Unit 14 Metabolic Coma/Drugs Flashcards by Tony Maselli

When can coma occur?

When pressure is put on the brainstem

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What is there an increased risk of with ICP Monitoring?

Infection

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What is the 1st indicator of ICP/brain issue?

ALOC

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What is the definition Encephalopathy or (Metabolic Coma)?

-Broad term for any brain disease that alters brain function or structure.

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What are some causes of metabolic coma?

Drug induced
Diseases: Viral and bacterial
Anoxia (absence of oxygen)
Hypo/hyperglycemia
Meningitis
DKA
Carbon monoxide poisoning
SIADH

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What are characteristics of metabolic coma?

Change in LOC

Absence of brain lesions/abnormalities

Lab values will show abnormality somewhere

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What is Meningitis?

Inflammation of the arachnoid and pia matter of brain and spinal column. (spreads rapidly)

Bacteria and viral organisms (aseptic meningitis) are most often the cause.

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What is the pathophysiology of Meningitis?

Most common cause?

Organism enters CSF via bloodstream and crosses the blood-brain barrier.

Can be caused by direct entry

-Infection is most common cause

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Describe Bacterial Meningitis.

-Often related to Upper Respiratory Infection.

Pathogens - Pneumoniae, Neisseria meningitis (meningicoccal), H. Flu

Contagious
Has more favorable outcome if detected early and treatment is begun.

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What are the symptoms of Bacterial Meningitis?

Fever (40-41C)*
Stiff neck/Nuchal Rigidity*
Headache*** (Hallmark signs of bacterial meningitis)

Purpuric Rash

Photophobia
Seizures
Cold extremities
N and V

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What can be assessed in bacterial meningitis?

Nuchal rigidity

+ Kernig’s sign: PT flat on back, knee bent to 90 degrees then straightened up, if back pain then it is positive sign

+ Brudzinski’s sign: flat on back, when flexing head, knees automatically bend = + sign

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What is the Diagnosis for Meningitis?

Analyze CSF by lumbar puncture (L3 and L4):
-Confirms

CT scan:
-to rule out other causes

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What are complications of meningitis?

ICP

Seizures may occur

SIADH may occur

Shock

SIRS/SEPSIS

Septic emboli may lead to blocked circulation

Disseminated Intravascular Coagulation (DIC) may occur

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What is the collaborative care for meningitis?
What kind of precautions?
What kind of feedings?
What about those in close contact?
What about ICP in Meningitis?

Broad spectrum antibiotics (penicillin, cephalosporins, vancomycin) until C and S result (do first): 10 days on antibiotics

Prophylactic treatment w/ rifampin (24-48hrs) for those in close contact

Droplet precautions

Treat and prevent elevated ICP w/corticosteriods

Monitor neuro status, GCS

Antipyretics

Maintain O2

Enteral feedings

Prevent constipation

Supportive care

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Describe Viral Meningitis.

What will be obtained in the CSF culture?

Often associated to other viral illnesses such as: mumps, measles, varicella, herpes simplex

No organisms will be obtained in CSF culture.

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What will be assessed in Viral Meningitis?

Nuchal rigidity

Fever

Photophobia

Lumbar puncture for CSF has no bacteria/cultures

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What is the treatment of viral meningitis?

Symptom management

Possibly antivirals

Antipyretics

IV fluids

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When should the vaccine for meningitis be given?

What are they called?

Study These Flashcards

At 11-12 years of age
Booster at 16-24

Vaccines are: (meningiconjucate) Menactra, Menveo

Strep group b meningitis vaccine for teens and adults

What is Encephalitis?
Caused by?
Who’s most at risk?

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Inflammation of the brain tissue and often meninges

Caused by: virus, bacteria, fungus, parasite

Elderly most at risk

What is the pathophysiology of Encephalitis?

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Virus reproduces in brain tissue causing an inflammatory response

Edema and compression of blood vessels cause elevated ICP

What are specific diseases causing Encephalitis?

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Herpes Simplex (most common)

West Nile Virus

MMR

Chicken pox

Rabies

What are the symptoms of Encephalitis (arbovirus)?

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Flulike symptoms
Fever
Confusion
Coma
Arthralgia
Lethargy
Rash
Motor dysfunction
Ataxia
Photophobia
Increases WBCs (normal if viral)

What test measures antibodies in the blood to check what’s causing Encephalitis(arbovirus)?

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Elisa Test

What is used to diagnose Encephalitis?

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Symptoms

Lumbar puncture to rule out meningitis

Elisa test

Serology testing

What is the collaborative care for Encephalitis?

- Care is supportive (virus) - acyclovir or vidarabine IV for herpes simplex or varicella - Treat the cause

What are nursing interventions for Encephalitis?

Assess LOC I and Os Prevent constipation Droplet precautions Maintain O2 Enteral feedings

What are preventions/teaching for Encephalitis(Arborvirus)?

Protection w/ DEET (bugspray) Picaridin (insect repellent) Oil of lemon eucalyptus IR2525 (skin guard plus) Long clothing Mosquito management

Describe Alcohol in relation to Metabolic Coma.

CNS depressant Affects all levels of brain function Most common substance abuse Crosses blood-brain barrier

Describe what happens with chronic alcohol use.

Can cause liver disorder/failure Elevated NH3 Wernicke's Encephalopathy - (depletion of thiamine- vitamin b1) causing confusion, ataxia, etc.) Korsafoff's Psychosis - Short term memory loss, possible hallucinations

What are mild to moderate symptoms of alcohol withdraw?

``` Tremors N and V Diaphoresis Dilated pupils Headache Palpations Anxiety/Depression Insomnia ```

What is the severe complication of alcohol withdraw?

Delirium Tremens: life threatening complication (~3 days in) - Hallucinations - High fever - Intense agitation - Tachycardia - Tachypnea - Seizures

What are nursing interventions/collaborative management for alcohol withdraw?

3'S's of detox *safety/sedation/supplements* - Monitoring of withdraw symptoms and safe environment - Vitamins and minerals: B complex (thiamine replacement), C, Mg, and Calcium - Refer to follow up/support group

What is the assessment tool for alcohol withdraw? What is the criteria being assessed? What are the score ranges?

CIWA (clinical institute withdrawal assessment) Criteria: - N and V - Tremors - Agitation - Hallucinations - VS - Diaphoresis - LOC - Auditory disturbances <8 = mild 8-15 = moderate > 15 = severe

What is the treatment for alcohol withdraw?

Librium Benzo's valproic acid (Depakote)

What is acute alcohol poisoning?

Depression of the CNS: - Often die of hypothermia, aspiration, or ingestion of other CNS depressants. - Brain stem and hypothalamus extremely depressed - Irregular/Decreased RR - No gag reflux - Decreased LOC - Fatal

What are ED nursing considerations when drawing Blood Alcohol Concentration?

No alcohol pad used Chain of custody for specimen Know laws of state Document

What is acetaminophen overdose? What are early symptoms? What is the treatment of acetaminophen OD?

Extremely toxic to liver cells Death can occur in 1-4 days Early symptoms: N and V, diarrhea, abdominal pain Treatment of OD: -N-Acetylcysteine (mucomyst or NAC) oral or NGT - blocks absorption of acetaminophen -Activated charcoal if presents within 1 hr of ingestion and stable consciousness

What is the acute care for drug OD?

- ABCs, Obtain VS, neuro checks, intubate if necessary - Bloodwork: CBC, BMP, Glucose, toxic screen, ETOH, ABG - Administer: IV meds: Thiamine, Narcan - Gastric lavage, charcoal, cathartic (NGT) - Treat w/specific antidote

What are the two acronyms for assessing a PT with an ALOA?

``` A lcohol E pilepsy I nsulin O piates U remia ``` ``` T ruama I nfection P sych P oison S troke ```

What diagnoses tests would help w/ an unconscious patient in the ED?

Blood glucose Urinalysis History of state VS CT of head

Describe Persistent Vegetative Sate.

No awareness of self or environment No evidence of purposeful response to visual, auditory, or tactile stimuli Intermittent wakefulness Incontinence Preserved brainstem autonomic functions Variable cranial and spinal reflexes

What is brain death?

Cessation and irreversibility of all brain functions including brain stem Coma, apnea, pupils fixed and dilated No ocular response Flat EEG

Name some club drugs. What are the intoxication/acute effects? What is the collaborative treatment for OD?

Liquid X, Liquid Ecstasy Intoxication/acute effects: euphoria, drowsiness, confusion, memory impairment, excited or aggressive behavior Monitor cardiac conditions Warming blanket for hypothermia Institute seizure & aspiration precautions

Define CNS depressants. Name some. What are intoxication symptoms? What are overdose symptoms? What is the treatment for OD?

Drugs that depress the central nervous system Ex: Alcohol, Benzo's, Barbiturates, Anti-convusants/depressants Intoxication symptoms: Drowsiness, Confusion, Impaired coordination, Blurred vision Overdose symptoms: Respiratory depression Treatment: airway management Give antidote: flumazenil for benzodiazepine overdose

Unit 14 Metabolic Coma/Drugs Flashcards

(44 cards)