Nursing study guide
Neurologic + brain disorders
Detect change early, protect airway and safety, and compare every finding with baseline.
First priorities
ABCs, glucose when indicated, level of consciousness, pupils, speech, movement, sensation, vital signs, onset, and last known well.
Trend
A subtle new change in behavior, attention, strength, gait, or speech may be more important than an isolated normal value.
Time matters
Sudden deficit, prolonged seizure, declining consciousness, or signs of increased intracranial pressure require immediate escalation.
Focused assessment
Observe before you stimulate
Use the same method and document the patient’s best response.
| Domain | Assess | Important change |
|---|---|---|
| Consciousness | Arousal, attention, orientation, commands, behavior | Increasing sleepiness, agitation, confusion, or inability to follow commands |
| Pupils + cranial function | Size/reactivity, gaze, face, speech, swallow as appropriate | New asymmetry, fixed response, gaze change, dysarthria, or dysphagia |
| Motor + sensory | Drift, strength, symmetry, coordination, sensation, gait when safe | New unilateral weakness, numbness, ataxia, or loss of function |
| Context | Onset, baseline, medicines, trauma, infection, glucose, oxygenation, substances | Abrupt or unexplained deviation from baseline |
Stroke emergency
Think BE FAST and last known well
Do not wait for symptoms to improve.
Seizures
Protect, time, observe, and recover
One seizure does not by itself establish epilepsy.
During
Protect from injury, lower to a safe surface when possible, clear hazards, loosen restrictive clothing, and time the event.
Do not
Do not restrain movement and do not place anything in the mouth.
Airway
Position on the side when feasible, support oxygenation and suction as indicated, and follow emergency medication protocol.
After
Assess airway, breathing, circulation, glucose when indicated, injury, neurologic recovery, triggers, and the patient’s usual postictal pattern.
Emergency
A prolonged or recurrent seizure without recovery, breathing problem, injury, pregnancy, or first known seizure requires the emergency pathway.
Pressure + trauma
Prevent secondary brain injury
Declining neurologic status is not a routine pain or sleep finding.
Increased ICP clues
Worsening headache, vomiting, decreasing consciousness, pupil or motor change, seizures, and late abnormal vital-sign patterns.
Nursing priorities
Maintain oxygenation and perfusion, align head/neck, reduce unnecessary stimulation, avoid venous obstruction, and follow ordered positioning and monitoring.
After head injury
Trend neurologic findings, anticoagulant use, vomiting, behavior, amnesia, fluid balance, and signs of deterioration.
CNS infection
Meningitis and encephalitis can deteriorate quickly
Use ordered isolation precautions while the cause is evaluated.
Possible clues
Fever, severe headache, neck stiffness, photophobia, altered mental status, seizure, rash, or focal findings.
Priorities
ABCs, sepsis assessment, neurologic trend, cultures and antimicrobials without avoidable delay, seizure precautions, and fluid monitoring.
Escalate
Shock, purpuric rash, declining consciousness, new focal deficit, or signs of increased ICP require immediate response.
Chronic disorders
Function changes across the day and disease course
Individual patterns and medication timing matter.
| Disorder | Common pattern | Nursing focus |
|---|---|---|
| Parkinson disease | Bradykinesia, rigidity, tremor, postural and nonmotor symptoms | Fall/swallow safety, timed medicines, mobility, constipation, orthostasis, and communication. |
| Multiple sclerosis | CNS demyelination with variable sensory, motor, visual, bowel/bladder, fatigue, or cognitive effects | Energy pacing, temperature sensitivity, mobility, skin, elimination, and relapse recognition. |
| Myasthenia gravis | Fatigable skeletal-muscle weakness | Respiratory/swallow assessment, medication timing, aspiration prevention, and crisis recognition. |
| Peripheral neuropathy | Pain, numbness, weakness, or autonomic change | Foot/skin protection, falls, glucose or cause management, and medication safety. |
Cognition
Dementia is not delirium
A new acute change needs a medical evaluation even when dementia is present.
| Pattern | Course | Nursing approach |
|---|---|---|
| Alzheimer disease/dementia | Usually progressive decline that interferes with daily function | Preserve routine and abilities, simplify communication, assess safety, pain, nutrition, wandering, caregiver needs, and advance planning. |
| Delirium | Acute, fluctuating inattention and cognition from an underlying cause | Find and treat causes such as infection, medicines, hypoxia, retention, constipation, withdrawal, or metabolic change. |
Care + delegation
Safety plans must preserve dignity
The RN establishes the baseline, precautions, and findings that require escalation.
Environment
Use fall and seizure precautions as indicated, communication aids, orientation cues, sleep support, and aspiration precautions after assessment.
Delegate
Stable routine hygiene, intake/output, ambulation, and observation may be assigned with explicit safety instructions and report parameters.
RN retains
Neurologic and swallow assessment, interpretation of change, unstable care, teaching, and evaluation.
Sources
Reference notes
Follow the current stroke, seizure, trauma, and infection pathways.