1) Neuro – Seizures, Stroke, ICP, Movement Disorders
Seizure Care
● During a seizure: Protect airway & patient — side‑lying position, clear area of hazards,
assess airway/breathing, apply O₂ if indicated. Do NOT place objects in mouth; avoid
restraints.
● Postictal priorities: Assess breathing pattern, vital signs, and injuries first; then
reorient, document onset/offset, precipitating factors.
● Status epilepticus (first‑line): IV benzodiazepine (e.g., diazepam/lorazepam), then
maintenance (e.g., phenytoin/fosphenytoin) per protocol.
● Phenytoin monitoring: Therapeutic total level ~10–20 mcg/mL; <10 = subtherapeutic
→ assess adherence, timing, interactions (tube feeds/antacids) before dose changes.
Stroke/ICP
● Increased ICP: HOB ~30°, neutral neck, quiet/non‑stimulating environment, avoid hip
flexion/valsalva; prevent fever/hypercapnia; avoid hypotonic fluids and flat supine
positioning.
● TIA: Transient neuro deficits (e.g., ataxia, aphasia, weakness, vision change) that
resolve; a warning for future ischemic stroke.
● Thrombolytics for AIS: Assess “last seen normal” (LSN), screen contraindications
(bleeding, recent surgery), baseline labs (including PT/INR as policy), dose/infuse per
protocol timeline.
● Hemorrhagic stroke: Monitor closely for acute neuro changes—new N/V, severe
headache, BP management, HOB 30°.
Parkinson’s Disease
● Symptoms: Resting tremor, rigidity, bradykinesia, postural instability; autonomic issues
→ orthostatic hypotension.
● Teaching: Plan activities for medication “on” periods; fall precautions; do not stare at
feet when ambulating; exercises that improve balance (e.g., Tai Chi) may help.
● Swallowing risk: Adventitious lung sounds or swallow difficulty → aspiration
precautions/dysphagia diet until formal swallow eval.
Headache/Migraine
● Sumatriptan: Contraindicated with nitrates/CAD; may cause chest
symptoms/vasoconstriction.
● Alcohol: Triggers vasodilation that can precipitate migraine.
Seizure Care
● During a seizure: Protect airway & patient — side‑lying position, clear area of hazards,
assess airway/breathing, apply O₂ if indicated. Do NOT place objects in mouth; avoid
restraints.
● Postictal priorities: Assess breathing pattern, vital signs, and injuries first; then
reorient, document onset/offset, precipitating factors.
● Status epilepticus (first‑line): IV benzodiazepine (e.g., diazepam/lorazepam), then
maintenance (e.g., phenytoin/fosphenytoin) per protocol.
● Phenytoin monitoring: Therapeutic total level ~10–20 mcg/mL; <10 = subtherapeutic
→ assess adherence, timing, interactions (tube feeds/antacids) before dose changes.
Stroke/ICP
● Increased ICP: HOB ~30°, neutral neck, quiet/non‑stimulating environment, avoid hip
flexion/valsalva; prevent fever/hypercapnia; avoid hypotonic fluids and flat supine
positioning.
● TIA: Transient neuro deficits (e.g., ataxia, aphasia, weakness, vision change) that
resolve; a warning for future ischemic stroke.
● Thrombolytics for AIS: Assess “last seen normal” (LSN), screen contraindications
(bleeding, recent surgery), baseline labs (including PT/INR as policy), dose/infuse per
protocol timeline.
● Hemorrhagic stroke: Monitor closely for acute neuro changes—new N/V, severe
headache, BP management, HOB 30°.
Parkinson’s Disease
● Symptoms: Resting tremor, rigidity, bradykinesia, postural instability; autonomic issues
→ orthostatic hypotension.
● Teaching: Plan activities for medication “on” periods; fall precautions; do not stare at
feet when ambulating; exercises that improve balance (e.g., Tai Chi) may help.
● Swallowing risk: Adventitious lung sounds or swallow difficulty → aspiration
precautions/dysphagia diet until formal swallow eval.
Headache/Migraine
● Sumatriptan: Contraindicated with nitrates/CAD; may cause chest
symptoms/vasoconstriction.
● Alcohol: Triggers vasodilation that can precipitate migraine.
