Neurologic System

## 1. Meningitis Signs: Kernig & Brudzinski * **Kernig’s Sign**: Pain and resistance when extending the knee while the hip is flexed at 90°. * **Brudzinski’s Sign**: Involuntary flexion of hips and knees when the neck is flexed. ➡️ Both are classic signs of **meningeal irritation**. --- ## 2. Types of Seizures * **Generalized Seizures** * Tonic-clonic: stiffening (tonic) then jerking (clonic). Postictal confusion. * Absence: brief staring, “daydreaming,” no postictal phase. * Myoclonic: brief jerking/twitching. * Atonic: sudden loss of muscle tone → falls. * **Focal (Partial) Seizures** * Simple: no loss of consciousness, localized twitch/sensory change. * Complex: impaired awareness, automatisms (lip-smacking, picking). --- ## 3. Differentiating Conditions * **Seizure**: Sudden abnormal electrical activity; repetitive, stereotyped movements, possible postictal confusion. * **Stroke (CVA/TIA)**: Focal neurological deficits (weakness, aphasia, vision loss), usually sudden and lasting longer than 24 hrs (TIA < 24 hrs). * **Scotoma**: Visual field defect (blind spot, flashes, zig-zag lines), often prodrome to **migraine aura**. --- ## 4. Nursing Care by Condition ### TIA / Stroke * **Ischemic stroke**: Give thrombolytics (tPA within 3–4.5 hr if eligible), anticoagulants, antiplatelets (aspirin, clopidogrel). * **Hemorrhagic stroke**: No anticoagulants. Manage BP, surgery possible. Prevent ICP ↑. * **Nursing care**: Neuro checks, airway, swallowing assessment, aspiration precautions, rehab (PT/OT/ST). ### Bell’s Palsy * Facial droop due to CN VII inflammation. * **Meds**: Corticosteroids, antivirals (if viral cause suspected). * **Nursing**: Eye protection (artificial tears, patch), soft diet, reassurance. ### Migraine * **Meds**: Triptans, NSAIDs, antiemetics, beta-blockers for prevention. * **Nursing**: Dark quiet environment, avoid triggers, encourage rest. ### Meningitis * **Meds**: IV antibiotics (if bacterial), corticosteroids, antipyretics. * **Nursing**: Droplet precautions (bacterial), monitor ICP, seizure precautions, reduce stimuli. ### Seizure * **Meds**: Antiepileptics (phenytoin, carbamazepine, valproic acid, levetiracetam). * **Nursing**: Protect from injury (turn on side, clear area), do not restrain, do not put anything in mouth, monitor postictal phase, document onset/duration. --- ## 5. Neurological Terminology * **Dysphagia** – difficulty swallowing * **Aphasia** – impaired language * *Expressive*: can’t speak well (Broca’s) * *Receptive*: can’t understand (Wernicke’s) * **Ataxia** – uncoordinated movements * **Hyporeflexia** – decreased reflexes * **Diplopia** – double vision * **Homonymous hemianopsia** – loss of same half of visual field in both eyes * **Flexion/extension posturing** – severe brain injury signs * **Lateral gaze palsy** – CN VI damage --- ## 6. Nursing Diagnoses for Brain Disorders * **Impaired physical mobility** r/t hemiplegia * **Risk for aspiration** r/t dysphagia * **Impaired verbal communication** r/t aphasia * **Acute pain** r/t migraine/cluster headache * **Risk for injury** r/t seizure activity * **Disturbed sensory perception** r/t vision changes or hemianopsia --- ## 7. Headache Types * **Tension**: Bilateral, “band-like,” constant pressure. Often stress-related. * **Migraine**: Unilateral, throbbing, may have aura, photophobia, nausea. * **Cluster**: Severe unilateral pain around eye, tearing, nasal congestion; occurs in cycles/clusters, more common in men. --- ✅ **Test Tip (ATI style):** Always prioritize **airway, breathing, circulation, neuro checks, seizure precautions, and safety**. Distinguish between conditions by onset (sudden stroke vs aura before migraine), consciousness (seizure vs TIA), and laterality (cluster headaches are unilateral).