meningitis

Question 1

what is meningitis

Answer 1

inflammation of the meninges

Question 2

what are the causative agents of meningitis

Answer 2

haemophilus influenza type B
neisseria meningitidis
streptococcus pneumoniae

Question 3

MOT of meningitis

Answer 3

droplet
contact—-soiled secretions

Question 4

incubation period of meningitis

Answer 4

2-10 days

Question 5

diagnostic test for meningitis

Answer 5

lumbar puncture/ tap
spinal puncture/tap
quickenstedts test

Question 6

s/sx of meningitis

Answer 6

nuchal rigidity
kernig’s sign
brudzinki’s sign

Question 7

what is nuchal rigidity

Answer 7

inability to flex the neck forward

Question 8

what is kernig’s sign

Answer 8

pt complains pain upon extension or straightening the KNEE/legs

Question 9

What is brudzinki’s sign

Answer 9

flexion of the neck causes flexion of the knee

Question 10

normal color of CSF

Answer 10

colorless, clear

Question 11

normal amount of CSF

Answer 11

100-150ml (normal production 500ml)

Question 12

normal glucose in CSF

Answer 12

50-80mg/dl (always decrease in meningitis)

Question 13

normal protein in csf

Answer 13

20-50 mg/dl (always increase in any infection of the brain)

Question 14

normal ICP in newborn

Answer 14

2-5mmHg

Question 15

normal ICP in children

Answer 15

8-10 mmHg

Question 16

normal ICP in adults

Answer 16

8-15 mmHg

Question 17

signs of increase ICP

Answer 17

Cushing’s Triad (increase BP, decrease RR, PR)

anisocoria
diplopia
doll’s eye
high fever/chills
N/V
Photosensitivity
Wide pulse pressure
Restlessness
Convulsions/seizures

Question 18

what is anisocoria

Answer 18

dilated pupils d/t compression of CN3 (occulomotor)

Question 19

diplopia

Answer 19

this is d/t compression of CN6 (abducens) (longest CN therefore prone to compression)

Question 20

initial sign of increase ICP

Answer 20

restlessness

Question 21

normal ICP

Answer 21

75-180mmH2O or 0-15 mmHg

Question 22

how many minutes do CEREBRAL CORTEXT tolerate HYPOXIA

Answer 22

4-6 mins (irreversible brain damage)

Question 23

what do cerebral context tolerate?

Answer 23

HYPOXIA

Question 24

what do MEDULLA OBLONGATA tolerates?

Answer 24

HYPOXIA

Question 25

how many minutes do MEDULLA OBLONGATA tolerates hypoxia?

Answer 25

10-12 mins (beyond could result to irreversible brain damage)

Question 26

Pharmacological management for meningitis

Answer 26

ANTIBIOTICS (penG) OSMOTIC DIURETICS (mannitol) CORTICOSTEROIDS (dexamethasone) ANTICONVULSANT PAIN RELIEVERS (codein) (may headache siya) ANTACIDS (aluminum or magnesium based) PPI (zantac/ranitidine)

Question 27

why we need to give antibiotics (penG) to pt wd meningitis

Answer 27

bacteria siya eh

Question 28

why we need osmotic diuretics? (mannitol)

Answer 28

to decrease cerebral edema

Question 29

nursing responsibilities for osmotic diuretics in meningitis

Answer 29

Monitor urine output (5-10 mins) WOF dizziness and hypotension since mag increase urine output niya

Question 30

common side effect of ANTACIDS ALUMINUM BASED

Answer 30

constipation

Question 31

common side effect of ANTACIDS MAGNESIUM BASED

Answer 31

diarrhea

Question 32

what drug is to be given when a pt is taking dexamethasone

Question 33

why we give PPI for pt with meningitis

Answer 33

to prevent ulcers

Question 34

position during and after lumbar tap?

Answer 34

Lateral decubitus position: hindi sure

Question 35

purpose of lumbar tap

Answer 35

collect a sample of CSF

Question 36

what color indicates: Normal Infection Haemorrhage

Answer 36

clear and colorless cloudt bloody

Question 37

restrict fluids to??

Answer 37

1000-1500 ml of water

Question 38

where do they insert the needle in lumbar tap??

Answer 38

L3-L4, L4-L5, L5-S1

Question 39

how many ml of CSF contains 1 sample?

Answer 39

1-2ml

Question 40

how many sample of CSF to be placed in sterile test tubes?

Answer 40

3 samples

Question 41

this is a test to subarachnoid obstruction

Answer 41

Queckenstedt’s Test

Question 42

discuss Queckenstedt’s test

Answer 42

-to confirm increase ICP -done by the physician

Question 43

how they do queckenstedt’s test?

Answer 43

compresses the right jugular vein for 10 secs then same for the left jugular vein

Question 44

manometer

Answer 44

rapid rise of pressure—— increase ICP

Question 45

why there is an Increase BP in cushing’s triad for pt with meningitis?

Answer 45

it is a force of cardiac contractility in attempt to increase tissue perfusion

Question 46

in cushing’s triad, there is an involvement of the ____

Answer 46

medulla oblongata

Question 47

in any brain/neurologic disorder, the pulse pressure will??

Answer 47

widened

Question 48

after lumbar puncture, the recommended position is?

Answer 48

flat on bed for 6-8 hours to prevent spinal headache

Question 49

common SE or complication after lumbar pubcture??

Answer 49

post spinal headache

Question 50

what is doll’s eye

Answer 50

dysconjugate movement of the eyes

Question 51

why we give dexamethasone to patient with meningitis?

Answer 51

to decrease inflammation and the only corticosteroid drug that can cross the BBB

Question 52

dexamethasone causes??

Answer 52

GI irritation and ulcers

Question 53

if dexamethasone causes GI irritation and ulcers then give ___

Answer 53

antacids (aluminum and magnesium based) PPI - zantac/ranitidine

Question 54

anticonvulsants for meningitis

Answer 54

prevent seizures and convulsions phenobarbital tegretol phenytoin/dilantin

Question 55

DOC (anticonvulsants)

Answer 55

Phenytoin/dilantin

Question 56

serum therapeutic level of dilantin

Answer 56

10-20 mcg/dl

Question 57

if dilantin is given per orem??

Answer 57

give with food to prevent GI upset

Question 58

if dilantin is given per IV??

Answer 58

prepare 10ml/cc of NSS because phenytoin readily crystallises in the veins

Question 59

how to prevent crystallizes in the veins when giving phenytoin?

Answer 59

- first administer with 5ml NSS - then phenytoin - then flush with the last 5ml of NSS

Question 60

Do’s and Dont’s when giving Dilantin Therapy

Answer 60

- avoid driving (causes drowsiness) - monitor glucose level (dilantin inhibits insulin release) (you could have HYPERGLYCEMIA) - dilute with NSS and not dextrose sol (bec dextrose could cause PRECIPITATION) - avoid IM injection (could irritate tissues) - avoid alcohol - monitor CBC (causes bone marrow depression) - contraindicated in pregnancy (it has teratogenic effect) - gradual withdrawal of phenytoin to prevent STATUS EPILEPTICUS

Question 61

what is status epilepticus

Answer 61

a type of seizure occuring in rapid succession with no consciousness between seizures can cause brain damage or coma

Question 62

SE OF DILANTIN IF PER OREM

Answer 62

BRANG -red urine -ataxia (involuntary movement of the extremities) -nystagmus (involuntary eye movement) -bone marrow depression (leukopenia, anemia, thrombocytopenia — decrease platelet count kaya prone to BLEEDING, ECCHYMOSIS, BRUISING) -GINGIVAL HYPERPLASIA

Question 63

common SE of dilantin (Per orem)

Answer 63

GINGIVAL HYPERPLASIA

Question 64

MANAGEMENT FOR -GINGIVAL HYPERPLASIA

Answer 64

- soft bristle toothbrush - regular dental check up - good oral care/hygiene - massage gums

Question 65

what is -GINGIVAL HYPERPLASIA

Answer 65

overgrowth of the gum tissues (swelling or bleeding)

Question 66

MANAGEMENT OF ICP

Answer 66

- position: SEMI FOWLER’s (promotes lung expansion, improves cerebral tissue perfusion) - elevate HOB - 30-40 degree maximum of 45 defrees ** do not attempt to elevate to 90— it will cause brain herniation then can further lead to Increase ICP or hemorrhage - fluid restriction to 1L to 1.5L to limit CSF production

Question 67

factors that increase ICP

Answer 67

N/V Valsalva maneuver oversuctioning enema rectal exam bending or stooping