Neuro 1
Neuro 2
Neuro 3
Endocrine 1
Endocrine 2

What is the difference between a hemorrhagic and ischemic stroke and what is a common cause of each?

Hemorrhagic: bleeding, most often caused by HTN, also aneurysm or AVM

Ischemic: vascular obstruction, thrombi, emboli (vascular disease)


What are 5 abnormal neurologic findings  that would be expected with neurologic decline:

1: First sign *Decreased LOC

2:Pupillary changes (sluggish, fixed, downward gaze, dilated, pinpoint, nonreactive, unable to follow 6 cardinal gazes)

3:Posturing (decorticate, decerebrate/extension, lack of reaction to noxious stimuli).

4:Changes in respiratory status (irregular, resp depression, c02 retention)

5:Lack of response to cold caloric (oculobestibular reflex)

6) Changes in vital signs (Cushing Triad *late finding), increased/decreased temp, sudden hypotension, sudden increase or decrease in ICP

7) Coma (dysfunction of reticular activating system/sleep-wake system)


Discuss priority care for patients with suspected cerebral or intracerebral hemorrhage:

-Baseline severity score from American Stroke association

-Rapid neuroimaging (CT without contrst vs MRI)

-Coag panel and reversal

-POC blood glucose

-Critical care admission

-Mental status monitoring/EEG

Box 17.4



Discuss two treatments for Thyroid storm:

address dysrhythmias and prevent cardiovascular arrest


antipyretics (Tylenol not aspirin (why?)

Beta Blockers to reduce catecholamines

Antithyroid medication


Discuss three hormones and systemic effects related to the endocrine system:
Corticotropin-stimulates cortisol that alters carb, fat, and protein metabolism making energy immediately available in stress response

Antidiuretic hormone (ADH,vasopressin)- vasoconstriction-increased volume and BP as a protective measure to stress response

Epinephrine-vasoconstrictive, increased HR/BP, slowed GI motility

Glucagon (triggers release of insulin)- released to prevent  hypoglycemia due to times of stress 



List three facts pertaining to nursing care for a patient with a ventriculostomy drain:

1) Limit movment/stimulus

2) Dressing change only when ordered

3) Monitor LOC and changes in drainage (amt/color)

4) Monitor for infection

5) Monitor ICP trends related to output from drain

6) Closed system 

7) External auditory meatus landmark for zeroing (generally 15 cm above)


Name 3 abnormal findings of lumbar puncture CSF sample and  nursing care points:

1) Blood/rust tinged = blood

2) Cloudy or tubid= microorganism or WBC 

3) Positive serology for Syphillis

4) Elevated Glucose = bac meningitis, TB, 

5) Protein elevated = bac meningitis, tumor, ALS, Guillain Barre

Nursing Care: s/s of pain, anxiety, hemorrhage, vital signs, education, awareness of contraindications


What is the priority nursing interventions (including education) would you provide for a patient in a coma?

ABC, secretion, aspiration precautions, support of underlying cause, nutrition, skin care/repositioning, family education related to cause, prognosis, support


Discuss two treatments for patient in Myxedema coma:

Ventilator support r/t CNS depression

fluid/electrolyte imbalance

corticosteroid supplementation

Thyroid hormone replacement therapy

Gradual rewarming to prevent vasodilation

improve circulation with skin care/repositioning


Discuss IV two treatments for SIADH along with two nursing assessments.

hypertonic solutions (3%) and furosimide

500-600 ml over 3-4 hours

*not too fast

Conivaptan (Vaprisol)-inhibits ADH, may also be indicated

Nursing assessment: Intake/output, serum/urine osmolality, daily weights, neuro status, serum electrolytes

Discuss risk factors and assessment findings for patient experiencing subarachnoid hemorrhage.

Risk factors: traumatic, infectious, atherosclerosis, neoplasm, prior hx of, family hx, ETOH abuse, HTN, elicit substance/stimulant use.

Assessment: Sudden onset seer pain, headache, n/v/ photophobia, increased ICP/decreased perfusion, syncope, progression to coma/death.


Purpose of comparing MAP and ICP and clinical indications that affect this comparison: 


-Autoregulation: vessels constrict/dilate to regulate Cerebral perfusion

-Oxygenation or lack of 

-Head trauma-cerebral edema

-Changes in brain matter (masses), CSF, or blood (intracranial hem/stroke/infection) within cranial cavity

-Cushing Triad (bradycardia, syst hypertension, bradypnea

-Intracranial Hypertension

-Chiari Malformation, Atrioventricular Malformation



Describe two causes of intracranial hypertension and two nursing interventions:

Abscess, tumor, TBI, anoxic injury, encephalopathy, edema r/t tumors or trauma, hemorrhage, vasospasm, vasodilation

Nursing interventions: Monitor for changes in ICP and herniation (Cushing triad), monitor brainstem reflexes, positioning, hyperventilation (decreased PCO2 to vasoconstrict), decrease metobolic rate to decrease blood flow, medication to manage hypertension


Describe the Thyroid gland, related hormones, and associated disorders:


2) Free T3 and Free T4

1) Myxedema- severe deficiency of thyroid hormone producing hypothyroidism, increased TSH

2)Thyroid Storm/Thyrotoxicosis: Graves disease-hyperthyroidism, low TSH

Alterations from medications ASA (increase Free T3/T4, Amiodorone)


List differences between the following

1) Thyroid Storm 

2)Myxedema Coma

Thyroid- Extremely low TSH, increased FT4 and FT3 (severe hyperthyroidism), FEver, AFIB/SVT, Acute HF, agitation, restless, N/V, diarrhea,

Myxedema- Increased TSH and decreased FT4 and FT3 (severe hypothyroidism), CNS depression, decreased CO, bradycardia, decreased temp, anemia *opposite of thyroid storm


What is the initial top priority for a person with a traumatic brain injury, stroke, subarachnoid hemorrhage?


What is a top inpatient nursing assessment related to the nervous system? (once airway is managed)

Change in LOC


List 2 surgical procedures related to the neurologic system (brain specifically) and nursing care:

1)Aneurysm clipping or coiling

2) Burr hole/craniotomy/ventriculostomy for drainage, resection or decompression

3) Resection of AVM (arteriovenous malformation) 

Nursing care: ABC, control hypertension and ICP,  environment/stress manangment, monitor for rebleeding and vasospasm, nutrition, skin eye care, positioning, seizure control, temp control, monitor CSF drainage, DVT prophylaxis,fluid management, early rehab, education, med administration, infection monitoring,


Discuss 2 causes of coma:

Structural or surgical-ischemic stroke, intracerebral hemorrhage, trauma, hemorrhage, surgical

Metabolic/medical-medication induced, drug overdose, infectious disease, endocrine disorder, poisonings, anoxia, poisoning

** affect reticular activating system/sleep/wake ability


What is the syndrome that results from deficit in ADH related to pituitary disfunction (or small cell carcinoma) and what would you expect to see regarding urine output?

Diabetes Insipidus

high urine output that are dilute, signs of dehydration


Explain the difference between DKA and HHS and why this difference likely occurs.

DKA cause acidosis because of increased ketone production, HHS is not a state of acidosis.

HHS; Type 2 DM, have some insulin production

HHS generally has significantly higher serum blood glucose levels when compared to DM


Describe ways to decrease intracranial pressure in a intubated patient (give 4 ways).

1. Manage CO2 levels: high is a vasodilator, low is a vasoconstrictor

2. Administer Mannitol: increases serum osmolality and decreases cerebral blood volume and edema

3. Analgesics: often times opioids such as fentanyl and morphine

4. Anesthetics/Induced Coma: Propofol and neuromuscular blockers

5. Blood pressure management: beta-blockers, Ace inhibitors ( if elevated)

6. seizure prophylaxis, craniotomy, HOB elevated and head neutral, minimize environmental stimuli


Discuss three medications related to neurologic function as well as any special indications:

1) tPA (fibrinolytic)- contraindicated with hemorrhagic stroke, bleeding our outside window of 4.5 hours

2) Nimodipine-targets cerebral tissue, treat vasospasm, may cause hypotension

3) Phenytoin (Dilantin)-administer with NS only, no more than 50 mg/min, monitor serum levels

4) Mannitol (osmotic diuretic)- cerebral edema treatment 

5) Phenobarbitol-CNS depression (barbituate)


Explain Autonomic Dysreflexia after a spinal cord injury and immediate interventions.

stimulation below level of injury caused by bladder or intestinal distention, spasticity, ulcer, or other stimulation: causes vasoconstriction and extreme HTN, bradycardia, headache, flushing, vision changes

Treatment: check urinary catheter for kinks, elevate HOB, check for bowel impaction, give sublingual nifedipine.


Describe the adrenal gland, related hormones, and associated disorders:

1) glucocorticoid/cortisol


3) aldosterone

Cushing Syndrone -excess cortisol

Primary Aldosteronism-excess aldosterone

Addison disease/crisis-hyposecretion of cortisol and/or aldosterone

Pheochromocytoma-neuroendocrine tumor-release of epinephrine or norepinephrine


Explain the difference between diabetes mellitus and diabetes insipidus and what is similar.

DI: lack of ADH

DM: glucose/insulin related (r/t hormone insulin)

Similar: both may cause massive diuresis.