CH 46&47: Neurological Disorders Flashcards
what is meningitis
Inflammation of the meninges
– Protective membranes that cover the brain and spinal cord
causes of meningitis
Bacterial & Viral (Most Common)
Fungi & parasites (Less Common)
pathogens of bacterial meningitis
streptococcus pneumoniae*
neisseria meningitidis (Primarily occurs in dense community groups)
–Ex: College campuses or military installations
Haemophilus influenzae
– Rare cause of bacterial meningitis because it is now a standard childhood vaccine (HIB vaccine)
– Watch for in non-vaccinated individuals
whos at risk for bacterial meningitis
Tobacco use
Viral URIs
Otitis Media
Mastoiditis - jaw
Immunosupressed
Under 2 months old
Elderly
direct spread of bacterial meningitis
Trauma injury to the facial bones
Skull or spine infection
Secondary to surgical procedures
Sinusitis, otitis, brain/spinal abscesses
Secondary to invasive procedures
isolation for contagious meningitis pathogen
isolation precautions (e.g., droplet)
patho of bacterial meningitis
Introduced host immune response cell breakdown inflammatory response in the meninges neutrophil response CSF thickens
Thick CSF = poor absorption Hydrocephalus
Increased ICP
CSF collection for meningitis will show:
lumbar puncture
decreased glucose
increased protein
increased WBC
clinical manifestations of bacterial meningitis**
Headache & Fever = Initial Symptoms
Altered level of consciousness / Disorientation
Nuchal Rigidity (stiff neck) = Early Sign
–Any attempts of flexion of the neck are difficult due to spasms in the muscles of the neck
Positive Kernig Sign
–Lying the patient in the supine position with the hip flexed at a 90-degree angle, resistance is met during passive extension of the knee
Positive Brudzinski Sign
–When the patient’s neck is flexed, flexion of the knees and hips are produced
Photophobia (sensitivity to light)
Rash
–Seen in patients infected with the Neisseria Meningitidis
–Petechial rash with purpuric lesions to large areas of ecchymosis
Possible seizure activity - 40-50%**
Bacterial Meningitis: Diagnostics
Diagnostics: Bacterial culture and gram stain of CSF (via lumbar puncture), and blood (venipuncture)
–No antibiotics until these are done!
–Gold Standard for definitive diagnosis
Head or spinal CT for abscess or lesion detection
abx for Bacterial Meningitis
Earlier the antibiotics = better outcomes
– Penicillins, cephalosporins, vancomycin (+ rifampin); All given IV
Note on blood cultures: 24-72 hours before results so can’t wait that long = empiric therapy will be started before results
Bacterial Meningitis: Nurse Management
Draw blood cultures first!!
IV fluids and abx for treatment
Seizure precautions (medications and seizure pads and oxygen)**
Watch for increased ICP and report to provider
Frequent neuro assessments
ABG’s, I&Os, DW, electrolytes
May need to be on a ventilator
dexamethasone purpose
steroid given to decrease inflammation
most common types of viral meningitis
Acute Aseptic Meningitis OR Acute benign lymphocytic meningitis
Most common of all types!
pathogens for viral meningitis
Enteroviruses (e.g., coxsackievirus, poliovirus, echovirus)
Found in immunocompromised (e.g., HIV) and in children
Viral Meningitis: Manifestation & Assessment
Headache, low-grade fever, nuchal rigidity, photophobia, malaise, viral URI symptoms
Does not usually have altered mental status and seizure activity
CT scan for signs of increased ICP
Lumbar puncture (clear CSF, not cloudy)
CSF: Increased protein and WBC but normal glucose and no bacteria
These patients do not normally have AMS and seizure
Viral Meningitis: Nurse Management
Less mortality with viral (Recovery in about 10 days)
Supportive care
Vomiting and pain management
Elevate HOB to at least 30 degrees with neutral head alignment
Dark quiet environment
Fever management
I&O’s
Nursing Assistance for a Lumbar Puncture
Informed consent
Patient Education
– Aseptic procedure carried out by inserting a needle into the lumbar subarachnoid space to withdraw CSF
– Patient must also void prior to procedure
Assist provider with patient positioning
– Patient positioned on one side (knee to chest position)
Medications pre/post procedure
Post-procedure Management
Encephalitis
Acute inflammation of brain tissue
Caused by bacteria, viruses, fungi, parasites
Viral most common (HSV 1 & 2)
– HSV-1 Children/adults
– HSV-2 Neonates through vaginal delivery
Encephalitis: HSV-1 Patho
Retrograde intraneuronal path
– Through the olfactory (smell) or trigeminal (facial movement) cranial nerves
Latent virus in brain tissue may reactivate
Cerebral edema and petechial hemorrhages neuron damage
Initial symptoms are similar to meningitis:
– Fever, headache, nuchal rigidity, and confusion
Encephalitis: HSV-1 Manifestations
Focal neuro symptoms based on area inflamed
Behavior changes, seizures, dysphasia, hemiparesis, altered LOC, auditory/visual hallucination
Encephalitis: HSV-1 Diagnostics
Diagnostics: EEG, CT/MRI, CSF examination
Polymerase Chain Reaction (PCR) is the standard test for early diagnosis of HSV-1 Encephalitis; High validity of PCR between 3-10 days after onset of symptoms
Encephalitis: HSV-1 Management
Meds: Acyclovir (Zovirax)** is the antiviral agent of choice - 60-70% down to 30%
– Early admin improves prognosis!
Treat for 3 weeks
Slow IV rate (over 1-hour) + fluids to help prevent crystallization of the medication in the renal tubules
Assess neuro and kidney* function (labs + I&Os)
Comfort measures: Dimming the lights, limiting noise, and administering analgesics
Seizure precautions
Encephalitis: Arboviral West Nile Virus & St. Louis Arbovirus
West Nile Virus & St. Louis Arbovirus
Patho: Mosquito gets it from bird bites human viral replication in human if survives, gets to cerebral capillaries
Spreads among neurons, affecting cortical gray matter, the brainstem & thalamus irritates the meninges and increases ICP
