CNS Communicable diseases Flashcards
MENINGITIS, RABIES
Inflammation of meninges
MENINGITIS
protects the brain from traumatic
injury / blow to your head (shock absorber)
Meninges
Parts/ Layers of Meninges:
- Dura mater: outer layer, closest to skull
- Arachnoid: middle layer
- Pia mater: inner layer, closest to brain tissue
↑ICP → Cerebral hypoxia
Cerebral edema
Normal ICP:
75 – 180 mmH2O / 0-15 mmHg
Cerebral Cortex – could only tolerate hypoxia for
4-6 mins
if this exceeds, leads to irreversible brain damage
center for respiration
Medulla Oblongata
Medulla Oblongata – center for respiration, could
only tolerate hypoxia for
10-12 mins
if this exceeds, leads to irreversible brain damage
MENINGITIS CA:
- Haemophilus influenzae Type B
- Neisseria meningitidis
- Streptococcus pneumoniae
MENINGITIS MOT
- Droplet
- Contact (soiled secretion)
MENINGITIS IP
2-10 days
MENINGITIS DX TEST:
Lumbar puncture / tap
aka Spinal puncture / tap
- To evaluate subarachnoid obstruction
- To confirm ↑ICP
- Done by the physician
1. Compresses the right jugular vein for 10 secs
/ left jugular vein for 10 secs
2. Manometer – observe for rapid rise of
pressure (↑ICP in manometer)
Queckenstedt’s Test
1. Collect a sample of CSF
Normal CSF production:
Absorbed by blood:
- Normal CSF production: 500 ml
- Absorbed by blood: 100 – 150 ml
- DURING SPINAL TAP Position:
- Orthopneic position – sitting / leaning
forward on an overbed table - Fetal position / Left lateral recumbent
– feet are flexed to the chest
- Insert a small needle into
L3-L4,
L4-L5,
L5-S1
3 samples contains
(1-2 ml of CSF) to be placed
in 3 sterile test tubes
After SPINAL TAP position:
flat on bed for 6-8hrs
flat on bed for 6-8hrs to prevent?
- After position: flat on bed for 6-8hrs (prevent
headache / post spinal headache)
MENINGITIS 6. Nursing management:
Restrict fluids1000-
1500 ml to decrease CSF production
SIGNS AND SYMPTOMS (↑ICP):
- Nuchal Rigidity – inability to flex the neck
forward - Kernig’s sign – pain upon extension or
straightening of knees/legs - Brudzinski’s sign – flexion of the neck
causes flexion of the knee
Normal color of CSF:
clear, colorless
(cloudy =infection; reddish = hemorrhage)
Normal amount of CSF:
production 500 ml
absorbed by blood, but the remaining is 100-150ml
Normal glucose in CSF:
50-80 mg/dL (↓ = infection)
Normal proteins in CSF:
20-50 mg/dL (↑ =infection)
Normal ICP in newborn:
2-5 mmHg
Normal ICP in children:
8-10 mmHg
Normal ICP in adults:
8-15 mmHg
OTHER SIGNS AND SYMPTOMS (↑ICP):
- Cushing’s triad (HyperBradyBrady; ↑BP, ↓PR,
↓RR) - Anisocoria – dilated pupils d/t compression of
CN3 (Oculomotor) - Diplopia – double vision, compression of CN6
(Abducens, largest cranial nerve, prone to
compression) - Doll’s eye – position on right side, observe for
direction of the eyes; disconjugate movement of
the eyes = ↑ICP - High Fever and Chills
- Nausea and vomiting (projectile)
- Photosensitivity
- Wide Pulse Pressure
- Restlessness (initial sign of ↑ICP)
- Convulsions / Seizures (place in dark & quiet
environment)
dilated pupils d/t compression of
CN3 (Oculomotor)
Anisocoria
double vision, compression of CN6 (Abducens, largest cranial nerve, prone to
compression)
Diplopia
position on right side, observe for direction of the eyes; disconjugate movement of
the eyes = ↑ICP
Doll’s eye
OTHER SIGNS AND SYMPTOMS (↑ICP):
- High Fever and Chills
- Nausea and vomiting (projectile)
- Photosensitivity
- Wide Pulse Pressure
- Restlessness (initial sign of ↑ICP)
- Convulsions / Seizures (place in dark & quiet
environment)
MENINGITIS DOC
- can give antibiotic, Penicillin G
1. Osmotic diuretic – mannitol; to reduce cerebral edema; observe urine output in 5-10
mins; observe BP (hypotension, dizziness)
2. Corticosteroids – Dexamethasone; cross
blood brain barrier, reducing inflammation /
cerebral edema; Dexamethasone causes GI
infection
Antacids – aluminum based (lead to constipation), magnesium based (lead to diarrhea)
PPI – Zantac / Ranitidine to prevent ulcer
3. Pain relievers
4. Anticonvulsants – Tegretol Phenobarbital; common: Phenytoin / Dilantin
Dilantin Therapeutic Range:
10-20 (PO, IV)
COMMON SIDE EFFECTS OF DILANTIN:
- Red Urine - normal s/e
- Ataxia – involuntary movement of
extremities; loss of muscle control - Nystagmus – involuntary movements of the
eyes - Bone Marrow Depression – leukopenia,
anemia, thrombocytopenia, bleeding,
bruising / ecchymosis - Gingival hyperplasia – overgrowth /
swelling of the gum tissues → prone to
bleeding
Gingival hyperplasia Management:
- Soft bristled toothbrush
- Regular dental check-up
- Good oral hygiene
- Massage gums
MANAGEMENT OF ↑ICP
1. Positioning:
2. HOB elevation:
3. Fluid Restriction:
- Positioning: Semi fowlers (drain excess
CSF, promotes lung expansion, improves
cerebral tissue perfusion) - HOB elevation: 30-40 degrees (max 45
degrees) not 90 degrees since it may cause
brain herniation, and it could further ↑ICP that
can lead to hemorrhage - Fluid Restriction: 1L to 1500mL only (limit /
↓CSF production)
FACTORS THAT ↑ICP
- Nausea and vomiting
- Valsalva maneuver (straining of stool)
- Over suctioning
- Enema
- Rectal exam
- Bending / Stooping
RABIES
- Latin →
-Greek →
- Latin → “madness”
- Greek → “lyssa” → violent
RABIES Other terms:
Lyssa, Hydrophobia
RABIES CA:
Rhabdovirus
GENUS:
FAMILY:
GENUS: Lyssavirus
FAMILY: Rhabdoviridae
RABIES MOT:
- Bite / scratch of a rabid animal (any warmblooded
animal) (direct contact) - Touched the saliva of the infected animal and put
it on your eyes - Airborne d/t inhalation of the aerosols of the virus
RABIES IP:
1-3 months extends to 1 year / 14 days to 20 years;
1 year to several years
RABIES COMPLICATION:
- Meningitis
- Encephalitis
- death occurs
replicate in motor neurons / brains
↓
Travels to peripheral NS
↓
ANS
↓
Migrate to salivary glands
Observe the dog for 10 days, if it dies, cut head,
bring to PHO to confirm rabies virus / locate Negri
bodies
Cytoplasmic inclusions – study in lab to confirm
rabies
2 TYPES OF RABIES VACCINE:
- Purified Vero Cell Rabies Vaccine (PVRV)
- Purified Chick Embryo Cell Vaccine (PCECV)
DOSE
Purified Vero Cell Rabies Vaccine (PVRV)
- 0.5ml, IM
- 0.1ml, ID (alternative dose)
DOSE
Purified Chick Embryo Cell Vaccine (PCECV)
- 1 ml, IM
- 0.1ml, ID (alternative dose)
Purified Chick Embryo Cell Vaccine (PCECV)
Number of Doses:
Days:
Number of Doses: 4 doses (1st trimester)
Days: 0, 3, 7, 14 days (2 weeks)
2 Booster Doses
- Had received the vaccine before
- after an exposure
Days: 0 and 3 days
RABIES s/sx:
- Apprehension
- Hydrophobia (cover IVF with cloth / paper)
- Fever (earliest sign)
- Headache
- Muscle spasm in throat and larynx
- Paralysis (respiratory paralysis)
- Disorientation / Confusion
RABIES management
- Wound care: for 15 minutes, soap water,
povidone iodine or alcohol - Vaccination / Immunization (ideally: 0, 3, 7,
14) - Observe pet for 10 days
- Have pet immunized at 3 months of age
and every year after
