NCLEX-RN 이것만이라도 보고 가자! : Emergency / Critical Care │ Nurse Haley

날짜:

NCLEX-RN 이것만이라도 보고 가자! : Neurology Disorders │ Nurse Haley

날짜:

🧠 Neurology Disorders by Nurse Haley

CNS · PNS 주요 질환 / 약물 / 간호중재 총정리



안녕하세요! 오늘의 간호사 Haley 입니다. 오늘 다뤄볼 part는 Neurology로, 출제율이 높은 부분들을 다뤄봤습니다.

📖 Table of Contents

🧩 Central Nervous System (CNS Disorders)

Disorder Pathophysiology / Key Features High-Yield Nursing Points
1️⃣ Multiple Sclerosis (MS) Autoimmune destruction of myelin sheath → impaired nerve transmission.
Periods of relapse/remission; onset 20–40 yrs. 		• Avoid “4S”: Stress, Sickness, Smoking, Sun/Heat.
• Balance rest & activity.
• Diplopia (double vision) → eye patch alternate.
• Meds: IVIG, corticosteroids, immunosuppressants (Cyclosporine).
• Promote independence (assistive devices, energy conservation).
2️⃣ Parkinson’s Disease ↓ Dopamine in basal ganglia → tremor, rigidity, bradykinesia.
Mask-like face, shuffling gait, “pill-rolling” tremor at rest. 		• Meds: Levodopa + Carbidopa (monitor dyskinesia, orthostatic hypotension).
• Avoid high-protein diet (↓ absorption).
• Encourage deliberate movement & ROM.
• Small frequent meals for swallowing difficulty.
• Do NOT stop meds abruptly → NMS risk (rigidity + fever + confusion).
3️⃣ Alzheimer’s Disease Progressive cognitive decline from neuronal loss; affects memory & judgment first. • Safe environment (remove rugs, lock exits).
• Redirection, not reorientation (avoid arguing).
• Consistent caregivers & routines.
• Meds: Donepezil, Rivastigmine — improve cognition.
• Watch for wandering and sundowning.
4️⃣ Huntington’s Disease Genetic autosomal dominant disorder → chorea, psychiatric changes, cognitive decline. • Genetic counseling before pregnancy.
• Fall prevention & aspiration precautions.
• Emotional support (progressive, no cure).
• High-calorie diet (increased movement).

⚡ Peripheral Nervous System (PNS Disorders)

Disorder Pathophysiology / Key Features High-Yield Nursing Points
1️⃣ Myasthenia Gravis (MG) Autoimmune destruction of acetylcholine receptors at neuromuscular junction.
“Gravis = gravity” — weakness worsens with activity, improves with rest. 		• Meds: Pyridostigmine, Neostigmine (cholinergic).
• Give 30–60 min before meals.
• Semi-solid foods, aspiration precautions.
• Myasthenic Crisis: airway obstruction from underdose → prepare for intubation.
• Cholinergic Crisis: overmedication → bradycardia, salivation → atropine ready.
• Avoid aminoglycosides & beta-blockers (worsen weakness).
2️⃣ Amyotrophic Lateral Sclerosis (ALS) Degeneration of motor neurons → progressive paralysis with intact cognition.
Usually fatal within 3–5 years due to respiratory failure. 		• Maintain airway, suction, oxygen.
• Monitor dysphagia/dysarthria — aspiration risk.
• Communicate using boards/devices.
• Med: Riluzole slows progression.
• Emotional & palliative support.
3️⃣ Guillain–Barré Syndrome (GBS) Autoimmune demyelination following viral infection → ascending paralysis.
Moves from legs → trunk → respiratory muscles. 		• Early sign: can’t lift head or eyebrows, weak cough.
• Prepare for intubation & mechanical ventilation.
• Frequent respiratory assessment.
• Meds: IVIG, plasmapheresis.
• Prevent immobility complications (ROM, DVT prophylaxis).
⚠️ NCLEX 핵심포인트: - MG, ALS, GBS → 모두 airway 우선!
- MG: underdose = Myasthenic Crisis, overdose = Cholinergic Crisis.
- Parkinson: Levodopa + Carbidopa 병용, 단백질 제한.
- Alzheimer: Reorient ❌, Redirect ⭕.
- MS: Avoid hot environment & infection.

📘 Quick Comparison Table (한눈정리표)

Category Disorder Cause Key Symptoms Nursing Focus
CNS MS Autoimmune demyelination Weakness, spasm, visual changes IVIG, avoid heat/stress, rest–exercise balance
Parkinson ↓ Dopamine Shuffling gait, tremor, rigidity Levodopa/Carbidopa, fall prevention
Alzheimer Neuronal loss Memory loss, wandering Safe room, redirection, Donepezil
Huntington Genetic dominant Chorea, mood changes Genetic counseling, high-calorie diet
PNS MG ↓ ACh receptor Weakness ↑ with activity Anticholinesterase before meals, airway setup
ALS Motor neuron death Paralysis, dysphagia, intact cognition Airway, suction, Riluzole
GBS Post-viral autoimmune Ascending paralysis Respiratory monitoring, IVIG/plasmapheresis

🩺 General Nursing Principles

  • All are progressive or chronic; focus on function, not cure.
  • Promote independence — do not perform all ADLs.
  • Gait training sequence: cane → walker → wheelchair.
  • Prioritize respiratory status in MG, ALS, GBS.
  • Use interdisciplinary team (PT, OT, speech therapy).
💡 Exam Tip:
If you see a neuro disorder question → always check:
① Airway
② Swallowing ability
③ Medication timing & side effects
④ Heat, stress, infection triggers (MS, MG)

정리: 오늘의 간호사 Haley

📌 본문 내용은 오늘의 간호사 Haley의 저작물로 무단 복제·배포를 금합니다.

#NCLEX #Neurology #MS #MG #ALS #GBS #Parkinson #Alzheimers #Huntington #간호요약 #신경계간호