MS1 NOTES (DAVIDSON) 🌧PAGE 1
NURS 120 Med Surge 1 (MS 1) STUDY GUIDE (DAVIDSON) +all weekly questions
explained 2025-2026 West Coast University
WEEK 8: Neuro
60, 62, 63, 59
EXEMPLAR STROKES (CEREBROVASCULAR ACCIDENT OR CVA)
DISEASES Ischemic Stroke
Embolic vs. Thrombotic Stroke
Transient Ischemic Attack (TIA) or “mini strokes”
Hemorrhagic Stroke
SEIZURES
CLASSIFICATIONS
Generalized vs. Focal/Partial
7 TYPES
Tonic-Clonic (Grand Mal)
Tonic
Clonic
Atonic (Drop Attacks)
Absence (Petite Mal)
Myoclonic
Psychogenic Nonepileptic Seizure (PNES)
Status Epilepticus (Complication)
Basic Management of Intracranial Pressure (ICP)
TERMS TO KNOW Dysphagia: difficulty swallowing
Dysphasia or Aphasia: difficulty with speech and/or language
Medulla oblongata in brain stem: manages heart, circulation, bleeding
If there’s damage to medulla oblongata → damage to cranial nerves:
● #9: glossopharyngeal (mouth) → gag reflex, taste, saliva, mouth sensations
● #10: vagus → most important → controls whole system (parasympathetic
control of heart, lungs, digestive system)
● #11: accessory (neck & upper back) → head turn, shrug shoulders
● #12: hypoglossal (tongue) → speak & swallow (dysphagia)
If there’s damage to pons → damage to cranial nerves:
● #7: facial → facial expression, tear & salivary glands
Common conditions that affect medulla
1. Aneurysm
2. Concussion
3. Stroke
4. TBI (traumatic brain injury)
5. TIA
6. Cancer (metastasized to the brain)
, MS1 NOTES (DAVIDSON) 🌧PAGE 2
The pyramids
in the medulla
are responsible
for the cross-
over part of the
brain (why
damage to one
side of the
brain →
paralysis/weak
ness on
opposite)
, MS1 NOTES (DAVIDSON) 🌧PAGE 3
STROKE Stroke “cerebrovascular attack (CVA)” “brain attack” occurs when there is (1)
ischemia (inadequate blood flow) to a part of the brain or (2) hemorrhage (bleeding)
cerebrovascular into the brain → infarction (death of brain cells)
attack ● Severity of loss of function varies based on location/extent of the brain damage
(CVA) ● Medical emergency → immediate medical attention to decrease risk of
disability (hemiparesis, aphasia) and death
brain attack
NIH stroke scale: increases or decreases prognosis by evaluating LOC, motor skills,
speech, vision
● 16+ = bad
● Want < 6 = better recovery
DIAGNOSIS
1. CT
2. MRI
3. FAST
4. Transcranial Doppler
5. Lumbar puncture
6. Barium swallow study (evaluates swallowing ability, commonly for stroke
, MS1 NOTES (DAVIDSON) 🌧PAGE 4
patients experiencing dysphagia. Stroke patients are at high risk for aspiration
PNA d/t impaired muscle coordination. Need to be NPO and teach staff/family
not to sneak in food/eat. Might do basic swallow test by a speech pathologist.
RISK FACTORS
● Modifiable: 90% of strokes
○ Lifestyle, medication Tx (HTN, ♥dz, DM, hyperlipidemia, ETOH,
obesity, sleep apnea, metabolic syndrome, poor diet/exercise)
○ *Uncontrolled HTN – non-compliance of HTN meds is the #1 cause
of stroke
● Nonmodifiable: age, gender, ethnicity, race, family Hx
○ 55+ (d/t HTN and obesity)
○ 65+ (most strokes)
○ More common in men, but more women die
○ Blacks
○ Family Hx
SS: BE FAST
● BALANCE unbalanced gait (ataxia)
● EYES double vision (diplopia), blurred vision
● FACIAL drooping, asymmetrical
● ARMS weakness, drifting (down), numbness or tingling
● SPEECH slurred, difficulty w/ language or communicating
● TIME of onset of SS → call 911 at first sign, note time of first sign
COMPLICATIONS
● Communicating w/ patient w/ aphasia (pg 1532)
○ Decrease stimuli, treat patient as adult, speak normal tone, keep
questions “yes” or “no”, be patient (do not interrupt), can utilize
pointing at pictures
● Urinary frequency, urgency, or incontinence
● Dysphagia → difficulty swallowing
○ Keep NPO until speech therapist does swallow evaluation
● Dysphasia → problems w/ speech or language
● Injury (fall)
○ Provide non-slip socks
○ Environment control (remove clutter, adequate lighting)
● Sensory-Perceptual problems (p1532)
○ Understand that Stroke location is opposite of what side of the body is
affected (Left-sided stroke = Right hemiplegia)
○ Right-sided stroke (R is for reckless)
■ Left hemiplegia → risk for injury
■ Left-sided neglect
■ Spatial-perceptual deficits
■ Tends to deny problems r/t stroke
■ Rapid performance, short attention span
■ Impulsive & impatient → safety problems
■ Impaired judgment/time concepts
■ Directions best given verbally
○ Left-sided stroke (L is for language)
■ Right hemiplegia → risk for injury
■ Impaired speech/language
■ Impaired right/left discrimination
■ Slow performance, cautious
■ More fearful or anxious of stroke → depression
NURS 120 Med Surge 1 (MS 1) STUDY GUIDE (DAVIDSON) +all weekly questions
explained 2025-2026 West Coast University
WEEK 8: Neuro
60, 62, 63, 59
EXEMPLAR STROKES (CEREBROVASCULAR ACCIDENT OR CVA)
DISEASES Ischemic Stroke
Embolic vs. Thrombotic Stroke
Transient Ischemic Attack (TIA) or “mini strokes”
Hemorrhagic Stroke
SEIZURES
CLASSIFICATIONS
Generalized vs. Focal/Partial
7 TYPES
Tonic-Clonic (Grand Mal)
Tonic
Clonic
Atonic (Drop Attacks)
Absence (Petite Mal)
Myoclonic
Psychogenic Nonepileptic Seizure (PNES)
Status Epilepticus (Complication)
Basic Management of Intracranial Pressure (ICP)
TERMS TO KNOW Dysphagia: difficulty swallowing
Dysphasia or Aphasia: difficulty with speech and/or language
Medulla oblongata in brain stem: manages heart, circulation, bleeding
If there’s damage to medulla oblongata → damage to cranial nerves:
● #9: glossopharyngeal (mouth) → gag reflex, taste, saliva, mouth sensations
● #10: vagus → most important → controls whole system (parasympathetic
control of heart, lungs, digestive system)
● #11: accessory (neck & upper back) → head turn, shrug shoulders
● #12: hypoglossal (tongue) → speak & swallow (dysphagia)
If there’s damage to pons → damage to cranial nerves:
● #7: facial → facial expression, tear & salivary glands
Common conditions that affect medulla
1. Aneurysm
2. Concussion
3. Stroke
4. TBI (traumatic brain injury)
5. TIA
6. Cancer (metastasized to the brain)
, MS1 NOTES (DAVIDSON) 🌧PAGE 2
The pyramids
in the medulla
are responsible
for the cross-
over part of the
brain (why
damage to one
side of the
brain →
paralysis/weak
ness on
opposite)
, MS1 NOTES (DAVIDSON) 🌧PAGE 3
STROKE Stroke “cerebrovascular attack (CVA)” “brain attack” occurs when there is (1)
ischemia (inadequate blood flow) to a part of the brain or (2) hemorrhage (bleeding)
cerebrovascular into the brain → infarction (death of brain cells)
attack ● Severity of loss of function varies based on location/extent of the brain damage
(CVA) ● Medical emergency → immediate medical attention to decrease risk of
disability (hemiparesis, aphasia) and death
brain attack
NIH stroke scale: increases or decreases prognosis by evaluating LOC, motor skills,
speech, vision
● 16+ = bad
● Want < 6 = better recovery
DIAGNOSIS
1. CT
2. MRI
3. FAST
4. Transcranial Doppler
5. Lumbar puncture
6. Barium swallow study (evaluates swallowing ability, commonly for stroke
, MS1 NOTES (DAVIDSON) 🌧PAGE 4
patients experiencing dysphagia. Stroke patients are at high risk for aspiration
PNA d/t impaired muscle coordination. Need to be NPO and teach staff/family
not to sneak in food/eat. Might do basic swallow test by a speech pathologist.
RISK FACTORS
● Modifiable: 90% of strokes
○ Lifestyle, medication Tx (HTN, ♥dz, DM, hyperlipidemia, ETOH,
obesity, sleep apnea, metabolic syndrome, poor diet/exercise)
○ *Uncontrolled HTN – non-compliance of HTN meds is the #1 cause
of stroke
● Nonmodifiable: age, gender, ethnicity, race, family Hx
○ 55+ (d/t HTN and obesity)
○ 65+ (most strokes)
○ More common in men, but more women die
○ Blacks
○ Family Hx
SS: BE FAST
● BALANCE unbalanced gait (ataxia)
● EYES double vision (diplopia), blurred vision
● FACIAL drooping, asymmetrical
● ARMS weakness, drifting (down), numbness or tingling
● SPEECH slurred, difficulty w/ language or communicating
● TIME of onset of SS → call 911 at first sign, note time of first sign
COMPLICATIONS
● Communicating w/ patient w/ aphasia (pg 1532)
○ Decrease stimuli, treat patient as adult, speak normal tone, keep
questions “yes” or “no”, be patient (do not interrupt), can utilize
pointing at pictures
● Urinary frequency, urgency, or incontinence
● Dysphagia → difficulty swallowing
○ Keep NPO until speech therapist does swallow evaluation
● Dysphasia → problems w/ speech or language
● Injury (fall)
○ Provide non-slip socks
○ Environment control (remove clutter, adequate lighting)
● Sensory-Perceptual problems (p1532)
○ Understand that Stroke location is opposite of what side of the body is
affected (Left-sided stroke = Right hemiplegia)
○ Right-sided stroke (R is for reckless)
■ Left hemiplegia → risk for injury
■ Left-sided neglect
■ Spatial-perceptual deficits
■ Tends to deny problems r/t stroke
■ Rapid performance, short attention span
■ Impulsive & impatient → safety problems
■ Impaired judgment/time concepts
■ Directions best given verbally
○ Left-sided stroke (L is for language)
■ Right hemiplegia → risk for injury
■ Impaired speech/language
■ Impaired right/left discrimination
■ Slow performance, cautious
■ More fearful or anxious of stroke → depression
