Head and neckHigh yield
Brainstem
The stalk at the base of the brain, made of the midbrain, pons, and medulla, that joins the rest of the brain to the spinal cord and holds the centers that control breathing, heart rate, and blood pressure.
Why the exam cares
The brainstem runs the functions that keep a patient alive, so squeezing it is the last stage of rising intracranial pressure. The NCLEX tests whether the nurse catches the early signs, starting with a change in level of consciousness, and acts before the brainstem is compressed.
- It cannot be felt; it sits deep in the skull, resting on the sloping bone of the skull base and ending at the foramen magnum, the large opening where the medulla becomes the spinal cord.
- The midbrain passes through the notch in the tentorium, the dural shelf that separates the cerebrum above from the cerebellum below; the cerebellum sits behind the pons and medulla.
- The nurse reads it through its cranial nerve reflexes: pupils for the midbrain (CN III), corneal reflex for the pons, and gag and cough for the medulla.
- Vital signs are its other window: blood pressure, pulse, and breathing pattern change when it is being compressed.
The first change is level of consciousness: restlessness, new confusion, or a patient who is harder to wake. A sluggish or unequal, dilated pupil comes later and means CN III is being pinched as brain tissue is pushed toward the midbrain; fixed, dilated pupils on both sides mean the midbrain itself is failing. The nurse reports the change in consciousness right away rather than waiting for the pupils.
Rising systolic pressure with a widening pulse pressure, a slowing heart rate, and irregular breathing together mean the brainstem is being compressed. This is a late sign: the nurse calls the provider or rapid response team at once, keeps the head of the bed at about 30 degrees with the neck midline, and avoids anything that raises pressure, such as straining, coughing, or sharp hip flexion.
Decorticate posturing (arms bent in toward the chest, fists clenched, legs straight) points to damage higher up, in the cerebral hemispheres or the motor pathway above the brainstem's lower centers. Decerebrate posturing (arms and legs rigidly straight, forearms turned inward, toes pointed, head arched back) means the brainstem is involved and the outlook is worse. A shift from bending to extending is deterioration, and the nurse reports it immediately.
Brain death is the permanent loss of all brain function, including the brainstem: no pupil, corneal, gag, or cough reflex, and no effort to breathe during a formal apnea test; spinal reflexes can still occur. In the US it is legal death, even with a beating heart on a ventilator. The nurse supports the family, keeps organs perfused, and follows facility policy for referral to the organ procurement organization.
Physiological AdaptationReduction of Risk Potential
Head and neck
Cerebellum
The cerebellum is the small, deeply folded 'little brain' at the back of the skull, below the cerebrum and behind the brainstem, that keeps balance and movement smooth and accurate.
Why the exam cares
A patient with cerebellar damage keeps full strength but cannot walk or reach steadily, so the nurse judges safety by gait and coordination, not by grip strength. Sudden unsteadiness is treated as a possible stroke, and new ataxia in a patient on phenytoin means the nurse checks for toxicity before giving the next dose.
- Lies deep to the occipital bone at the back of the head, just above the nape of the neck, in the lowest back part of the skull (posterior cranial fossa).
- Sits below the occipital lobes, separated from them by a tent-shaped fold of dura (tentorium cerebelli), and directly behind the pons and medulla.
- Each side of the cerebellum controls the same side of the body, so a right cerebellar problem shows up as right-sided clumsiness, unlike cerebral strokes where deficits cross over.
Sudden vertigo, vomiting, headache, and inability to stand or walk in a patient with normal arm and leg strength can be a cerebellar stroke, and it is easy to dismiss as a dizzy spell because face droop and arm drift may be absent. The nurse notes the time last known well, activates the stroke alert per facility protocol, keeps the patient in bed and NPO until a swallow screen is passed, and checks level of consciousness and pupils often. A swelling cerebellum can press on the brainstem, so any drop in level of consciousness is reported at once as an emergency.
The nurse checks finger-to-nose, heel-to-shin, and rapid alternating hand movements on each side. Overshooting the target, a tremor that worsens as the hand nears the target (intention tremor), or clumsy, irregular alternating movements point to the cerebellum on that same side. A finding that is new since the last assessment is reported to the provider promptly, because it can be the first sign of a posterior stroke.
A cerebellar patient walks wide-based and staggering and is unsteady even with the eyes open, so the deficit is read from gait and coordination. A Romberg that is steady with eyes open but lost once the eyes close points to lost position sense or an inner-ear problem, not the cerebellum. The nurse stands close with arms ready during any balance test, and an unsteady patient walks with a gait belt and the nurse, never alone.
Nystagmus is often the first sign of phenytoin toxicity, followed by ataxia and slurred speech as the level rises above the usual therapeutic range of 10 to 20 mcg/mL; acute alcohol intoxication causes the same picture. The nurse holds the next dose, notifies the provider, and obtains a phenytoin level as ordered, because another dose on top of a high level deepens the toxicity. Fall precautions go in place: bed low, call light in reach, and the nurse walks with the patient.
Safety and Infection ControlPharmacological and Parenteral TherapiesPhysiological Adaptation
Head and neckHigh yield
Cerebrum and its lobes
The large, folded upper part of the brain, split into two halves and four lobes on each side: frontal at the front, parietal on top, temporal at the side, occipital at the back.
Why the exam cares
A stroke question on the NCLEX is really a lobe question: the deficit the nurse sees tells you where the clot or bleed is, and the side of the body affected is opposite the side of the brain. Knowing that language usually lives on the left and spatial attention on the right lets the nurse predict aphasia or neglect, and the safety needs that follow, before they are charted.
- Fills the skull above the eyebrows and back to the bump at the base of the skull; the frontal lobe sits behind the forehead.
- The parietal lobe sits under the crown of the head, above and behind the ears.
- The temporal lobe lies beside the ear, just inside the temple.
- The occipital lobe is at the very back, above the neck, and handles vision.
Frontal: personality change, poor judgment, weakness on the opposite side, trouble producing speech. Parietal: lost sensation and neglect of one side of the body or space. Temporal: trouble understanding speech, memory loss. Occipital: visual field loss. The nurse uses the pattern to set up the room and the meal tray on the side the patient can still see and feel.
Expressive (Broca's) aphasia comes from the frontal lobe: the patient understands you but cannot get words out, so the nurse asks yes/no questions and waits. Receptive (Wernicke's) aphasia comes from the temporal lobe: speech flows but makes little sense and the patient does not understand you, so the nurse uses gestures, pictures, and short simple phrases.
Facial droop, arm drift, and slurred speech mean a stroke until proven otherwise. The nurse records the exact time the patient was last seen normal, because the clot-dissolving window is measured from that moment, and keeps the patient NPO until a swallow screen is passed, because feeding a patient who cannot swallow safely causes aspiration.
A left-hemisphere stroke usually brings right-sided weakness, aphasia, and a slow, cautious patient. A right-hemisphere stroke brings left-sided weakness, left-sided neglect, and an impulsive patient who overestimates what they can do, which is the bigger fall risk: the nurse keeps the bed low and the call light on the side the patient still attends to, and does not leave them to transfer alone.
Physiological AdaptationReduction of Risk PotentialSafety and Infection Control
Head and neckHigh yield
Eye
The eye is the paired organ of sight that sits in the bony orbit, where light passes through the cornea, pupil, and lens to the retina, which sends the image to the brain through the optic nerve.
Why the exam cares
The eye shows up in every neuro check and in common medication, post-op, and emergency questions. The nurse reads the pupils for rising brain pressure, keeps beta-blocker eyedrops out of the bloodstream, and knows which eye complaint needs help right now.
- The eye sits in the bony orbit. The brow ridge protects it from above, the cheekbone forms the outer rim, and the orbital floor below is thin bone that can crack when something hits the eye.
- The pupil is the black opening in the center. The colored iris around it is a ring of muscle that tightens under the penlight, so the pupil gets smaller.
- When the nurse gently pulls the lower lid down, a pocket forms. This is the lower conjunctival sac, and eyedrops go here, not straight onto the clear cornea.
- The inner corner of the eye, beside the nose, is where tears drain into the nasolacrimal duct. The nurse presses here after giving drops.
Check that the pupils are equal and round and that they react to light and accommodation. Then have the patient follow a finger or penlight through the six cardinal fields, which tests cranial nerves III, IV, and VI. In a patient with a head injury or a dropping level of consciousness, a new dilated, sluggish, or fixed pupil on one side can mean the swelling brain is pressing on cranial nerve III, so the nurse calls the provider right away.
Pull the lower lid down, place the drop in the pocket without touching the tip to the eye, then press gently on the inner corner of the eye for about a minute. Drops that drain down the tear duct get absorbed into the blood, and pressing the corner keeps a beta blocker such as timolol from slowing the heart or tightening the airways. When the patient uses more than one eye medication, wait about 5 minutes between them so the first one is not washed out.
After cataract surgery, teach the patient to wear the eye shield at night and not to bend at the waist, lift heavy objects, strain, or sleep on the operative side. These activities raise pressure inside the healing eye. Tell the patient to report sudden eye pain, a drop in vision, or increasing redness or drainage right away, because these can signal bleeding, infection, or a detached retina.
New flashes of light, a sudden shower of floaters, or a curtain or shadow across part of the vision means the retina may be pulling away. It does not hurt, so the nurse treats the patient's report as the emergency. The nurse limits activity as ordered, covers the eye, and gets the patient an urgent eye exam, because the detached part of the retina stops working and vision can be lost for good.
Physiological AdaptationReduction of Risk PotentialPharmacological and Parenteral Therapies
Head and neckHigh yield
Larynx and epiglottis
The larynx is the voice box at the top of the windpipe in the front of the neck, and the epiglottis is the leaf-shaped cartilage at its top that folds back over the airway opening each time the patient swallows.
Why the exam cares
The larynx has to close with every swallow and stay open with every breath. The NCLEX tests the nurse's decisions at that gate: keep a patient after a stroke NPO until they pass a swallow screen, keep everything out of the mouth of a drooling child with epiglottitis, and treat new stridor or a worsening voice after thyroid surgery as an airway emergency.
- The Adam's apple (the laryngeal prominence of the thyroid cartilage) is the most prominent bump in the front of the neck. It forms the front wall of the larynx, which spans about the C3 to C6 level in an adult.
- Below the thyroid cartilage is the cricoid cartilage, a firm ring. The soft dip between the two is the cricothyroid membrane, the site for an emergency surgical airway.
- The epiglottis sits behind the base of the tongue at the top of the larynx, above the vocal cords, at the back of the throat. It cannot be felt from outside the neck.
A child with a sudden high fever, drooling, a muffled voice, and stridor who sits upright leaning forward in the tripod position may have a swollen epiglottis that is about to block the airway. The nurse puts nothing in the mouth (no tongue blade, no throat swab), does not lay the child flat, and delays upsetting care such as an IV start, because crying or a throat exam can trigger complete obstruction. The nurse keeps the child calm on the parent's lap and gets the provider and emergency airway equipment to the bedside at once.
After a stroke, a gag reflex does not prove a safe swallow, so the nurse keeps the patient NPO until they pass a swallow screen; after a breathing tube is removed, the nurse follows the facility's swallow protocol. After a procedure that numbs the throat, such as a bronchoscopy or EGD, the nurse keeps the patient NPO until the gag reflex returns and the patient is alert. Once eating is allowed, the patient sits fully upright for meals and for about 30 minutes after, and the nurse treats coughing while eating, a wet or gurgly voice, or new fever or crackles as signs of aspiration.
The nerves that move the vocal cords run beside the thyroid, and bleeding in the neck can press on the airway, so the nurse regularly checks the voice, listens for stridor, and checks the dressing and the back of the neck for blood. Mild hoarseness is common, but a voice that gets worse, new stridor, or a neck that feels tight means the airway is at risk (low calcium can also cause laryngeal spasm; see Parathyroid glands). The nurse keeps suction, oxygen, and a tracheostomy set at the bedside and calls for help at the first sign of stridor rather than waiting for distress.
Reduction of Risk PotentialPhysiological Adaptation
Head and neckHigh yield
Meninges and cerebrospinal fluid
Three layers called the dura, arachnoid, and pia wrap the brain and spinal cord, and clear cerebrospinal fluid (CSF) cushions them from the space between the inner two.
Why the exam cares
Bacterial meningitis can kill within hours, so the nurse must spot it, isolate, and push for the first antibiotic dose without delay. The nurse also screens and positions the patient for a lumbar puncture, and keeps anything from going up the nose when CSF leaks after a head injury.
- The dura is the tough outer layer just inside the skull and spinal canal; the arachnoid lies under it, and the pia clings to the brain and cord.
- In adults the spinal cord ends at about L1-L2, but the fluid-filled sac runs on to about S2, so a needle at L3-L4 or L4-L5 reaches CSF below the cord.
- A line drawn between the tops of the iliac crests crosses the spine at about L4 and guides the choice of puncture level.
- The skull base is thin behind the nose and ears, so a fracture there can let CSF drip out of the nose or ear.
Look for fever, severe headache, a stiff neck that resists bending forward, light sensitivity, and a falling level of consciousness. Kernig sign is pain and resistance when the knee is straightened with the hip flexed. Brudzinski sign is the hips and knees bending when the neck is flexed. The nurse starts droplet precautions on suspicion, not after the culture result. Blood cultures are drawn and the first antibiotic dose is given right away, never held for the lumbar puncture or its results, because every hour of delay raises the risk of death and brain damage. A spreading purple rash with these signs points to meningococcal disease, which can bring septic shock fast.
Before the tap, the nurse reports any sign of raised intracranial pressure, such as a falling level of consciousness, unequal or sluggish pupils, or vomiting, because draining fluid from below can pull the brainstem down into the base of the skull. The nurse has the patient void, then positions them side-lying with knees to chest and chin tucked to open the lumbar spaces, and helps them hold still. Afterward the patient rests flat for the ordered time and drinks fluids. A headache that worsens sitting up and eases lying down means CSF is still leaking, so the nurse keeps the patient flat, encourages fluids, and reports it so the provider can consider a blood patch.
Clear or blood-tinged fluid from the nose or ear after head trauma is treated as CSF until proven otherwise. The nurse screens clear fluid for glucose or checks bloody drainage for a halo ring on gauze, lets it drain onto a loose dressing, and reports it. Nothing goes into the nose or ear: no packing, no nasal suctioning, no nasogastric tube, and no nose blowing, because the fracture that lets fluid out lets bacteria in, and a tube can pass through the broken skull base into the brain. The nurse then watches for fever and a stiff neck.
Safety and Infection ControlReduction of Risk PotentialPhysiological Adaptation
Head and neckHigh yield
Nose and nasopharynx
The nostrils and nasal cavity, which open at the back into the nasopharynx, the upper part of the throat that sits above the soft palate.
Why the exam cares
A newborn breathes mainly through the nose, so a blocked nose quickly becomes a breathing and feeding problem. In older patients the nose carries cannulas, packing, and tubes, and the nurse must know when nothing may be passed through it.
- The two nostrils (nares) are split by the septum; the upper bridge of the nose is bone and the lower, soft part is cartilage.
- The nasal cavity runs straight back, not upward, to the nasopharynx above the soft palate, where an NG tube turns down into the throat.
- The floor of the nasal cavity is the hard palate; its roof is thin bone (the cribriform plate) with the brain just above it.
- Nasal cannula prongs sit just inside the nares, and the tubing crosses the cheeks and loops over the ears, so the nurse checks the skin at the nares, cheeks, and ears.
The nurse suctions the mouth with the bulb syringe first, then the nose. Touching the nostrils can make the baby gasp, and any secretions still in the mouth would be pulled into the airway. A congested newborn may stop sucking to breathe or turn dusky during feeds, so the nurse clears the nose before feeding.
The nurse sits the patient up, leaning forward, and pinches the soft part of the nose closed for 10 to 15 minutes without letting go to check. Tipping the head back sends blood down the throat, where it can be swallowed or aspirated and hides how much is lost. If the nose is packed, the patient must breathe through the mouth, so the nurse watches breathing and oxygen saturation and checks the back of the throat for blood; frequent swallowing can signal bleeding behind the packing.
The nurse checks the nostrils, cheeks, and tops of the ears on a regular schedule per facility policy while a cannula or NG tube is in place. The nurse secures an NG tube so it does not press on the edge of the nostril and pads cannula tubing over the ears. Turning the patient does not take pressure off skin under a device, so only inspection and repositioning the device protect it.
The nurse does not insert an NG tube or nasal suction catheter when a basilar skull fracture is known or suspected, such as clear fluid draining from the nose, bruising behind the ears, or bruising around both eyes. The bone above the nasal cavity may be broken, and a tube can pass into the brain, so tubes go through the mouth instead. The nurse tells the patient not to blow the nose and to avoid straining.
Reduction of Risk PotentialHealth Promotion and MaintenancePhysiological Adaptation
Head and neckHigh yield
Oral cavity, teeth, and gums
The mouth: the lips, cheeks, hard and soft palate, gums, and the teeth of the upper and lower jaw, opening back into the throat.
Why the exam cares
The mouth is the top of the airway, so oral care for an unconscious or ventilated patient is really about preventing aspiration and pneumonia, and positioning and suction matter as much as the brush. The mouth also shows treatment side effects the nurse must catch and teach about, such as chemo mucositis, thrush from inhaled steroids, and gum overgrowth from phenytoin.
- Lips and cheeks in front; the hard palate is the bony roof you feel with the tongue, and the soft palate and uvula hang behind it.
- The gums (gingiva) wrap the base of each tooth; healthy gums are pink and firm and do not bleed when brushed.
- A child has 20 primary teeth and an adult has 32 permanent teeth; note any that are loose, capped, or missing.
- Use a penlight and tongue blade: pull the cheek aside, lift the lip, and check the gum line and under the tongue, where sores hide.
For an unconscious patient the nurse places the patient side-lying with the head turned so fluid drains out of the mouth, keeps suction ready, and uses a moistened swab or small amounts of fluid, never a large pour. With no reliable gag or cough reflex, pooled fluid runs into the lungs. Before surgery the nurse removes dentures and documents loose teeth, because anything loose in a sedated patient's mouth can be inhaled or block the airway.
For an intubated patient the nurse brushes the teeth, gums, and tongue at least twice a day and swabs and moistens the mouth about every 2 to 4 hours, following the facility's oral care protocol, including whether an antiseptic rinse such as chlorhexidine is used. The nurse suctions oral secretions and keeps the head of the bed at 30 to 45 degrees unless contraindicated. Mouth bacteria travel down around the tube into the lungs, so clearing them helps prevent ventilator-associated pneumonia.
For chemo mucositis the nurse uses a soft brush or foam swab and saline or baking-soda rinses, avoids alcohol mouthwash and lemon-glycerin swabs because they dry and burn raw tissue, and skips flossing when platelets are low. White patches after inhaled steroids are thrush, so the nurse teaches the patient to use a spacer and to rinse and spit after every dose. For gums growing over the teeth on phenytoin, the nurse teaches a soft brush, daily flossing, and regular dental visits.
Before repair the nurse feeds the infant upright with a special cleft nipple or bottle and burps often, because the open palate lets milk into the nose and air into the stomach. After palate repair nothing hard goes in the mouth, so no straws, pacifiers, spoons, or suction catheters, and elbow restraints keep the hands away from the suture line while it heals.
Basic Care and ComfortSafety and Infection ControlPharmacological and Parenteral Therapies
Head and neckHigh yield
Parathyroid glands
Four pea-sized glands on the back of the thyroid that release parathyroid hormone, the signal that keeps blood calcium up.
Why the exam cares
These glands are so small and so close to the thyroid that neck surgery can remove or bruise them by accident, and calcium drops fast when it happens. The NCLEX tests the two bedside signs of low calcium and the airway spasm that follows if they are missed.
- Embedded in the back surface of the thyroid lobes, two on each side, in the lower front of the neck.
- Cannot be felt through the skin; the nurse assesses their function through calcium levels and nerve excitability, not palpation.
Chvostek: tap the cheek in front of the ear and the face twitches on that side. Trousseau: inflate a blood pressure cuff above systolic for up to three minutes and the hand cramps into a claw. Either sign means calcium is low enough to make nerves fire on their own, and the nurse reports it and prepares IV calcium.
Untreated low calcium moves from tingling lips and fingers to muscle cramps, seizures, and spasm of the vocal cords that closes the airway. The nurse keeps calcium gluconate, suction, and an airway at the bedside after thyroidectomy and treats stridor as an emergency.
Too much hormone pulls calcium out of bone: kidney stones, bone pain and fractures, constipation, and a weak, tired, confused patient. The nurse pushes fluids to flush the kidneys, encourages walking to slow bone loss, and moves the patient carefully because bones are fragile.
Reduction of Risk PotentialPhysiological Adaptation
Head and neckHigh yield
Pituitary and hypothalamus
A pea-sized gland in a bony pocket at the skull base, hanging beneath the hypothalamus, that releases the hormones controlling the thyroid, adrenals, gonads, growth, and water balance.
Why the exam cares
The pituitary's back lobe releases ADH, the hormone that tells the kidneys to hold water, and both too little and too much show up as a sodium problem the nurse must catch from urine specific gravity and serum sodium. The NCLEX also asks about pituitary surgery, which is done through the nose and leaves the brain one sneeze away from infection.
- Sits in the middle of the head, behind the bridge of the nose and above the back of the nasal cavity, in a saddle-shaped pocket of the skull base.
- The surgical route runs through the nostril and the sphenoid sinus, which is why nasal drainage after surgery is watched for CSF.
- The optic nerves cross just above it, so a pituitary tumor often first shows as lost side vision.
Too little ADH (diabetes insipidus): the patient pours out liters of dilute urine with a specific gravity near 1.005, gets thirsty and dehydrated, and sodium climbs; the nurse tracks strict intake and output, replaces fluid, and gives desmopressin as ordered. Too much ADH (SIADH): urine is scant and concentrated, water is retained, sodium falls, and the patient becomes confused and can seize; the nurse restricts fluids, monitors sodium, and puts seizure precautions in place.
After surgery through the nose, the nurse keeps the head of bed raised, checks the nasal drip pad for a clear halo around blood and tests drainage for glucose (CSF), and teaches the patient not to blow the nose, cough hard, bend over, strain, or brush the front teeth until cleared, and to sneeze, if a sneeze comes, with the mouth open. Any of those can open the surgical seal and let bacteria reach the brain, so clear drainage, a new headache, or a stiff neck is reported at once.
Swelling around the surgical site often causes temporary diabetes insipidus. The nurse measures urine output every hour, reports sudden high volumes of pale urine, checks specific gravity, and watches sodium, because the patient can dehydrate into hypovolemia within hours.
In adults, too much growth hormone enlarges the hands, feet, jaw, and tongue (acromegaly) and brings joint pain, sleep apnea, and high blood sugar. The nurse anticipates a difficult airway if sedation or intubation is needed and monitors glucose.
Physiological AdaptationReduction of Risk Potential
Head and neckHigh yield
Thyroid gland
A butterfly-shaped gland in the front of the lower neck, wrapped around the windpipe just below the voice box, that sets the body's metabolic rate.
Why the exam cares
The thyroid lies on the airway, with the parathyroids on its back and the voice nerves close behind it, so after thyroidectomy the nurse checks airway, bleeding, voice, and calcium first. When the gland runs too hot or too cold, the nurse must spot thyroid storm or myxedema coma from the vital signs and act before the heart or breathing fails.
- The narrow middle bridge (isthmus) crosses the windpipe below the cricoid ring, over about the second to fourth tracheal rings; each lobe runs up beside the thyroid cartilage (Adam's apple).
- The lobes sit on either side of the trachea and rise when the patient swallows, which helps tell a thyroid lump from other neck lumps. A hard lump that stays fixed when the patient swallows is a warning sign, and the nurse always reports it.
- To feel it, the nurse stands behind the seated patient, places the fingertips on both sides of the trachea just below the cricoid, and has the patient sip water and swallow. An overactive gland is felt lightly and briefly.
- The parathyroid glands sit on the back of the lobes, and the recurrent laryngeal nerves to the vocal cords run close to them in the groove between the trachea and esophagus. That is why thyroid surgery can lower calcium or change the voice.
Bleeding into the closed neck can press the trachea shut. The nurse checks the front dressing and slides a hand behind the neck for pooled blood, and watches for a neck that feels tight or swollen, stridor, trouble swallowing, or a voice growing weaker. Tightness or stridor means calling the surgeon and rapid response at once; a tracheostomy tray, suction, and oxygen stay at the bedside, and the patient stays in semi-Fowler position with the head and neck supported, not flexed or extended.
If the parathyroids were bruised or removed, calcium can fall in the first few days, and severe tetany can close the airway through laryngospasm. The nurse asks about tingling around the mouth and in the fingers at every check, reports the first tingling without waiting for a lab result, and keeps IV calcium gluconate available. Chvostek and Trousseau signs are covered with the parathyroid glands.
Thyroid storm is hot and fast: high fever, a racing pulse, agitation or confusion, often after surgery, infection, or stopping antithyroid drugs. The nurse cools the patient and gives acetaminophen, never aspirin, which frees more hormone; gives oxygen, IV fluids, the beta blocker, and the antithyroid drug before any iodine, as ordered. Myxedema coma is cold and slow: low temperature, slow pulse, low blood pressure, shallow breathing, and a patient hard to wake; the nurse supports the airway, warms with blankets rather than a heating device, gives IV levothyroxine as ordered, and avoids sedatives and opioids.
The dose starts low and goes up slowly, especially in older adults and heart patients, because speeding up metabolism too fast can bring on chest pain or a fast irregular rhythm. The nurse gives it each morning on an empty stomach, 30 to 60 minutes before breakfast, keeps calcium, iron, and antacids about 4 hours apart from it, and holds the dose and reports a pulse over 100, palpitations, or chest pain. The nurse teaches that for most patients it is lifelong and is not stopped once they feel better.
Reduction of Risk PotentialPhysiological AdaptationPharmacological and Parenteral Therapies
