Beth - Week 6 - Exam 3 Flashcards
what is meningitis?
an inflammation of the protective membranes covering the brain and spinal cord
what causes the SWELLING of meningitis?
a bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling
what can meningitis be caused by?
injuries, cancer, certain drugs, other types of infections
what is the main takeaway point for meningitis?
knowing the specific cause of meningitis directs treatment
ex. need to know what type → bacterial but tx for fungal → will die
how does transmission of meningitis occur?
direct exposure of CS to environment
what is the pathophysiology of bacterial meningitis?
The presence of an organism in subarachnoid space
produces inflammatory response–forming an exudate–arachnoid villi plug–obstruction of CSF absorption
what is the pathophysiology of viral meningitis?
no exudate
T/F: venous system serving nasopharynx/middle ear/and mastoid are close to veins draining meninges
TRUE
**nose, sore throat, cold sxs → meningitis easily missed.
what are the 7 different types of meningitis?
- bacterial
- viral
- fungal
- tuberculous
- syphilitic (↑↓ on the specific side - HIV, lupus, diabetes)
- parasitic
- lyme
what are leading causes (microbes) of bacterial meningitis in the US?
- streptococcus pneumoniae
- group B strptococcus
- neisseria meningitdis
- haemophilus influenzae
- listeria monocytogenes (not frequent)
who is at risk for developing bacterial meningitis pneumococcus (streptococcus pneumoniae)?
children < 5, young adults, elderly
what is the prevention for pneumococcus (streptococcus pneumoniae)?
vaccine
TEST what are the precautions used for a patient with pneumococcus (streptococcus pneumoniae)?
DROPLET
what are the s/sx of pneumococcus (streptococcus pneumoniae)?
infection of oropharynx, otitis media, pneumonia, skull fx
what is the prevention for meningococcus (neisseria meningitdis)?
vaccine
who is at risk for developing meningococcus (neisseria meningitdis)?
infants, children, YOUNG ADULTS
populations that live in close quarters - students, prisons, skilled nursing facilities
how is meningococcus (neisseria meningitdis) transmitted?
inhalation or direct contact
***carried in the nose/throat
what are the s/sx of meningococcus (neisseria meningitdis)?
petechial rash, purpuric lesions
overwhelming septicemia
HA, general malaise
basic cold symptoms
what is the prevention for haemophilus influenza type b?
vaccine
who is at risk for developing haemophilus influenza type b?
much less apparent in children < 5 years now that children are vaccinated
what are the clinical manifestations of haemophilus influenza type b?
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
Most cases of viral meningitis are ____ and _____. patients need only ___ and require no _____
benign and self-limited
patients need only supportive care and require no specific therapy
what are the different types of viral meningitis?
immune deficiency (↓ tx isn’t any different; assume bacterial)
HIV meningitis
herpes simplex meningitis
cytomegalovirus meningitis
what are the causes of fungal meningitis?
- cryptococcus
- cimmitis
- hcapsulatum
- candida species
- schenckii (rare)
what are the risk factors for meningitis per CDC?
- 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)
TEST: what are the three signs of meningeal irritation?
- kernig’s sign (knee up extend leg - pain)
- brudzinski sign (supine → knees up; head pulled up → pain)
- nuchal rigidity (neck back then forward → pain)
what are the nursing assessment findings for meningitis?
- 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
what are assessment finding for CSF if there is a bacterial infection?
cloudy CSF ↑ CSF pressure ↑ CSF protein ↑ cell count ↓ glucose or absent (bacteria are using the glucose) ↑ WBC count - neutrophils organism found
what are assessment findings for CSF if there is a viral infection?
clear or cloudy
protein normal or slightly ↑
glucose normal
white count possibly ↑ – lymphocytes
why is a lumbar puncture and CSF fluid used as a diagnostic study?>
- 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
what are the systemic complications of acute bacterial meningitis?
- 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
what is the management for meningitis?
- 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
in order to isolate the bacteria, what kind of transmission precautions do we institute? when do they come off?
DROPLET - respiratory isolation x 24hrs after antibiotic started (unless patient gets worse - even if febrile)
what is the adult ATB dosing < 50 years old?
- 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
what is the adult ATB dosing > 50 years old?
- 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)
what are the adult ATB dosing > 50 years old if the CSF stain shows gram negative bacilli?
ceftazidime (2 g IV every 8 hours) ´plus ampicillin (50 mg/kg IV every 6 hours) Other options are meropenem, TMP-SMX, and doxycycline
what is the steroid used for meningitis and what is the dosing for >50years old?
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
what are the nursing assessments/priorities with meningitis?
- 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
what is the pathophysiology of lumbar back pain?
- 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
what are the risk factors for lumbar back pain?
- 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
what is the most common cause of lower back pain?
spondylolisthesis
what are the other causes of lower back pain? (4)deformitiy
- degenerative disc disease (r/t spondylolisthesis)
- facet joint dysfunction
- sacroiliac joint dysfunction
- inflammatory joint disease (osteoarthritis, arthritis, RA, spondyloarthriritis or spondyloarthropathy)
what are the mechanical causes of lower back pain? (9)
- sprains and strains
- intervertebral disc degeneration
- lumbar herniated or ruptured disc
- radiculopathy
- sciatica
- spondylolisthesis
- traumatic injury
- spinal stenosis
- deformity (scoliosis/lordosis/kyphosis)
what are underlying causes of lower back pain (5)?
- 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)
what are the diagnostics used for lower back pain?
- 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)
what is the medical tx for lower back pain?
- hot and cold pack
- activity
- strengthening exercises
- PT
- transcutaneous electrical nerve stimulation (TENS)
- medications
what meds are used to tx lower back pain?
- analgesia
- NSAIDs
- muscle relaxants
- gabapentin
- pregablin
- epidural corticosteroid injections
what are 5 teaching points for lower back pain?
- 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
what are 4 more teaching points for lower back pain?
- 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
what are the surgical interventions/tx for lower back pain?
- Vertebroplasty and kyphoplasty
- Spinal laminectomy (also known as spinal decompression)
- Discectomy or microdiscectomy
- Foraminotomy
what are the additional surgical tx for lower back pain?
- 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
what is a laminectomy?
- removal of posterior arch of a vertebra
- removal of lamina and HNP
- LOS 1-2 days (based on pain/mobility)
what are the post op nursing assessment priorities?
- frequent neuro assessment
- wound
what is part of the FREQUENT neuro assessment?
- sensation
- motor/muscle strength
- bladder
- bowel
- pain assessement
what is part of the wound assessment?
- incision/drain
- graft site is often more painful
what should the neuro assessment include?
- prior hx of deficits
- assess for any changes from pre-op
- if a change worsens, call MD ASAP
what is the post op care pt and family teaching for lower back?
- 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
