Neuro Conditions

Question 1

inflammatory conditions of the brain

Answer 1

brain abscesses, meningitis, encephalitis

Question 2

bacterial meningitis

Answer 2

acute inflammation of meningeal tissue surrounding brain and spinal cord

Question 3

when does bacterial meningitis occur

Answer 3

fall, winter, or early spring

Question 4

what is bacterial meningitis typically r/t

Answer 4

a viral respiratory disease

Question 5

what are the leading causes of bacterial meningitis

Answer 5

streptococcus pneumonial, neisseria, meningitis

Question 6

pathophysiology of bacterial meningitis

Answer 6

organisms enter CNS through upper respiratory tract/bloodstream; may enter through skull wounds/fractures

Question 7

inflammatory response of bacterial meningitis

Answer 7

increased cerebrospinal fluid production; purulent secretions spread to other areas of brain through CSF; cerebral edema and increased ICP becomes problematic (if extends to parenchyma)

Question 8

key signs of bacterial meningitis

Answer 8

fever, severe headache, nausea, vomiting, nuchal rigidity

Question 9

2 ways to check for bacterial meningitis

Answer 9

tuck chin in, light sensitivity, and fever

Question 10

when would a coma be associated with a poor prognosis

Answer 10

photophobia; decreased level of consciousness

Question 11

signs of increased intracranial pressure

Answer 11

seizure occurs in 1/3 cases; headache worsens; vomiting and irritability

Question 12

complications of bacterial meningitis

Answer 12

increased ICP; residual neurologic function; optic nerve (CN II) compressed by increased ICP; ocular movements affected with irritation to CN III, IV, VI; CN V irritation; inflammation of CN VII; irritation of CN VIII; hemiparesis, dysphagia, hemianopsia; cerebral abscess, subdural empyema, subdural effusion, or persistent meningitis occurs if everything doesn’t happen

Question 13

increased ICP s/s

Answer 13

major cause in change in mental status

Question 14

residual neurologic function s/s

Answer 14

cranial nerves II, III, IV,V, VI, VII, VIII can become dysfunctional

Question 15

optic nerve (CN II) compressed by increased ICP s/s

Answer 15

papilledema with possible blindness

Question 16

ocular movements affected with irritation to CN III, IV, and VI s/s

Answer 16

ptosis, unequal pupils, diplopia

Question 17

CN V irritation s/s

Answer 17

sensory loss and loss of corneal reflex

Question 18

inflammation of CN VII s/s

Answer 18

facial paresis

Question 19

irritation of CN VIII s/s

Answer 19

tinnitus, vertigo, deafness; hearing loss may be permanent

Question 20

what might acute cerebral edema cause

Answer 20

seizures, CN II palsy, bradycardia, hypertensive coma, death

Question 21

diagnostic studies for neuro condition

Answer 21

blood culture; CT scan; neutrophils are predominant WBC in CSF; x-rays of the skull; MRI

Question 22

how can the diagnosis of bacterial meningitis be verified

Answer 22

lumbar puncture; analysis of CSF; specimen of secretions are cultured to identify causative; gram-stain to detect bacteria

Question 23

interprofessional care for bacterial meningitis

Answer 23

rapid diagnosis is crucial; this is a medical emergency

Question 24

what is started before diagnosis is confirmed for bacterial meningitis

Answer 24

broad spectrum antibiotics

Question 25

what should the initial assessment should include for bacterial meningitis

Answer 25

vital signs; neurological assessment; I&Os; evaluation of lungs and skin

Question 26

nursing diagnoses of bacterial meningitis

Answer 26

decreased intracranial adaptive capacity; ineffective tissue perfusion; hyperthermia; acute pain

Question 27

overall nursing goals for bacterial meningitis

Answer 27

return to maximum neurological functioning; resolve the infection; control pain and discomfort

Question 28

health promotion (implementation) for meningitis

Answer 28

vaccinations for pneumonia and influenza; meningococcal vaccines; early, vigorous treatment of respiratory infections; prophylactic antibiotics for anyone exposed to bacterial meningitis

Question 29

acute care (implementation) bacterial meningitis

Answer 29

close observation and assessment; provide relief for head and neck pain; position for comfort; darkened room and cool cloth over eyes for photophobia; minimize environmental stimulus (delirium and hallucinations may occur); provide safety

Question 30

observe and record seizures (implementation) bacterial meningitis

Answer 30

prevent injury; give anti-seizure drugs as ordered

Question 31

vigorously mange fever (implementation) bacterial meningitis

Answer 31

fever increases cerebral edema and risk of seizures; neurologic damage may result from high, prolonged fever

Question 32

ambulatory care (implementation) bacterial meningitis

Answer 32

provide for several weeks of recovery; increased activity as tolerated (stress adequate nutrition and encourage adequate rest/sleep); progressive ROM exercises and warm baths for muscle rigidity; ongoing assessment for recovery of vision, hearing, cognitive skills, motor, and sensory abilities; be aware of anxiety and stress felt by family and caregivers

Question 33

other nursing implementations for bacterial meningitis

Answer 33

assess for dehydration; follow designed antibiotic schedule to maintain therapeutic blood levels; respiratory isolation until cultures are negative

Question 34

nursing evaluations for bacterial meningitis

Answer 34

patient will: have appropriate cognitive function; AAOx3; maintain body temp within normal range; report satisfaction with pain control

Question 35

viral meningitis

Answer 35

treat with antibiotics after obtaining diagnostic sample but while awaiting test results

Question 36

what are the most common causes for viral meningitis

Answer 36

enterovirus, arbovirus, HIV, and HSV

Question 37

how is viral meningitis spread

Answer 37

direct contact with respiratory secretions

Question 38

how does viral meningitis present

Answer 38

headache, fever, photophobia, and stiff neck

Question 39

transient ischemic attack

Answer 39

a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, but without acute infraction of brain

Question 40

brain tumor

Answer 40

occur in any part of brain, benign and malignant, primary vs. secondary

Question 41

what does the brain tumor do

Answer 41

apply pressure to surrounding brain tissue causing decreased overflow of CSF resulting in increased ICP, cerebral edema, neurodeficits

Question 42

clinical manifestations of a brain tumor

Answer 42

dysarthria, dysphagia, positive romberg and babinski sign, vertigo, hemiparesis, loss of gag reflex

Question 43

manifestations of supratentorial tumors

Answer 43

severe headache, visual changes, seizures, loss of movement, cognitive function, paralysis

Question 44

manifestations of infratentorial tumors

Answer 44

hearing loss, facial drooping, dysphagia, hemiparesis, and ataxia

Question 45

diagnostics for brain tumors

Answer 45

CBC, x-ray, LP, cerebral biopsy, CT, MRI, renal, endocrine, lab work, and electrolyte status

Question 46

nursing management for brain tumors

Answer 46

maintain airway, safety and seizure precautions; administer O2; monitor lung sounds, neurological status

Question 47

medications for brain tumors

Answer 47

analgesics, steriods, anticonvulsants, antiemetic, H2 antagonists

Question 48

other treatment options for brain tumors

Answer 48

chemo, radiation, craniotomy

Question 49

complications

Answer 49

SIADH

Question 50

SIADH

Answer 50

fluid retained due to overproduction of vasopressin or antidiuretic hormone; hypothalamus is damaged

Question 51

s/s of complications

Answer 51

disorientation, headache, vomiting, muscle weakness, decreased LOC, irritability, weight fain, seizures, coma

Question 52

treatment for complication

Answer 52

fluid restriction; treat hypnotremia

Question 53

CSW

Answer 53

complication of CNS disease; causes hypnotremia and hypovolemia; monitor electrolytes, I&O, weight, fluid balance, hydration