CNS Exam Flashcards
Pathophysiology of Meninginitis
It is an inflammation of the brain and spinal cord that may be caused by either bacterial or viral infections.
Bacterial is a serious infection that is spread by direct contact with discharge from the respiratory track of an infected person.
Viral is more common and rarely serious.
etiology of meningitis
The infection generally begins in another area such as the upper respiratory tract, enters the blood, and invades the CNS
This causes the meninges to become inflamed and intracranial pressure to increase.
Prevention of Meningitis
Hib vaccination and pneumonia vaccination.
s/s of meninginitis
Severe headache Fever, Photophobia, Petechial rash Nuchal rigidity: Positive Kernig Brudzinski’s sign Nausea and vomiting tachycardia alterations in motor function Encephalopathy: Short attention span. Poor memory, and disorientation
What is a positive kerning’s sign
after flexing the knee 90 degrees, trying to extend it all the way will cause hamstring pain.
What is a positive Brudzinski’s sign
When flexing the neck downward, the knees will flex and there will be pain in the neck.
complications of meningitis
Hydrocephalus
Seizures
Respiratory impairment
Neurological deficits
Dx of meningitis
Lumbar puncture
Culture and sensitivity
Bacterial +: fluid is cloudy from the increase in WBC.
Viral: is clear, But the WBC count is elevated.
therapeutic interventions for meningitis
Antibiotics: for bacterial
Antipyretics: for fever
Cooling blanket: for fever
Dark, quiet environment: to decrease risk potential for seizures
Analgesics
Codeine products (once it’s diagnosed)
Antiemetics: to reduce the possibility of further increasing ICP
Isolation: prevention of spread! (remember it’s respiratory)
pathophysiology of encephalitis
Inflammation of brain tissue in a local area
IICP (increased intracranial pressure) may occur and lead to herniation of the brain.
Neurological effects depend on area of brain affected.
etiology of encephalitis
Viruses
Some viruses are carried by ticks or mosquitoes
Some viruses are caused by systemic infections
Herpes simplex is the most common viral cause.
s/s of encephalitis
Headache Fever Nausea and vomiting Nuchal rigidity Confusion Decreased LOC Seizures Photophobia Tremors
complications of encephalitis
Cognitive disabilities Personality changes: These are the hardest on family members. You have to take this into consideration with discharge planning. Ongoing seizures Motor deficits Blindness
Dx of encephalitis
CT
EEG
LP: fluid will be yellow due to possible hemmorhage & elevated WBC
therapeutic interventions for encephalitis
Analgesics
Antipyretics
Anti-virals
Neurological assessment
Symptomatic care
There is no treatment for insect borne encephalitis.
Acyclovit is given for herpes simplex encephalitis.
Meds are given to reduce seizures, headaches and fever.
Pathophysiology of ICP
patient with an intracranial condition is at risk for increased intracranial pressure.
ICP is the pressure exerted within the cranial cavity by it’s components (blood, brain, and cerebrospinal fluid)
Monro-Kellie doctrine: theory stating…
that there are 3 components in the skull: brain, blood, CSF. If one increases and something else doesn’t, the result will be Increased ICP.
S/S of ICP
Restlessness Headache Seizures Irritability Decrease in LOC Pupil changes-due to pressure -papilledema, impaired eye movement increased BP Decrease Pulse Decreased Respirations vomiting changes in speech
s/s of ICP in infants
bulging fontanels
cranial suture separation
increased head circumference
high bitched cry
lowest score of glascow coma scale
3
highest score of glascow coma scale
15
explain migraine
Starts with vasoconstriction followed by vasodilation.
Hereditary is a factor and triggers such as food, noise, lights, alcohol and stress.
These pts may have a prodromal period which there are changes prior to the h/a. Such as: tingling, difficulty speaking, and visual disturbances.
These type of headaches are accompanied with nausea and vomiting and can last from hours to days.
B/P meds may be given prophylactically. (they help eliminate the vascular changes that occur during the headache. Monitor B/P!!
Other meds may be ordered that can be taken at the onset of a migraine. (anti-seizure)
Dietary restrictions may be helpful if precipitating foods or beverages can be identified. Have them take a food inventory diary to determine this.
What is a cluster headache and what is the treatment
These headaches come in clusters periodically.
Stress, anxiety, and emotional distress are proposed causes of cluster headaches
Frequently these headaches will occur at the same time of each day.
Treatment: cool compresses, dark & quiet environment, and NSAID’s may be used.
What is a tension headache and the treatment for it
These headaches consist of persistent contractions of the scalp, facial or cervical muscles can be the cause.
Can be d/t premenstrual, stress or anxiety.
Pressure, aching, steady and tight are describing words
Symptom management: massage the affected muscles, rest, localized heat, non-narcotic analgesics
Treatment for headaches
Assessment Patient education Keep diary Record triggers, timing, symptoms Medication teaching
Seizures
Abnormal electrical discharge within the brain due to instability of the neuron cell membrane.
Seizures may be a symptom of epilepsy or other neurological disorders such a tumor or brain attack.
What are the classifications of seizures
Partial Seizure
Begin on one side of cerebral cortex
Generalized Seizure
Both hemispheres involved
etiology of seizures
Idiopathic
No cause identified, and they usually begin before age 20
Acquired
Underlying neurological disorder such as a traumatic brain injury and anoxic events (events where the brain is left without oxygen).
partial seizure symptoms
Automatisms may be present and are the classic symptom: They are repetitive, purposeless behaviors
The patient may be in a dreamlike state while picking at his or her clothing, chewing, or smacking his lips.
These behaviors are sometimes inappropriate.
Absence (petit mal) are
classic in children and they stare for several seconds.
two types of generalized seizures
absence (petit mal) tonic clonic (grand mal)
what is a grand mal seizure
Rigidity followed by muscle contraction and relaxation with twitching movements: tonic/clonic
Postictal period follows the seizure which is a recovery period.
After a tonic clonic, the patient may sleep for several minutes to hours.
treatment for seizures
-Anticonvulsant medication
Blood levels must be monitored
May cause drowsiness
-Treatment begins with a dose and it is increased until the therapeutic levels are attained
-Surgical Management: resection of area causing problem. The goal is to reduce the frequency or severity of the seizures
emergency care during seizures
Pad side rails Prevent injury Monitor airway Turn on side to prevent aspiration Suction PRN Observe and document
What is status epileptic
30 minutes of seizure activity without a return to consciousness.
Neuro damage can occur due to the brain not getting it’s metabolic needs.
treatment for status epileptics
Treatment
Ensure airway and oxygenation
Administer IV diazepam
traumatic brain injury can cause
Cerebral edema
Hydrocephalus
Brain herniation
Death
acceleration head injuries
a moving object hitting a stationary head (the frying pan hitting your husband’s head)
deceleration head injury
when the head is in motion and strikes a stationary surface (the husband falling down and hits his head on the floor)
a concussion, and what is it characterized by
A mild brain injury with loss of consciousness for under 5 minutes
Characterized by: headache, dizziness, nausea and vomiting.
what is a contusion
Bruising of the brain tissue, possibly accompanied by hemorrhage.
Respirations, pupil reaction and motor response are affected.
hemotoma
Usually a venous bleed
Classified as acute or chronic based on the time interval between injury and onset of symptoms.
Acute: Occur 24 hours after an injury. As it increases: the patient may exhibit extremity weakness or dilation of the pupil. LOC may further deteriorate as ICP increases
Chronic hematomas are due to the chronic stretches of veins between the brain and the dura. A minor fall can cause the veins to rupture and bleed.
what is an epidural hemotoma
Usually an arterial bleed between the dura mater and the skull. Because it’s arterial, it can become large quickly!
Loss of consciousness occurs and a dilated pupil. Seizures or hemiparesis may occur, especially if there is no interventions.
This is a fatal condition if not treated. The goal is to keep an oral airway and decrease the ICP.
treatment of hemotoma
Surgical removal of hematoma
Control IICP with use of osmotic diuretics (such as Mannitol).
Mechanical hyperventilation: which will lower ICP by causing vasoconstriction.
Therapeutic coma: this reduces the metabolic needs of the brain
Keep in mind that the brain injured patient may be partially or completely dependent for maintenance of respiration, nutrition, elimination, movement, and skin integrity.
complication of brain injuries
Brain Herniation: due to uncontrolled edema
Diabetes insipidus:
due to effects on the pituitary or hypothalamus and the inadequate release of ADH
Acute hydrocephalus:
vital signs fluctuation: due to pressure on the brainstem
Post-traumatic syndrome: Ongoing symptoms
Cognitive and personality changes: This is a biggie!!
potential problems for brain injuries
Ineffective cerebral tissue perfusion r/t increased ICP
Ineffective breathing pattern r/t pressure on the respiratory center
Ineffective airway clearance r/t reduced cough reflex and decreased LOC
Pain r/t tissue damage
Impaired physical mobility r/t decreased LOC
pathophysiology of brain tumors
Neoplastic growths of the brain or meninges
May be primary or secondary (metastatic)
Metastatic tumors arise from the primary cancer of:
Prostate, thyroid, breast, liver and kidney
s/s of brain tumor
Seizures Motor and sensory deficits Headaches Visual disturbances Hormone disturbances
thereaputic intervention for brain tumors
Medical: Involves treating the symptoms Anticonvulsants for seizure control Dexamethasone to lessen the edema Radiation therapy Chemotherapy
postof care for brain surgery
Nursing diagnoses
Risk for ineffective cerebral tissue perfusion r/t edema of the operative site
Risk for infection related to surgical procedure
Body image disturbance related to changes in appearance or function
