controls right side + language.
Name the most common trigger of autonomic dysreflexia.
Bladder distention (kinked catheter, urinary retention, full drainage bag) — accounts for ~75–85% of AD episodes; FIRST: check catheter for kinks, obstructions, or retention.
Always check the catheter FIRST. Straighten tubing, irrigate if blocked, or insert a new catheter. If bladder cause is ruled out → check bowel (impaction), skin (pressure injury), tight clothing, or any noxious stimulus below the injury level. Systematic and rapid identification of the trigger is the key to resolving the episode.
This autoimmune disorder causes muscle weakness that worsens with activity and improves with rest.
Myasthenia gravis
Autoimmune attack on ACh receptors.
A patient with a spinal cord injury presents with hypotension, bradycardia, and warm, dry skin. Identify the type of shock.
Neurogenic shock
Loss of sympathetic tone → vasodilation + bradycardia.
Name the brain region responsible for voluntary speech production and describe what happens when it is damaged.
Broca's area (left frontal lobe); damage causes expressive aphasia — patient understands language but cannot produce fluent speech.
Broca's aphasia is non-fluent and effortful. Contrast with Wernicke's aphasia (left temporal lobe): fluent but meaningless speech, poor comprehension. NCLEX: assess speech quality AND comprehension separately. Aphasia affects language, NOT intelligence — always treat patients with dignity.
Name one early sign and one late sign of increased intracranial pressure (ICP).
Early: headache, nausea/vomiting, or change in LOC; Late: Cushing's Triad — hypertension + bradycardia + irregular respirations.
Early ICP signs reflect mild compression of meningeal vessels and beginning cortical dysfunction. Cushing's Triad is a pre-herniation emergency — the brainstem is being compressed. Progression from early to late can be rapid. Nurses must escalate early signs before Cushing's Triad appears — waiting for late signs may be too late.
Name the hallmark cardiovascular finding of neurogenic shock.
Bradycardia + hypotension + warm/flushed skin; in hypovolemic shock, tachycardia and cool/clammy skin would be expected.
Neurogenic shock: disruption of SNS outflow (high SCI ≥T6) → vasodilation + loss of compensatory tachycardia; unopposed vagal tone → bradycardia. Warm, flushed skin results from vasodilation. Treatment: IV fluids first, then vasopressors (norepinephrine preferred). If tachycardia is present in a suspected neurogenic shock patient → assume hemorrhage until proven otherwise.
This genetic disorder causes chorea (dance-like movements), cognitive decline, and psychiatric symptoms and is inherited in an autosomal dominant pattern.
Huntington’s disease
Chorea + genetic transmission (prognosis is poor -> Live 15-20 years after symptoms arise; psych counseling)
A spinal cord injury patient is at risk for pressure injuries. What is the most important nursing intervention to prevent this complication?
Reposition every 2 hours
Loss of sensation → cannot feel pressure → skin breakdown risk.
Explain what the Glasgow Coma Scale measures. State the maximum score and what a score of 8 or less indicates.
GCS measures LOC via Eye opening (1–4), Verbal (1–5), Motor (1–6); maximum = 15; GCS ≤8 = severe injury — consider intubation.
Mnemonic: Eyes (4), Verbal (5), Motor (6) = '4-5-6 keeps the airway alive.' GCS 13–15 = mild; 9–12 = moderate; ≤8 = severe. A 2-point decline is clinically significant — notify provider immediately. Motor component is most prognostically important.
Describe decorticate vs. decerebrate posturing
Decorticate (M3): arms flex, legs extend → cortical damage above brainstem; Decerebrate (M2): arms AND legs extend → brainstem involvement at midbrain level → MORE ominous.
Both are abnormal motor responses to stimuli indicating severe brain injury. Decerebrate posturing reflects damage at or below the midbrain/red nucleus — brainstem is being compressed. Progression from decorticate to decerebrate in a monitored patient is a critical deterioration sign. Both require IMMEDIATE provider notification. Document which posturing is present and whether it is spontaneous or stimulus-induced.
Name the classic triad of bacterial meningitis.
Fever, Nuchal rigidity (stiff neck), Photophobia
These findings reflect meningeal irritation. Fever = systemic infection. Nuchal rigidity = patient resists/cannot flex the neck (positive Brudzinski's, Kernig's signs). Photophobia = meningeal/optic nerve irritation. A petechial/purpuric rash with fever and meningismus = meningococcal meningitis until proven otherwise — a true emergency requiring immediate antibiotics and isolation.
This autoimmune disorder causes demyelination in the central nervous system and often presents in young adults.
Multiple sclerosis (MS)
Myelin destruction → impaired nerve conduction.
A patient with a suspected spinal cord injury arrives in the ER after a motor vehicle accident. What is the nurse’s PRIORITY action?
Maintain airway with cervical spine stabilization
ABCs first + prevent further spinal damage.