Overview
This lecture was a review session covering key neurology topics for the NCLEX, using question drills to emphasize critical nursing actions, patient safety, and medication considerations.
Traumatic Brain Injury Nursing Actions
- Avoid placing patients with traumatic brain injury in Trendelenburg position; keep head midline and bed at 30 –45° to maintain cerebral perfusion.
- Log roll technique is appropriate to maintain spinal alignment when turning patient.
- Monitor pupils and gag/cough reflexes as part of neurologic assessment.
Thrombolytic Therapy for Ischemic Stroke
- Alteplase (tPA) is contraindicated with blood pressure over 185/110 due to risk of intracerebral hemorrhage.
- Symptom onset within 4.5 hours is safe for tPA administration.
- Recent major surgery within 14 days, active bleeding, or coagulopathy are also contraindications.
Stroke Complications (Right-sided Stroke)
- Risks include aspiration, joint contractures, impulsive behavior, and impaired concept of time.
- Left-sided muscle weakness is common due to contralateral effects.
- Numbness of feet is not typical; more related to peripheral neuropathy.
Seizure Precautions
- Do not place tongue blades at bedside or in patient’s mouth during seizures.
- Ensure IV access, remove restrictive clothing/jewelry, and have oxygen/suction equipment available.
Prioritizing Actions for Suspected Stroke
- Priority is rapid transport for a head CT scan to differentiate ischemic versus hemorrhagic stroke.
- Assess for hypoglycemia, but do not administer dextrose without checking blood sugar.
- 12-lead ECG and potassium level are not immediate priorities.
Alzheimer’s Disease Care
- Physical restraints are not appropriate for agitation/confusion; use least restrictive measures first.
- Short-term memory loss precedes long-term memory loss.
- Support caregivers and consider genetic risk factors.
Parkinson’s Disease Nursing Interventions
- Encourage slow position changes to prevent orthostatic hypotension.
- Remove throw rugs to prevent falls due to shuffling gait.
- Teach visualization for freezing episodes (e.g., imagining stepping over an object).
- Do not discourage snacks or take carbidopa/levodopa with high-protein meals.
Phenytoin (Dilantin) Adverse Effects
- Central nervous system depression is a notable adverse effect, especially at toxic levels.
- May cause sedation, ataxia, nystagmus, diplopia, and cognitive impairment.
- Not associated with hypertension, kidney injury, or DVT.
Key Terms & Definitions
- Trendelenburg position — Patient’s body laid flat on back with feet higher than head.
- Alteplase (tPA) — Thrombolytic medication for ischemic stroke.
- Glasgow Coma Scale — Assessment tool for neurological status.
- Orthostatic hypotension — Sudden blood pressure drop upon standing.
- Freezing episodes (Parkinson’s) — Sudden, temporary inability to move.
Action Items / Next Steps
- Review medication contraindications and adverse effects for neuro drugs.
- Practice prioritizing nursing interventions for neuro emergencies.
- Attend next session (tomorrow, 3 p.m. Central); check UWorld Nursing’s website for events and study resources.