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COMMUNICABLE DISEASES > CNS Communicable diseases > Flashcards

CNS Communicable diseases Flashcards

MENINGITIS, RABIES

1
Q

Inflammation of meninges

A

MENINGITIS

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2
Q

protects the brain from traumatic
injury / blow to your head (shock absorber)

A

Meninges

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3
Q

Parts/ Layers of Meninges:

A
  • Dura mater: outer layer, closest to skull
  • Arachnoid: middle layer
  • Pia mater: inner layer, closest to brain tissue
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4
Q

↑ICP → Cerebral hypoxia

A

Cerebral edema

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5
Q

Normal ICP:

A

75 – 180 mmH2O / 0-15 mmHg

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6
Q

Cerebral Cortex – could only tolerate hypoxia for

A

4-6 mins

if this exceeds, leads to irreversible brain damage

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7
Q

center for respiration

A

Medulla Oblongata

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8
Q

Medulla Oblongata – center for respiration, could
only tolerate hypoxia for

A

10-12 mins

if this exceeds, leads to irreversible brain damage

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9
Q

MENINGITIS CA:

A
  1. Haemophilus influenzae Type B
  2. Neisseria meningitidis
  3. Streptococcus pneumoniae
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10
Q

MENINGITIS MOT

A
  • Droplet
  • Contact (soiled secretion)
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11
Q

MENINGITIS IP

A

2-10 days

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12
Q

MENINGITIS DX TEST:

A

Lumbar puncture / tap
aka Spinal puncture / tap

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13
Q
  • 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)
A

Queckenstedt’s Test

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14
Q

1. Collect a sample of CSF

Normal CSF production:
Absorbed by blood:

A
  • Normal CSF production: 500 ml
  • Absorbed by blood: 100 – 150 ml
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15
Q
  1. DURING SPINAL TAP Position:
A
  • Orthopneic position – sitting / leaning
    forward on an overbed table
  • Fetal position / Left lateral recumbent
    – feet are flexed to the chest
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16
Q
  1. Insert a small needle into
A

L3-L4,
L4-L5,
L5-S1

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17
Q

3 samples contains

A

(1-2 ml of CSF) to be placed
in 3 sterile test tubes

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18
Q

After SPINAL TAP position:

A

flat on bed for 6-8hrs

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19
Q

flat on bed for 6-8hrs to prevent?

A
  1. After position: flat on bed for 6-8hrs (prevent
    headache / post spinal headache)
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20
Q

MENINGITIS 6. Nursing management:

A

Restrict fluids1000-
1500 ml to decrease CSF production

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21
Q

SIGNS AND SYMPTOMS (↑ICP):

A
  1. Nuchal Rigidity – inability to flex the neck
    forward
  2. Kernig’s sign – pain upon extension or
    straightening of knees/legs
  3. Brudzinski’s sign – flexion of the neck
    causes flexion of the knee
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22
Q

Normal color of CSF:

A

clear, colorless

(cloudy =infection; reddish = hemorrhage)

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23
Q

Normal amount of CSF:

A

production 500 ml
absorbed by blood, but the remaining is 100-150ml

24
Q

Normal glucose in CSF:

A

50-80 mg/dL (↓ = infection)

25
Q

Normal proteins in CSF:

A

20-50 mg/dL (↑ =infection)

26
Q

Normal ICP in newborn:

A

2-5 mmHg

27
Q

Normal ICP in children:

A

8-10 mmHg

28
Q

Normal ICP in adults:

A

8-15 mmHg

29
Q

OTHER SIGNS AND SYMPTOMS (↑ICP):

A
  1. Cushing’s triad (HyperBradyBrady; ↑BP, ↓PR,
    ↓RR)
  2. Anisocoria – dilated pupils d/t compression of
    CN3 (Oculomotor)
  3. Diplopia – double vision, compression of CN6
    (Abducens, largest cranial nerve, prone to
    compression)
  4. Doll’s eye – position on right side, observe for
    direction of the eyes; disconjugate movement of
    the eyes = ↑ICP
  5. High Fever and Chills
  6. Nausea and vomiting (projectile)
  7. Photosensitivity
  8. Wide Pulse Pressure
  9. Restlessness (initial sign of ↑ICP)
  10. Convulsions / Seizures (place in dark & quiet
    environment)
30
Q

dilated pupils d/t compression of
CN3 (Oculomotor)

A

Anisocoria

31
Q

double vision, compression of CN6 (Abducens, largest cranial nerve, prone to
compression)

A

Diplopia

32
Q

position on right side, observe for direction of the eyes; disconjugate movement of
the eyes = ↑ICP

A

Doll’s eye

33
Q

OTHER SIGNS AND SYMPTOMS (↑ICP):

A
  1. High Fever and Chills
  2. Nausea and vomiting (projectile)
  3. Photosensitivity
  4. Wide Pulse Pressure
  5. Restlessness (initial sign of ↑ICP)
  6. Convulsions / Seizures (place in dark & quiet
    environment)
34
Q

MENINGITIS DOC

A
  • 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
35
Q

Dilantin Therapeutic Range:

A

10-20 (PO, IV)

36
Q
A
37
Q
A
38
Q

COMMON SIDE EFFECTS OF DILANTIN:

A
  1. Red Urine - normal s/e
  2. Ataxia – involuntary movement of
    extremities; loss of muscle control
  3. Nystagmus – involuntary movements of the
    eyes
  4. Bone Marrow Depression – leukopenia,
    anemia, thrombocytopenia, bleeding,
    bruising / ecchymosis
  5. Gingival hyperplasia – overgrowth /
    swelling of the gum tissues → prone to
    bleeding
39
Q

Gingival hyperplasia Management:

A
  1. Soft bristled toothbrush
  2. Regular dental check-up
  3. Good oral hygiene
  4. Massage gums
40
Q

MANAGEMENT OF ↑ICP
1. Positioning:
2. HOB elevation:
3. Fluid Restriction:

A
  1. Positioning: Semi fowlers (drain excess
    CSF, promotes lung expansion, improves
    cerebral tissue perfusion)
  2. 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
  3. Fluid Restriction: 1L to 1500mL only (limit /
    ↓CSF production)
41
Q

FACTORS THAT ↑ICP

A
  1. Nausea and vomiting
  2. Valsalva maneuver (straining of stool)
  3. Over suctioning
  4. Enema
  5. Rectal exam
  6. Bending / Stooping
42
Q

RABIES
- Latin →
-Greek →

A
  • Latin → “madness”
  • Greek → “lyssa” → violent
43
Q

RABIES Other terms:

A

Lyssa, Hydrophobia

44
Q

RABIES CA:

A

Rhabdovirus

45
Q

GENUS:
FAMILY:

A

GENUS: Lyssavirus
FAMILY: Rhabdoviridae

46
Q

RABIES MOT:

A
  • 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
47
Q

RABIES IP:

A

1-3 months extends to 1 year / 14 days to 20 years;
1 year to several years

48
Q

RABIES COMPLICATION:

A
  1. Meningitis
  2. Encephalitis
  3. 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

49
Q

2 TYPES OF RABIES VACCINE:

A
  1. Purified Vero Cell Rabies Vaccine (PVRV)
  2. Purified Chick Embryo Cell Vaccine (PCECV)
50
Q

DOSE

Purified Vero Cell Rabies Vaccine (PVRV)

A
  • 0.5ml, IM
  • 0.1ml, ID (alternative dose)
51
Q

DOSE

Purified Chick Embryo Cell Vaccine (PCECV)

A
  • 1 ml, IM
  • 0.1ml, ID (alternative dose)
52
Q

Purified Chick Embryo Cell Vaccine (PCECV)
Number of Doses:
Days:

A

Number of Doses: 4 doses (1st trimester)
Days: 0, 3, 7, 14 days (2 weeks)

53
Q

2 Booster Doses

A
  • Had received the vaccine before
  • after an exposure
    Days: 0 and 3 days
54
Q

RABIES s/sx:

A
  1. Apprehension
  2. Hydrophobia (cover IVF with cloth / paper)
  3. Fever (earliest sign)
  4. Headache
  5. Muscle spasm in throat and larynx
  6. Paralysis (respiratory paralysis)
  7. Disorientation / Confusion
55
Q

RABIES management

A
  1. Wound care: for 15 minutes, soap water,
    povidone iodine or alcohol
  2. Vaccination / Immunization (ideally: 0, 3, 7,
    14)
  3. Observe pet for 10 days
  4. Have pet immunized at 3 months of age
    and every year after

COMMUNICABLE DISEASES (4 decks)

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