Nervous System Alterations Flashcards
Exam 3
1
Q
Central Nervous System:
What is it comprised of?
A
The CNS comprises the brain and spinal cord.
2
Q
Central Nervous System
Skull (cranium): What does it do?
A
Protects brain from traumatic injury
3
Q
Central Nervous System
Meninges: What is it?
A
Three layers cover brain and spinal cord.
4
Q
Central Nervous System
Cerebrospinal fluid: What does it do?
A
Fluid shock absorber
5
Q
Central Nervous System
Cerebral vasculature: What is it made up of?
A
Internal carotids and vertebral arteries
6
Q
Peripheral Nervous System
What is it comprised of?
A
The PNS consists of 12 pairs of cranial nerves and 31 pairs of spinal nerves.
7
Q
Peripheral Nervous System
Cranial Nerves: What do they do?
A
Supply motor and sensory fibers to the head, neck, upper back, and viscera to the level of the waist
8
Q
Peripheral Nervous System
Spinal Nerves: What is it attached to?
A
Attached to spinal cord in pairs
9
Q
Peripheral Nervous System
Spinal Nerves: Dorsal root?
A
Dorsal root houses nerve cell bodies of sensory neurons.
10
Q
Peripheral Nervous System
Spinal Nerves: Ventral root
A
Ventral root houses motor axons.
11
Q
Cells of the Nervous System
Include:
A
Neurons
Neuroglia
12
Q
Cells of the Nervous System
Include: Neuron
A
Basic functional unit
13
Q
Cells of the Nervous System
Neuroglia (glia cells)-
A
Neuroglia (glia cells)-constitute the supportive tissue associated with the neurons
14
Q
Cells of the Nervous System
Four types of neuroglia:
A
Microglia
Astrocytes
Ependymal
Oligodendroglia
15
Q
Cells of the Nervous System
Four types of neuroglia: Microglia
A
Phagocytic cells
16
Q
Cells of the Nervous System
Four types of neuroglia: Astrocytes
A
Supportive cells making up the blood-brain barrier
17
Q
Cells of the Nervous System
Four types of neuroglia: Ependymal
A
Line ventricles,
produce and circulate CSF
18
Q
Cells of the Nervous System
Four types of neuroglia: Oligodendroglia
A
Found in white matter, produce myelin
19
Q
Neurological Assessment
Physical Examination includes:
A
Mental status
Glasgow Coma Scale
Mini Mental State Examination
20
Q
Neurological Assessment
Physical Examination includes: Mental Status
What is included?
A
Level of consciousness and arousal
Orientation to the environment
Thought content
21
Q
Neurological Assessment
Physical Examination includes: Glasgow Coma Scale - When is this done?
A
if brain injury is suspected
22
Q
Physical Examination:
Mini Mental State Examination
A
Cognitive assessment, monitors disease progression in dementia and other neurological disease states
23
Q
Glasgow Coma Scale:
What is the tool for? What do scores range from?
A
The Glasgow Coma Scale is a tool for assessing a patient’s response to stimuli.
Scores range from 3 (deep coma) to 15 (normal)
24
Q
Testing cranial nerves
CN I: What is it?
A
CN I (olfactory) pertains to smell
25
Testing cranial nerves
CN II: What is it?
CN II (optic) pertains to vision
26
Testing cranial nerves
CN III, CN IV, and CN VI: What are they?
CN III, CN IV, and CN VI are assessed together because they pertain to the innervate extraocular muscles involved in eye movement.
27
Pupil size/reactivity:
What cranial nerve is assessed?
(CNII)
28
Pupil size/reactivity:
What are the three ways pupils are?
Pinpoint pupils
Dilated pupils
Aniscoria
29
Pupil size/reactivity:
Pinpoint pupils: What would this indicate?
Opiates
Medications for glaucoma
Nearly dead
30
Pupil size/reactivity:
Dilated pupils: What would this indicate?
Fear/panic/anxiety
Seizures
Cocaine,
31
Pupil size/reactivity:
Aniscoria: What is this? What would this indicate?
Unequal pupils
Can be normal, but can indicate neural dysfunction
32
Types of Abnormal Pupils include:
1. Small or Pinpoint Pupils
2. Large pupils
3. Midposition Fixed Pupils
4. One Large Pupil (Aniscoria)
33
Vital Signs:
Respirations: What does shallow indicate?
problem with maintaining patent airway/need suctioning
34
Vital Signs:
Respirations:
Snoring or stridor
Obstruction
35
Vital Signs:
Respirations:
Inability to maintain airway means?
Inability to maintain airway = cervical spinal cord lesion, neurodegenerative disease
36
Vital Signs:
Respirations:
Cheyne Stokes: What does this indicate?
Cheyne stokes = increased ICP
37
Vital Signs:
Respirations:
Hypoventilation: What does this indicate?
Hypoventilation = increased CO2, reduced O2- edema
38
Vital Signs:
Respirations:
Hyperventilation: What does this indicate?
Hyperventilation = respiratory alkalosis, decreased CO2-vasoconstriction- decreased cerebral blood flow
39
Vital Signs:
Temperature: What is it controlled by?
Control – hypothalamus
40
Vital Signs:
Temperature: Loss of control leads to?
Loss of control = Hyperthermia
41
Vital Signs:
Temperature: Hypothermia indicates?
Hypothermia = pituitary damage, spinal cord injury (SCI)
42
Vital Signs:
HR: What indicates increased ICP?
Increased ICP = tachycardia, altered ECG such ventricular or atrial dysrhythmias
43
Vital Signs:
HR: As ICP continues to rise, what happens?
As ICP continues to rise, bradycardia results indicating impending herniation
44
Vital Signs:
Blood pressure: WHat is most common?
Hypertension most common… as BP increases, CBF increases, and ICP increases
45
What is at the root of many neurological problems?
Increased intracranial pressure is at the root of many neurological problems.
46
As such, any patient who has sustained an injury to the central nervous system is at risk for ?
for increased intracranial pressure.
47
Signs of Increased Intracranial Pressure
What should be established?
Establish baseline neurologic assessment
48
Signs of Increased Intracranial Pressure
How does the person behave?
Decreased LOC, restlessness, confusion, combativeness
Lethargy, coma
49
Signs of Increased Intracranial Pressure
How are pupils?
Sluggish pupils to fixed and dilated, unequal pupils
50
Signs of Increased Intracranial Pressure
What are there changes in? What is a late finding?
Changes in motor function
Changes in VS are a late finding.
51
Signs of Increased Intracranial Pressure
What else occurs (triad)
Cushing triad:
increased systolic pressure,
bradycardia,
irregular respirations
52
Increased Intracranial Pressure:
Diagnostic Procedures include:
Computed tomography (CT) of the head
Magnetic resonance imaging (MRI)
Cerebral blood flow with transcranial
Doppler
Evoked potentials
EEG
Angiography
53
Intracranial Dynamics
How is the skull?
Skull is a rigid box.
54
Intracranial Dynamics
Contents include:
Blood vessels,
CSF,
brain parenchyma (tissue)
55
Intracranial Dynamics
According to the _________, the total volume of these three components remains constant because the skull is rigid and non-expandable. If the volume of one component increases, there must be a compensatory decrease in the volume of another to maintain normal intracranial pressure (ICP).
What is this?
Monro–Kellie doctrine
56
Intracranial Dynamics
Normal ICP range?
Range 0 to 15 mm Hg
57
Cerebral blood flow
What is autoregulation?
Autoregulation is the ability of an organ to maintain consistent blood flow despite marked changes in arterial circulatory and perfusion pressures.
58
Cerebral blood flow
What does the normal brain have the ability to do?
Normal brain has the ability to maintain CBF.
59
Cerebral blood flow
What is normal CBF maintained by?
Normal CBF maintained by CPP 60 to 100 mm Hg
60
Cerebral blood flow
To maintain functional autoregulation cerebral vessels, the following must be present: (3 things)
Normal Paco2
CPP greater than 60 mm Hg
MAP less than 160 mm Hg
61
Cerebral blood flow
To maintain functional autoregulation cerebral vessels, the following must be present:
Normal PaCO2: What is this and what does it do?
Paco2 is a potent vasodilator and will increase ICP.
62
Cerebral perfusion pressure (CPP)
How is it calculated?
Calculated: MAP – ICP = CPP
63
Cerebral perfusion pressure (CPP)
A CPP greater than 100mmHg indicates what?
CPP greater than 100 mm Hg indicates hyperperfusion and increased ICP.
64
Cerebral perfusion pressure (CPP)
CPP less than 60 mm Hg does what?
CPP less than 60 mm Hg decreases blood supply and hypoxia.
65
Cerebral perfusion pressure (CPP)
When MAP = ICP, what does this indicate?
MAP = ICP would indicate no cerebral blood flow.
66
Cerebral perfusion pressure (CPP)
CPP of ______ is maintained in critically ill patients.
CPP of 70 mm Hg is maintained in critically ill patients.
67
Increased Intracranial Pressure Medical Management
What is needed?
Adequate Oxygenation
Carbon Dioxide Management
Blood Pressure
Metabolic Demands
Diuretics
68
Increased Intracranial Pressure Medical Management
Adequate Oxygenation:
What is the goal?
Goal: PaO2 > 80 mm Hg
69
Increased Intracranial Pressure Medical Management
Adequate Oxygenation:
What must be done for this?
Airway vigilance
Mechanical ventilation
70
Increased Intracranial Pressure Medical Management
Adequate Oxygenation:
Mechanical ventilation: What is used and how?
Positive end-expiratory pressure (PEEP) – use with caution
71
Increased Intracranial Pressure Medical Management
Carbon Dioxide Management:
PaCO2 35-45 mm Hg
Avoid hyperventilation
72
Increased Intracranial Pressure Medical Management (Cont.)
Blood Pressure: What is the Goal?
Goal: MAP 70-90 mm Hg
CPP: at least 70 mm Hg
73
Increased Intracranial Pressure Medical Management (Cont.)
Blood Pressure: What should be avoided?
Avoid hypertension
74
Increased Intracranial Pressure Medical Management (Cont.)
Blood Pressure: What should be given to stop hypertension?
Nicardipine
75
Increased Intracranial Pressure Medical Management (Cont.)
Metabolic Demands- What is done?
Temperature control
Pharmacological therapy
Seizure prophylaxis
76
Increased Intracranial Pressure Medical Management (Cont.)
Metabolic Demands- Temperature control
What is done?
Induced hypothermia
Hypothermia continues to be explored as a means of reducing the brain’s metabolic demands during peak times of cerebral edema and brain injury.
77
Increased Intracranial Pressure Medical Management (Cont.)
Metabolic Demands- Pharmacological therapy
What meds are used?
Benzodiazepines
Propofol
Analgesia
78
Increased Intracranial Pressure Medical Management (Cont.)
Metabolic Demands-Diuretics?
What diuretics are used? What do they do?
Osmotic diuretics
Reduce brain tissue volume
79
Increased Intracranial Pressure Medical Management (Cont.)
Metabolic Demands-Diuretics?
What kind of osmotic diuretics reduce brain tissue volume?
Mannitol
Hypertonic saline (3% or 5% NaCl
80
Cerebral vascular disease: Acute Stroke
What is key to identify correct treatment and vascular distribution?
Differential early diagnosis is key to identify correct treatment and vascular distribution
81
Cerebral vascular disease: Acute Stroke
What occurs?
Neurologic deficit with sudden onset, resulting in permanent damage to brain tissue due to a disruption in blood flow
82
Cerebral vascular disease: Acute Stroke
Neurologic deficit with sudden onset, resulting in permanent damage to brain tissue due to a disruption in blood flow
What are the two main types?
Ischemic (75-85%)
Hemorrhage (15-25%)
83
Cerebral vascular disease: Acute Stroke
Neurologic deficit with sudden onset, resulting in permanent damage to brain tissue due to a disruption in blood flow
Ischemic (75-85%): What is this due to?
Thrombosis
Embolism
84
Cerebral vascular disease: Acute Stroke
Neurologic deficit with sudden onset, resulting in permanent damage to brain tissue due to a disruption in blood flow
Hemorrhage (15-25%): What is this due to?
Intracerebral
Subarachnoid
85
Definition and Classifications of Strokes
Stroke: What occurs?
Acute neurologic deficit that occurs when impaired blood flow to a localized area of brain results in injury to brain tissue
86
Definition and Classifications of Strokes
What is the fifth leading cause of death in the US? What is the leading cause of long term disability?
Stroke
Fifth-leading cause of death in United States
Leading cause of serious long-term disability
87
Definition and Classifications of Strokes
Major Classifications of Stroke include:
Ischemic strokes
Hemorrhagic strokes
88
Definition and Classifications of Strokes
Major Classifications of Stroke include:
Ischemic strokes: What is it?
When blood supply to a part of the brain is suddenly interrupted
89
Definition and Classifications of Strokes
Major Classifications of Stroke include:
Ischemic strokes: When blood supply to a part of the brain is suddenly interrupted
Interrupted by what?
Interruption of cerebral blood flow by thrombus or embolus
90
Definition and Classifications of Strokes
Major Classifications of Stroke include:
What is the most common type of stroke?
Ischemic strokes
91
Definition and Classifications of Strokes
Major Classifications of Stroke include:
Hemorrhagic strokes: What occurs?
When there is bleeding into brain tissue or the cranial vault
92
Definition and Classifications of Strokes
Major Classifications of Stroke include:
Hemorrhagic strokes: What does it result from? What percent of strokes is hemorrhagic strokes?
Brain trauma, aneurysms, arteriovenous malformations, or hypertension
10% of all strokes
93
Assessment and Diagnosis of Stroke:
Acronym: slide 30
BE FAST
Balance
Eyes
Face
Arm
Speech
Time
94
Acute Stroke – Hemorrhagic
What are the three types?
Intracerebral hemorrhage
Ruptured cerebral aneurysm
Arteriovenous malformation
95
Acute Stroke – Hemorrhagic
Intracerebral hemorrhage: What occurs? What is it caused by?
Bleeding into the brain
Uncontrolled hypertension
96
Acute Stroke – Hemorrhagic
Intracerebral hemorrhage: What is mortality?
mortality 44-75 % (highest if brainstem hemorrhage)
97
Acute Stroke – Hemorrhagic
Ruptured cerebral aneurysm: What occurs?
Dilated cerebral artery that ruptures
98
Acute Stroke – Hemorrhagic
Ruptured cerebral aneurysm: Where does the bleeding occur?
Bleeding into subarachnoid space (SAH)
99
Acute Stroke – Hemorrhagic
Arteriovenous malformation: What occurs?
Congenital abnormality forming an abnormal communication between arterial and venous systems in the brain
100
Nursing care and National Institutes of Health Stroke Scale (NIHSS):
What does NIHSS determine?
Severity of stroke, and if candidate for t-PA
101
Nursing care and National Institutes of Health Stroke Scale (NIHSS):
If appropriate, what should be administered?
If appropriate: Prepare to administer t-PA
102
Nursing care and National Institutes of Health Stroke Scale (NIHSS):
What kind of problems should be identified?
Hyperglycemia
Neuro assessment/impulsiveness, risk for falls
Communication
ASPIRATION RISK- Dysphagia screen
ECG changes-dysrhythmias
Thrombosis- PE, MI, DVT
U/O- inability to void, incontinence
Skin, contractures
Psychosocial-grief, depression, family coping
103
SEIZURES:
What is it?
Episode of abnormal and excessive discharge of neurons
104
SEIZURES:
Epilepsy: What is it?
Epilepsy-condition spontaneous and recurrent seizures
105
SEIZURES:
Status epilepticus: What is it?
Status epilepticus is continued or repetitive activity.
Status epilepticus is defined as a condition of either continued seizure activity or repetitive seizures without interictal recovery, over a period exceeding 30 minutes.
106
Status epilepticus can be associated with
Status epilepticus can be associated with tonic–clonic, complex–partial, or absence seizures.
107
Seizure Risk Factors:
Cerebrovascular disease
Hypoxemia
Fever (childhood)
Head injury
Hypertension
CNS infections
Brain tumor
Drug and alcohol withdrawal
108
Plan of Care for a Patient Experiencing a Seizure
Observation and documentation of what?
Observation and documentation of patient signs and symptoms before, during, and after seizure
109
Plan of Care for a Patient Experiencing a Seizure
What are nursing actions?
Nursing actions during seizure for patient safety and protection
110
Plan of Care for a Patient Experiencing a Seizure
What is done after seizure?
After seizure care to prevent complications
111
What are the types of seizures?
SIMPLE PARTIAL SEIZURE (SPS)
Complex Partial Seizures (CPS)
Generalized Tonic-Clonic Seizure
Absence Seizures
112
SIMPLE PARTIAL SEIZURE (SPS):
What is it?
Focal seizure without alteration in awareness
113
SIMPLE PARTIAL SEIZURE (SPS):
What is an example?
An “aura” is a simple partial seizure
114
SIMPLE PARTIAL SEIZURE (SPS):
What is it not associated with?
No associated EEG changes in the majority of cases
115
What is the most common seizure type?
Complex Partial Seizures (CPS)
116
Complex Partial Seizures (CPS)
What is it? What does it result in?
Focal seizure (often temporal) with bilateral spread resulting in an alteration in awareness.
May have SPS as aura
117
Complex Partial Seizures (CPS)
What may they have as an aura?
May have SPS as aura
118
Complex Partial Seizures (CPS)
What are signs and symptoms?
Staring often with automatisms, may be partially reactive, last 1-2 minutes
119
Complex Partial Seizures (CPS)
How are patients postictally?
Postictally often confused and tired
120
Complex Partial Seizures (CPS)
What would EEG show?
EEG with bilateral temporal ictal discharge
121
Generalized Tonic-Clonic Seizure:
What is this called?
“Grand mal”
Generalized Tonic-Clonic Seizure
122
Generalized Tonic-Clonic Seizure:
What occurs?
Loss of consciousness with generalized tonic then clonic activity
Cyanosis, foaming, tongue-biting, urinary incontinence, last 1-2 minutes
123
Generalized Tonic-Clonic Seizure:
What occurs postictally?
Postictally, often deep sleep then lethargy and confusion
124
Generalized Tonic-Clonic Seizure:
What should be done as first aid?
FIRST AID: maintain airway, protect head, don’t restrain
125
Generalized Tonic-Clonic Seizure:
What would EEG show?
EEG shows generalized polyspike activity
126
Absence Seizures:
What is this called?
“Petit mal”
127
Absence Seizures:
What does NOT occur in this?
No aura or postictal state
128
Absence Seizures:
What are symptoms? How long does this seizure last?
Unresponsive staring, often with blinking
Last 10-20 seconds
129
Absence Seizures:
What appears on EEF? What are seizures precipitated by?
Generalized 3 Hz spike-wave on EEG; seizures precipitated by hyperventilation
130
Absence Seizures:
How long in life do these last?
Usually outgrown by late childhood
131
Nursing MANAGEMENT OF SEIZURES
What should be maintained?
Maintain airway and ventilation
132
Nursing MANAGEMENT OF SEIZURES
What should be assessed? For what?
Neurological assessment
For Characteristics of seizure activity
133
Nursing MANAGEMENT OF SEIZURES
What kind of precautions should be taken?
Safety precautions
134
Seizure Medical Management:
What medications?
Benzodiazepines
Anticonvulsants
Barbituates
135
Seizure Medical Management:
Benzodiazepines: What do they do?
Block excessive activity of the gamma-aminobutyric acid-A (GABA-A) receptors in the brain and other areas in the central nervous system.
136
Seizure Medical Management:
Benzodiazepines: What are examples?
Xanax, Klonopin, diazepam, Ativan, midazolam
137
Seizure Medical Management:
Anticonvulsants: What do they do?
slow down impulses in the brain that cause seizures
138
Seizure Medical Management:
Anticonvulsants: What is an example?
Dilantin
139
Seizure Medical Management:
Barbituates: What do they do?
increasing the activity of the inhibitory neurotransmitter GABA.
140
Seizure Medical Management:
Barbituates: What is an example?
Phenobarbital
141
Guillain Barre Syndrome (GBS):
What is this?
Immune mediated demyelinating neuropathy
142
Guillain Barre Syndrome (GBS):
Symptoms?
Ascending weakness of limbs to paralysis-including respiratory muscles
143
Guillain Barre Syndrome (GBS):
What are ANS Symptoms?
ANS- postural hypotension, arrhythmias, facial flushing, sweating , urinary retention
144
Guillain Barre Syndrome (GBS):
Symptoms: What kind of pain occurs?
Pain in shoulder, back posterior thighs
145
Guillain Barre Syndrome (GBS):
How long is the acute phase:
Acute phase 1-4 weeks
146
Guillain Barre Syndrome (GBS):
How long is the acute phase:Acute phase 1-4 weeks: What occurs after?
then patient stabilizes and rehabilitation can begin; however, recovery may be lengthy, from 3 months to 2 years.
147
Nursing management of GBS
What kind of support may be necessary?
Ventilatory support as required
148
Nursing management of GBS
What should be monitored?
Monitor blood pressure and heart rate; detect and treat arrhythmias early
Monitor for constipation
Monitor for urinary retention
149
Nursing management of GBS
Monitor blood pressure and heart rate; What should be detected and treated early?
detect and treat arrhythmias early
150
Nursing management of GBS
Monitor for urinary retention: How?
intermittent urinary catheterization
151
Nursing management of GBS
What should be treated? What should they have assistance in?
Treat pain
Assist with ADLs
152
Autonomic dysreflexia:
What is it?
Autonomic dysreflexia is a syndrome in which there is a sudden onset of excessively high blood pressure
153
Autonomic dysreflexia:
Who is it most common in?
More common in people with SCI- spinal cord injury that involve the thoracic nerves or above (T7 or above).
154
Autonomic dysreflexia:
What are symptoms? (Not having to do with skin)
A pounding headache.
Nasal stuffiness.
Nausea.
Bradycardia
155
Autonomic dysreflexia:
What are symptoms? (having to do with skin)
A flushed face and/or red blotches on the skin above the level of spinal injury.
Sweating above the level of spinal injury.
Goose bumps below the level of spinal injury.
Cold, clammy skin below the level of spinal injury.
156
Autonomic Dysreflexia: Cause, Prevention / treatment
What are causes (What are triggering conditions)
Overfilled bladder
Overfull bowel or constipation
Pressure injuries, ingrown nails
Tight clothing or devices
157
Autonomic Dysreflexia: Cause, Prevention / treatment
What are causes (What are triggering conditions): Overfilled bladder
What is prevention and treatment of this?
Prevent UTI, assess bladder, monitor I &O,
may be incontinent or neurogenic bladder… bladderscan q4-6h for residual volume,
regular toileting if able
158
Autonomic Dysreflexia: Cause, Prevention / treatment
What are causes (What are triggering conditions): Overfull bowel or constipation
What is prevention and treatment of this?
Fiber and fluids.
Assess bowel sounds,
elimination
Potential for ileus, GI ulcers
159
Autonomic Dysreflexia: Cause, Prevention / treatment
What are causes (What are triggering conditions): Pressure injuries, ingrown nails
What is prevention and treatment of this?
Check skin, podiatry consult if necessary
160
Autonomic Dysreflexia: Cause, Prevention / treatment
What are causes (What are triggering conditions): Tight clothing or devices
What is prevention and treatment of this?
Ensure comfort
Avoid wrinkles in sheets,
Monitor equipment to ensure not pulling
161
Spinal Cord Injury Nursing Management include:
Airway management
Cardiovascular stability
DVT prophylaxis
Skin care
Elimination
162
Spinal Cord Injury Nursing Management include:
Airway management: What are you assessing?
Assessment of respiratory function
163
Spinal Cord Injury Nursing Management include:
Airway management: What are you optimizing? How?
Optimize pulmonary function
Positioning
164
Spinal Cord Injury Nursing Management include:
Cardiovascular stability: Why?
Maintain spinal cord perfusion
165
Spinal Cord Injury Nursing Management include:
Spinal cord stabilization: How?
Halo vest
Surgical intervention (plates, rods, bone grafts)
166
Spinal Cord Injury Nursing Management include:
What kind of meds are used?
Glucocorticoids – high dose
Vasopressors/fluids
Proton pump inhibitors (Prilosec, protonix)
IV fluids
167
CNS Infections:
What is an example?
Bacterial meningitis
168
CNS Infections:
Bacterial meningitis: What is it considered?
Neurological emergency
169
CNS Infections:
Bacterial meningitis: What is it an infection of?
Infection of the pia and arachnoid layers of the brain and spinal cord,
and the Cerebrospinal Fluid (CSF)
170
CNS Infections:
Bacterial meningitis: How is it transmitted?
Blood
CSF contamination during surgical procedures
Skull
171
Acute Meningitis
*Meningoencephalitis: What does this refer to as?
*Meningoencephalitis refers to inflammation to meninges and brain parenchyma
172
Acute Meningitis
What is it?
An acute inflammatory process of leptomeninges and CSF
173
Acute Meningitis
Leptomeninges: What is this?
(Leptomeninges: The two innermost layers of tissues that cover the brain and spinal cord. The two layers are called the arachnoid mater and pia mater.)
174
Acute Meningitis:
What is the infection process?
Bloodstream infection and multiplies in CSF, resulting in inflammation of sub arachnoid space and pia mater
175
Acute Meningitis:
What are the types?
Septic (bacterial)
Aseptic (viral infection, lymphoma, leukemia, or brain abscess)
176
Acute Meningitis:
Septic (bacterial): Like what bacteria?
(Streptococcus pneumoniae, Neisseria meningitidis)
177
Acute Meningitis:
Aseptic : Like what?
Aseptic
(viral infection,
lymphoma,
leukemia,
or brain abscess)
178
Acute Meningitis:
What are manifestations?
headache, fever
changes in LOC: disorientation, poor memory
behavioral changes,
nuchal rigidity (stiff neck),
positive Kernig's sign,
positive Brudzinski’s sign
photophobia
179
Meningitis:
Diagnosis/Management:
What is needed for prevention?
Prevention meningococcal conjugated vaccine – entry to high school, college
Also: vaccination against Haemophilus influenzae and S. pneumoniae for all children and all at-risk adults
180
Meningitis:
Diagnosis/Management:
What is diagnosis?
CT scan
MRI
Lumbar puncture:
181
Meningitis:
Diagnosis/Management:
What is diagnosis? Lumbar puncture:
CSF for bacterial culture and Gram staining
182
Meningitis:
Diagnosis/Management:
What is management?
Initiation of appropriate antibiotic therapy
183
Meningitis:
Diagnosis/Management:
What is medical management: What should be administered early? What else is given?
Early administration of high doses IV antibiotics for bacterial meningitis
Dexamethasone
Treatment dehydration, shock, and seizures
184
Meningitis:
Diagnosis/Management:
What is medical management: What should be treated?
Treatment dehydration, shock, and seizures
185
Nursing care of patient with Meningitis:
What should be instituted? How long?
Instituting infection control precautions until 24 hours after initiation of antibiotic therapy (oral and nasal discharge is considered infectious)
186
Nursing care of patient with Meningitis:
What should there be assistance in?
Assisting with pain management due to overall body aches and neck pain
Assisting with getting rest in a quiet, darkened room
187
Nursing care of patient with Meningitis:
What should there be implemented?
Implementing interventions to treat the elevated temperature, such as antipyretic agents and cooling blankets
188
Nursing care of patient with Meningitis:
What should be encouraged to the patient?
Encouraging the patient to stay hydrated either orally or peripherally
189
Nursing care of patient with Meningitis:
What should be ensured?
Ensuring close neurologic monitoring
