Exam 3 · Week 7 · Standalone study page
M7 · Neurologic Dysfunction & Cerebrovascular Disorders
This page keeps all of the original course information, while reducing the decision to one module: brain function, stroke recognition and neurologic priorities.
▸M7Neurologic Dysfunction & Cerebrovascular DisordersWeek 7
💡 The one idea
The skull cannot expand. Brain, blood and CSF share a fixed box, so anything that swells or bleeds pushes something else out. Every neuro emergency is that competition.
The earliest sign of rising ICP is a change in level of consciousness — always.
| Rising ICP | What you see |
|---|---|
| EARLIEST | Change in LOC — restless, confused, harder to rouse |
| Then | Headache, vomiting (often projectile), pupil changes |
| LATE — Cushing’s triad | ↑ systolic with widening pulse pressure · ↓ heart rate · irregular respirations |
🚨 Cushing’s triad is a late, ominous sign
By the time the triad appears, herniation is close. It is never the answer to "earliest sign".
Positioning: head of bed 30°, head midline, no neck flexion, no hip flexion. Avoid coughing, straining and suctioning longer than 10 seconds.
| Ischemic stroke | Hemorrhagic stroke | |
|---|---|---|
| Cause | Clot blocks a vessel (~87%) | Vessel ruptures and bleeds |
| Onset | Sudden deficits, often on waking | Sudden “worst headache of my life” |
| First test | Non-contrast CT — before any treatment decision | |
| tPA | Yes, within 3–4.5 h of onset | ABSOLUTELY NOT |
🧠 Why the CT comes first
Ischemic and hemorrhagic strokes look identical at the bedside, and the treatment for one is fatal in the other. CT exists to rule out bleeding before giving tPA.
BE-FAST: Balance · Eyes · Face droop · Arm drift · Speech · Time — note the last known well time.
⬅️ LEFT brain stroke
Right-sided weakness. Aphasia — language is on the left.
Slow, cautious, anxious. Aware of the deficit, so depression is common.
➡️ RIGHT brain stroke
Left-sided weakness. Left-sided neglect — ignores that half of the world.
Impulsive, poor judgment, unaware of the deficit — so a major fall risk.
⭐ The one intervention that prevents the common killer
Swallow screen before anything by mouth. Aspiration pneumonia is the leading cause of death after stroke.
Nothing by mouth - not even water or medications - until swallowing is formally assessed.
⭐ High-yield — what the exam actually asks
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- Normal ICP
10–15 mmHg; normal CPP>50 mmHg; CPP = MAP − ICP. Rising ICP drops CPP and starves the brain. - A change in LOC is the earliest sign of rising ICP. Cushing's triad — rising systolic with widened pulse pressure, bradycardia, irregular/Cheyne-Stokes respirations — is a late herniation sign.
- Mannitol and 3% saline pull fluid off the brain; confirm mannitol is working by increased urine output. Never Trendelenburg with raised ICP.
- GCS: eye 1–4, verbal 1–5, motor 1–6. Max 15, min 3. GCS ≤8 → intubate.
- Decorticate = arms in toward the core, better prognosis. Decerebrate = arms out/extended, brainstem damage, worse.
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- Non-contrast CT within 25 minutes of arrival decides ischemic vs hemorrhagic and t-PA candidacy. CT first acutely; MRI is better detail but too slow for the emergency.
- Ischemic stroke ~
87%, hemorrhagic ~13%. t-PA window3–4.5 hrfrom symptom onset. Contraindicated with anticoagulants, SBP >180, recent bleed or surgery, age under 18, or abnormal glucose. Not a candidate → heparin drip. - Hemorrhagic: "worst headache of my life." No t-PA ever. Lower the BP, check and reverse coags, then surgical evacuation. Always ask when the symptoms started.
- Left-brain stroke → right-sided weakness plus language and swallowing deficits (airway risk), slow cautious behavior. Right-brain stroke → left-sided weakness, homonymous hemianopsia and neglect, impulsive behavior, big fall risk.
- Carotid endarterectomy removes plaque (>70% blockage, or >50% with TIAs). Post-op watch for HTN, neck swelling, hoarseness. Stroke care: VS
q1–2 hr, notify for SBP >180 or DBP >110, keep SpO2 >92%.
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- Seizures: protect the airway, turn her to the side, time it, pad the head. Never restrain, never put anything in the mouth. Status epilepticus (>5 min, or repeated without recovery) → IV lorazepam first, then fosphenytoin or levetiracetam.
- Migraine POUND: Pulsating, One-day duration (4–72 hr), Unilateral, Nausea, Disabling. Triptans/NSAIDs acutely, beta blockers to prevent.
- A TIA resolves fully with no infarct on imaging — but it gets the same urgency of workup as a stroke.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
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- Posturing scores on the GCS motor scale: decorticate = 3, decerebrate = 2. The scale runs 3–15 — "you get 3 points just for showing up." Eye 4, verbal 5, motor 6. 8 or less: sedate and intubate. Posturing means the brainstem is being compressed.
- With posturing and high ICP, elevate the HOB to 30° first. It takes seconds and gravity does the work; mannitol has to be fetched and mixed. That is the whole reason it beats the drug.
- Their ICP mechanism table, worth learning as cause → effect: head elevation → venous outflow · sedation → less metabolic demand · mannitol or 3% saline → osmotic diuresis pulling free water out of brain tissue · hyperventilation → CO₂ washout → cerebral vasoconstriction · CSF drainage → less volume.
- Mannitol and 3% saline are either/or, never both — together they pull too much fluid. Treat them as interchangeable when you see them as options.
- ICP hyperventilation target: PaCO₂ 30–35 (normal 35–45) → cerebral vasoconstriction → less volume in the skull.
- Reducing ICP, their SATA: HOB 30°, mannitol, quiet and dimly lit room. Not coughing and deep breathing — that is a Valsalva and it raises ICP. Not fluid restriction to 500 mL — very few conditions justify restricting fluid at all.
- Cushing's triad: bradycardia, irregular respirations, widened pulse pressure. Once ICP exceeds the MAP the brain stops being perfused — a true emergency.
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- Hematoma pattern recognition — Epidural: arterial, a blow to the temple (the thinnest bone), brief LOC → lucid interval → decline, needs burr holes urgently. Subdural: venous, crescent-shaped, elderly / alcohol / anticoagulated, confusion and unsteadiness over 3–5 days, may recall a bump a week ago. Subarachnoid: berry aneurysm (~1% of people), thunderclap "worst headache of my life", photophobia, no trauma; calcium channel blockers for vasospasm. Intracerebral: elderly, chronic hypertension, sudden severe headache.
- Their anatomy note: three of the four are arterial; only the subdural is venous — which is why it is the one that unfolds over days instead of an hour.
- Why the elderly get subdurals: the brain shrinks with age, the skull does not, so it rattles on a minor knock and tears the bridging veins.
- Subarachnoid vs intracerebral sound almost identical. Only the CT tells them apart.
- Worst-headache workup: non-contrast CT first. MRI takes 45–60 minutes; an LP needs a needle, a lab and a wait. Analgesia is given, but it is not the priority.
- Elderly + chronic alcohol + minor fall + days of confusion → non-contrast CT for a subdural. Not thiamine (no gait or memory picture, so no Wernicke's), not a withdrawal protocol (they are not withdrawing), not dementia screening. The alcohol matters because a damaged liver makes fewer clotting factors.
- Basilar skull fracture: raccoon eyes + Battle sign + clear rhinorrhoea. Confirm CSF with the halo sign or a glucose test strip — nasal mucus has no glucose, CSF does. No NG tube — it can pass through the fracture into the brain. This is the one head injury laid flat.
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- Seizure priority is protect the client from injury — turn them side-lying so vomit does not go into the lungs. The benzodiazepine and the documentation both come after. Never restrain a seizing client — it injures muscle and can stop their breathing — and never put anything in the mouth.
- Post-ictal: do very little. The brain is exhausted. Raise the head slightly, monitor vitals, and let them wake on their own — do not overstimulate them to rouse them.
- Head-injury room setup, their SATA: bed in the lowest position, seizure precautions, quiet dim room, suction at the bedside, HOB 30°. No coughing and deep breathing, no NG tube, no soft restraints.
- Hemorrhagic stroke, indicated vs contraindicated: indicated — HOB 30°, mannitol, normal glucose, frequent neuro checks. Contraindicated — alteplase (any bleed is absolute) and "encourage frequent suctioning"; gagging spikes ICP, so suction only when it is needed. Watch that wording.
- Intracerebral hemorrhage SATA: HOB 30°, normothermia (fever raises metabolic demand), PaCO₂ 30–35, vasopressors to keep systolic above 100 so the brain is still perfused, frequent neuro checks. Not frequent suctioning, not restricting nutrition for 72 hours, not alteplase.
- Epidural picture (temple blow, LOC then awake): emergent CT, monitor for rising ICP, frequent neuro checks, 3% saline or mannitol. Not alteplase, and not flat in bed — flat is only for the basilar skull fracture.
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- Their stroke matrix — TIA: resolves within 24 h, usually within an hour; painless; antiplatelets or anticoagulants; the only one that may get a carotid endarterectomy to prevent a future stroke. Ischemic: a clot; painless; CT before thrombolytics; rapid neuro assessment for eligibility; alteplase within 4.5 h. Hemorrhagic: sudden severe headache, nausea, photophobia; may need surgical evacuation.
- Ischemic strokes and TIAs do not hurt. A severe headache means a rupture. Their shorthand: a stroke is either a blocked artery or a broken one.
- Stroke screening is BEFAST — balance, eyes, face, arms, speech, time. NIHSS runs 0–42: 0 is no damage, 42 is severe.
- Suspected stroke with airway and breathing already confirmed: next is a rapid neuro assessment — GCS, pupils, grip, feet, speech, about 20 seconds — then the CT. You cannot give aspirin before the CT, because you do not yet know whether it is a bleed.
- Their explicit priority ruling: hypotension 82/50 with HR 130 outranks a new unilateral dilated sluggish pupil. "If we don't fix #4, #3 won't matter." ABC before D, every time — and the full order is A-B-C-D-E, ending in exposure.
- Calc: esmolol 50 mcg/kg/min, 67 kg, supplied 2,500 mg/250 mL →
20.1 mL/hr, rounded to the nearest tenth with no trailing zero.
⚠️ Exam traps
- t-PA dissolves the clot, endovascular therapy removes it, a stent opens the artery, endarterectomy removes plaque. Four different answers.
- The early ICP change is a subtle LOC change, not Cushing's triad. If the triad is there, you are late.
⚠️ What it turns into — the complication for each one
The disorder cards below run definition, causes, signs, diagnostics, management and nursing. This is the part they do not have, and it is where the exam lives: so what happens if this is missed or left? Everything here is about the space inside a rigid skull: a bleed, a clot or swelling all end in the same place if nothing is done.
| Disorder | What it turns into |
|---|---|
| Ischemic stroke | Hemorrhagic transformation, particularly after thrombolysis. Cerebral edema peaking at 48–72 hours. Aspiration pneumonia from dysphagia — which is why she is NPO until the swallow screen. DVT and PE, contractures, and post-stroke depression |
| Hemorrhagic stroke and cerebral aneurysm | Rebleeding, and vasospasm between days 4 and 14 causing a second, delayed stroke. Hydrocephalus, rising ICP and herniation, seizures, and sodium disorders — SIADH or cerebral salt wasting |
| Increased intracranial pressure | Herniation and death. Cushing triad — rising systolic with widening pulse pressure, bradycardia, irregular breathing — is a late sign, not an early warning. Permanent injury and diabetes insipidus |
| Seizures and status epilepticus | Status epilepticus — hypoxia, aspiration, rhabdomyolysis and acute kidney injury, hyperthermia, and permanent neuronal death. Injury during the seizure itself: fractures, head trauma, tongue laceration |
🧠 Cerebrovascular and neurologic emergencies, section by section
The two kinds of stroke, whose treatments are opposites, then the pressure problem underneath most neurological deterioration, then seizures. Same six sections every time.
Ischemic StrokeTime is brainOpenClose
Definition and Overview
Sudden loss of brain function because a vessel is blocked and the tissue it feeds is starved of oxygen. It accounts for about 85% of strokes. Thrombotic strokes build on atherosclerotic plaque and often come on over hours, sometimes during sleep; embolic strokes arrive suddenly from elsewhere, most often from a heart in atrial fibrillation. The dead core cannot be saved; the surrounding penumbra can, and only for a few hours — which is the whole reason for the urgency.
Causes and Risk Factors
Hypertension is the single biggest modifiable risk factor, then atrial fibrillation, diabetes, hyperlipidaemia, smoking, obesity, physical inactivity, heavy alcohol use, obstructive sleep apnea, carotid stenosis and previous TIA or stroke. Non-modifiable: age, male sex, Black ancestry, and family history. Oral contraceptives combined with smoking in women.
Clinical Manifestations
Sudden onset of: one-sided weakness or numbness of the face, arm or leg; confusion; trouble speaking or understanding; visual loss; dizziness or loss of balance; or a severe headache. Deficits follow the vessel: a left-hemisphere stroke gives right-sided weakness and aphasia; a right-hemisphere stroke gives left-sided weakness, unilateral neglect and impulsiveness. Also dysphagia, homonymous hemianopsia, emotional lability and incontinence. A transient ischemic attack resolves completely within 24 hours, and it is not reassuring — it is a warning that a stroke is coming, and it needs urgent work-up.
Assessment and Diagnostic Findings
Non-contrast CT of the head immediately — the first job is to rule out hemorrhage, because the treatment for the two is opposite. Establish the last known well time, which decides eligibility for treatment more than anything else. NIH Stroke Scale, blood glucose (hypoglycaemia mimics stroke), ECG for atrial fibrillation, coagulation studies, CBC, electrolytes and troponin. Then CT angiography or MRI, carotid ultrasound and echocardiography to find the source. A swallow screen before anything by mouth — including medications and water.
Medical Management
Intravenous thrombolysis with alteplase or tenecteplase within 4.5 hours of the last known well time, once hemorrhage is excluded and the exclusion criteria are checked. Mechanical thrombectomy for a large-vessel occlusion, up to 24 hours in selected clients. Then aspirin, or dual antiplatelet therapy for minor stroke, and anticoagulation for atrial fibrillation. Statin, blood pressure control, glucose control, and carotid endarterectomy for significant stenosis. Early rehabilitation.
Nursing Management and Client Education
Ask when the client was last seen normal and make sure that time is documented and handed over — it is the number the whole treatment decision rests on. Nil by mouth until the swallow screen is passed, then thickened fluids and upright positioning as directed by speech and language therapy. During and after thrombolysis: neurological checks and vital signs on the protocol schedule, no invasive lines, injections or urinary catheters for 24 hours, and report any headache, vomiting or deterioration at once — that is bleeding. Blood pressure is deliberately allowed to run high in ischemic stroke that is not being thrombolysed, to perfuse the penumbra — do not treat it on your own initiative. Position with the head of the bed as ordered and the affected limbs supported; range of motion from day one to prevent contracture. For neglect, approach from the unaffected side at first and then teach scanning to the neglected side. Communicate with an aphasic client using short sentences, one question at a time, yes/no options and a picture board — and never assume that receptive aphasia means the person cannot understand or is not listening. Fall and aspiration precautions, skin care, bowel and bladder programme, and early referral to physiotherapy, occupational therapy and speech therapy. Teach FAST to the family — Face, Arms, Speech, Time to call — and teach the risk factor control that prevents the next one.
Hemorrhagic Stroke and Cerebral AneurysmWorst headache of my lifeOpenClose
Definition and Overview
Bleeding into or around the brain. Intracerebral hemorrhage is bleeding into the brain tissue itself, usually from long-standing hypertension. Subarachnoid hemorrhage is bleeding into the space around the brain, usually from a ruptured berry aneurysm. Only about 15% of strokes are hemorrhagic, but they carry much higher mortality, because blood in the skull raises pressure in a box that cannot expand.
Causes and Risk Factors
Uncontrolled hypertension above all. Then aneurysms and arteriovenous malformations, anticoagulant and antiplatelet therapy, thrombolysis, trauma, cocaine and amphetamine use, bleeding disorders, and cerebral amyloid angiopathy in older adults. Aneurysm rupture is more common in women, with smoking, heavy alcohol use, family history and polycystic kidney disease.
Clinical Manifestations
Sudden, severe headache — classically described as 'the worst headache of my life' — with nausea and vomiting, neck stiffness and photophobia in subarachnoid hemorrhage, and rapid deterioration in level of consciousness. Focal deficits, seizures, and signs of rising intracranial pressure: a falling level of consciousness is the earliest and most sensitive sign, long before the late Cushing triad of rising blood pressure with a widening pulse pressure, bradycardia and irregular breathing — by then herniation is imminent. A dilating, sluggish or fixed pupil on one side is an emergency.
Assessment and Diagnostic Findings
Non-contrast CT immediately, which shows blood. If CT is negative and suspicion remains, lumbar puncture looking for blood or xanthochromia — but never before imaging, because a lumbar puncture with raised pressure can cause herniation. CT angiography or cerebral angiography to find the aneurysm. Frequent neurological checks with the Glasgow Coma Scale and pupil assessment, blood pressure, coagulation studies, and intracranial pressure monitoring in severe cases.
Medical Management
Control the blood pressure — here it is lowered, the opposite of ischemic stroke — usually with a titratable intravenous agent. Reverse anticoagulation urgently if the client is on it. Manage raised intracranial pressure with head elevation, osmotic therapy (mannitol or hypertonic saline), sedation and sometimes an external ventricular drain. Secure the aneurysm early by surgical clipping or endovascular coiling. Nimodipine for 21 days after subarachnoid hemorrhage to reduce vasospasm, which typically peaks days 4 to 14 and causes delayed deficits. Seizure prophylaxis, and stool softeners.
Nursing Management and Client Education
Neurological checks are the intervention — changes here are the client's only warning. Report any decline in level of consciousness, new pupil asymmetry, worsening headache or vomiting immediately. Aneurysm precautions: quiet, dimly lit room, head of bed elevated 30 degrees with the head midline and the neck not flexed or rotated, limited visitors, no bright lights or loud noise, and clustering of care. Avoid anything that raises intracranial pressure: straining at stool, coughing, vomiting, hip flexion, suctioning for longer than 10–15 seconds, and the Valsalva maneuver — so give stool softeners and antiemetics rather than waiting. Watch for vasospasm as a new or worsening deficit days after the bleed. Seizure and fall precautions. Keep the family informed and prepare them for how quickly this can change; involve them in the quiet environment rather than excluding them from it.
Increased Intracranial PressureLOC firstOpenClose
🖼️ InfographicsIncreased Intracranial PressureIncreased ICP 1Increased ICP 2
Definition and Overview
The skull is a fixed box holding brain tissue, blood and cerebrospinal fluid. If any one increases, another must decrease or the pressure rises — that is the Monro–Kellie doctrine. Normal intracranial pressure is 5–15 mmHg; sustained pressure above 20 compromises perfusion and, untreated, ends in herniation. Cerebral perfusion pressure = mean arterial pressure − intracranial pressure, and it needs to stay above about 60 mmHg.
Causes and Risk Factors
Anything that adds volume: traumatic brain injury, hemorrhage, stroke with edema, tumor, abscess, meningitis and encephalitis, hydrocephalus, and metabolic causes such as hepatic encephalopathy. Made worse by hypoxia, hypercapnia, fever, seizures, pain and agitation — all of which increase cerebral blood flow or metabolic demand.
Clinical Manifestations
A change in level of consciousness is the earliest and most sensitive sign — restlessness, irritability, confusion, drowsiness — and it appears long before anything dramatic. Then headache worse in the morning and with coughing, projectile vomiting without nausea, pupil changes (sluggish, then unequal, then fixed and dilated on the side of the lesion), papilloedema, weakness and posturing — decorticate (arms flexed inward) is less ominous than decerebrate (arms extended). The Cushing triad — rising systolic pressure with a widening pulse pressure, bradycardia and irregular respirations — is a very late sign and means herniation is close.
Assessment and Diagnostic Findings
Serial neurological assessment: Glasgow Coma Scale, pupils, motor response and vital signs, at the ordered frequency and compared with the previous set. CT or MRI for the cause. Intracranial pressure monitoring by external ventricular drain, which both measures and treats, or an intraparenchymal monitor; calculate cerebral perfusion pressure. ABGs, electrolytes and osmolality, temperature, and glucose.
Medical Management
Head of bed elevated 30 degrees with the head midline to promote venous drainage. Osmotic therapy — mannitol or hypertonic saline — to pull fluid out of the brain. Sedation and analgesia; neuromuscular blockade in severe cases. Cerebrospinal fluid drainage via the ventricular drain. Controlled ventilation to maintain normal carbon dioxide; brief hyperventilation only as a rescue measure, because sustained hypocapnia causes ischemia. Treat fever and seizures aggressively. Corticosteroids for tumor-related edema, but not for traumatic brain injury. Decompressive craniectomy as a last resort.
Nursing Management and Client Education
Assess neurologically and report the trend, not just the number — a client who is a little harder to rouse than an hour ago is the finding that matters. Position: head of bed 30 degrees, head midline, neck neutral, hips not flexed more than 90 degrees. Avoid everything that raises pressure: clustering painful care together, suctioning for more than 10–15 seconds or without pre-oxygenation, straining, coughing, vomiting, and Valsalva. Space out interventions and give stool softeners, antiemetics and analgesia rather than letting these happen. Keep the environment quiet and calm and limit stimulation, but talk to the client before touching them, because hearing and awareness may persist. Maintain normothermia, treat fever promptly, and prevent seizures. Monitor fluid balance and osmolality closely on mannitol, and watch for dehydration and electrolyte shifts. Care for the ventricular drain exactly as protocol requires — level, clamp for transfers, strict asepsis. Support the family: they see restlessness as the client 'waking up' when it may be the opposite, and they need that explained gently.
Seizures and Status EpilepticusOpenClose
🖼️ InfographicsSeizures 2Seizures 1
Definition and Overview
A seizure is a sudden, abnormal, excessive electrical discharge in the brain. Epilepsy is the condition of recurrent unprovoked seizures. Broadly, focal seizures begin in one area, with or without impaired awareness, and generalized seizures involve both hemispheres from the start — including the tonic-clonic type and the brief absence seizures of childhood. Status epilepticus is a seizure lasting more than 5 minutes, or repeated seizures without recovery between, and it is an emergency.
Causes and Risk Factors
Idiopathic in many people. Otherwise: head injury, stroke, brain tumor, infection (meningitis, encephalitis), hypoxia, congenital malformation, and metabolic causes — hypoglycaemia, hyponatraemia, hypocalcaemia, uraemia and liver failure. Common triggers in a person with known epilepsy: missed medication (the single commonest cause of status epilepticus), sleep deprivation, alcohol or its withdrawal, illness and fever, flashing lights, and stress.
Clinical Manifestations
Often an aura first — a smell, taste, visual change or rising sensation — which is itself a focal seizure and a useful warning. Tonic-clonic: loss of consciousness, stiffening then rhythmic jerking, tongue biting, incontinence, and cyanosis, followed by a postictal phase of confusion, headache, deep sleep and muscle soreness that can last hours. Focal seizures with impaired awareness show as staring with automatisms — lip smacking, picking at clothes — and are often mistaken for daydreaming or intoxication. A postictal client who is confused and combative is not being difficult; they are still recovering, and restraining them is both unkind and dangerous.
Assessment and Diagnostic Findings
Describe the seizure precisely: what the client was doing beforehand, whether there was an aura, where the movement started and how it spread, whether the eyes deviated, the duration, incontinence, and the length and character of the postictal state. That description is worth more than any test. EEG, MRI or CT, glucose at the bedside, electrolytes, calcium, magnesium, renal and liver function, toxicology, and antiepileptic drug levels — a subtherapeutic level usually explains the breakthrough seizure.
Medical Management
Antiepileptic drugs chosen by seizure type: levetiracetam, lamotrigine, valproate, carbamazepine, phenytoin and others, aiming for monotherapy at the lowest effective dose. Treat metabolic causes. Status epilepticus: intravenous benzodiazepine first (lorazepam or midazolam), then a loading dose of an antiepileptic such as levetiracetam, fosphenytoin or valproate, with airway support, oxygen, glucose and thiamine, escalating to general anaesthesia if it continues. Surgery, vagus nerve stimulation or a ketogenic diet for refractory epilepsy.
Nursing Management and Client Education
During a seizure: stay with the client, turn them on their side, protect the head, loosen tight clothing, clear the area, and time it. Never put anything in the mouth, never restrain the limbs, and never try to stop the movements — you will cause injury and you will not shorten the seizure. Afterwards, keep them on their side, suction if needed, reorient gently, allow them to sleep, and document everything you observed. Seizure precautions: bed in the lowest position with rails padded and up, suction and oxygen at the bedside, and a saline lock rather than repeated needlesticks. Teaching is what prevents recurrence: take the medication exactly and never stop it abruptly — abrupt withdrawal causes status epilepticus; keep regular sleep; limit alcohol; know your triggers; carry medical identification; and understand the local driving restrictions, which is the loss clients feel most. Warn about specific drugs: phenytoin causes gum overgrowth (so meticulous oral care and dental visits) and interacts with a great many drugs; carbamazepine and valproate need blood counts and liver monitoring; several are teratogenic, so pregnancy needs planning in advance. Teach the family what to do and, just as importantly, what not to do.
🧠 Mind maps 6
One per disorder, built from the structure of your ATI chapter.
🩺 What you do
- Have the client avoid food and fluids for at least
6 hrbefore angiography. - Assess allergy history; a contrast allergy may need pretreatment with a steroid or antihistamine.
- Bleeding disorders or anticoagulant use call for extra monitoring for post-procedure clotting.
- Check BUN and creatinine to confirm the kidneys can clear the contrast dye.
💬 What you teach
- The head will be immobilized; the client must stay still throughout the procedure.
- Void immediately before the cerebral angiography procedure begins.
- Expect a metallic taste and a warm sensation right after dye injection.
⚠️ What goes wrong
- Cerebral angiography risks bleeding or hematoma at the arterial entry site.
- After angiography, check the site and distal pulses, color, and refill; apply pressure and notify the provider for bleeding.
- Before contrast or sedated CT, hold food and fluids
4 hr; shellfish allergy alone doesn't rule out iodine contrast. - Remove all metal objects before CT or MRI; the client wears a hospital gown.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎯 Who gets it
- Undertreatment risk factors: cultural attitudes, lack of knowledge, fear of addiction, and exaggerated fear of respiratory depression.
- Infants, children, older adults, and clients with substance use disorder face the highest risk of undertreated pain.
- Common pain causes include trauma, surgery, cancer, arthritis, fibromyalgia, and neuropathy.
- Cancer pain can stem from tumor invasion, nerve compression, bone metastases, infection, or immobility.
👀 What you see
- Nonverbal cues can supplement self-report: facial grimacing, restlessness, pacing, or guarding.
- Moaning, crying, and a shortened attention span can signal pain in nonverbal clients.
- Vital signs may rise briefly with acute pain but normalize even as pain continues.
- Because vital signs stabilize over time, they aren't a reliable long-term pain measure.
🩺 What you do
- Parenteral opioids suit immediate, short-term acute pain; oral suits stable chronic pain.
- Nonpharmacologic options, such as yoga, meditation, distraction, heat or cold, and TENS, can lower medication needs.
- The WHO analgesic ladder starts with nonopioids and progresses through weak to strong opioids as needed.
- Oral opioid dosing needs a higher dose than IV because less medication reaches the bloodstream.
⚠️ What goes wrong
- Undertreated pain can worsen anxiety with acute cases or fuel depression with chronic pain.
- Opioid overdose can cause sedation, respiratory depression, and coma.
- Identify clients at high risk for over-sedation, such as older adults.
- Titrate opioid doses carefully while closely monitoring respiratory status.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎯 Who gets it
- Viral meningitis follows viral illness (mumps, measles, herpes, West Nile); no vaccine exists
- Fungal meningitis (Cryptococcus neoformans) is a severe sinus-based infection
- Bacterial meningitis often follows infections like otitis media, pneumonia, or sinusitis
- Bacterial organisms: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae
👀 What you see
- Severe constant headache, nuchal rigidity, and photophobia are classic subjective complaints
- Fever, chills, nausea, and vomiting are common objective findings
- Altered consciousness ranges from confusion to lethargy, difficulty arousing, or coma
- Positive Kernig's sign: leg extension from flexed hip causes pain/resistance
🧪 What confirms it
- Culture/sensitivity of urine, throat, nose, blood guides antibiotic choice, not diagnostic alone
- CBC typically shows an elevated white blood cell count
- Lumbar puncture with CSF exam is the top test confirming meningitis
- Bacterial CSF: cloudy, high WBC/protein, low glucose, high pressure
🩺 What you do
- Isolate the client right away once meningitis is suspected; start droplet precautions
- Continue droplet precautions until 24 hr of antibiotics and secretions clear
- Report meningococcal cases to the public health department promptly
- Keep a quiet, dim environment with minimal stimuli; raise HOB to 30°
💊 Drugs
- Ceftriaxone or cefotaxime plus vancomycin covers bacterial meningitis until cultures return
- Antifungals treat fungal meningitis; antivirals treat viral meningitis
- Phenytoin is given for rising ICP or an active seizure
- Acetaminophen or ibuprofen treat headache and fever; avoid opioids that mask consciousness
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎯 Who gets it
- Genetic predisposition raises absence-seizure risk, especially in children
- Acute fever, head trauma, cerebral edema, and stroke (first 24 hr) can trigger seizures
- Abrupt AED discontinuation can cause rebound seizure activity
- Infection, metabolic imbalance, toxin exposure, and hypoxia are common causes
👀 What you see
- Generalized seizures affect both cerebral hemispheres; some start with an aura
- Tonic-clonic: brief muscle stiffening and loss of consciousness, then 1-2 min of rhythmic jerking
- Breathing can stop in the tonic phase and turn irregular, causing cyanosis
- A postictal period of confusion and sleepiness follows tonic-clonic seizures
🧪 What confirms it
- Check alcohol and illicit substance levels, HIV status, and toxin screening if indicated
- CBC, electrolytes, BUN, and glucose help rule out other causes
- EEG records brain electrical activity to pinpoint seizure origin
- MRI, CT/CAT, PET, CSF analysis, or skull x-ray can identify the cause
🩺 What you do
- Shield the client from onlookers while a seizure runs; dignity is part of seizure care.
- Position for a patent airway; suction secretions and turn the client onto their side
- Loosen tight clothing; never restrain the client or force the jaw open
- Never insert padded tongue blades or any object into the mouth
💊 Drugs
- AEDs like phenytoin aim to control seizures using one medication first
- If one AED fails, the dose is raised or another drug added
- Routine blood tests confirm therapeutic AED levels and medication adherence
💬 What you teach
- Take AEDs at the same time daily to boost their effectiveness
- Tolerance or age-related sensitivity may need more frequent level checks and dose changes
- Watch for drug-specific side effects and food or drug interactions
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎯 Who gets it
- Cluster headaches tend to peak during spring and fall
- Cluster headaches are more common in males aged 20-50
👀 What you see
- Migraines bring photophobia, phonophobia, nausea or vomiting, and unilateral pain behind the eye
- Migraine symptoms usually stay consistent and disrupt ADLs for 4-72 hr
- Classic migraine (with aura): prodrome of irritability, cravings, or GI change beforehand
- Aura stage brings numbness, tingling, confusion, and visual flashes over minutes to an hour
🧪 What confirms it
- Neuroimaging is warranted for neuro findings or new headaches after age 50
🩺 What you do
- Pain management is the main focus of care during a headache episode
- Keep the environment cool, dark, and quiet; raise the head of bed to 30°
- Give prescribed analgesics and antiemetics as ordered by the provider
💊 Drugs
- Abortive therapy works best during the aura or right after headache onset
- For mild migraine: NSAIDs, acetaminophen, or OTC migraine-formula anti-inflammatories
- Metoclopramide, an antiemetic, relieves migraine-related nausea and vomiting
- For severe migraine: triptans like zolmitriptan, sumatriptan, or eletriptan cause vasoconstriction
💬 What you teach
- Keep a headache diary of patterns and triggers; report new neuro changes
- Stay in a cool, dark, quiet room and elevate the head of bed
- Women over age 50 face higher cardiovascular and stroke risk
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎯 Who gets it
- Cerebral aneurysm or AV malformation increases hemorrhagic stroke risk.
- Higher stroke risk in Black American, Hispanic, Indigenous, and Alaska Native populations.
- A family history of stroke raises a person's overall risk.
- Age over
65years raises ischemic stroke risk.
👀 What you see
- Sudden stroke signs: severe headache, dizziness, gait or vision changes, confusion, slurred speech, unilateral numbness.
- TIA causes brief neuro deficits from focal ischemia without permanent damage.
- TIA symptoms resolve within
1-24 hourswith no lasting deficits. - Deficits are contralateral to the damaged hemisphere — left damage causes right-sided weakness.
🩺 What you do
- Priority: assess LOC, airway patency, vital signs, and circulation first.
- Check VS every
15 min to 2 hr; report BP over185/110 mm Hg. - Give oxygen to keep saturation above
94%or if LOC drops. - Place on a cardiac monitor and obtain a 12-lead ECG for dysrhythmias.
💊 Drugs
- Alteplase (tPA) dissolves clots; give within
3 to 4.5 hrof symptom onset. - Alteplase goal: administer within
45 minutesof ED arrival. - Alteplase is contraindicated with active bleeding; hold antiplatelets or anticoagulants
24 hrs. - Watch for alteplase adverse effects: hypotension, intracranial bleeding, bruising.
💬 What you teach
- Follow prescribed liquid and food consistency levels to reduce choking risk.
- Sit upright and tuck chin forward when swallowing to lower aspiration risk.
- Unilateral neglect means the client can't see, feel, or move the affected side.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎥 Lecture recordings 2
Tap a card to open that recording in Google Drive. The same list lives in the lecture library.
All NUR 258 recordings →🖼️ Infographics 18
Tap a card to open the matching graphics in your infographic library.
📄 Simple Nursing handouts for this module — 8 of them, straight from your Drive.
📋 Active Learning Templates 6
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
📋 Neurologic Diagnostic Procedures6 parts
🖼️ InfographicsFocused Neurological Assessment 2
Filled from ATI chapter 4, row by row from that chapter’s own sections — 12 of 12 rows have content.
8 rows came from outside your ATI chapter — 5 cite a source, 3 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- This chapter reviews neuro diagnostics: cerebral angiography, CT, EEG, the Glasgow Coma Scale, ICP monitoring, lumbar puncture, MRI, PET/SPECT, and x-ray, covering purpose, informed consent, prep, and nursing care before, during, and after each test.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Explain the procedure fully — neurological tests are frightening and much of the distress is avoidable.
- Screen for metal implants, pacemakers and pregnancy before MRI; the scanner magnet is always on.
- Check renal function and contrast allergy before contrast studies.
- Check anticoagulation and platelets before lumbar puncture.
- Establish a neurological baseline before the procedure, so any change afterwards is interpretable.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from StatPearls, 2025.
- About 10 to 40 percent of patients get a headache after a lumbar puncture, usually within two to three days.
- Choosing a small, non-cutting spinal needle of 24 gauge or smaller lowers that headache risk to roughly 2 percent.
- The headache is positional, easing when the patient lies flat and returning within minutes of sitting up.
- Most cases resolve on their own within one to two weeks with rest, fluids, and caffeine.
StatPearls (NCBI Bookshelf) · Postdural Puncture Headache · open the source →
Assessment — Expected Findings
Not in your ATI chapter — filled from MedlinePlus, 2025.
- Normal cerebrospinal fluid is clear and essentially free of cells, protein, and toxins.
- Cloudy or abnormal fluid can point to an infection, an autoimmune condition, or another disease of the brain or spinal cord.
MedlinePlus (National Library of Medicine) · Cerebrospinal Fluid (CSF) Analysis · open the source →
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not in your ATI chapter — filled from MedlinePlus, 2025.
- CSF analysis checks fluid drawn by spinal tap for infections such as meningitis and encephalitis, plus autoimmune disease, bleeding, or tumors.
- Collecting the sample during the lumbar puncture takes about five minutes, and the patient needs to stay still throughout.
- Providers usually order more tests to confirm a diagnosis rather than relying on the CSF result alone.
MedlinePlus (National Library of Medicine) · Cerebrospinal Fluid (CSF) Analysis · open the source →
Diagnostic Procedures
Not in your ATI chapter — filled from NINDS, 2026.
- EEG records the brain's electrical activity through scalp electrodes and usually takes about an hour to complete.
- A longer, sleep-based EEG of about four hours may be needed to capture a seizure that a routine study misses.
- Cerebral angiography injects dye into blood vessels to show aneurysms, malformations, and areas of narrowing or blockage in the brain.
NINDS (NIH) · Neurological Diagnostic Tests and Procedures · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Have the client avoid food and fluids for at least
6 hrbefore angiography. - Assess allergy history; a contrast allergy may need pretreatment with a steroid or antihistamine.
- Bleeding disorders or anticoagulant use call for extra monitoring for post-procedure clotting.
- Check BUN and creatinine to confirm the kidneys can clear the contrast dye.
- A mild sedative may be given; monitor vital signs continuously during the procedure.
- After the procedure, closely watch the insertion site to confirm clotting occurs.
- Restrict movement per the arterial closure method used to prevent rebleeding.
- Perform frequent neuro checks and vital sign monitoring after the procedure.
- Apply an ice pack to the insertion site.
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Sedation or anxiolysis for MRI in claustrophobia, with proper monitoring.
- Hold antiepileptics before EEG only if specifically instructed; usually they are continued.
- Avoid caffeine before EEG; sleep deprivation may be requested deliberately.
- Contrast agents — check allergy and renal function; hold metformin per policy.
- Analgesia for post-lumbar-puncture headache; a blood patch if it persists.
Therapeutic Procedures
Not in your ATI chapter — filled from NINDS, 2026.
- For a lumbar puncture the patient lies curled on one side or leans forward so a needle can pass between two vertebrae.
- A local anesthetic numbs the lower back before the needle is inserted to withdraw roughly three teaspoons of spinal fluid.
- The sample can help detect brain bleeding, infection, multiple sclerosis, metabolic disease, or other neurologic conditions.
NINDS (NIH) · Neurological Diagnostic Tests and Procedures · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
- The head will be immobilized; the client must stay still throughout the procedure.
- Void immediately before the cerebral angiography procedure begins.
- Expect a metallic taste and a warm sensation right after dye injection.
- A catheter goes into a groin or neck artery to inject dye and take x-rays.
- After imaging, the catheter is removed and pressure or a closure device seals the artery.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Neurologist and neuroradiologist for selection and interpretation.
- Radiology technologist for safety screening and positioning.
- Anesthesia where sedation is needed.
- Pharmacist for contrast interactions and antiepileptic timing.
- Rehabilitation team alerted early where results suggest a deficit.
⚠️ What goes wrongComplications
Complications
- Cerebral angiography risks bleeding or hematoma at the arterial entry site.
- After angiography, check the site and distal pulses, color, and refill; apply pressure and notify the provider for bleeding.
- Before contrast or sedated CT, hold food and fluids
4 hr; shellfish allergy alone doesn't rule out iodine contrast. - Remove all metal objects before CT or MRI; the client wears a hospital gown.
- EEG recording runs
45 to 120 min; wash hair first and skip caffeine, stimulants, or sedatives as directed. - Total GCS score equals eye plus verbal plus motor points; the highest possible score,
15, means full consciousness. - A GCS score under
8signals severe head injury and coma.
📋 Pain Management6 parts
Filled from ATI chapter 5, row by row from that chapter’s own sections — 12 of 12 rows have content.
8 rows came from outside your ATI chapter — 2 cite a source, 6 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- Chapter covers holistic pain management: nurses' duty to assess and treat pain using self-report as the gold standard, nociceptive versus neuropathic physiology, acute versus chronic patterns, and a focused assessment covering location, quality, intensity, timing, and aggravating or relieving factors.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Pain is what the client says it is. Believe the report; disbelief is the commonest barrier to treating it.
- Prevent rather than chase — scheduled analgesia for predictable pain, and premedication before painful procedures.
- Start a bowel regimen the same day an opioid starts.
- Screen for the beliefs that drive under-treatment: fear of addiction, of being a nuisance, and of masking a diagnosis.
- Multimodal analgesia lowers opioid requirement and side effects.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
- Undertreatment risk factors: cultural attitudes, lack of knowledge, fear of addiction, and exaggerated fear of respiratory depression.
- Infants, children, older adults, and clients with substance use disorder face the highest risk of undertreated pain.
- Common pain causes include trauma, surgery, cancer, arthritis, fibromyalgia, and neuropathy.
- Cancer pain can stem from tumor invasion, nerve compression, bone metastases, infection, or immobility.
- Diagnostic or treatment procedures, such as injections, intubation, or radiation, can also cause pain.
- Infants cannot verbalize pain; older adults often have several pain-causing conditions at once.
- Fatigue can heighten a client's sensitivity to pain.
- Genetic differences can raise or lower a person's pain tolerance.
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Nonverbal cues can supplement self-report: facial grimacing, restlessness, pacing, or guarding.
- Moaning, crying, and a shortened attention span can signal pain in nonverbal clients.
- Vital signs may rise briefly with acute pain but normalize even as pain continues.
- Because vital signs stabilize over time, they aren't a reliable long-term pain measure.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
- No laboratory test measures pain.
- Renal and hepatic function, since both change opioid and NSAID dosing.
- Acetaminophen level in suspected overdose; watch the total daily dose across combination products.
- CBC before NSAIDs where bleeding risk or low platelets are a concern.
- Urine drug screening where a monitoring agreement is in place — used to support care, never as a punishment.
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Structured assessment: site, quality, severity, timing, aggravating and relieving factors, and functional effect.
- A consistent scale used the same way each time; a behavioral tool where the client cannot self-report.
- Reassess after every intervention and document it.
- Distinguish nociceptive from neuropathic pain — burning, shooting and electric pain needs an adjuvant, not more opioid.
- Function is the better outcome: sleeping, walking, eating, and getting out of the chair.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Parenteral opioids suit immediate, short-term acute pain; oral suits stable chronic pain.
- Nonpharmacologic options, such as yoga, meditation, distraction, heat or cold, and TENS, can lower medication needs.
- The WHO analgesic ladder starts with nonopioids and progresses through weak to strong opioids as needed.
- Oral opioid dosing needs a higher dose than IV because less medication reaches the bloodstream.
- Acetaminophen must not exceed
4 gper day for clients50 kg (110 lb)or more. - Acetaminophen can be safely combined with NSAIDs since the two act by different mechanisms.
- "Narcotic" is not the same as "opioid"; severe-pain opioid effects are compared against morphine.
- Watch for and manage opioid adverse effects: constipation, orthostatic hypotension, urinary retention, nausea, and sedation.
- Sedation always precedes respiratory depression, so monitor level of consciousness closely.
Medications
Not in your ATI chapter — filled from StatPearls, 2023.
- Mild pain is treated first with a non-opioid such as an NSAID or acetaminophen, with or without an adjuvant drug.
- Moderate pain adds a weaker opioid like hydrocodone, codeine, or tramadol, often paired with a non-opioid agent.
- Severe pain calls for a stronger opioid such as morphine, oxycodone, fentanyl, or methadone.
- Adjuvant drugs such as antidepressants, anticonvulsants, topical anesthetics, and corticosteroids can boost pain control alongside the primary analgesic.
- The stepwise approach favors dosing on a fixed schedule and by the oral route whenever possible, moving up a step only as needed.
StatPearls (NCBI Bookshelf) · WHO Analgesic Ladder · open the source →
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2023.
- Patient-controlled analgesia lets the patient self-dose IV pain medication within limits set by the prescriber.
- A lockout interval blocks another dose for a set time after each button press, even if the patient tries again sooner.
- One- and four-hour dose caps alert staff when a patient's pain is not being controlled within the ordered limits.
- Nurses should reassess pain and sedation level every one to two hours for the first day or two of therapy.
- Only the patient should press the button; having a family member dose the pump for the patient raises the risk of overdose.
StatPearls (NCBI Bookshelf) · Patient-Controlled Analgesia · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Report pain early — it is easier to control before it is severe.
- Explain that addiction is uncommon when opioids treat real pain, and what tolerance and physical dependence actually mean.
- Constipation is expected with opioids and is prevented, not waited for.
- No alcohol or unprescribed sedatives with opioids; do not drive until the effect is known.
- Store opioids locked and dispose of leftovers properly — most misused prescription opioids come from a friend or relative’s cabinet.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Pain service or anesthesia for regional blocks and patient-controlled analgesia.
- Pharmacist for opioid rotation and equianalgesic conversion.
- Physiotherapy and occupational therapy — function and pain move together.
- Psychology for cognitive behavioral therapy, which has good evidence in chronic pain.
- Palliative care for complex pain, whatever the prognosis.
⚠️ What goes wrongComplications
Complications
- Undertreated pain can worsen anxiety with acute cases or fuel depression with chronic pain.
- Opioid overdose can cause sedation, respiratory depression, and coma.
- Identify clients at high risk for over-sedation, such as older adults.
- Titrate opioid doses carefully while closely monitoring respiratory status.
- Hold the opioid and give naloxone if breathing drops under
8/min, is shallow, or the client won't wake. - Monitor closely after giving naloxone; the opioid can outlast it, requiring repeat doses.
- Always determine the underlying cause whenever sedation occurs.
📋 Meningitis6 parts
Filled from ATI chapter 6, row by row from that chapter’s own sections — 12 of 12 rows have content.
4 rows came from outside your ATI chapter — 4 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- Meningitis inflames the meninges protecting the brain and spinal cord. Viral meningitis is common and self-limiting; fungal affects immunocompromised clients; bacterial meningitis is highly contagious with high mortality, requiring rapid diagnosis and vaccination-based prevention.
Health Promotion & Disease Prevention
- Hib vaccine: 4-dose series starting at 2 months, final dose at 12-15 months
- PPSV targets respiratory infection but also lowers CNS infection risk
- Vaccinate immunocompromised adults, those with chronic disease, smokers, and LTC residents
- Give one PPSV dose to unvaccinated adults over 65 with no prior disease
- MCV4 covers Neisseria meningitidis; give it before college dorm living
- Immunize other communal-living groups too, such as military recruits
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
- Viral meningitis follows viral illness (mumps, measles, herpes, West Nile); no vaccine exists
- Fungal meningitis (Cryptococcus neoformans) is a severe sinus-based infection
- Bacterial meningitis often follows infections like otitis media, pneumonia, or sinusitis
- Bacterial organisms: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae
- A weakened immune system (immunosuppression) raises meningitis risk considerably
- Direct spinal fluid contamination is a risk factor
- Invasive procedures, skull fracture, or penetrating wounds increase risk
- Overcrowded living environments raise the risk of transmission
Assessment — Expected Findings
- Severe constant headache, nuchal rigidity, and photophobia are classic subjective complaints
- Fever, chills, nausea, and vomiting are common objective findings
- Altered consciousness ranges from confusion to lethargy, difficulty arousing, or coma
- Positive Kernig's sign: leg extension from flexed hip causes pain/resistance
- Positive Brudzinski's sign: neck flexion causes involuntary hip and knee flexion
- Hyperactive deep tendon reflexes and tachycardia can occur
- Seizures and marked restlessness or irritability may also develop
- A red macular rash suggests meningococcal meningitis specifically
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
- Culture/sensitivity of urine, throat, nose, blood guides antibiotic choice, not diagnostic alone
- CBC typically shows an elevated white blood cell count
Diagnostic Procedures
- Lumbar puncture with CSF exam is the top test confirming meningitis
- Bacterial CSF: cloudy, high WBC/protein, low glucose, high pressure
- Viral meningitis CSF typically appears clear rather than cloudy
- CIE on CSF distinguishes viral from protozoal cause, especially if antibiotics were given first
- CT or MRI can reveal increased ICP or a brain abscess
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Isolate the client right away once meningitis is suspected; start droplet precautions
- Continue droplet precautions until 24 hr of antibiotics and secretions clear
- Report meningococcal cases to the public health department promptly
- Keep a quiet, dim environment with minimal stimuli; raise HOB to 30°
- Have the client avoid coughing or sneezing, which raise ICP; use seizure precautions
- Replace fluids and electrolytes per lab results; older adults risk secondary pneumonia
- Watch vital signs for septic shock and monitor for rising ICP
- For ICP: watch consciousness, pupils, and eye-movement changes; give IV mannitol
- SIADH risk: watch for dilute blood, concentrated urine, and daily weight gain
Medications
- Ceftriaxone or cefotaxime plus vancomycin covers bacterial meningitis until cultures return
- Antifungals treat fungal meningitis; antivirals treat viral meningitis
- Phenytoin is given for rising ICP or an active seizure
- Acetaminophen or ibuprofen treat headache and fever; avoid opioids that mask consciousness
- Ciprofloxacin, rifampin, or ceftriaxone are given prophylactically to close contacts
- Dexamethasone or prednisone corticosteroids are given to reduce inflammation
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2023.
- Anyone suspected of having bacterial meningitis should get a lumbar puncture to collect CSF for gram stain, culture, cell count, glucose, and protein.
- Bacterial meningitis typically shows low glucose, high protein, and a high neutrophil count on the CSF sample.
- A gram stain or positive culture from the CSF confirms the diagnosis and guides antibiotic choice.
StatPearls (NCBI Bookshelf) · Bacterial Meningitis · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not in your ATI chapter — filled from CDC, 2026.
- Routine meningococcal conjugate vaccination is recommended for all preteens and teens as part of the standard immunization schedule.
- A meningococcal B vaccine series is also available and may be recommended for certain higher-risk patients.
- Vaccination greatly lowers risk but cannot prevent every case, so patients should still seek care promptly for fever, headache, or stiff neck.
- Mild, temporary side effects such as soreness lasting one to five days are common after vaccination.
Centers for Disease Control and Prevention · Meningococcal Vaccination · open the source →
Interprofessional Care
Not in your ATI chapter — filled from CDC, 2024.
- Patients with known or suspected meningococcal meningitis are placed on droplet precautions until they have had 24 hours of effective antibiotics.
- Staff who were within about three feet of the patient for more than eight hours need preventive antibiotics regardless of vaccination status.
- Preventive antibiotics such as rifampin, ciprofloxacin, or ceftriaxone are most effective when started within 24 hours of exposure.
- Infectious disease specialists, emergency physicians, laboratory staff, and nursing work together so antibiotics start without waiting on culture results.
Centers for Disease Control and Prevention · Meningococcal Disease | Infection Control · open the source →
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2023.
- Roughly one in four people with meningococcal disease develops a lasting complication.
- Documented after-effects include seizures, hearing loss, vision loss, and problems with memory, balance, coordination, or speech.
- Bacterial meningitis carries a mortality rate of about 10 to 15 percent.
- Delayed treatment can let intracranial pressure rise and reduce blood flow to the brain, which can be fatal.
StatPearls (NCBI Bookshelf) · Bacterial Meningitis · open the source →
📋 Seizures and Epilepsy6 parts
Filled from ATI chapter 7, row by row from that chapter’s own sections — 12 of 12 rows have content.
2 rows came from outside your ATI chapter — 2 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- Seizures are sudden abnormal brain electrical discharges causing altered consciousness or motor/sensory changes; epilepsy means recurrent unprovoked seizures. This chapter covers seizure types, triggers, safety care, medications, surgical options, and status epilepticus.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from CDC, 2024.
- Preventing head injury lowers epilepsy risk — using seat belts, car seats, helmets, and fall precautions all help.
- Managing stroke risk through a healthy diet, activity, not smoking, and limiting alcohol also lowers epilepsy risk since stroke can trigger it.
- Cysticercosis, a preventable parasitic infection, is the leading cause of epilepsy worldwide and is avoided through handwashing and safe food and water.
- Staying current on recommended vaccines helps prevent infections that can lead to seizures and epilepsy.
- Following a prenatal care plan helps prevent epilepsy linked to pregnancy or birth complications.
Centers for Disease Control and Prevention · Preventing Epilepsy · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
- Genetic predisposition raises absence-seizure risk, especially in children
- Acute fever, head trauma, cerebral edema, and stroke (first 24 hr) can trigger seizures
- Abrupt AED discontinuation can cause rebound seizure activity
- Infection, metabolic imbalance, toxin exposure, and hypoxia are common causes
- Brain tumors and fluid or electrolyte imbalances can also trigger seizures
- In older adults, cerebrovascular disease raises seizure risk considerably
- Hormonal shifts with menses or pregnancy can change seizure patterns
- Common triggers: intense activity, stress, hyperventilation, fatigue, alcohol, and excess caffeine
Assessment — Expected Findings
- Generalized seizures affect both cerebral hemispheres; some start with an aura
- Tonic-clonic: brief muscle stiffening and loss of consciousness, then 1-2 min of rhythmic jerking
- Breathing can stop in the tonic phase and turn irregular, causing cyanosis
- A postictal period of confusion and sleepiness follows tonic-clonic seizures
- Tonic seizures: sudden loss of consciousness with increased muscle tone only
- Myoclonic seizures: brief, symmetric or asymmetric jerking or stiffening of limbs
- Atonic/akinetic seizures: seconds of lost muscle tone, often causing falls
- Absence seizures: 5-10 second lapses in consciousness, minimal motor activity, often clustered
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
- Check alcohol and illicit substance levels, HIV status, and toxin screening if indicated
- CBC, electrolytes, BUN, and glucose help rule out other causes
Diagnostic Procedures
- EEG records brain electrical activity to pinpoint seizure origin
- MRI, CT/CAT, PET, CSF analysis, or skull x-ray can identify the cause
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Shield the client from onlookers while a seizure runs; dignity is part of seizure care.
- Position for a patent airway; suction secretions and turn the client onto their side
- Loosen tight clothing; never restrain the client or force the jaw open
- Never insert padded tongue blades or any object into the mouth
- Document seizure onset, duration, consciousness, apnea, cyanosis, motor activity, and incontinence
- Postictal: keep the client side-lying, check vitals, assess injuries, do neuro checks
- Ask about an aura afterward — it can hint at seizure origin
- In status epilepticus: secure the airway, give oxygen, get IV access and an ECG
- Give IV diazepam or lorazepam, then IV phenytoin or fosphenytoin
Medications
- AEDs like phenytoin aim to control seizures using one medication first
- If one AED fails, the dose is raised or another drug added
- Routine blood tests confirm therapeutic AED levels and medication adherence
Therapeutic Procedures
- Vagal nerve stimulation treats focal seizures unresponsive to medication therapy
- The device implants in the left chest wall, wired to the left vagus nerve
- It delivers programmed intermittent brain stimulation tailored to the client's needs
💬 Around the patientClient Education · Interprofessional Care
Client Education
- Take AEDs at the same time daily to boost their effectiveness
- Tolerance or age-related sensitivity may need more frequent level checks and dose changes
- Watch for drug-specific side effects and food or drug interactions
- Some AEDs cause gum overgrowth — stress routine oral hygiene and dental visits
- Phenytoin lowers oral contraceptive effectiveness — advise backup birth control
- Several AEDs reduce warfarin absorption and speed its metabolism, weakening anticoagulation
- Antiseizure drugs raise birth-defect risk — pregnant clients should consult their provider
Interprofessional Care
- Refer clients to community resources like the Epilepsy Foundation
- For school-age children, involve the disability office to arrange an IEP
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from CDC, 2024.
- Sudden unexpected death in epilepsy (SUDEP) affects about 1 in 1,000 adults with epilepsy each year, and about 1 in 4,500 children.
- The strongest risk factors are generalized seizures and seizures that are frequent or poorly controlled.
- SUDEP most often occurs during sleep, from a combination of breathing pauses and dangerous heart rhythm changes during a seizure.
- Taking antiseizure medication consistently is described as the most important step a patient can take to lower SUDEP risk.
Centers for Disease Control and Prevention · Sudden Unexpected Death in Epilepsy · open the source →
📋 Headaches6 parts
Filled from ATI chapter 12, row by row from that chapter’s own sections — 12 of 12 rows have content.
3 rows came from outside your ATI chapter — 1 cite a source, 2 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- Headaches range from primary (migraine, tension, cluster — no organic cause) to secondary (tumor, aneurysm — needs workup). This chapter details migraine and cluster headache patterns, triggers, diagnostics, pain management, medications, and prevention.
Health Promotion & Disease Prevention
- Teach stress-management strategies and how to recognize headache triggers
- A headache diary helps track type and response to treatment
- Hand hygiene helps prevent viral illness that mimics cold symptoms
- Review OTC medications and herbal remedy options for pain control
- Common triggers: alcohol, allergies, strong odors, bright light, medication overuse
- Other triggers: fatigue, sleep loss, depression, stress, anxiety, hormone shifts
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
- Cluster headaches tend to peak during spring and fall
- Cluster headaches are more common in males aged 20-50
Assessment — Expected Findings
- Migraines bring photophobia, phonophobia, nausea or vomiting, and unilateral pain behind the eye
- Migraine symptoms usually stay consistent and disrupt ADLs for 4-72 hr
- Classic migraine (with aura): prodrome of irritability, cravings, or GI change beforehand
- Aura stage brings numbness, tingling, confusion, and visual flashes over minutes to an hour
- Second stage: severe throbbing pain with nausea, vomiting, drowsiness, and vertigo over hours
- Common migraine (no aura): unilateral pulsating pain worsened by activity for 4-72 hr
- Older adults may get a visual aura with no pain, called a visual migraine
- Status migrainosus is a headache lasting more than 72 hr
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
- No routine bloods — primary headache is a clinical diagnosis.
- ESR and CRP in anyone over 50 with a new headache — giant cell arteritis.
- Lumbar puncture where subarachnoid hemorrhage or meningitis is suspected and imaging is normal.
- Electrolytes, glucose and toxicology for headache with confusion.
- A sudden, worst-ever, thunderclap headache is imaged and investigated, never treated as migraine.
Diagnostic Procedures
- Neuroimaging is warranted for neuro findings or new headaches after age 50
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Pain management is the main focus of care during a headache episode
- Keep the environment cool, dark, and quiet; raise the head of bed to 30°
- Give prescribed analgesics and antiemetics as ordered by the provider
Medications
- Abortive therapy works best during the aura or right after headache onset
- For mild migraine: NSAIDs, acetaminophen, or OTC migraine-formula anti-inflammatories
- Metoclopramide, an antiemetic, relieves migraine-related nausea and vomiting
- For severe migraine: triptans like zolmitriptan, sumatriptan, or eletriptan cause vasoconstriction
- Ergotamine combined with caffeine narrows blood vessels and reduces inflammation
- Isometheptene combination drugs are used when other options fail
- Preventive therapy: NSAID plus a beta-blocker, calcium channel blocker, or AED
- Check pulse when taking beta-blockers or calcium channel blockers for prevention
Therapeutic Procedures
- Home oxygen at 12 L/min for 15-20 min can relieve cluster pain within 15 min
💬 Around the patientClient Education · Interprofessional Care
Client Education
- Keep a headache diary of patterns and triggers; report new neuro changes
- Stay in a cool, dark, quiet room and elevate the head of bed
- Women over age 50 face higher cardiovascular and stroke risk
- Avoid tyramine foods like pickles, caffeine, beer, wine, aged cheese, processed meats
- Estrogen, nitroglycerin, and nifedipine are medications that can trigger migraines
- Manage anger and conflict, get enough sleep, and avoid light glare
- Track your menstrual cycle — hormone shifts around menses can trigger migraines
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Neurologist for refractory or atypical headache and for preventive therapy.
- Pharmacist — medication overuse headache is common and is caused by the treatment.
- Psychology for cognitive behavioral therapy and biofeedback, which have real evidence.
- Physiotherapy for cervicogenic headache.
- Ophthalmology where visual symptoms or raised intracranial pressure are suspected.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2025.
- Using simple pain relievers or NSAIDs on 15 or more days a month can itself trigger medication overuse headache.
- Using combination analgesics, triptans, ergots, or opioids on just 10 or more days a month carries the same risk.
- The pattern is diagnosed when headaches occur 15 or more days a month for over three months in someone with an existing headache disorder.
- Complete withdrawal of the overused medication gives the best outcome, though about half of patients relapse within five years.
- Withdrawal can bring on nausea, anxiety, irritability, restlessness, and trouble concentrating for a time.
StatPearls (NCBI Bookshelf) · Medication Overuse Headache · open the source →
📋 Stroke6 parts
Filled from ATI chapter 16, row by row from that chapter’s own sections — 12 of 12 rows have content.
3 rows came from outside your ATI chapter — 3 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- Covers stroke pathophysiology, hemorrhagic vs. ischemic types, risk factors, and FAST recognition, plus emergency nursing priorities, thrombolytic and anticoagulant therapy, surgical options, and rehabilitation needs for post-stroke deficits like aphasia and neglect.
Health Promotion & Disease Prevention
- Hypertension, diabetes, and smoking raise stroke risk — treat early to reduce it.
- Control blood pressure, keep glucose in target range, and quit smoking to lower risk.
- Maintain a healthy weight and exercise regularly to reduce stroke risk.
- Use FAST to screen for stroke: face drooping, arm drift, slurred speech, time to call 911.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
- Cerebral aneurysm or AV malformation increases hemorrhagic stroke risk.
- Higher stroke risk in Black American, Hispanic, Indigenous, and Alaska Native populations.
- A family history of stroke raises a person's overall risk.
- Age over
65years raises ischemic stroke risk. - Diabetes mellitus and obesity are both modifiable risk factors.
- Untreated sleep apnea also contributes to stroke risk.
- Hypertension, atherosclerosis, and hyperlipidemia are major vascular risk factors.
- Hypercoagulable states such as sickle cell disease raise clot risk.
Assessment — Expected Findings
- Sudden stroke signs: severe headache, dizziness, gait or vision changes, confusion, slurred speech, unilateral numbness.
- TIA causes brief neuro deficits from focal ischemia without permanent damage.
- TIA symptoms resolve within
1-24 hourswith no lasting deficits. - Deficits are contralateral to the damaged hemisphere — left damage causes right-sided weakness.
- Aphasia types: expressive (cannot speak) and receptive (cannot understand language).
- Agnosia is failure to recognize familiar objects; alexia is trouble reading.
- Agraphia is difficulty writing; apraxia is inability to follow simple commands.
- Ataxia causes poor coordination and balance loss after stroke.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not in your ATI chapter — filled from AHA/ASA, 2023.
- Stroke workup includes blood tests along with the medical history and neurologic exam, though the page does not name a specific required panel.
- Results from laboratory testing are combined with imaging findings rather than used alone to confirm a stroke diagnosis.
American Stroke Association · Common Diagnosis Methods · open the source →
Diagnostic Procedures
Not in your ATI chapter — filled from AHA/ASA, 2023.
- CT and MRI scans are the primary imaging tools used to diagnose stroke.
- MRI gives a sharper, more detailed picture of brain injury than CT.
- Electrical tests such as EEG and evoked response testing, plus blood-flow tests like ultrasound and angiography, may add further diagnostic detail.
American Stroke Association · Common Diagnosis Methods · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Priority: assess LOC, airway patency, vital signs, and circulation first.
- Check VS every
15 min to 2 hr; report BP over185/110 mm Hg. - Give oxygen to keep saturation above
94%or if LOC drops. - Place on a cardiac monitor and obtain a 12-lead ECG for dysrhythmias.
- Watch for rising ICP signs like decreasing level of consciousness.
- Check glucose; hyperglycemia is linked to worse neurologic outcomes.
- Elevate head of bed to
30°and keep neck midline to lower ICP. - Start seizure precautions and perform frequent neurologic status checks.
- NIHSS score of
10or higher suggests a severe stroke.
Medications
- Alteplase (tPA) dissolves clots; give within
3 to 4.5 hrof symptom onset. - Alteplase goal: administer within
45 minutesof ED arrival. - Alteplase is contraindicated with active bleeding; hold antiplatelets or anticoagulants
24 hrs. - Watch for alteplase adverse effects: hypotension, intracranial bleeding, bruising.
- Warfarin targets INR
2 to 3for atrial fibrillation-related stroke prevention. - Anticoagulant therapy is avoided for clients with hemorrhagic stroke.
- DOACs (dabigatran, apixaban, rivaroxaban) are alternatives to warfarin for afib.
- Low-dose aspirin given within
24 to 48 hrafter ischemic stroke prevents further clots.
Therapeutic Procedures
- Thrombolytic therapy must start within
6 hrof symptom onset. - Thrombolytics are contraindicated in hemorrhagic stroke or high bleeding risk.
- MRI rules out hemorrhage before starting thrombolytic therapy.
- Thrombectomy to remove the clot can be mechanical, endovascular, or intra-arterial.
- Carotid angioplasty with stenting places a stent via femoral catheter access.
- Stenting causes less blood loss and a shorter hospital stay than endarterectomy.
💬 Around the patientClient Education · Interprofessional Care
Client Education
- Follow prescribed liquid and food consistency levels to reduce choking risk.
- Sit upright and tuck chin forward when swallowing to lower aspiration risk.
- Unilateral neglect means the client can't see, feel, or move the affected side.
- Neglect raises injury risk and creates a self-care deficit on that side.
- Dress and care for the affected side of the body first each time.
- Pull the affected limb to midline to protect it from the wheelchair.
- Periodically look toward the affected side to stay aware of it.
Interprofessional Care
- Stroke team includes neurologist, social worker, rehab coordinators, psychologist, PT/OT, SLP, dietitian, pharmacist.
- SLP provides language therapy and helps manage swallowing difficulties.
- PT rebuilds ambulation using canes, walkers, or wheelchair adaptations.
- OT restores hand and arm function; recommends massage or gloves if it doesn't return.
- Social services arrange rehab placement and evaluate home safety needs before discharge.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from AHA/ASA, 2023.
- Reduced mobility and swallowing trouble after stroke can let material enter the lungs and cause pneumonia.
- Immobility after stroke raises the risk of deep vein thrombosis from blood pooling in the leg veins.
- Seizures are described as common after larger strokes because of abnormal electrical activity in the injured brain tissue.
- Post-stroke depression is a treatable complication that can be more severe in patients with a prior history of depression.
- Prolonged pressure from immobility after a stroke can lead to skin breakdown and pressure injuries.
American Stroke Association · Let's Talk About Complications After Stroke · open the source →
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
- Normal ICP
10–15 mmHg; normal CPP>50 mmHg; CPP = MAP − ICP. Rising ICP drops CPP and starves the brain. - Mannitol and 3% saline pull fluid off the brain; confirm mannitol is working by increased urine output. Never Trendelenburg with raised ICP.
- GCS: eye 1–4, verbal 1–5, motor 1–6. Max 15, min 3. GCS ≤8 → intubate.
- Non-contrast CT within 25 minutes of arrival decides ischemic vs hemorrhagic and t-PA candidacy. CT first acutely; MRI is better detail but too slow for the emergency.
- Ischemic stroke ~
87%, hemorrhagic ~13%. t-PA window3–4.5 hrfrom symptom onset. Contraindicated with anticoagulants, SBP >180, recent bleed or surgery, age under 18, or abnormal glucose. Not a candidate → heparin drip. - Hemorrhagic: "worst headache of my life." No t-PA ever. Lower the BP, check and reverse coags, then surgical evacuation. Always ask when the symptoms started.
- Carotid endarterectomy removes plaque (>70% blockage, or >50% with TIAs). Post-op watch for HTN, neck swelling, hoarseness. Stroke care: VS
q1–2 hr, notify for SBP >180 or DBP >110, keep SpO2 >92%. - Seizures: protect the airway, turn her to the side, time it, pad the head. Never restrain, never put anything in the mouth. Status epilepticus (>5 min, or repeated without recovery) → IV lorazepam first, then fosphenytoin or levetiracetam.
- Migraine POUND: Pulsating, One-day duration (4–72 hr), Unilateral, Nausea, Disabling. Triptans/NSAIDs acutely, beta blockers to prevent.
- Posturing scores on GCS motor: decorticate = 3, decerebrate = 2. Scale runs
3–15— "an object gets 3." Eye 4, verbal 5, motor 6. ≤8: sedate and intubate. A drop from 14 to 10 is the reportable event. - With posturing and high ICP, elevate the HOB to 30° first — it takes seconds, and mannitol has to be fetched and mixed.
- Mannitol and 3% saline are interchangeable as osmotic options on their items.
- ICP hyperventilation target: PaCO2
30–35(normal 35–45) → cerebral vasoconstriction → less volume. - Hematoma pattern recognition — Epidural: arterial, temple blow, brief LOC then lucid then decline, burr holes. Subdural: crescent-shaped, elderly / alcohol / anticoagulated, confusion and unsteadiness over 3–5 days, may recall a bump a week ago. Subarachnoid: berry aneurysm (~1% of people), thunderclap "worst headache of my life," photophobia; calcium channel blockers for vasospasm.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Nothing here yet — drop it in when you have it