Neurological nursing: GCS, raised ICP, stroke, seizures & spinal injury

Neuro items usually give you a change in the patient — a drop in alertness, a new weakness, a fit, a severe headache, a head or spine injury — and ask you to name the problem, choose the FIRST nursing action, pick the finding to REPORT, protect the patient from a complication, or teach safely. Because the brain and cord sit inside a rigid skull and vertebral column, the exam keeps returning to a short list of high-stakes events: rising INTRACRANIAL PRESSURE, loss of AIRWAY protection as consciousness falls, acute STROKE, prolonged SEIZURE, and cord injury with autonomic instability.

A reliable frame for any neurological scenario:

• •Watch the LEVEL OF CONSCIOUSNESS first. A change in alertness or orientation is the EARLIEST and most sensitive sign of a deteriorating brain — a patient who was chatty and is now drowsy or confused is getting worse until proven otherwise. Report a falling conscious level early; do not wait for the late signs.
• •Protect the airway and oxygenation. A depressed conscious level, a seizure, a brainstem stroke and a high cord injury all threaten breathing. Positioning, suction, oxygen and airway support are frequent right answers, because hypoxia and hypercarbia themselves worsen brain swelling.
• •Think about PRESSURE and PERFUSION. Anything that adds volume inside the skull (blood, oedema, tumour, blocked CSF) raises intracranial pressure and squeezes the brain; the nursing goal is to promote venous drainage and avoid anything that spikes pressure.
• •Localise and time it. WHERE is the deficit (which side, which limbs, which cranial nerves) and WHEN did it start? In stroke, time is brain — onset time decides whether clot-busting is possible.

Reference figures quoted below are widely used adult values (normal intracranial pressure is roughly 5–15 mmHg; the Glasgow Coma Scale runs 3–15; the intravenous thrombolysis window for ischaemic stroke is up to about 4.5 hours from a known onset in eligible patients). Protocols and guidelines differ, so always read against your own local policy and the current DHA guidance.