Beth - Week 6 - Exam 3

Question 1

what is meningitis?

Answer 1

an inflammation of the protective membranes covering the brain and spinal cord

Question 2

what causes the SWELLING of meningitis?

Answer 2

a bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling

Question 3

what can meningitis be caused by?

Answer 3

injuries, cancer, certain drugs, other types of infections

Question 4

what is the main takeaway point for meningitis?

Answer 4

knowing the specific cause of meningitis directs treatment

ex. need to know what type → bacterial but tx for fungal → will die

Question 5

how does transmission of meningitis occur?

Answer 5

direct exposure of CS to environment

Question 6

what is the pathophysiology of bacterial meningitis?

Answer 6

The presence of an organism in subarachnoid space

produces inflammatory response–forming an exudate–arachnoid villi plug–obstruction of CSF absorption

Question 7

what is the pathophysiology of viral meningitis?

Answer 7

no exudate

Question 8

T/F: venous system serving nasopharynx/middle ear/and mastoid are close to veins draining meninges

Answer 8

TRUE

**nose, sore throat, cold sxs → meningitis easily missed.

Question 9

what are the 7 different types of meningitis?

Answer 9

• bacterial
• viral
• fungal
• tuberculous
• syphilitic (↑↓ on the specific side - HIV, lupus, diabetes)
• parasitic
• lyme

Question 10

what are leading causes (microbes) of bacterial meningitis in the US?

Answer 10

• streptococcus pneumoniae
• group B strptococcus
• neisseria meningitdis
• haemophilus influenzae
• listeria monocytogenes (not frequent)

Question 11

who is at risk for developing bacterial meningitis pneumococcus (streptococcus pneumoniae)?

Answer 11

children < 5, young adults, elderly

Question 12

what is the prevention for pneumococcus (streptococcus pneumoniae)?

Answer 12

vaccine

Question 13

TEST what are the precautions used for a patient with pneumococcus (streptococcus pneumoniae)?

Answer 13

DROPLET

Question 14

what are the s/sx of pneumococcus (streptococcus pneumoniae)?

Answer 14

infection of oropharynx, otitis media, pneumonia, skull fx

Question 15

what is the prevention for meningococcus (neisseria meningitdis)?

Answer 15

vaccine

Question 16

who is at risk for developing meningococcus (neisseria meningitdis)?

Answer 16

infants, children, YOUNG ADULTS

populations that live in close quarters - students, prisons, skilled nursing facilities

Question 17

how is meningococcus (neisseria meningitdis) transmitted?

Answer 17

inhalation or direct contact

***carried in the nose/throat

Question 18

what are the s/sx of meningococcus (neisseria meningitdis)?

Answer 18

petechial rash, purpuric lesions
overwhelming septicemia
HA, general malaise
basic cold symptoms

Question 19

what is the prevention for haemophilus influenza type b?

Answer 19

vaccine

Question 20

who is at risk for developing haemophilus influenza type b?

Answer 20

much less apparent in children < 5 years now that children are vaccinated

Question 21

what are the clinical manifestations of haemophilus influenza type b?

Answer 21

ear infections, upper respiratory, spreads to lungs

• nonblanchable purple lesions → blood outside the vessel wall
• petechae: smaller than 3 mm
• ecchymoses: larger than 3 mm - turn to blisters → black → amputation

Question 22

Most cases of viral meningitis are ____ and _____. patients need only ___ and require no _____

Answer 22

benign and self-limited

patients need only supportive care and require no specific therapy

Question 23

what are the different types of viral meningitis?

Answer 23

immune deficiency (↓ tx isn’t any different; assume bacterial)
HIV meningitis
herpes simplex meningitis
cytomegalovirus meningitis

Question 24

what are the causes of fungal meningitis?

Answer 24

• cryptococcus
• cimmitis
• hcapsulatum
• candida species
• schenckii (rare)

Question 25

what are the risk factors for meningitis per CDC?

Answer 25

- age (newborns; babies; children; teens and young adults; older adults) - community setting (college campuses - n. meningitdis) - low immunity (certain medical conditions, meds, and surgical procedures) - travel (sub-sarharan africa and mecca - n meningitdis)

Question 26

TEST: what are the three signs of meningeal irritation?

Answer 26

- kernig's sign (knee up extend leg - pain) - brudzinski sign (supine → knees up; head pulled up → pain) - nuchal rigidity (neck back then forward → pain)

Question 27

what are the nursing assessment findings for meningitis?

Answer 27

- Fever - Headache - Photophobia - Changes in LOC - Nausea & Vomiting - IICP/cerebral - Confusion/agitation from Cerebral edema and infection - Seizures - Petechial hemorrhagic rash **indicator - Stroke Symptoms from Septic emboli * **can be missed because mimic flu symptoms

Question 28

what are assessment finding for CSF if there is a bacterial infection?

Answer 28

``` cloudy CSF ↑ CSF pressure ↑ CSF protein ↑ cell count ↓ glucose or absent (bacteria are using the glucose) ↑ WBC count - neutrophils organism found ```

Question 29

what are assessment findings for CSF if there is a viral infection?

Answer 29

clear or cloudy protein normal or slightly ↑ glucose normal white count possibly ↑ -- lymphocytes

Question 30

why is a lumbar puncture and CSF fluid used as a diagnostic study?>

Answer 30

- in acute meningitis, a LP and CSF is indicated to identify the causative organism and in bacterial meningitis, LP is performed to obtain microbiology studies * ** if the CSF glucose remains normal, and the pt continues to look well, the infection is most likely NONbacterial

Question 31

what are the systemic complications of acute bacterial meningitis?

Answer 31

- hypotension or shock - hypooxemia - hyponatremia (from SIADH) - cardiac arrhythmias and ischemia - stroke (bacteria in blood → big enough → goes to brain and acts like a clot - exacerbation of chronic disease

Question 32

what is the management for meningitis?

Answer 32

- Prevention: Vaccination - Isolate the patient - Eliminate the vector - Prophylaxis (for Meningococcal meningitis) • Age 1mo-50 yrs-Vancomycin plus Cefotaxime or Rocephine • Age >50 yrs-Vancomycin plus ampicillin plus Cefotaxime & Rocephine

Question 33

in order to isolate the bacteria, what kind of transmission precautions do we institute? when do they come off?

Answer 33

DROPLET - respiratory isolation x 24hrs after antibiotic started (unless patient gets worse - even if febrile)

Question 34

what is the adult ATB dosing < 50 years old?

Answer 34

- Cefotaxime – 2 g IV q 4 hours - Ceftriaxone – 2 g IV q 12 hours - Vancomycin – 750-1000 mg IV q 12 hours or 10-15 mg/kg IV q 12 hours

Question 35

what is the adult ATB dosing > 50 years old?

Answer 35

- Cefotaxime (2 g IV q 4 hours) or ceftriaxone (2 g IV q 12 hours) - plus vancomycin (750-1000 mg IV q 12 hours or 10-15 mg/kg IV q 12 hours)

Question 36

what are the adult ATB dosing > 50 years old if the CSF stain shows gram negative bacilli?

Answer 36

ceftazidime (2 g IV every 8 hours) ´plus ampicillin (50 mg/kg IV every 6 hours) Other options are meropenem, TMP-SMX, and doxycycline

Question 37

what is the steroid used for meningitis and what is the dosing for >50years old?

Answer 37

Dexamethasone (0.4 mg/kg IV every 12 hours for 2 days or 0.15 mg/kg every 6 hours for 4 days) is given 15-20 minutes before the first dose of antibiotics * *crosses BBB - anti-inflammatory

Question 38

what are the nursing assessments/priorities with meningitis?

Answer 38

- Frequent Neuro checks/assessment - Pain control - Antiemetic's - Antipyretics (Treat fever greater than 101) - Maintain adequate hydration (equal I&O) - Keep HOB at 30 degrees or greater as tolerated - Quiet environment (protect from light-photophobia) - Cluster care - Teaching patient and family - Vaccinations

Question 39

what is the pathophysiology of lumbar back pain?

Answer 39

- Lower back = L1-L5 - Lumbar region supports much of the weight of the upper body - Vertebrae are shock absorbers - intervertebral discs-round, rubbery pads - Ligaments-bands of tissue hold the vertebrae in place - Tendons attach the muscles to the spinal column - 31 pairs of nerves are rooted to the spinal cord

Question 40

what are the risk factors for lumbar back pain?

Answer 40

- age (the first attack of low back pain occurs 30 - 50 and becomes more common) - fitness level - pregnancy - weight gain - genetics - occupational risk factors (RN) - mental health factors (lack of movement) - backpack overload in children

Question 41

what is the most common cause of lower back pain?

Answer 41

spondylolisthesis

Question 42

what are the other causes of lower back pain? (4)deformitiy

Answer 42

- degenerative disc disease (r/t spondylolisthesis) - facet joint dysfunction - sacroiliac joint dysfunction - inflammatory joint disease (osteoarthritis, arthritis, RA, spondyloarthriritis or spondyloarthropathy)

Question 43

what are the mechanical causes of lower back pain? (9)

Answer 43

- sprains and strains - intervertebral disc degeneration - lumbar herniated or ruptured disc - radiculopathy - sciatica - spondylolisthesis - traumatic injury - spinal stenosis - deformity (scoliosis/lordosis/kyphosis)

Question 44

what are underlying causes of lower back pain (5)?

Answer 44

- infections (osteomyelitis, discitis, sacroilitis) - tumors - cauda equina syndrome (disc is pushed into the spinal) - abdominal aortic aneurysms (pain is a sign aneurysm is near rupture) - kidney stones (usually on one side)

Question 45

what are the diagnostics used for lower back pain?

Answer 45

- Xray - CT - Myelograms - Discography - MRI - Electrodiagnostics (EMG) - Nerve conduction studied (NCS) - Evoke potential (EP) - Bone Scan - Ultrasound imaging - Blood Testing (HLA-B27 - genetic marker for ankylosing spondylititis or reactive arthritis AND CRP)

Question 46

what is the medical tx for lower back pain?

Answer 46

- hot and cold pack - activity - strengthening exercises - PT - transcutaneous electrical nerve stimulation (TENS) - medications

Question 47

what meds are used to tx lower back pain?

Answer 47

- analgesia - NSAIDs - muscle relaxants - gabapentin - pregablin - epidural corticosteroid injections

Question 48

what are 5 teaching points for lower back pain?

Answer 48

- Always stretch before exercise or other strenuous physical activity. - Don’t slouch when standing or sitting. - At home or work, make sure work surfaces are at a comfortable height. - Sit in a chair with good lumbar support and proper position and height for the task. Keep shoulders back. - Wear comfortable, low-heeled shoes

Question 49

what are 4 more teaching points for lower back pain?

Answer 49

- Don’t try to lift objects that are too heavy • Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back. • When lifting, keep objects close to the body • Do not twist when lifting - Maintain proper nutrition and diet to reduce and prevent excessive weight gain - Quit smoking

Question 50

what are the surgical interventions/tx for lower back pain?

Answer 50

- Vertebroplasty and kyphoplasty - Spinal laminectomy (also known as spinal decompression) - Discectomy or microdiscectomy - Foraminotomy

Question 51

what are the additional surgical tx for lower back pain?

Answer 51

- IDET-intradiscal electrothermopasty - Interspious process decompression - Spinal Fusion with bone grafting - Minimally invasive lumbar fusion - Percutaneous laser discectomy - Artificial disc replacement - Chartite or Prodisc-1 - Radiofrequency discal nucleoplasy - Outpatient - Minimal invasive

Question 52

what is a laminectomy?

Answer 52

- removal of posterior arch of a vertebra - removal of lamina and HNP - LOS 1-2 days (based on pain/mobility)

Question 53

what are the post op nursing assessment priorities?

Answer 53

- frequent neuro assessment | - wound

Question 54

what is part of the FREQUENT neuro assessment?

Answer 54

- sensation - motor/muscle strength - bladder - bowel - pain assessement

Question 55

what is part of the wound assessment?

Answer 55

- incision/drain | - graft site is often more painful

Question 56

what should the neuro assessment include?

Answer 56

- prior hx of deficits - assess for any changes from pre-op - if a change worsens, call MD ASAP

Question 57

what is the post op care pt and family teaching for lower back?

Answer 57

- Report any new changes in sensation; Weakness/numbness - Maintain good body alignment - Log roll to exit bed - No twisting - Wear brace (TLSO), Orthotic device at all times while out of bed - No lifting more then 5# - No sitting for long periods of time - Report any issues of not being able to empty bowel or bladder - Maintain good posture - S/S of infection - No driving for 4-6 weeks