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NCLEX PART 2

CH 06. Neurological & Musculoskeletal

Neuro changes are subtle but deadly.
The earliest sign of brain trouble is NOT a coma—it's a slight change in behavior (LOC).

For MSK, remember: Pain unrelieved by medication is a huge red flag for Compartment Syndrome.
Let's protect the brain and save the limbs!

1. Increased ICP (The Silent Killer)

Pressure inside the skull is rising. You must intervene before brain herniation occurs.

Sign / Symptom Description & Nursing Action
Early Signs
(Watch closely!)		 - Change in LOC (Level of Consciousness): Restlessness, confusion, irritability.
- Headache.
- Pupillary changes (Slow reaction).
Late Signs
(Emergency!)		 - Cushing's Triad (Systolic BP ↑, HR ↓, RR ↓/Irregular).
- Posturing: Decorticate (Arms to core) / Decerebrate (Arms extended - Worse!).
- Projectile Vomiting.
Interventions - Elevate HOB 30° (Promote venous drainage).
- Keep head midline (No neck flexion).
- Administer Mannitol (Osmotic diuretic).
- Avoid: Coughing, straining (Valsalva), suctioning (limit to 10s).

2. Seizures & Stroke (CVA)

① Seizure Precautions

  • During Seizure:
    - Turn client to the side (Aspiration prevention).
    - Protect head, loosen clothing.
    - DO NOT insert anything into the mouth.
    - DO NOT restrain.

② Stroke (CVA)

  • Priority Action:
    Get a CT Scan immediately to rule out Hemorrhagic Stroke before giving tPA (Clot buster).
  • Communication (Aphasia):
    - Expressive (Broca's): Understands but can't speak. Use Yes/No questions.
    - Receptive (Wernicke's): Can't understand. Speak slowly, use gestures.

3. Musculoskeletal: Fractures & Traction

① Compartment Syndrome ★High Yield

Pressure builds up within the muscle fascia, cutting off blood flow.

  • The 6 P's:
    1. Pain (Unrelieved by meds - Early & Key sign!)
    2. Paresthesia (Tingling)
    3. Pallor (Pale)
    4. Pressure
    5. Paralysis
    6. Pulselessness (Late sign)
  • Action:
    Notify MD immediately. Prepare for Fasciotomy (Surgery to cut fascia).
    Do NOT elevate above heart level.

② Traction Care

  • Weights:
    Weights must hang freely. They should never touch the floor.
  • Pin Care:
    Monitor for infection (Purulent drainage, Redness).
    Clean pins according to protocol (usually Chlorhexidine).

Neuro Tip: LOC is the most sensitive indicator.
MSK Tip: "Pain out of proportion to injury" = Compartment Syndrome.
Next, we move to the Endocrine, GI, and Renal systems!

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