NR 325 Exam 2

Student Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

Exam #2 – Comprehensive Study Guide

Head Injury

Anticipating Seizures in Brain Injuries

Whenever a brain procedure or injury occurs, seizure risk must be anticipated. Patients should be placed on prophylactic anticonvulsant therapy during the acute recovery phase to prevent seizures and secondary neuronal damage.

What are the signs and symptoms (S&S) of head injury?

• Leakage of CSF: Clear, watery fluid from the nose (rhinorrhea) or ears (otorrhea), which may test positive for glucose.
• Discolorations: Raccoon eyes (periorbital bruising) and Battle’s sign (mastoid bruising), often associated with basilar skull fractures.

Increased Intracranial Pressure (ICP)

What are the signs and symptoms?

• Severe headache, vomiting (often without nausea), papilledema, unequal pupils, altered mental status, bradycardia, hypertension, and abnormal respiratory patterns.

How do we manage it?

• Elevate the head of bed to 30 degrees.
• Maintain head and neck in a neutral position.
• Administer osmotic diuretics (mannitol) and corticosteroids if indicated.
• Avoid hypercapnia and hyperthermia.
• Limit suctioning and stimulation.

How do we monitor them?

• Frequent neurological assessments using the Glasgow Coma Scale (GCS).
• Invasive monitoring via ventriculostomy or subarachnoid bolt if ordered.
• Observation for Cushing’s triad (bradycardia, irregular respirations, widened pulse pressure).

How do we place the patient?

• Head of bed at 30% elevation, with alignment to optimize venous return.

Glasgow Coma Scale (GCS)

A neurological assessment tool scoring eye opening (1–4), verbal response (1–5), and motor response (1–6).

• 15: Fully alert and oriented
• 3: Deep coma or death

What are the abnormal postures?

• Decorticate posturing: Flexion of arms toward the body with legs extended — suggests damage above the brainstem.
• Decerebrate posturing: Extension and pronation of all extremities — indicates brainstem injury, poorer prognosis.

Stroke

Know the Different Types

• Ischemic Stroke: Caused by obstruction of cerebral blood flow via thrombus or embolus.
• Hemorrhagic Stroke: Caused by ruptured blood vessel leading to intracerebral bleeding.

Management

Patent Airway – Primary priority; maintain oxygenation.
Swallow Study/Test – Performed before oral intake to prevent aspiration.
CT Scan Immediately – Differentiates between ischemic and hemorrhagic stroke; determines appropriate treatment.

What are the signs and symptoms (S&S) of stroke?

• Sudden unilateral weakness, speech difficulties, vision loss, dizziness, coordination problems, and severe headache.

How do we manage those symptoms?

• Support airway and breathing.
• Manage blood pressure per guidelines.
• Control fever and blood glucose.
• Initiate early rehabilitation.

Thrombolytic Therapy

• For ischemic stroke: Administer IV alteplase within 4.5 hours of symptom onset.
• Avoid in hemorrhagic strokes or in patients with high bleeding risk.

Treatments for Each Type of Stroke

Stroke Type	Primary Intervention	Additional Measures
Ischemic	Thrombolytics, antiplatelet agents	BP control, glucose management
Hemorrhagic	Surgery, BP reduction	ICP management, seizure prevention

Active Stroke – How do we manage them?

• Airway first.
• Maintain oxygen >94%.
• Elevate head 30 degrees.
• Prevent hypotension or extreme hypertension.

NR 325 Exam 2

Left-Sided vs. Right-Sided Stroke

Affected Hemisphere	Common Deficits
Left	Aphasia, right-sided weakness, slow behavior
Right	Neglect of left side, impulsive behavior, poor spatial judgment

Transient Ischemic Attack (TIA)

Mini stroke — temporary blockage of cerebral blood flow with symptoms resolving within 24 hours.

How do we manage them?

• Control risk factors (HTN, diabetes, hyperlipidemia).
• Start antiplatelet therapy.
• Lifestyle modification and possible carotid endarterectomy if significant stenosis.

Seizures

Different Types

• Generalized: Tonic-clonic, absence, myoclonic, atonic.
• Focal: Simple partial, complex partial.

The Precautions

• Seizure pads on bed rails.
• Suction equipment ready.
• Oxygen available.
• Remove harmful objects from surroundings.

Status Epilepticus

A neurological emergency — continuous seizure activity lasting >5 minutes or recurrent seizures without return to baseline. Requires immediate IV benzodiazepines.

Seizure Medications

Know the types: Phenytoin, valproic acid, carbamazepine, levetiracetam.
Implications: Monitor drug levels, liver function, and watch for gingival hyperplasia (phenytoin).

Meningitis

S&S

• Fever, stiff neck, photophobia, headache, altered mental status, possible rash.

How do we manage the S&S and the patient with it?

• Initiate antibiotics immediately after cultures.
• Droplet precautions until pathogen identified.
• Manage fever and pain.

How do we test for it?

• Lumbar puncture: CSF analysis shows elevated protein, low glucose, high WBC count.

Parkinson’s Disease

S&S

• Resting tremor, bradykinesia, rigidity, postural instability.

Alzheimer’s Disease

How do we know?

• Progressive memory loss, impaired judgment, language deficits.
• Diagnosis of exclusion.

S&S

• Disorientation, mood changes, loss of ADL independence.

How do we manage a patient with it?

• Maintain routine, ensure safety, provide cognitive stimulation.

Increased Intracranial Pressure (ICP)

Symptoms

• Headache, vomiting, papilledema, decreased LOC.

Normal Value

• 5–15 mmHg.

Implications of Increased ICP

• Decreased cerebral perfusion pressure, herniation risk.

Things to Avoid During Increased ICP

• Valsalva maneuver, excessive stimulation, hyperthermia.

Treatment

• Osmotic diuretics, controlled ventilation, surgical decompression.

Cranial Nerves

Know names and functions — sensory, motor, or both.

Parts of the Brain

• Cerebellum: Balance and coordination, tested via Romberg test.

Myasthenia Gravis

Paralysis & Priority Care

• Risk for respiratory compromise; monitor vital capacity.

Tensilon Test

• Improvement after edrophonium administration confirms diagnosis.

Amyotrophic Lateral Sclerosis (ALS)

Progressive Weakness & Priority Care

• Maintain respiratory function and nutrition; palliative support.

Guillain-Barré Syndrome

Priority Care

• Monitor for respiratory failure; supportive care with possible IV immunoglobulin.

Multiple Sclerosis

Presentation

• Visual changes, muscle weakness, fatigue, spasticity.

Treatment

• Corticosteroids for exacerbations; disease-modifying agents.

Delirium

Acute Confusion Presentation

• Sudden onset, fluctuating attention, disorganized thinking.

Care

• Treat underlying cause, ensure safety, reorientation strategies.

Spinal Cord Injury

Levels

• T12: Lower limb involvement.
• C9: Quadriplegia risk.

Complications

• Autonomic dysreflexia, respiratory compromise.

Gallbladder Disease

Inflammation & Stones

• Pain in RUQ, nausea after fatty meals.

Post-Surgery Care

• Monitor for bile leak, promote ambulation.

Pancreatitis

Acute vs. Chronic

• Acute: Severe pain, elevated amylase/lipase, hypocalcemia.
• Chronic: Malabsorption, steatorrhea.

Hepatitis

Know all types (A–E) and modes of transmission.

Cirrhosis of the Liver

End Stage

• Irreversible fibrosis, portal hypertension.

S&S

• Ascites, jaundice, weight gain.

Labs

• Elevated bilirubin, prolonged PT/INR.

Complications

• Variceal bleeding, hepatic encephalopathy.

Pancreatic Cancer

• Linked to chronic pancreatitis; poor prognosis.

Liver Cancer

• Associated with hepatitis B/C, cirrhosis.

References

American Heart Association. (2023). Guidelines for the management of stroke. https://www.heart.org

Centers for Disease Control and Prevention. (2024). Meningitis. https://www.cdc.gov/meningitis

National Institute of Neurological Disorders and Stroke. (2023). Brain injury and seizure prevention. https://www.ninds.nih.gov

NR 325 Exam 2

National Multiple Sclerosis Society. (2024). Multiple sclerosis information. https://www.nationalmssociety.org

World Health Organization. (2023). Neurological disorders. https://www.who.int