Neurological and Musculoskeletal Adult Nursing
Key Takeaways
- Stroke: FAST screening, check glucose, urgent CT, NPO until swallow evaluation, neuro checks.
- Increased ICP: Cushing triad late sign; avoid hypotonic fluids and neck strain.
- Seizure: protect head, time event, lateral position after, no restraint during convulsion.
- Compartment syndrome: pain out of proportion, pallor, paresthesia—surgical emergency.
- Post-hip replacement: DVT prophylaxis and hip precautions per surgical approach.
Quick Answer: SNLE neuro-musculoskeletal items test stroke FAST response, seizure first aid, increased ICP signs, spinal cord injury precautions, fracture and joint replacement care, and compartment syndrome—prioritize neurologic decline and limb-threatening ischemia.
Neurological and Musculoskeletal Adult Nursing
Neurologic emergencies are time-critical; orthopedic complications are limb-threatening. Adult Nursing stems combine Glasgow Coma Scale trends, motor/sensory checks, and mobility safety in rehabilitation wards common in Saudi tertiary hospitals.
Acute Ischemic Stroke
Time last known well determines thrombolysis eligibility. Nursing: FAST screening, glucose check (hypoglycemia mimics stroke), NPO pending swallow screen, head of bed 30 degrees unless hypotensive, frequent neuro checks, prepare for CT without delay.
Hemorrhagic stroke: sudden worst headache, hypertension—lower BP cautiously per protocol; no thrombolysis.
Increased Intracranial Pressure
| Sign | Mechanism |
|---|---|
| Headache, vomiting | Rising pressure |
| Pupil changes | CN III compression |
| Cushing triad | Late—wide pulse pressure, bradycardia, irregular respirations |
| Decorticate/decerebrate posturing | Brainstem involvement |
Avoid neck flexion, excessive stimulation, hypotonic fluids; maintain PaCO2 normocapnia per ventilator goals.
Seizure Nursing
Protect head, do not restrain, note time, turn to side after convulsion, suction if needed, benzodiazepine per protocol if prolonged >5 min (status). Document postictal state. Teach medication adherence and trigger avoidance.
Spinal Cord Injury
Immobilization until cleared, log-roll, monitor neuro level, autonomic dysreflexia in T6 and above—sudden hypertension, headache, bladder distension—sit upright, loosen clothes, check catheter, notify provider.
Fractures and Joint Replacement
Neurovascular checks: pain, pallor, pulselessness, paresthesia, paralysis—compartment syndrome is surgical emergency. Post-TKR/THR: DVT prophylaxis, early mobilization per protocol, hip precautions (no flexion past 90 degrees, no internal rotation adduction for posterior approach hip).
Musculoskeletal Chronic Conditions
Rheumatoid arthritis: morning stiffness, joint protection, biologic infection screening.
Osteoporosis: fall prevention, calcium/vitamin D, hip protector education—relevant for postmenopausal Saudi women with vitamin D deficiency prevalence.
Traumatic Brain Injury
GCS every hour initially, watch for epidural hematoma lucid interval, avoid sedatives masking neuro changes unless intubated.
Worked Scenario
Post-TKR day 1, calf pain, foot pale, pain unrelieved by opioids, compartment pressure concern. Stop passive ROM, elevate leg at heart level not above (debated—follow policy), notify surgeon emergently, prepare fasciotomy.
Traps
- Thrombolysis clock ignored
- Restraining active seizure patient
- Flexing hip past precautions after THR
Final Check
State FAST components, Cushing triad elements, and five P's of neurovascular compromise.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
Saudi clinical vignettes may include heat-related fluid shifts, dust-storm respiratory triggers, and SFDA medication naming—always cluster assessment data before selecting an answer.
SNLE cardiovascular and respiratory items frequently test first nursing actions before physician notification when standing protocols authorize nurse-initiated care in MOH hospitals.
Adult Nursing domain items at forty percent weight make system-based med-surg review the highest return on study time for Prometric SNLE Part 1 and Part 2.
A patient arrives within ninety minutes of sudden left-sided weakness and slurred speech. Blood glucose is normal. What is the priority nursing action after ABC stabilization?
Which finding cluster suggests developing compartment syndrome in a casted limb?
A patient with T6 spinal cord injury develops sudden severe headache and blood pressure 210/120 with bradycardia. What is the first nursing action?