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Neurological

Neurological System Review

Educational Use Only. This app is not intended to replace instructor guidance, institutional policies, clinical judgment, or professional medical training.

Overview

The neurological system controls brain, spinal cord, and peripheral nerves. NCLEX covers stroke, seizures, increased ICP, spinal cord injury, and degenerative disorders. Neuro assessments and recognizing deterioration are critical.

Key Concepts

  • 1

    Stroke: ischemic (thrombotic/embolic, 87%) vs hemorrhagic (13%); 'time is brain' — tPA within 3-4.5 hours of symptom onset

  • 2

    Increased ICP: Cushing's triad (bradycardia, irregular respirations, widened pulse pressure) — late sign

  • 3

    Glasgow Coma Scale: eye opening (1-4), verbal (1-5), motor (1-6); total 3-15; <8 = coma

  • 4

    Seizure types: generalized (tonic-clonic, absence, atonic) vs focal; status epilepticus = >5 min or no recovery between

  • 5

    Spinal cord injury: complete vs incomplete; spinal shock (loss of reflexes below injury, temporary); neurogenic shock (loss of sympathetic tone)

  • 6

    Meningitis: bacterial (needs isolation, antibiotics) vs viral; signs: fever, headache, nuchal rigidity, photophobia, positive Kernig/Brudzinski

  • 7

    Myasthenia gravis: muscle weakness worsens with activity, improves with rest; myasthenic crisis vs cholinergic crisis

Nursing Interventions

  • Perform neuro checks: pupils, GCS, motor/sensory, vital signs every 1-2 hours for acute patients

  • For increased ICP: elevate HOB 30 degrees, maintain neutral head position, avoid hip flexion

  • Maintain PaCO2 35-40 (hyperventilation lowers ICP but only short-term); avoid hypoxia

  • For stroke: monitor for hemorrhage after tPA, control BP, assess swallowing before PO intake

  • Seizure precautions: padded side rails, suction available, oxygen; do not restrain or put anything in mouth

  • For spinal cord injury: immobilize C-spine, log-roll for turning, monitor respiratory function

  • Administer osmotic diuretics (mannitol) for ICP; monitor for fluid/electrolyte imbalance

Critical Red Flags

  • Sudden severe headache 'worst of my life' — subarachnoid hemorrhage

  • Unequal pupils or dilated fixed pupil — herniation syndrome

  • Cushing's triad (bradycardia, irregular respirations, widened pulse pressure) — impending herniation

  • Sudden unilateral weakness, facial droop, slurred speech — stroke (BE FAST)

  • Seizure lasting >5 minutes or repeated without recovery — status epilepticus

  • Loss of consciousness with decerebrate or decorticate posturing — severe brain injury

Key Lab Values

GCS: 15 normal, 13-14 mild impairment, 9-12 moderate, ≤8 severe (intubate)

ICP: 5-15 mmHg normal (>20 requires treatment)

CPP (cerebral perfusion pressure): 60-70 mmHg target (CPP = MAP - ICP)

CSF: clear, WBC 0-5, protein 15-50, glucose 40-80 (low glucose and high WBC in bacterial meningitis)

Serum sodium: 135-145 (hyponatremia can cause seizures)

Patient Teaching

  • Take antiseizure medications exactly as prescribed; do not stop abruptly (risk of seizures)

  • Avoid triggers for seizures: sleep deprivation, alcohol, stress, flashing lights (if photosensitive)

  • Wear medical alert identification; inform family about seizure first aid

  • For stroke prevention: control BP, diabetes, cholesterol; stop smoking; take antiplatelets as ordered

  • Report worsening headache, vomiting, or altered mental status — signs of increased ICP

  • Participate in rehab: physical, occupational, and speech therapy as indicated

Educational Use Only — Not a substitute for professional training.