[Exam 4] Chapter 69: Management of Patients with Neurologic Infections, Autoimmune Disorders, and Neuropathies ( Page 2065-2068, 2069-2089 ) Flashcards
What are the Infectious Neurologic Disorders?
Meningitis
Encephalitis
Creutzfeldt-Jakob Disease and Variant Creutzfeldt-Jakob Disease
Meningitis: What is this?
Inflammation of the membranes and the fluid space surrounding the brain and spinal cord
Meningitis: What are the two types?
Bacterial
Viral
Meningitis: What do we do with Viral version?
Its Aseptic
Usually benign and does not require intervention
Meningitis: What can cause Aseptic Meningitis?
Viral infection, Lymphoma, Leukemia, or Brain Abscess
Meningitis: What causes septic meningitis?
Bacteria S. Pneumoniae or Neisseria Meningitidis.
Meningitis: How does bacterial version occur?
Aerosol and secretion transmission
Meningitis: What does bacterial version require?
Intervention
Meningitis: N. Meningitidis transmitted by?
Secretions or aerosol contamination, and infection is most likely in dense community groups such as college campuses
Meningitis: Manifestations of this includes
severee headache, fever, change in LOC, behavioral changes, nuchal rigidity (Stiff neck, painful), positive Kernig’s/Brudzinski’s sign, and photophobia
Meningitis: What is required for those living in close quarters?
A vaccine for bacterial meningitis.
Meningitis: Which one is the most contagious?
Bacterial, requires hospital care
Meningitis: What is Kernig’s Sign?
Patient is laying flat on back. Hip brought up to 90 degree angle. If knee at 90 degree angle as well and tried to straighten the knee, they won’t be able to. Hamstrings are very tight.
Meningitis: What is Brudzinski’s Sign?
Patient lying supine. If head flexed , chin to chest, will cause pain and will reflexively bring the knees up as well.
Meningitis: Medical Management for Bacterial Meningitis?
Vaccination for all children and at-risk adults.
Prevention by meningococcal vaccination for adolescents and high-risk groups
Early administration of IV antibiotics for bacterial
Dexamethasone
Treat dehydration(bc of high fever), shock, seizures
Meningitis: Nursing Management for this? (6)
Freq Assess including VS/LOC, motor movement, eye movement, speech
Protect pt from injury related to seizure or altered LOC
Prevent comps associated with immobility (ROM for them)
infection control precautions (high fever, so provide hydration)
supportive care
measures to facilitate coping with pt/fam
Meningitis: Nursing management, what will you monitor?
Daily weight, serum electrolytes, urine volume, specific gravity, and osmolality
Encephalitis: What is this?
Acute, inflammatory process of the brain tissue typically caused by a viral infections(herpes), vector-borne viral infection (west nile, st louis) can also be fungal
Encephalitis: Signs of this includes
headache, fever, confusion, changes in LOC
Encephalitis: Vector Borne signs? (West Nile, St. Louis)
Rash, Flaccid Paralysis, Parkinson-Like Movements
Encephalitis: Herpes Encephalitis treatment
Acyclovir IV
Encephalitis: Fungal Encephalitis treatment
Amphotericin
Encephalitis: West Nile Encephalitis treatment
No actual medication to treat virus. Dexamethasone can decrease inflammation
Encephalitis: Nursing Management for this?
Frequent, and ongoing assessment
Supportive Care
Antibacterial if by bacteria, run course if viral.
Seizure Precautions
Treat fever, watch hydration
Administer Dexamethasone.
Creutzfeldt-Jakob Disease: What is this?
Rare, degenerative infectious, transmissible spongiform encephalopathy. (TSEs)
Creutzfeldt-Jakob Disease: How does someone get this?
Body is exposed to prions (small proteinaceous particles that are smaller than a virus and resistant to sterilization)
Creutzfeldt-Jakob Disease: What is this known as to the public?
Mad cow disease
Creutzfeldt-Jakob Disease: How is this spread?
No contact. By indigestion of infected beef (vCJD) or by surgical tools used in eye or brain surgery. Brain or spinal fluids, tissue.
Creutzfeldt-Jakob Disease: Lifespan for someone with this?
One year
Creutzfeldt-Jakob Disease: Treatment?
No treatment, progressive and fatal
Creutzfeldt-Jakob Disease: Diagnostic test of choice?
EEG. Electrodes watch on brain.
Creutzfeldt-Jakob Disease: How can CJD differ from vCJD?
It can be genetic, or spontaneously occurs.
vJCD is from eating infected beef.
Creutzfeldt-Jakob Disease: Sigins of this?
Affective (behavioral changes, limb pain, sensory disturbance, muscle spasms, rigidity and cognitive impairments
Creutzfeldt-Jakob Disease: Nursing Management?
Prevention of disease transmission, blood and body fluid precautions, supportive care
Risk Factors for Bacterial Meningitis
Living in dense communities
Risk Factors for Cruetzfeldt-Jakob
Eye or any CNS Infected Exposure
Infectious Neurologic Disorders: Complications include
ICP
Skin Breakdown
Seizures
Dehydration
How to prevent bacterial meningitis?
Vaccination
How to prevent Crutzfeldt-Jakob?
Improved screening of tissues
Infectious Neurologic Disorders: Labs and Diagnostic Tests?
Serum Electrolytes and Hydration
Urine Volume and SpG
CVJ Diseased Diagnosed by EEG
Infectious Neurologic Disorders: Nursing Diagnosis?
Ineffective Protection
RF Imbalanced Fluid Balance
RF Imbalanced Temp
RF Injury-Seizures
Confusion
Altered LOC
Infectious Neurologic Disorders: Goals for this?
Avoidance of complications
Infectious Neurologic Disorders: Education to patient for this?
Prevention
What are some Autoimmune Neurologic Disorders?
Multiple Sclerosis (MS)
Myasthenia Gravis
Gullian-Barre Syndrome
Multiple Sclerosis: What is this?
A PROGRESSIVE immune-related demyelination disease of the CNS
Multiple Sclerosis: Body produces T Cell antibodies against what?
myelin sheath of the axon
Multiple Sclerosis: What do the T Cells cause in the body?
Demyelination of the sheath. Nerve impulses unable to travel to target tissues.
Multiple Sclerosis: Inflammation along the pathway can cause what?
Pain along the nerve pathways. Causing exacerbation’s and remissions
Multiple Sclerosis: Frequeuntly the disease is relapsing and remitting, has exacerbations and recurrences of symptoms including
fatigue, weakness, numbness, difficulty in coordination, loss of balance, pain with muscle spasms, and visual disturbances
Loss of bowel and bladder control
Gait
Swallowing
Skin Breakdown
Multiple Sclerosis: Cure for this?
No. Progressive for this
Multiple Sclerosis: Medical Management for this?
Disease Modifying Therapies: Interferon B-1a and Interferon B-1b (Increase neuron surivival, decrease inflammatory rsponse) glatiramer acetate (Copaxone, blocks myelin damaging T Cells) and Iv Methyprednisolone (Steroid to decrease inflammation, suppresses immune system)
Multiple Sclerosis: Symptom management of what symptoms?
Muscle spasms, fatigue, Ataxia, Bowel and Bladder Control
Multiple Sclerosis: Assessment that needs to be done include
Neurologic Deficits
Secondary Comps: UTI (Weak Muscles), Pain, Falls, Aspiration
Impact of disease on physical, social, and emotional function and lifestyle
Patient and Family Coping
Multiple Sclerosis: Nursing Diagnosis? (8)
Impaired Physical Mobility
RF Injury
Impaired Bowel/Bladder
Impaired Verbal Communication
Disturbed Thought Process
Ineffective Coping
Impaired Home Maintenance
Potential Sexual Dysfunction
Multiple Sclerosis: Goals for this? (6)
Promotion of Physical Mobility
Adapation to Sexual Function
Avoidance of Injury
Achievement of Bowel/Bladder Continence
Promote Speech and Swallowing
Improved Cognitive Function
Multiple Sclerosis: Interventions with multiple professions include what?
Collaborative approach in healthcare
Coordinate and refer as needed to health care services: social services, speech therapy, PT, counseling, Home Care
Multiple Sclerosis: Interventions with Activity and Rest includes what?
Program of activity and daily exercise
Relaxation , coordination exercises, walking, muscle stretching
Avoid Strenuous activity and extreme fatigue
Multiple Sclerosis: Interventions for bowel and bladder control?
Instruction or administration of prescribed meds
Voiding Schedule
Bowel Training Program
Adequate fluid and fiber to prevent constipation
Multiple Sclerosis: Reinforce and encourage
swallowign instructions, with strategies to reduce risk of aspiration
Multiple Sclerosis: What can be done to enhance cognitive function?
Memory aides, structured environment, and daily routine
Multiple Sclerosis & Interventions: What daily exercise should be done?
Stretching technique and ROM
Multiple Sclerosis & Interventions: What does their diet look like?
Fluid and Fiber
Multiple Sclerosis & Interventions: How do they drink/eat?
Chin tucked swallowing and no straws. HOB is kept up
Multiple Sclerosis & Interventions: What assistive devices would help?
Walkers, Velcro
Multiple Sclerosis & Interventions: You should support what worries?
Allow expression of worries of LTC placement or burden of family. Support the coping
Multiple Sclerosis: What patient education would be given?
Avoid Fatigue/Stress/Strenous Activity
Avoid Extreme Temp
Memory Aids like calendars, pillboxes
No Rugs
Multiple Sclerosis: Risk factors for this?
caucasian Women b/w 15-60
Family History
Epstein-Barr Virus
Pts with DM1 or inflammatory bowel disease
Smoking
Multiple Sclerosis: Labs to test for this?
MRI
Lumbar Puncture
Multiple Sclerosis: How to prevent this?
No smoking
Good , general health
Multiple Sclerosis: What complications can this lead to?
Muscle Stiff/Spasms
Paralysis in legs
Problems with bladder, bowel, or sexual function
Mental Changes such as forgetfulness or mood swings.
Depression
Epilepsy
UTI
Aspiration
Myasthenia Gravis: What is this?
Autoimmune disorder affecting the myoneural junction, characterize by varying degrees of weakness of the voluntary muscles
Myasthenia Gravis: When does the thymus typically stop producing antibodies?
After Puberty
Myasthenia Gravis: What does the Thymus do in these patients?
Thymus continues to produce antibodies for unknown reasons.
Myasthenia Gravis: what do the antibodies do here?
Attack the acetylcholine receptor sites at the myoneural junction which impairs transmission of impulses
Myasthenia Gravis: First symptoms are seen in what area?
Motor disorders
Myasthenia Gravis: Initial symptoms involve
ocular muscles : Diplopia (Perception of two images of a single object) and Ptosis (Drooling or falling of upper eyelid)
Myasthenia Gravis: Patient will visit a physician which will perform what test?
Tensolin Test: Given to patient . Within 30 seconds, ptosis and facial weakness should be regained. Lasts for 5 minutes. Half Life is very short.
Myasthenia Gravis: What are some of the symptoms that patients could have?
Weakness of Facial Muscles
Swallowing (Aspiration)
Dysphonia (Voice Impairment)
Generalized Muscle Weakness
Myasthenia Gravis: Risk factors for thiss?
Over 60 years old
Family History
Myasthenia Gravis: How to prevent this?
Stress, illness, and fatigue can cause exacerbation bout
Myasthenia Gravis: Labs for this?
Anti-Acetylcholine receptor Antibody
Myasthenia Gravis: Is there a cure for this?
No, its a progressive disease
Myasthenia Gravis: What should you do for a patient with this?
Focus on patient
Medication education/manage
Energy Conservation
Strategies to help with ocular manifestations
Prevent comps/crisis
Reduce RF Aspiration
Avoid stress, infection, vigorous physical activity, some meds, and high environmental temps
Myasthenia Gravis & Medical Management: Therapy effective when..
there is improvement in symptoms
Myasthenia Gravis & Medical Management: When should meds be given?
30 mins prior to meals to help with swallowing
Myasthenia Gravis & Medical Management: What meds would be given?
Cholinesterase Inhibitor (Pyrostigmine Bromide (Mestinon): Has to be taken at same time everyday. No leeway with it.
Immunomodulating Therapy (Suppress immune system)
Myasthenia Gravis & Medical Management: What other therapeutic effects can be done?
Plasmapheresis : Run blood through dialysis machine to remove antibodies
Thymectomy: Remove part of Thymus or all of it.
Myasthenia Gravis: What are two major comps that can occur?
Myasthenic Crisis
Cholinergic Crisis
Myasthenia Gravis: What is a Myasthenic Crisis a result of?
Disease exacerbation or precipitating event, most commonly a respiratory infection. Can also occur is med is missed or late.
Myasthenia Gravis: What happens with a Myasthenic Crisis?
Severe generalized weakness with respiratory complications / failure
Myasthenia Gravis: What may patient develop in Myasthenic Crisis?
Respiratory compromise failure. Patient can no longer breathe
Myasthenia Gravis: What is Cholinergic Crisis caused by?
Overmedication
Myasthenia Gravis: Signs of Cholinergic Crisis?
Severe muscle weakness with respiratory weakness
Myasthenia Gravis: What may patients develop in Cholinergic Crisis?
Respiratory compromise and failure
Myasthenia Gravis: Difference between Cholinergic Crisis and Myasthenic Crisis?
The difference in level of acetylcholine. Both still cause respiratory failure
Myasthenia Gravis: What happens if you miss Mestinon too early, or miss it?
Miss it: Myasthenic Crisis
Too Early: Cholinergic Crisis
Myasthenia Gravis: What complications can occur with this?
Pneumonia
Aspirations
Myasthenic Crisis
Cholinergic Crisis
Myasthenia Gravis: What are signs of someone with this?
Motor symptoms (generalized weakness)
Initial symptoms with ocular msucles (diplopia and ptosis)
Facial weakness
Swallowing impairment
Dysphonia (voice impariemtn)
Luung sounds checked
Myasthenia Gravis: Patient education includes what?
Meds taken at same time
Reduce Stress
Avoid Extreme Temp.Fatigue
Avoid Vigorous Exercise
Signs of Myasthenic/Cholinergic Crisis
Teach family Heimlich
Myasthenia Gravis: What may be needed to ensure adequate ventilation?
Intubation and Mechanical Ventilation
Myasthenia Gravis: What supporitive measures should be done?
Measure airway/respiratory support
If patient cannow swallow, NG feeding may be required
Avoid sedatives and transquilizers
Myasthenia Gravis: What labs checked?
ABGs, Serum Electrolytes, I/O, Daily Weight
Myasthenia Gravis: Nursing Diagnosis for this?
RF Aspiration
Self-Care Deficit
Impaired Communication
Impaired Nutrition
RF Skin Breakdown
Ineffective Airway Clearance
Myasthenia Gravis: What interventions will be performed?
Energy conservation
Aspiration Precautions
Turn Q2H
Cough and Deep Breath, CPT, IS, Semi Fowlers
Humidification
Myasthenia Gravis: How much fluid will someone consume?
2500 mL to thin secretions
Guillain-Barre Syndrome: What is this?
Autoimmune disorder with acute attack of peripheral nerve myelin
Guillain-Barre Syndrome: What do the antibodies do here?
Attack the myelin sheath causing a RAPID demyelination
Guillain-Barre Syndrome: What does the demyelination possibly cause symptom wise?
Respiratory failure and autonomic nervous system dysfunction.
Guillain-Barre Syndrome: Where does the muscle weakness start?
Lower periphery and move up the body. As it subsides, it will move in reverse order
Guillain-Barre Syndrome: What is not affected here?
Cognition and LOC
Guillain-Barre Syndrome: This typically follows what
Viral Infection
Guillain-Barre Syndrome: What is recovery like?
Patients will have no residual disabilities
Guillain-Barre Syndrome: Symptoms include what?
Weakness to Paralysis
Vocal Paralysis
Paresthesia
Pain
Diminished to Absent Reflexes starting toes to head
Tachy/Bradycardia
Hyper/Hypotension
Guillain-Barre Syndrome: Risk factors?
Viral Infection
Guillain-Barre Syndrome: How to prevent?
CAn’t prevent
Guillain-Barre Syndrome: Labs for this?
Lumbar puncture will show elevated proteins with normal WBC
Guillain-Barre Syndrome: Most important thing to do when in paralyzed state is to
Don’t develop comps . Do ROM, no Pneumonia, turn frequently, kep feet in proper alignment to prevent footdrop. Won’t have reflexes at all.
Watch VS because hypo/hypertensive
Guillain-Barre Syndrome: Potential Complications?
Resp Failure Autonomic Dysfunction (BP, HR) DVT (Immobile) Pulmonary Embolism (Bedrest) Urinary Retention (Bladder paralyzed)
Pain, Contractures, Skin Breakdown, Paralytic Ileus, SIADH
Guillain-Barre Syndrome: Goals for this?
No Comp
Improved Resp Function
Increased Mobility
Improved nutritional status
Ability to communicate
Decreased fear/anxiety
Guillain-Barre Syndrome: Ongoing assessment consists of
emphasis on early detection of life-threatening comps of respiratory failure, cardiac dysrhythmias , and DVT
Guillain-Barre Syndrome: Monitor for changes in
vital capacity and negative inspiratory force
Guillain-Barre Syndrome: What will be continuously monitored?
VS, ECG
Guillain-Barre Syndrome: Nursing Diagnosis for this?
Ineffective Breathing Pattern
Impaired Gas Exchange
Impaired Physical Mobility
Imbalance Nutrition
Impaired Verbal Commun
Fear
Anxiety
Guillain-Barre Syndrome: Meds to treat this?
None
Guillain-Barre Syndrome: Antibiotics used to ..
prevent/tx UTI or resp infection
Guillain-Barre Syndrome: Whats given for pain?
Morphine
Guillain-Barre Syndrome: Why are anticoagulants given?
Prevent DVT and PE
Guillain-Barre Syndrome: What to give if hypotensive?
Vasopressors
Guillain-Barre Syndrome: What does medical management require?
Intensive care management with continuous monitoring and respiraotry support
Guillain-Barre Syndrome: What is used to reduce circulating antibodies?
Plasmapheresis and IVIG
Guillain-Barre Syndrome: What will be performed if someone cannot breathe?
Tracheostomy
Guillain-Barre Syndrome: Treatment for bradycardia?
Pacemaker
Guillain-Barre Syndrome: What to do if someone is on a ventilator?
TPN IV Fluids
Guillain-Barre Syndrome and Interventions: How do you enhance physical mobility and prevention of DVT?
Support limbsin functional position
ROM twice daily
Position changes every 2 hours
Elastic compression hose (SCDS or Ted Hose) or sequential compression boots
Adequate hydration
Guillain-Barre Syndrome and Interventions: What to do with aspiration?
Aspiration Precautions by assessing swallowing and gag reflex
Guillain-Barre Syndrome and Interventions: What labs will be monitored?
I/O and Urinary Retention
Guillain-Barre Syndrome and Interventions: Develop a plan for what?
Communication individualized to patient needs
Guillain-Barre Syndrome and Interventions: How to decrease fear and anxiety?
Provide information and support
Referral to support group
Relaxation measures
Maintain positive attitude and atmosphere to promote sense of well-being
Diversional activites
Guillain-Barre Syndrome: Patients and LOC
They never lose it. They have complete mental capacity during whole thing
Guillain-Barre Syndrome: Patient Education?
Change position slowly due to orthostatic hypotension
Explain syndrome will reverse over time
What are the Cranial Nerve Disorders?
Trigeminal Neuralgia (Tic Douloureux)
Bells’ Palsy
Trigeminal Neuralgia (Tic Douloureux): What is this?
Condition of the fifth cranial nerve characterized by paroxysms of pain
Trigeminal Neuralgia (Tic Douloureux): Most commonly occur in what branches of the nerve?
2nd and 3rd.
Trigeminal Neuralgia (Tic Douloureux): Most probable cause of this?
Vascular compression and pressure
Trigeminal Neuralgia (Tic Douloureux): Occurs more often to who and when?
Women that are 50-60 and those with MS
Trigeminal Neuralgia (Tic Douloureux): Pain can occur when?
With any stimulation such as washing face, brushing teeth, eating, or draft of air
Trigeminal Neuralgia (Tic Douloureux): Patients may do what to avoid the pain?
Avoid eating, neglect hygiene, and even isolate themselves to prevent attacks
Trigeminal Neuralgia (Tic Douloureux): Patho of this?
Vascular compression and demylination of 5th cranial nerve causing paroxysm of pain when trigger zones (cheek, lip, gum, forehead) are stimulated
Trigeminal Neuralgia (Tic Douloureux): What can the lightest sitmulation cause? (draft in room)
Severe pain
Trigeminal Neuralgia (Tic Douloureux): How often does this occur?
Has exacerbations and remission periods
Trigeminal Neuralgia (Tic Douloureux): How to prevent this?
Can’t
Trigeminal Neuralgia (Tic Douloureux): Labs for this?
Xray to rule out infection
Trigeminal Neuralgia (Tic Douloureux): Complications that can result?
Social Isolation
Malnutrition
Insomnia
Trigeminal Neuralgia (Tic Douloureux): Nursing Diagnosis of this?
Acute Pain
Impaired Nutiriton
Disturbed Sleep Pattern
Trigeminal Neuralgia (Tic Douloureux): What do you assess in patient?
How often pt experiences episdoes
Assess hygiene and eating habits
Pain scale
Trigeminal Neuralgia (Tic Douloureux): Medical Management fr this, what medications prescribed?
Antiseizure meds or Antispasmodic Meds
Analgesics
Trigeminal Neuralgia (Tic Douloureux): Surgical tx for this?
Microvascular decompression of trigeminal nerve
Rhizotomy: Destroys root, results in loss of reflex, sensation, and some m ovement
Radiofrequency thermal coagulation: Uses heat to destroy ganglion but preserves corneal reflex and sense of touch destroy
Percutanous baloon microcompression
Trigeminal Neuralgia (Tic Douloureux): Nursing Interventions?
Pt Education RT Pain Prevention and Treatment Regimen
Avoid Triggers
Care of Pt with Pain
Maintain Hygiene
Use Soft foods, chew on unaffected side , no spicy, avoid extreme temp . Tube feedings if cannot do it
Maintain room at moderate temp
Provide small frequent meals of lukewarm meals
Interventions for anxiety
depression, insomnia
Trigeminal Neuralgia (Tic Douloureux): Education for pt?
Avoidance of triggers
Chew on unaffected side
Avoid extremes of temp
Trigeminal Neuralgia (Tic Douloureux): Goals for this?
Maintain nutrition and hydration
Control pain
Maintain hygeien
Achieve complete sleep cycle
Bell’s Palsy: What is this?
Facial paralysis caused by unilateral infalmmation of seventh cranial nerve
Bell’s Palsy: Signs of this?
Unilateral facial muscle weakness or paralysis with facial disortion and painful sensations in the face. May have difficuclty with speech and eating
Bell’s Palsy: Recovery time?
In 3-5 weeks and the disorder rarely reoccurs
Bell’s Palsy: Patho?
Inflammation of 7th cranial nerve caused by herpes Type 1 and herpes zoster, but can be caused by other virsues too
Bell’s Palsy: Risk factors?
Herpes Infection
Viral Infection
Bell’s Palsy: Labs and Diagnostic?
None
Bell’s Palsy: Prevention?
None
Bell’s Palsy: Complications?
Corneal Damage
Permanent contractures of facial muscle
Bell’s Palsy: Nursing Diagnosis for this?
Acute Pain
Disturbed Sensory Perception
Disturbed Body Image
Bell’s Palsy: Assessment of this?
Unilateral Facial Paralysis with sudden onset
Increased tearing on affected side
Loss of blink reflex on affected side
Loss of corneal reflex on affected side
Pain Scale
Bell’s Palsy: Medical Treatment for this?
Corticosteroid therapy to reduce inflammation and diminish severity of disorder
Artifical tears 4x / day
Pt: Stimulate facial nerve and maintain muscle tone
Bell’s Palsy: Why would Acyclovir be prescribed?
Antiviral Medication
Bell’s Palsy: Why would Prednisone be prescribed?
Anti-Inflammatory
Bell’s Palsy: Patient Education?
Assure that patient did not have stroke.
Protect eye with shield and tape shut at night. Or have them close eye and use sunglasses. Can use eye ointment or drops
Be careful using eye patch.
Perform facial exercises and massages to maintain muscle tone
Bell’s Palsy: What nursing interventions will you perform?
Moist heat
Soft Meals
Inspect mouth after eating for pocketed food
Practice wrinkling foreheading, closing eye, blowing air through puckered lips, and whistling for 5 minutes 3-5 times a day