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Registered Nurse (RN)
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HESI®
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HESI®-RN Comprehensive Review
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Neurologic System

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HESI®-RN Comprehensive Review | Registered Nurse (RN) School Study Aid

Neurologic System
61 Picmonics to Learn | 2 hrs 6 mins
Primary Open-Angle Glaucoma (POAG - Chronic)
Mechanism
Flow of Aqueous Humor Slowed
Signs and Symptoms
Slow Onset
No Pain
Tunnel Vision
IOP 22-32mm Hg
Considerations
Drug Therapy
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1 min
Primary Angle-Closure Glaucoma (PACG - Acute)
Mechanism
Rapid Increase in IOP
Signs and Symptoms
Rapid Onset
Pain
Blurred Vision
Halos Around Lights
Nausea and Vomiting
IOP over 30 mm Hg
Considerations
Drug Therapy
Surgery
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1 min
Eye
Characteristics
Sclera
Cornea
Iris
Lens
Ciliary Muscles
Optic Nerve
Rods
Cones
Retina
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1 min
Eye Assessment
Inspect External Structures
Eye and Eyebrow Symmetry
Eyeball Alignment
Inspect Eyeball Structures
Examine Cornea and Lens for Cloudiness
Iris and Pupil Shape and Size
Pupillary Light Reflex and Accommodation
P.E.R.R.L.A
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2 mins
Eye Medication Administration
Procedure
Supine with Neck Hyperextended
Wash Away Crusts
Cotton Ball on Cheekbone
For Ophthalmic Drops
Instill Drops into Conjunctival Sac
Repeat if Missed or Patient Blinks
5 Minutes Before 2nd Medication
For Ophthalmic Ointment
Thin Stream Along Inner Edge
Inner Canthus to Outer Canthus
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2 mins
Care for the Visually Impaired
Assessment
Decreased Visual Acuity
Snellen Chart
Status of Corrective Lenses
Nursing Considerations
Sighted-Guide Technique
Communication
Safe Environment
Medications
Clock Technique for Food
Activities of Daily Living (ADL)
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1 min
Cataract
Mechanism
Age-related
Assessment
No Pain
Cloudy Opaque Lens
Decreased Visual Acuity
Occurs Gradually
Treatment
Surgery
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1 min
Common Eye Disorders
Common Eye Disorders
Conjunctivitis
Refractive Errors
Presbyopia
Cataract
Glaucoma
Uveitis
Age-Related Macular Degeneration
Diabetic Retinopathy
Retinal Detachment
Leukocoria
Cranial Nerve Palsies
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4 mins
Pilocarpine (Pilocar)
Mechanism
Direct Cholinergic Agonist
Contracts Iris Sphincter
Contracts Ciliary Muscle
Indications
Xerostomia
Glaucoma
Side Effects
Detached Retina
Decreased Visual Acuity
Eye Irritation
Cholinergic Effects
Considerations
Avoid with Asthma or Bradycardia
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2 mins
Systemic Effects of Beta-Blockers
Respiratory
Bronchoconstriction
Metabolic
Decreased Insulin
Decreased Glycolysis and Lipolysis
Eye
Reduces Intraocular Pressure
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1 min
Carboprost (Hemabate)
Mechanism
Prostaglandin F2-alpha Analog
Smooth Muscle Contraction
Indications
Postpartum Hemorrhage
Abortion
Side Effects
GI Distress
Hypertension
Fever
Bronchoconstriction
Considerations
Identify Cause of Fever
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2 mins
Preoperative Care
Preop Education
Surgical Procedure
NPO
Turn, Cough, Deep Breathe, Incentive Spirometer
Lower Extremity Exercises
Compression Stockings or SCD's
Pain Management
Safety
Informed Consent
Physical Preparation
Preop Checklist
Handoff to Surgery
Universal Precautions
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2 mins
External Eye Abnormalities
Extraocular Muscle Dysfunction
Strabismus
Eyelid Abnormalities
Exophthalmos
Ptosis
Ectropion
Entropion
eyelid lesions
Blepharitis
Dacryocystitis
Hordeolum (Stye)
Chalazion
Pupil Abnormalities
Anisocoria
Mydriasis
Miosis
Abnormalities on Cornea and Iris
Pterygium
Hyphema
Hypopyon
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4 mins
Internal Eye Abnormalities
Lens Opacities
Nuclear Cataract
Cortical Cataract
Optic Disc Abnormalities
Papilledema
Optic Atrophy
Excessive Cup-Disc Ratio
Visual Field Loss
Macular Degeneration
Scotomas
Increased Ocular Pressure
Retinal Detachment
Optic Tract Lesions
Vascular Abnormalities of the Retina
Arteriovenous Crossing
Attenuated Arteries
Diabetic Retinopathy
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4 mins
Detached Retina
Assessment
Flashes of Light
Floaters
Curtain Like Shadow
Interventions
Eye Patch
Bed Rest
Surgical Emergency
Considerations
No Vigorous Activity
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2 mins
Ear Assessment
EXTERNAL EAR
Inspect Position and Symmetry
Inspect for Lesions, Drainage, Nodules or Redness
Inspect Opening of Ear Canal
OTOSCOPIC EXAMINATION
Insert Speculum
Position Scope
View Structures
Light Reflect
HEARING ACUITY TESTS
Whisper Test
Weber’s Test
Rinne Test
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4 mins
Care for the Hard of Hearing
Assessment
Normal: 0-15 dB
Rinne's Test
Weber's Test
Tinnitus
Difficulty Following Conversations
Nursing Considerations
Face Patient/Speak Clearly
Rephrase Misunderstood Statements
Repeat Statements Back
Hearing Aids
Sign Language
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2 mins
Otitis Media Assessment
Red or Bulging Tympanic Membrane
Ear Pain
Pulling at Ear
Fever
Upper Respiratory Infection
Considerations
More Common in Young Children
Eustachian Tube Narrower
Conductive Hearing Loss
Smoking Increases Risk
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2 mins
Otitis Media Interventions
Antipyretics
Analgesics
Antibiotics
Irrigation
Position on Affected Side
Myringotomy
Tympanostomy Tube
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2 mins
Glasgow Coma Scale
LOC Assessment
Score of 3 to 15
8 or Less = Coma
Eye Opening
Verbal Response
Motor Response
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1 min
Level of Consciousness: Descriptive guide for Glasgow Coma Scale
Conscious
Confused
Delirious
Somnolent
Obtunded
Stuporous
Comatose
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3 mins
ROM Assessment
Types of ROM
Active ROM (AROM)
Active Assisted ROM (AAROM)
Passive ROM (PROM)
Upper Extremity
Neck Flexion, Extension and Rotation
Shoulder Flexion, Extension and Rotation
Elbow Flexion and Extension
Fingers and Wrist Flexion and Extension
Lower Extremity
Hip and Knee Flexion
Hip Abduction and Rotation
Ankle Rotation
Toe Flexion and Extension
Lumbar Rotation and Spine Inspection
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4 mins
Immobility
Assessment
Mobility Continuum
Complications
Cardiovascular
Respiratory
Musculoskeletal
Integumentary
Gastrointestinal
Urinary
Considerations
Turn, Cough, Deep Breathe (TCDB)
Range of Motion (ROM)
Skin Care
Fluids
Balanced Diet
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2 mins
Interventions for Impaired Skin Integrity
Assessment
Signs of Skin Breakdown
Pain
Redness
Decreased Skin Turgor
Bleeding
Bony Prominences
Intervention
Reposition Q2H
Pressure Relief
Maintain Clean and Dry Skin
Adequate Nutrition and Hydration
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2 mins
Increased Intracranial Pressure (ICP) Assessment
Change in LOC
Headache
Cushings Triad
Irregular Respirations
Widening Pulse Pressure
Bradycardia
Projectile Vomiting
Abnormal Pupils
Papilledema
Posturing
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2 mins
Increased Intracranial Pressure (ICP) Interventions
Interventions
Elevate Head Of Bed
Foley Catheter
Mannitol (Osmitrol)
High Dose Barbiturates
Passive Hyperventilation
Dexamethasone (Neoplasm or Infection)
Considerations
Neuro Assessment
Maintain Normal Temperature
Avoid Activities That Increase ICP
Intracranial Monitoring System
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2 mins
Colostomy Care
Wash with Warm Water
Cut 1/8 inch Around Stoma
Decreases Skin Irritation
Empty When 1/3 to 1/2 Full
Change 3-7 Days
Considerations
Avoid Odor Causing Foods
Irrigate at Same Time
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2 mins
Traumatic Brain Injury Assessment
Assessment
Change in LOC
Personality Changes
Amnesia
Increased Intracranial Pressure
Diplopia
Posturing
Location of Injury
Basilar Skull Fracture
Halo or Ring Sign
Considerations
Intracranial Bleeding
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2 mins
Types of Head Injuries
Open Head Injury
Linear Fracture
Comminuted Fracture
Depressed Fracture
Open Fracture
Basilar Skull Fracture
Closed Head Injury
Coup and Contrecoup
Brain Contusion
Concussion
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2 mins
Delirium
Mechanism
Rapid Onset
Reversible
Assessment
Hallucinations
Decline in Cognition
Short Attention Span
Rapid Speech
Change in Activity Level
Mood Swings
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2 mins
Types of Seizures
Tonic-Clonic
Tonic
Clonic
Absence (Petit Mal)
Myoclonic
Atonic
Partial (Focal) Seizure
Focal Aware (Formerly Called Simple Partial)
Focal Impaired Awareness (Formerly Called Complex Partial)
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3 mins
Seizure Interventions
Maintain Airway
Side-lying Position
Support Head
Move to Floor
Benzodiazepines
Considerations
Never Restrain
No Objects in Mouth
Document Details
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2 mins
Seizure Precautions
Reduce Environmental Stimuli
Identify Triggers
Aura
Pad Side Rails
Bed Lowest Position
Oxygen and Suction Available
Consideration
Monitor Therapeutic Drug Levels
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2 mins
Magnetic Resonance Imaging (MRI)
Procedure
Internal Body Images
Detects Variations of Soft Tissues
Considerations
No Metal Objects
No Pacemakers
Contrast is Non-Iodine
Safe During Pregnancy
Long Procedure
Antianxiety Medications
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2 mins
Phenobarbital (Barbiturates)
Mechanism
Barbiturate
Indications
Seizures
Side Effects
Ataxia
Paradoxical Excitement
Fatigue/Drowsiness
Considerations
Monitor Plasma Levels
High Potential for Abuse
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1 min
Use of Restraints
Use Guidelines
During Emergency
Protecting From Harm
For Limited Time
Considerations
Last Resort
May Further Agitation
Frequent Observation
Obtain Order Within 1 Hour
Quick-Release Tie
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2 mins
Phenytoin (Dilantin)
Mechanism
Blocks Na+ Channels
Indications
Tonic-clonic Seizures
Side Effects
Ataxia
Nystagmus
Sedation
Gingival Hyperplasia
Purple Glove Syndrome
Hirsutism
Rash
Anemia
Considerations
Individualized Dosing
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2 mins
Mannitol (Osmitrol)
Mechanism
Osmotic Diuresis
Indications
Reducing Intracranial Pressure
Reducing Intraocular Pressure
Renal Failure Prophylaxis
Side Effects
Edema
Fluid and Electrolyte Imbalance
Considerations
Avoid Use in Cardiac Patients
IV Administration
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2 mins
Posttraumatic Stress Disorder (PTSD)
Assessment
Re-experience Traumatic Event
Flashbacks
Nightmares
Avoidance
Self-destructive Behaviors
Considerations
Assess Suicide Risk
Actively Listen to Stories
Anxiety Medications
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2 mins
Spinal Cord Injuries
Complications
Spinal Shock
Respiratory Complications
Autonomic Dysreflexia (Hyperreflexia)
Orthostatic Hypotension
Deep Vein Thrombosis
Thermal Regulation
Circulatory Problems
Spasticity
Dermal Complications
Genitourinary Complications
Spinal Cord Injury Syndromes
Anterior Cord Syndrome
Central Cord Syndrome
Brown-Sequard’s Syndrome
Conus Medullaris Syndrome
Cauda Equina Syndrome
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4 mins
Autonomic Dysreflexia
Injury Above T6
Assessment
Paroxysmal Hypertension
Bradycardia
Diaphoresis
Flushing Above Lesion
Piloerection
Nasal Congestion
Headache
Interventions
Elevate Head of Bed
Remove Noxious Stimuli
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2 mins
Postoperative Care
Head to Toe Assessment
Complications
Hemorrhage
Clotting
Pain
Dehiscence or Evisceration
Respiratory Complications
Paralytic Ileus
Infection
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2 mins
Atropine
Mechanism of Action
Muscarinic Antagonist
Indications
Bradycardia
Increased Exocrine Secretions
Smooth Muscle Spasms
Side Effects
Tachycardia
Dry Mouth
Urinary Retention
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2 mins
CSF Lab Values: Normal
Pressure: < 20 cm H2O
Color/Appearance: Clear or Colorless
Proteins: < 40 mg/dL
Lactate Dehydrogenase: 10% of Serum Level
Cells: 0-5 Small Lymphocytes
Glucose: 40-70 mg/dL
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2 mins
Multiple Sclerosis Assessment
Cause/Mechanism
Nerve Fiber Demyelination
Assessment
Motor Issues
Cerebellar Signs
Fatigue
Paresthesias
Spasticity
Urinary Incontinence
Optic Neuritis
Considerations
Women Between 20-50 Years Old
Relapse and Remission of Symptoms
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2 mins
Multiple Sclerosis Interventions
Drug Therapy
Corticosteroids
Interferon Beta
Dimethyl Fumarate (Tecfidera)
Fingolimod (Gilenya)
Mitoxantrone (Novantrone)
Natalizumab (Tysabri)
Considerations
Increase Exercise
Identify Triggers
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2 mins
Myasthenia Gravis Assessment
Weakness with Muscle Use
Diplopia
Ptosis
Dysphagia
Difficulty Speaking
Fatigue
Complications
Cholinergic Crisis
Overmedicated
Myasthenic Crisis
Not Enough Medication
Respiratory Muscle Paralysis
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2 mins
Indirect Cholinomimetics
Acetylcholinesterase Inhibitors
Doesn't Cross BBB
Edrophonium
Myasthenia Gravis (Diagnosis)
Pyridostigmine and Neostigmine
Myasthenia Gravis (Tx)
Ileus
Crosses BBB
Physostigmine
Atropine Overdose
Glaucoma
Donepezil
Alzheimer's
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2 mins
Cranial Nerve Pathologies
Cranial Nerve Pathologies
Horner Syndrome
Trigeminal Neuralgia
Bell's Palsy
Brain or Brainstem Lesion
Microvascular Cranial Nerve Palsy
Glossopharyngeal Neuralgia
Multiple Sclerosis
Arnold Chiari Malformation
Amyotrophic Lateral Sclerosis (ALS)
Guillain Barre’ Syndrome
Parkinson's Disease
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3 mins
Parkinson's Disease Assessment
Assessment
Decreased Dopamine
Older Adult
Cogwheel Rigidity
Bradykinesia
Shuffling Gait
Resting Tremor
Pill-Rolling
Mask-Like Face
Cognitive Decline
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2 mins
Parkinson's Disease Interventions
Medications
Levodopa/Carbidopa (Sinemet)
Entacapone (Comtan)
Selegiline (Eldepryl)
Amantadine (Symmetrel)
Bromocriptine (Parlodel)
Benztropine (Cogentin)
Considerations
Allow Extra Time
Ensure Patient Safety
Surgery As Last Resort
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2 mins
Levodopa/Carbidopa (Sinemet)
Mechanism
Increases Dopamine in Brain
Indications
Parkinson's Disease
Side Effects
Nausea and Vomiting
Arrhythmias
Dyskinesia
Psychosis
Orthostatic Hypotension
Considerations
Report Uncontrolled Movements
Darkened Sweat or Urine
Off and On Phenomenon
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2 mins
Parkinson's Drugs
Parkinsons Characteristics
Decreased Dopamine
Increased Acetylcholine
Drug Names
BALSA Acronym
Bromocriptine
Amantadine
Levodopa
Selegiline
Antimuscarinics
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2 mins
Guillain-Barre Syndrome Assessment
Assessment
Ascending Paralysis
Muscle Weakness
Paresthesias (Pins and Needles)
Diplopia
Difficulty Speaking
Dysphagia
Labile Blood Pressure
Loss of Bowel and Bladder Control
Considerations
Aggressive Airway Management
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2 mins
Anticholinergics
B.O.AT.S Acronym
Benztropine
Parkinson's Disease
Oxybutynin
Decrease bladder spasms
Atropine
Mydriasis and Cycloplegia
Scopolamine
Motion Sickness
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1 min
Benztropine (Cogentin)
Mechanism
Anticholinergic
Indications
Parkinson's Disease
Acute Dystonia
Side Effects
Mydriasis
Dry Mouth
Urinary Retention
Tachycardia
Constipation
Psychosis
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1 min
Monoamine Oxidase Inhibitors (MAO-Is)
Indications
Atypical Depression
Mechanism of Action
Increase Levels of Amine Neurotransmitters
Drugs
"Takes Pride In Shanghai"
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline
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1 min
Types of Strokes
Warning Signs
Transient Ischemic Attack (TIA)
Reversible Ischemic Neurologic Deficit (RIND)
Types
Ischemic
Thrombotic
Atherosclerosis
Embolic
Atrial Fibrillation
Hemorrhagic
Severe Hypertension
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3 mins
Right Hemisphere Stroke Assessment
Opposite Side Weakness (Hemiplegia)
Poor Proprioception
Disoriented to Person, Place, Time
Can't Recognize Faces (Prosopagnosia)
Loss of Judgement and Awareness
Impulsiveness
Personality Changes
Tonal Hearing Loss
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2 mins
Left Hemisphere Stroke Assessment
Opposite Side Weakness (Hemiplegia)
Side to Side Discrimination
Aphasia
Agraphia
Slow Performance
Aware of Deficits
Anxiety
Depression
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2 mins
Aphasia Post Stroke
Causes
Cerebrovascular Accident
Non-Fluent Aphasia
Broca’s Aphasia
Fluent Aphasia
Wernicke’s Aphasia
Other Types of Aphasia
Global Aphasia
Conduction Aphasia
Verbal Apraxia
Dysarthria
Diagnosis
Cerebral Angiography
Computed Tomography
Magnetic Resonance Imaging (MRI)
Intervention
Simple Short Sentences
Visual and Tactile Cues
Speech Therapy
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4 mins

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