Acute Neurologic Disorders Flashcards
(40 cards)
1
Q
Meningitis
A
inflammation of the CSF and meninges, which are the connective tissues that cover the brain and spinal cord
2
Q
Reyes Syndrome
A
life threatening disorder that involves acute encephalopathy and fatty changes in liver
3
Q
Viral Meningitis
A
Aseptic
usually requires only supportive care for recovery
4
Q
Bacterial Meningitis
A
Septic
is a contagious infection. Prognosis depends on how quickly care is intitiated
5
Q
Risk factors for Viral Meningitis
A
many viral illnesses, such as cytomegalovirus, adenovirus, mumps, herpes simplex virus, and arbovirus
6
Q
Risk factors for Bacterial Meningitis
A
- infections caused by bacterial agents: meningococcal, pneumococcal, Hib, and E. coli.
- injuries that have provided direct access to CSF (Skull fracture, penetrating head wound)
- crowded living conditions
7
Q
Expected Findings
A
Photophobia
Nausea
Irritability
Headache
8
Q
Physical Assessment of Newborns: meningitis
A
- no illness is present at birth, but it progresses within a few days.
- manifestations are age and diffuse to diagnose: poor muscle tone, weak cry, poor such, refuses feeding, and vomiting or diarrhea.
- neck is supple without nuchal rididity
- building fontanels are a late sign
9
Q
Physical Assessment of 3mos-2yrs: meningitis
A
- seizures with a high pitched cry
- fever and irritability
- bulging fontanels
- possible nuchal rigidity
- poor feeding
- vomiting
- Brudzindki’s and Kernig’s signs not reliable for diagnosis
10
Q
Physical assessment of 2 years - adolescents: meningitis
A
- seizures (often initial sign)
- nuchal rigidity
- positive Brusinski sign
- Positive Kernig sign
- fever and chilld
- headache
- vomiting
- irritability and restlessness that can progress to drowsiness, delirium, stupor, and coma
- petechiae or purpuric-type rash (with meningococcal infection)
- involvement of joints (with meningococcal and Hib)
- chronic draining of ear (with pneumococcal infection)
11
Q
Brudzinski’s sign
A
flexion of extremities occurring with deliberate flexion of child’s neck
12
Q
Kernig’s Sign
A
resistance to extension of the child’s leg from a flexed position
13
Q
Lab Tests: Meningitis
A
- blood cultures are sometimes positive when the CSF culture is negative
- collect CBC
- CSF analysis
14
Q
CSF Analysis for Bacterial meningitis
A
- cloudy clear
- elevated WBC
- elevated protein content
- decreased glucose content
- positive Gram stain
15
Q
CSF Analysis for Viral Meningitis
A
- clear cloudy
- slightly elevated WBC count
- normal or slightly elevated protein count
- normal glucose content
- Negative Gram stain
16
Q
Lumbar Puncture
A
this is the definitive diagnostic test for meningitis.
- the provider inserts a spinal needle into the subarachnoid space between L3 and L4, L4 and L5 vertebral spaces.
- measures spinal fluid pressure and collects CSF for analysis
17
Q
RN Actions with LP
A
- have the child empty their bladder
- assist the provider with the procedure
- a topical anesthetic (EMLA) can be applied over the biopsy area 45 minutes to 1 hr prior to the procedure
- place the child in the side-lying position with the head a knees drawn upward toward the chest, and assist in maintaining this position.
- the child can be sedated with fentanyl or midazolam
- the provider cleans the skin and injects a local anesthetic
- the provider takes pressure readings and collects 3-5 tubes of CSF
- pressure and an elastic bandage applied to the puncture site after the needle is removed
- label specimens appropriately, and deliver them to the lab
- monitor the site for bleeding, Hematoma, or infection
18
Q
Client Education with LP
A
Instruct the client to remain in bed in a flat position to precent leakage and a resulting spinal headache. This might not be possible for an infant, toddler, or preschooler. Time required for bed rest depends on facility protocol and amount of fluid collected.
19
Q
CT scan or MRI: meningitis
A
- preferred to identify increase ICP or an abscess.
- assist with positioning
- administer sedatives as prescribed
20
Q
RN care with Meningitis (PCC)
A
- the presence of petechiae or purpuric-type rash requires immediate medical attention
- isolate the client as soon as meningitis is suspected and maintain DROPLET precautions per facility protocol
- droplet precautions require a private room or a room with clients who have the same infection, ensuring that each client has his or her own designated equipment
- providers and visitors should wear a mask
- maintain respiratory isolation for a minimum of 24 hours after initiation of antibiotic therapy
- monitor vital signs, UO, fluid status, pain level, and neurologic status
- for newborns and infants, monitor head circumference and fontanels for presence of or changes in bulging.
- correct fluid volume deficit and then restrict fluids until no evidence of increased ICP and serum sodium levels are within the expected range.
- maintain NPO status if the client has a decreased level of consciousness. As the clients condition improves, advance to clear liquids and then a diet the client can tolerate.
- decrease environmental stimuli
- provide quiet environment
- minimize exposure to bright light (natural and electric)
- provide comfort measures
- keep the room cool
- position the client without a pillow, and slightly elevate the head of the bed. The client can also be positioned side lying to reduce neck discomfort.
- maintain safety (keep the bed in low position, implement seizure precautions)
- keep the family informed of the clients condition
21
Q
Medications: Meningitis
A
Antibiotics
Corticosteroids
Analgesics
22
Q
Antibiotics: Meningitis
A
Administer IV antibiotics for bacterial infections. Length of therapy is determined by the clients condition and CSF results (normal blood glucose levels, negative culture). Therapy can last up to 10 days.
- assess for allergies
- provide support for the client and family
- educate the family about the need to complete the entire course.
23
Q
Corticosteroids: Menigitis
A
dexamethasone
- not indicated for vital meningitis
- assists with initial management of increased ICP, but might not be effective for long-term complications.
- most effective in reducing neurologic complications in children who have infections caused bu Hib.
- assess for effectiveness of medications
- provide support for the client and family
- educate on administration and possible adverse effects the medication
24
Q
Analgesics: Meningitis
A
acetaminophen with codeine can be used to relieve discomfort
- assess temperature prior to administering acetaminophen or ibuprofen, which can mask a fever
- monitor respiratory status
- monitor LOC
- provide support for the client and family
25
Client Education: Meningitis
- early and complete treatment is necessary for upper respiratory infections
- encourage parents to maintain appropriate immunizations for the client. Children should receive the Hib and PCV vaccines at 2,4, and 6 months of age, then again and between 12 and 15 months of age.
26
Complications of Meningitis
Increase ICP
- could lead to neurologic dysfunction
- Monitor for signs of increased ICP
Newborns: bulging or tense fontanels, increased head circumference, high-pitched cry, distended scalp veins, irritability, bradycardia, and respiratory changes.
Children: increased irritability, headache, nausea, vomiting, diplopia, seizures, bradycardia, and respiratory changes.
- provide interventions to reduce ICP (positioning, avoid of coughing straining, and bright lights; minimizing environmental stimuli)
27
Reye Syndrom
- primarily affects the liver and brain, causing liver dysfunction and cerebral edema
- the cause is not understood
- peak incidence occurs when influenza is most common, typically January through March.
- can be mistaken for other disorders including encephalitis, meningitis, poisoning, sudden infant death syndrome, diabetes mellitus, and psychiatric illness.
- the prognosis for the client is best with early recognition and treatment
28
Risk factors of Reye Syndrome
- there is a potential associate between using aspirin products and treating fevers caused by viral infections and the development of Reyes syndrome
- Reye sendrom typically follows a viral illness (influenza, gastroenteritis, varicella)
29
Expected Findings of Reye Syndrome
```
Recent viral illness or use of aspirin or aspirin containing products
Physical Assessment:
- lethargy
- irritability
- combativeness
- confusion
-delirium
- profuse vomiting
- seizures
- LOC
```
30
Lab Test: Reye Syndrome
- liver enzymes (alanine aminotransferase, aspartate aminotransferase); elevated
- serum ammonia levels; elevated
- serum electrolytes: altered due to cerebral edema and liver changes
- coagulation times can be extended.
31
Lab Procedures: Reye Syndrome
liver biopsy
| CSF analysis
32
Liver Biopsy: Reye Syndrome
a liver biopsy consists of taking a piece of liver tissue via a large bore needle, and sending this tissue to the pathology department. Ensure that clotting studies are within normal limits prior to the procedure
- maintain NPO status prior to the procedure
- Monitor for hemorrhage postprocedure
- assess vitals frequently post procedure
- encourage the parents to limit the clients post procedure activities to decrease the risk of hemorrhage
33
CSF Analysis: Reye Syndrome
a lumbar puncture should be preformed to collect CSF and rule out meningitis
34
RN Care (PCC)
- maintain hydration while preventing cerebral edema.
- administer IV fluids as prescribed.
- Maintain accurate I&O
- insert indwelling urinary catheter as ordered
- Position the client
- avoid extreme flexion, extension, or rotation
- maintain the head in a midline, neutral position
- keep the head of the bed elevated 30 degrees
- Monitor coagulation and prevent hemorrhage
- note unexplained or prolonged bleeding
- apply pressure after procedures that cause bleeding
- monitor pain status and response to painful stimuli and administer pain medication when appropriate
- assist with intubation and maintain ventilator if required
- implement seizure precautions
- keep the family informed of the clients status
- provide private time for the family to be with the client if death is imminent
- initiate referrals to support resources for the family.
35
Medications: Reye Syndrome
osmotic diuretic
| Vitamin K
36
Osmotic Diuretic: Reye Syndrome
- to decrease cerebral swelling
| - monitor for increased ICP
37
Vitamin K: Reye Syndrome
- improves synthesis of blood clotting factors in the liver
- subcutaneous is the preferred route
- identify client sensitivity to benzyl alcohol or castor oil
- teach the client about dietary intake of vitamin K
38
Interprofessional Care: Reye Syndrome
- a client who has neurologic deficits post-Reye syndrome requires interventions from other members of the health care team
- occupational therapy and physical therapy can be needed to help the client adapt to neurologic deficits
- a dietician can be needed to assist in maintaining adequate nutrition
39
Client Education: Reye Syndrome
- teach the parents to avoid giving salicylate for pain or fever in children
- teach parents to read ales of OTC medications to check for the presence of salicylates
- clients regain full liver function, but can have some neurologic deficits
40
Complications of Reyes Syndrome
Neurologic Sequelae
- neurologic complications vary by degree of severity and sometimes include speech of hearing impairment, and developmental delays based on the length and severity of illness
- explain the clients condition and needs for the family
- help the family identify support services for home care
Death:
-support the family in grief
- make referrals to spiritual support as appropriate
