NSG 4100 — Exam 2 Quick Notes
Neurological, Renal, and Endocrine Disorders: Condensed Content
Review
Stroke & Increased ICP
Stroke
● Time = brain: activate stroke protocol, note LKW (last known well) time
● tPA window: 3-4.5 hr from onset; CT must rule out hemorrhage FIRST
● Post-tPA: no invasive procedures/IM injections x24hr, monitor for bleeding
Increased ICP
● HOB 30°, neutral neck, avoid Valsalva/coughing/suctioning triggers
● Cushing's triad = ↑BP (widened pulse pressure), ↓HR, irregular resp — LATE/ominous
sign
● Unilateral fixed dilated pupil = herniation emergency
● Mannitol: osmotic diuretic, monitor serum osmolality + urine output + watch for
pulmonary edema/HF
● Corticosteroids reduce vasogenic edema (tumor-related)
Head Trauma Signs
● Raccoon eyes / Battle's sign = basilar skull fracture
● Clear nasal/ear drainage → test for glucose (CSF+), halo sign; NO suctioning/NG
insertion
● Epidural hematoma classic: LOC → lucid interval → rapid decline
Spinal Cord Injury & Seizures
SCI
● C3-C5 → phrenic nerve/diaphragm → respiratory failure risk
● Autonomic dysreflexia (injury T6 and above): pounding headache, flushing above level,
severe HTN → SIT UP, check bladder/bowel for trigger first
Seizures
● During seizure: protect from injury, turn to side, nothing in mouth, do NOT restrain
● Status epilepticus: IV lorazepam/diazepam first-line
● Phenytoin: infuse slowly (rapid IV → hypotension/bradycardia), monitor levels, gingival
hyperplasia → dental care
● Valproic acid: monitor LFTs + platelets
Neurological, Renal, and Endocrine Disorders: Condensed Content
Review
Stroke & Increased ICP
Stroke
● Time = brain: activate stroke protocol, note LKW (last known well) time
● tPA window: 3-4.5 hr from onset; CT must rule out hemorrhage FIRST
● Post-tPA: no invasive procedures/IM injections x24hr, monitor for bleeding
Increased ICP
● HOB 30°, neutral neck, avoid Valsalva/coughing/suctioning triggers
● Cushing's triad = ↑BP (widened pulse pressure), ↓HR, irregular resp — LATE/ominous
sign
● Unilateral fixed dilated pupil = herniation emergency
● Mannitol: osmotic diuretic, monitor serum osmolality + urine output + watch for
pulmonary edema/HF
● Corticosteroids reduce vasogenic edema (tumor-related)
Head Trauma Signs
● Raccoon eyes / Battle's sign = basilar skull fracture
● Clear nasal/ear drainage → test for glucose (CSF+), halo sign; NO suctioning/NG
insertion
● Epidural hematoma classic: LOC → lucid interval → rapid decline
Spinal Cord Injury & Seizures
SCI
● C3-C5 → phrenic nerve/diaphragm → respiratory failure risk
● Autonomic dysreflexia (injury T6 and above): pounding headache, flushing above level,
severe HTN → SIT UP, check bladder/bowel for trigger first
Seizures
● During seizure: protect from injury, turn to side, nothing in mouth, do NOT restrain
● Status epilepticus: IV lorazepam/diazepam first-line
● Phenytoin: infuse slowly (rapid IV → hypotension/bradycardia), monitor levels, gingival
hyperplasia → dental care
● Valproic acid: monitor LFTs + platelets
