CNS Communicable diseases Flashcards
MENINGITIS, RABIES (55 cards)
1
Q
Inflammation of meninges
A
MENINGITIS
2
Q
protects the brain from traumatic
injury / blow to your head (shock absorber)
A
Meninges
3
Q
Parts/ Layers of Meninges:
A
- Dura mater: outer layer, closest to skull
- Arachnoid: middle layer
- Pia mater: inner layer, closest to brain tissue
4
Q
↑ICP → Cerebral hypoxia
A
Cerebral edema
5
Q
Normal ICP:
A
75 – 180 mmH2O / 0-15 mmHg
6
Q
Cerebral Cortex – could only tolerate hypoxia for
A
4-6 mins
if this exceeds, leads to irreversible brain damage
7
Q
center for respiration
A
Medulla Oblongata
8
Q
Medulla Oblongata – center for respiration, could
only tolerate hypoxia for
A
10-12 mins
if this exceeds, leads to irreversible brain damage
9
Q
MENINGITIS CA:
A
- Haemophilus influenzae Type B
- Neisseria meningitidis
- Streptococcus pneumoniae
10
Q
MENINGITIS MOT
A
- Droplet
- Contact (soiled secretion)
11
Q
MENINGITIS IP
A
2-10 days
12
Q
MENINGITIS DX TEST:
A
Lumbar puncture / tap
aka Spinal puncture / tap
13
Q
- To evaluate subarachnoid obstruction
- To confirm ↑ICP
- Done by the physician
1. Compresses the right jugular vein for 10 secs
/ left jugular vein for 10 secs
2. Manometer – observe for rapid rise of
pressure (↑ICP in manometer)
A
Queckenstedt’s Test
14
Q
1. Collect a sample of CSF
Normal CSF production:
Absorbed by blood:
A
- Normal CSF production: 500 ml
- Absorbed by blood: 100 – 150 ml
15
Q
- DURING SPINAL TAP Position:
A
- Orthopneic position – sitting / leaning
forward on an overbed table - Fetal position / Left lateral recumbent
– feet are flexed to the chest
16
Q
- Insert a small needle into
A
L3-L4,
L4-L5,
L5-S1
17
Q
3 samples contains
A
(1-2 ml of CSF) to be placed
in 3 sterile test tubes
18
Q
After SPINAL TAP position:
A
flat on bed for 6-8hrs
19
Q
flat on bed for 6-8hrs to prevent?
A
- After position: flat on bed for 6-8hrs (prevent
headache / post spinal headache)
20
Q
MENINGITIS 6. Nursing management:
A
Restrict fluids1000-
1500 ml to decrease CSF production
21
Q
SIGNS AND SYMPTOMS (↑ICP):
A
- Nuchal Rigidity – inability to flex the neck
forward - Kernig’s sign – pain upon extension or
straightening of knees/legs - Brudzinski’s sign – flexion of the neck
causes flexion of the knee
22
Q
Normal color of CSF:
A
clear, colorless
(cloudy =infection; reddish = hemorrhage)
23
Q
Normal amount of CSF:
A
production 500 ml
absorbed by blood, but the remaining is 100-150ml
24
Q
Normal glucose in CSF:
A
50-80 mg/dL (↓ = infection)
25
Normal proteins in CSF:
20-50 mg/dL (↑ =infection)
26
Normal ICP in newborn:
2-5 mmHg
27
Normal ICP in children:
8-10 mmHg
28
Normal ICP in adults:
8-15 mmHg
29
OTHER SIGNS AND SYMPTOMS (↑ICP):
1. Cushing’s triad (HyperBradyBrady; ↑BP, ↓PR,
↓RR)
2. Anisocoria – dilated pupils d/t compression of
CN3 (Oculomotor)
3. Diplopia – double vision, compression of CN6
(Abducens, largest cranial nerve, prone to
compression)
4. Doll’s eye – position on right side, observe for
direction of the eyes; disconjugate movement of
the eyes = ↑ICP
5. High Fever and Chills
6. Nausea and vomiting (projectile)
7. Photosensitivity
8. Wide Pulse Pressure
9. Restlessness (initial sign of ↑ICP)
10. Convulsions / Seizures (place in dark & quiet
environment)
30
dilated pupils d/t compression of
CN3 (Oculomotor)
Anisocoria
31
double vision, compression of CN6 (Abducens, largest cranial nerve, prone to
compression)
Diplopia
32
position on right side, observe for direction of the eyes; disconjugate movement of
the eyes = ↑ICP
Doll’s eye
33
OTHER SIGNS AND SYMPTOMS (↑ICP):
5. High Fever and Chills
6. Nausea and vomiting (projectile)
7. Photosensitivity
8. Wide Pulse Pressure
9. Restlessness (initial sign of ↑ICP)
10. Convulsions / Seizures (place in dark & quiet
environment)
34
MENINGITIS DOC
- can give antibiotic, Penicillin G
1. Osmotic diuretic – mannitol; to reduce cerebral edema; observe urine output in 5-10
mins; observe BP (hypotension, dizziness)
2. Corticosteroids – Dexamethasone; cross
blood brain barrier, reducing inflammation /
cerebral edema; Dexamethasone causes GI
infection
Antacids – aluminum based (lead to constipation), magnesium based (lead to diarrhea)
PPI – Zantac / Ranitidine to prevent ulcer
3. Pain relievers
4. Anticonvulsants – Tegretol Phenobarbital; common: Phenytoin / Dilantin
35
Dilantin Therapeutic Range:
10-20 (PO, IV)
36
37
38
COMMON SIDE EFFECTS OF DILANTIN:
1. Red Urine - normal s/e
2. Ataxia – involuntary movement of
extremities; loss of muscle control
3. Nystagmus – involuntary movements of the
eyes
4. Bone Marrow Depression – leukopenia,
anemia, thrombocytopenia, bleeding,
bruising / ecchymosis
5. Gingival hyperplasia – overgrowth /
swelling of the gum tissues → prone to
bleeding
39
Gingival hyperplasia Management:
1. Soft bristled toothbrush
2. Regular dental check-up
3. Good oral hygiene
4. Massage gums
40
MANAGEMENT OF ↑ICP
1. Positioning:
2. HOB elevation:
3. Fluid Restriction:
1. Positioning: Semi fowlers (drain excess
CSF, promotes lung expansion, improves
cerebral tissue perfusion)
2. HOB elevation: 30-40 degrees (max 45
degrees) not 90 degrees since it may cause
brain herniation, and it could further ↑ICP that
can lead to hemorrhage
3. Fluid Restriction: 1L to 1500mL only (limit /
↓CSF production)
41
FACTORS THAT ↑ICP
1. Nausea and vomiting
2. Valsalva maneuver (straining of stool)
3. Over suctioning
4. Enema
5. Rectal exam
6. Bending / Stooping
42
RABIES
- Latin →
-Greek →
- Latin → “madness”
- Greek → “lyssa” → violent
43
RABIES Other terms:
Lyssa, Hydrophobia
44
RABIES CA:
Rhabdovirus
45
GENUS:
FAMILY:
GENUS: Lyssavirus
FAMILY: Rhabdoviridae
46
RABIES MOT:
* Bite / scratch of a rabid animal (any warmblooded
animal) (direct contact)
* Touched the saliva of the infected animal and put
it on your eyes
* Airborne d/t inhalation of the aerosols of the virus
47
RABIES IP:
1-3 months extends to 1 year / 14 days to 20 years;
1 year to several years
48
RABIES COMPLICATION:
1. Meningitis
2. Encephalitis
3. death occurs
## Footnote
replicate in motor neurons / brains
↓
Travels to peripheral NS
↓
ANS
↓
Migrate to salivary glands
Observe the dog for 10 days, if it dies, cut head,
bring to PHO to confirm rabies virus / locate Negri
bodies
Cytoplasmic inclusions – study in lab to confirm
rabies
49
2 TYPES OF RABIES VACCINE:
1. Purified Vero Cell Rabies Vaccine (PVRV)
2. Purified Chick Embryo Cell Vaccine (PCECV)
50
# DOSE
Purified Vero Cell Rabies Vaccine (PVRV)
- 0.5ml, IM
- 0.1ml, ID (alternative dose)
51
# DOSE
Purified Chick Embryo Cell Vaccine (PCECV)
- 1 ml, IM
- 0.1ml, ID (alternative dose)
52
Purified Chick Embryo Cell Vaccine (PCECV)
Number of Doses:
Days:
Number of Doses: 4 doses (1st trimester)
Days: 0, 3, 7, 14 days (2 weeks)
53
2 Booster Doses
- Had received the vaccine before
- after an exposure
Days: 0 and 3 days
54
RABIES s/sx:
1. Apprehension
2. Hydrophobia (cover IVF with cloth / paper)
3. Fever (earliest sign)
4. Headache
5. Muscle spasm in throat and larynx
6. Paralysis (respiratory paralysis)
7. Disorientation / Confusion
55
RABIES management
1. Wound care: for 15 minutes, soap water,
povidone iodine or alcohol
2. Vaccination / Immunization (ideally: 0, 3, 7,
14)
3. Observe pet for 10 days
4. Have pet immunized at 3 months of age
and every year after
