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Nursing Semester 3 > Beth - Week 6 - Exam 3 > Flashcards

Beth - Week 6 - Exam 3 Flashcards

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1
Q

what is meningitis?

A

an inflammation of the protective membranes covering the brain and spinal cord

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2
Q

what causes the SWELLING of meningitis?

A

a bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling

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3
Q

what can meningitis be caused by?

A

injuries, cancer, certain drugs, other types of infections

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4
Q

what is the main takeaway point for meningitis?

A

knowing the specific cause of meningitis directs treatment

ex. need to know what type → bacterial but tx for fungal → will die

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5
Q

how does transmission of meningitis occur?

A

direct exposure of CS to environment

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6
Q

what is the pathophysiology of bacterial meningitis?

A

The presence of an organism in subarachnoid space

produces inflammatory response–forming an exudate–arachnoid villi plug–obstruction of CSF absorption

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7
Q

what is the pathophysiology of viral meningitis?

A

no exudate

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8
Q

T/F: venous system serving nasopharynx/middle ear/and mastoid are close to veins draining meninges

A

TRUE

**nose, sore throat, cold sxs → meningitis easily missed.

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9
Q

what are the 7 different types of meningitis?

A
  • bacterial
  • viral
  • fungal
  • tuberculous
  • syphilitic (↑↓ on the specific side - HIV, lupus, diabetes)
  • parasitic
  • lyme
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10
Q

what are leading causes (microbes) of bacterial meningitis in the US?

A
  • streptococcus pneumoniae
  • group B strptococcus
  • neisseria meningitdis
  • haemophilus influenzae
  • listeria monocytogenes (not frequent)
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11
Q

who is at risk for developing bacterial meningitis pneumococcus (streptococcus pneumoniae)?

A

children < 5, young adults, elderly

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12
Q

what is the prevention for pneumococcus (streptococcus pneumoniae)?

A

vaccine

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13
Q

TEST what are the precautions used for a patient with pneumococcus (streptococcus pneumoniae)?

A

DROPLET

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14
Q

what are the s/sx of pneumococcus (streptococcus pneumoniae)?

A

infection of oropharynx, otitis media, pneumonia, skull fx

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15
Q

what is the prevention for meningococcus (neisseria meningitdis)?

A

vaccine

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16
Q

who is at risk for developing meningococcus (neisseria meningitdis)?

A

infants, children, YOUNG ADULTS

populations that live in close quarters - students, prisons, skilled nursing facilities

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17
Q

how is meningococcus (neisseria meningitdis) transmitted?

A

inhalation or direct contact

***carried in the nose/throat

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18
Q

what are the s/sx of meningococcus (neisseria meningitdis)?

A

petechial rash, purpuric lesions
overwhelming septicemia
HA, general malaise
basic cold symptoms

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19
Q

what is the prevention for haemophilus influenza type b?

A

vaccine

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20
Q

who is at risk for developing haemophilus influenza type b?

A

much less apparent in children < 5 years now that children are vaccinated

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21
Q

what are the clinical manifestations of haemophilus influenza type b?

A

ear infections, upper respiratory, spreads to lungs

  • nonblanchable purple lesions → blood outside the vessel wall
  • petechae: smaller than 3 mm
  • ecchymoses: larger than 3 mm - turn to blisters → black → amputation
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22
Q

Most cases of viral meningitis are ____ and _____. patients need only ___ and require no _____

A

benign and self-limited

patients need only supportive care and require no specific therapy

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23
Q

what are the different types of viral meningitis?

A

immune deficiency (↓ tx isn’t any different; assume bacterial)
HIV meningitis
herpes simplex meningitis
cytomegalovirus meningitis

24
Q

what are the causes of fungal meningitis?

A
  • cryptococcus
  • cimmitis
  • hcapsulatum
  • candida species
  • schenckii (rare)
25
Q

what are the risk factors for meningitis per CDC?

A
  • age (newborns; babies; children; teens and young adults; older adults)
  • community setting (college campuses - n. meningitdis)
  • low immunity (certain medical conditions, meds, and surgical procedures)
  • travel (sub-sarharan africa and mecca - n meningitdis)
26
Q

TEST: what are the three signs of meningeal irritation?

A
  • kernig’s sign (knee up extend leg - pain)
  • brudzinski sign (supine → knees up; head pulled up → pain)
  • nuchal rigidity (neck back then forward → pain)
27
Q

what are the nursing assessment findings for meningitis?

A
  • Fever
  • Headache
  • Photophobia
  • Changes in LOC
  • Nausea & Vomiting
  • IICP/cerebral
  • Confusion/agitation from Cerebral edema and infection
  • Seizures
  • Petechial hemorrhagic rash **indicator
  • Stroke Symptoms from Septic emboli
  • **can be missed because mimic flu symptoms
28
Q

what are assessment finding for CSF if there is a bacterial infection?

A 
cloudy CSF
↑ CSF pressure
↑ CSF protein
↑ cell count
↓ glucose or absent (bacteria are using the glucose)
↑ WBC count - neutrophils 
organism found
29
Q

what are assessment findings for CSF if there is a viral infection?

A

clear or cloudy
protein normal or slightly ↑
glucose normal
white count possibly ↑ – lymphocytes

30
Q

why is a lumbar puncture and CSF fluid used as a diagnostic study?>

A
  • in acute meningitis, a LP and CSF is indicated to identify the causative organism and in bacterial meningitis, LP is performed to obtain microbiology studies
  • ** if the CSF glucose remains normal, and the pt continues to look well, the infection is most likely NONbacterial
31
Q

what are the systemic complications of acute bacterial meningitis?

A
  • hypotension or shock
  • hypooxemia
  • hyponatremia (from SIADH)
  • cardiac arrhythmias and ischemia
  • stroke (bacteria in blood → big enough → goes to brain and acts like a clot
  • exacerbation of chronic disease
32
Q

what is the management for meningitis?

A
  • Prevention: Vaccination
  • Isolate the patient
  • Eliminate the vector
  • Prophylaxis (for Meningococcal meningitis)
    • Age 1mo-50 yrs-Vancomycin plus Cefotaxime or Rocephine
    • Age >50 yrs-Vancomycin plus ampicillin plus Cefotaxime & Rocephine
33
Q

in order to isolate the bacteria, what kind of transmission precautions do we institute? when do they come off?

A

DROPLET - respiratory isolation x 24hrs after antibiotic started (unless patient gets worse - even if febrile)

34
Q

what is the adult ATB dosing < 50 years old?

A
  • Cefotaxime – 2 g IV q 4 hours
  • Ceftriaxone – 2 g IV q 12 hours
  • Vancomycin – 750-1000 mg IV q 12 hours or 10-15 mg/kg IV q 12 hours
35
Q

what is the adult ATB dosing > 50 years old?

A
  • Cefotaxime (2 g IV q 4 hours) or ceftriaxone (2 g IV q 12 hours)
  • plus vancomycin (750-1000 mg IV q 12 hours or 10-15
    mg/kg IV q 12 hours)
36
Q

what are the adult ATB dosing > 50 years old if the CSF stain shows gram negative bacilli?

A

ceftazidime (2 g IV every 8 hours) ´plus ampicillin (50 mg/kg IV every 6 hours) Other options are meropenem, TMP-SMX, and doxycycline

37
Q

what is the steroid used for meningitis and what is the dosing for >50years old?

A

Dexamethasone (0.4 mg/kg IV every 12 hours for 2 days or 0.15 mg/kg every 6 hours for 4 days) is given 15-20 minutes before the first dose of antibiotics

  • *crosses BBB
  • anti-inflammatory
38
Q

what are the nursing assessments/priorities with meningitis?

A
  • Frequent Neuro checks/assessment
  • Pain control
  • Antiemetic’s
  • Antipyretics (Treat fever greater than 101)
  • Maintain adequate hydration (equal I&O)
  • Keep HOB at 30 degrees or greater as tolerated
  • Quiet environment (protect from light-photophobia)
  • Cluster care
  • Teaching patient and family
  • Vaccinations
39
Q

what is the pathophysiology of lumbar back pain?

A
  • Lower back = L1-L5
  • Lumbar region supports much of the weight of the upper body
  • Vertebrae are shock absorbers - intervertebral discs-round, rubbery pads
  • Ligaments-bands of tissue hold the vertebrae in place
  • Tendons attach the muscles to the spinal column
  • 31 pairs of nerves are rooted to the spinal cord
40
Q

what are the risk factors for lumbar back pain?

A
  • age (the first attack of low back pain occurs 30 - 50 and becomes more common)
  • fitness level
  • pregnancy
  • weight gain
  • genetics
  • occupational risk factors (RN)
  • mental health factors (lack of movement)
  • backpack overload in children
41
Q

what is the most common cause of lower back pain?

A

spondylolisthesis

42
Q

what are the other causes of lower back pain? (4)deformitiy

A
  • degenerative disc disease (r/t spondylolisthesis)
  • facet joint dysfunction
  • sacroiliac joint dysfunction
  • inflammatory joint disease (osteoarthritis, arthritis, RA, spondyloarthriritis or spondyloarthropathy)
43
Q

what are the mechanical causes of lower back pain? (9)

A
  • sprains and strains
  • intervertebral disc degeneration
  • lumbar herniated or ruptured disc
  • radiculopathy
  • sciatica
  • spondylolisthesis
  • traumatic injury
  • spinal stenosis
  • deformity (scoliosis/lordosis/kyphosis)
44
Q

what are underlying causes of lower back pain (5)?

A
  • infections (osteomyelitis, discitis, sacroilitis)
  • tumors
  • cauda equina syndrome (disc is pushed into the spinal)
  • abdominal aortic aneurysms (pain is a sign aneurysm is near rupture)
  • kidney stones (usually on one side)
45
Q

what are the diagnostics used for lower back pain?

A
  • Xray
  • CT
  • Myelograms
  • Discography
  • MRI
  • Electrodiagnostics (EMG)
  • Nerve conduction studied (NCS)
  • Evoke potential (EP)
  • Bone Scan
  • Ultrasound imaging
  • Blood Testing (HLA-B27 - genetic marker for ankylosing spondylititis or reactive arthritis AND CRP)
46
Q

what is the medical tx for lower back pain?

A
  • hot and cold pack
  • activity
  • strengthening exercises
  • PT
  • transcutaneous electrical nerve stimulation (TENS)
  • medications
47
Q

what meds are used to tx lower back pain?

A
  • analgesia
  • NSAIDs
  • muscle relaxants
  • gabapentin
  • pregablin
  • epidural corticosteroid injections
48
Q

what are 5 teaching points for lower back pain?

A
  • Always stretch before exercise or other strenuous physical activity.
  • Don’t slouch when standing or sitting.
  • At home or work, make sure work surfaces are at a comfortable height.
  • Sit in a chair with good lumbar support and proper position and height for the task. Keep shoulders back.
  • Wear comfortable, low-heeled shoes
49
Q

what are 4 more teaching points for lower back pain?

A
  • Don’t try to lift objects that are too heavy
    • Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back.
    • When lifting, keep objects close to the body
    • Do not twist when lifting
  • Maintain proper nutrition and diet to reduce and prevent excessive weight gain
  • Quit smoking
50
Q

what are the surgical interventions/tx for lower back pain?

A
  • Vertebroplasty and kyphoplasty
  • Spinal laminectomy (also known as spinal decompression)
  • Discectomy or microdiscectomy
  • Foraminotomy
51
Q

what are the additional surgical tx for lower back pain?

A
  • IDET-intradiscal electrothermopasty
  • Interspious process decompression
  • Spinal Fusion with bone grafting
  • Minimally invasive lumbar fusion
  • Percutaneous laser discectomy
  • Artificial disc replacement
  • Chartite or Prodisc-1
  • Radiofrequency discal nucleoplasy
  • Outpatient
  • Minimal invasive
52
Q

what is a laminectomy?

A
  • removal of posterior arch of a vertebra
  • removal of lamina and HNP
  • LOS 1-2 days (based on pain/mobility)
53
Q

what are the post op nursing assessment priorities?

A
  • frequent neuro assessment

- wound

54
Q

what is part of the FREQUENT neuro assessment?

A
  • sensation
  • motor/muscle strength
  • bladder
  • bowel
  • pain assessement
55
Q

what is part of the wound assessment?

A
  • incision/drain

- graft site is often more painful

56
Q

what should the neuro assessment include?

A
  • prior hx of deficits
  • assess for any changes from pre-op
  • if a change worsens, call MD ASAP
57
Q

what is the post op care pt and family teaching for lower back?

A
  • Report any new changes in sensation; Weakness/numbness
  • Maintain good body alignment
  • Log roll to exit bed
  • No twisting
  • Wear brace (TLSO), Orthotic device at all times while out of bed
  • No lifting more then 5#
  • No sitting for long periods of time
  • Report any issues of not being able to empty bowel or bladder
  • Maintain good posture
  • S/S of infection
  • No driving for 4-6 weeks

Nursing Semester 3 (29 decks)

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