ICP & TBI
What is the earliest and often most sensitive sign of neurologic deterioration?
A change in level of consciousness.
What is the difference between an ischemic and hemorrhagic stroke?
Ischemic: blocked blood flow. Hemorrhagic: bleeding into or around the brain.
What neurotransmitter-related treatment is commonly used to improve motor symptoms of Parkinson disease?
Carbidopa/levodopa increases dopamine availability in the brain.
What are two common findings of hypothyroidism?
Fatigue, cold intolerance, weight gain, constipation, or bradycardia.
Which hormone replacement is used for hypothyroidism: Synthroid or methimazole?
Synthroid (levothyroxine).
What three vital-sign changes make up Cushing's triad?
Hypertension with widened pulse pressure, bradycardia, and irregular respirations.
During a generalized tonic-clonic seizure, what is the nurse's priority action?
Protect the patient from injury, maintain a safe airway position when possible, and time the seizure. Do not restrain or place anything in the mouth.
Name two classic motor manifestations of Parkinson disease.
Examples include resting tremor, rigidity, bradykinesia, and postural instability.
What autoimmune disease commonly causes hyperthyroidism and may produce exophthalmos?
Graves disease.
What hormone deficiency causes central diabetes insipidus, and what medication may replace its effect?
Antidiuretic hormone (ADH) deficiency; desmopressin (DDAVP).
A patient with increased ICP has the head of the bed elevated. How should the head and neck be positioned?
In neutral alignment, avoiding neck flexion or rotation to promote venous drainage.
Which medication is commonly used as an emergency benzodiazepine for prolonged seizures: diazepam or donepezil?
Diazepam.
A patient with a spinal cord injury develops a pounding headache, flushing, and severe hypertension. What complication should the nurse suspect?
Autonomic dysreflexia.
Which medication reduces thyroid hormone synthesis: methimazole or levothyroxine?
Methimazole
Name two common manifestations of Cushing syndrome.
Examples include central weight gain, moon face, truncal fat accumulation, thin skin, easy bruising, and hyperglycemia.
What is the purpose of mannitol in treating increased ICP?
It is an osmotic diuretic that draws fluid out of brain tissue and reduces cerebral edema.
A patient taking phenytoin needs which important ongoing assessment related to a common adverse effect?
Oral and gum assessment for gingival hyperplasia, along with oral hygiene teaching.
What should the nurse do first when autonomic dysreflexia is suspected?
Sit the patient upright, loosen restrictive clothing, and promptly assess for triggers such as bladder distention while monitoring blood pressure.
A patient with hyperthyroidism develops high fever, marked tachycardia, and agitation. What emergency is suspected?
Thyroid storm.
A patient with Addison disease is vomiting, profoundly weak, and hypotensive. What crisis should the nurse suspect?
Adrenal crisis, requiring emergency treatment with IV fluids and prescribed corticosteroids.
A head-injury patient suddenly develops one dilated pupil and declining consciousness. What is the priority?
Suspect neurologic deterioration or herniation; activate emergency assistance and support ABCs immediately.
What is status epilepticus, and why is it an emergency?
A prolonged seizure, commonly defined as lasting 5 minutes or more, or repeated seizures without recovery; it can compromise breathing and cause neurologic injury.
How does spinal shock differ from autonomic dysreflexia?
Spinal shock is temporary loss of reflexes and function below the injury; autonomic dysreflexia is a potentially life-threatening hypertensive response, usually in injuries at or above T6.
What clinical signs may indicate hypocalcemia after thyroid surgery?
Perioral or fingertip tingling, muscle cramps, tetany, or a positive Chvostek or Trousseau sign.
Bonus: what are Chvostek and Trousseau sign?
Why must long-term prednisone generally not be stopped abruptly?
It can suppress the hypothalamic-pituitary-adrenal axis; abrupt withdrawal can precipitate adrenal insufficiency or crisis.