406 E2 - infectious diseases

Question 1

meningitis

Answer 1

acute inflammation of the meningeal tissues of the brain and spinal core caused by infection (lung or bloodstream) or penetrating wounds
mainly effects the pia mater, subarachnoid space, ventricular system & CSF

Question 2

major culprits of meningitis

Answer 2

-streptococcus pneumonia & nesseria meningitidis (bacterial)
-enteroviruses (viral)

Question 3

the meninges

Answer 3

3 layers that protect the brain & spinal cord
-inner: pia mater
-middle: arachnoid
-outer: dura mater

Question 4

meningitis risk factors

Answer 4

-older adults or college students
-prisoners
-seasonal: winter & fall
-falls respiratory infection
-immuncomp
-pneumonia

Question 5

prevention of meningitis

Answer 5

vaccines (first dose given ~11 or 12 y/o w/ a booster at 16)

Question 6

meningitis pathogenesis

Answer 6

have meningocooci or pneumococci being inhaled & attaches to the epithelial cells which cross the BBB to enter the blood stream -> infection of arachnoid mater and CSF -> inflammatory response (inc neutrophils) and pus secretion -> increase in CSF production -> increase in ICP

Question 7

meningitis triad

Answer 7

fever
stiff neck
headache
will hurt if they touch their chin to their chest bc they are stretching the meninges

Question 8

meningitis clinical manifestations

Answer 8

-N/v
-photophobia
-altered mental status (drowsy, coma, seziures)
-meningococcus (skin rash, petechiae)

Question 9

two tests to check meningeal irritation

Answer 9

1) positive kernig sign (resistance to leg extension)
2) positive brudbinski sign (neck flexion causes hip/knee flexion)
both have pt in supine position

Question 10

bacterial meningitis

Answer 10

-most common form
-high fatality rate w/o treatment started quickly
-petechial rash (doesn’t fade with pressure)

Question 11

key nursing consideration w/ bacterial meningitis

Answer 11

do not hold antibiotics for any reason because pt can die within hours

Question 12

bacterial meningitis long term sx

Answer 12

-hearing loss
-seizures
-damage to brain

Question 13

acute viral meningitis

Answer 13

-milder form
-might not see elevated WBCs w/ lumbar puncture
-no long term effects
-can develop a septic emboli which can leads to loss of digits or limbs

Question 14

bacterial meningitis treatment

Answer 14

-aggressive abx therapy
-steroid therapy
-vaccines (prophylaxis)

Question 15

abx for bacterial meningitis

Answer 15

-IV
-ceftriaxone
-vancomycin (for MRSA form)
-acyclovir (prevents herpatic encephalitis if viral form but start before cultures are resulted then dc if needed)
usually multiple used

Question 16

encephalitis definiton

Answer 16

acute inflammation of the brain d/t viral infection (mosquitoes cause west nile, measles, chicken px, mumps, HSV1)

Question 17

herpatic encephalitis

Answer 17

rapid onset and high mortality rate
give acyclovir if patient presents w/ severe sx as well as abx

Question 18

encephalitis clinical manifestations

Answer 18

-signs appear on day 2 or 3 of infection
-range from mild changes in mental status to coma
-fever/headache/N/V/seizures/emotional changes
can vary based on where infection occurs

Question 19

encephalitis pharm

Answer 19

-viral: acyclovir is used for HSV infection (reduces mortality but not neurological complications)
-seizure: anti seizure meds
-supportive: fluids, Tylenol, antiemetics

Question 20

brain abscess

Answer 20

accumulation of pus within the brain tissues caused by local or systemic infection (most common: ear, tooth, mastoid or sinus infection)

Question 21

what is the major culprits of a brain abscess

Answer 21

streptococci or staphylococcus aureus (bacteria found on skin)

Question 22

treatment for brain abscess

Answer 22

-drain it to reduce pressure
-administer abx directly to the area

Question 23

brain abscess clinical manifestations

Answer 23

-headache
-fever
-N/v
-drowsiness, confusion, seizures (d/t inc IOP)
-focal sx based on area abscess is in