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CD part 2 > meningitis > Flashcards

meningitis Flashcards

1
Q

what is meningitis

A

inflammation of the meninges

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2
Q

what are the causative agents of meningitis

A

haemophilus influenza type B
neisseria meningitidis
streptococcus pneumoniae

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3
Q

MOT of meningitis

A

droplet
contact—-soiled secretions

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4
Q

incubation period of meningitis

A

2-10 days

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5
Q

diagnostic test for meningitis

A

lumbar puncture/ tap
spinal puncture/tap
quickenstedts test

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6
Q

s/sx of meningitis

A

nuchal rigidity
kernig’s sign
brudzinki’s sign

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7
Q

what is nuchal rigidity

A

inability to flex the neck forward

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8
Q

what is kernig’s sign

A

pt complains pain upon extension or straightening the KNEE/legs

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9
Q

What is brudzinki’s sign

A

flexion of the neck causes flexion of the knee

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10
Q

normal color of CSF

A

colorless, clear

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11
Q

normal amount of CSF

A

100-150ml (normal production 500ml)

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12
Q

normal glucose in CSF

A

50-80mg/dl (always decrease in meningitis)

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13
Q

normal protein in csf

A

20-50 mg/dl (always increase in any infection of the brain)

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14
Q

normal ICP in newborn

A

2-5mmHg

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15
Q

normal ICP in children

A

8-10 mmHg

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16
Q

normal ICP in adults

A

8-15 mmHg

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17
Q

signs of increase ICP

A

Cushing’s Triad (increase BP, decrease RR, PR)

anisocoria
diplopia
doll’s eye
high fever/chills
N/V
Photosensitivity
Wide pulse pressure
Restlessness
Convulsions/seizures

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18
Q

what is anisocoria

A

dilated pupils d/t compression of CN3 (occulomotor)

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19
Q

diplopia

A

this is d/t compression of CN6 (abducens) (longest CN therefore prone to compression)

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20
Q

initial sign of increase ICP

A

restlessness

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21
Q

normal ICP

A

75-180mmH2O or 0-15 mmHg

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22
Q

how many minutes do CEREBRAL CORTEXT tolerate HYPOXIA

A

4-6 mins (irreversible brain damage)

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23
Q

what do cerebral context tolerate?

A

HYPOXIA

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24
Q

what do MEDULLA OBLONGATA tolerates?

A

HYPOXIA

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25
Q

how many minutes do MEDULLA OBLONGATA tolerates hypoxia?

A

10-12 mins (beyond could result to irreversible brain damage)

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26
Q

Pharmacological management for meningitis

A

ANTIBIOTICS (penG)
OSMOTIC DIURETICS (mannitol)
CORTICOSTEROIDS (dexamethasone)
ANTICONVULSANT
PAIN RELIEVERS (codein) (may headache siya)
ANTACIDS (aluminum or magnesium based)
PPI (zantac/ranitidine)

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27
Q

why we need to give antibiotics (penG) to pt wd meningitis

A

bacteria siya eh

28
Q

why we need osmotic diuretics? (mannitol)

A

to decrease cerebral edema

29
Q

nursing responsibilities for osmotic diuretics in meningitis

A

Monitor urine output (5-10 mins)

WOF dizziness and hypotension since mag increase urine output niya

30
Q

common side effect of ANTACIDS ALUMINUM BASED

A

constipation

31
Q

common side effect of ANTACIDS MAGNESIUM BASED

A

diarrhea

32
Q

what drug is to be given when a pt is taking dexamethasone

A
33
Q

why we give PPI for pt with meningitis

A

to prevent ulcers

34
Q

position during and after lumbar tap?

A

Lateral decubitus position:

hindi sure

35
Q

purpose of lumbar tap

A

collect a sample of CSF

36
Q

what color indicates:

Normal
Infection
Haemorrhage

A

clear and colorless
cloudt
bloody

37
Q

restrict fluids to??

A

1000-1500 ml of water

38
Q

where do they insert the needle in lumbar tap??

A

L3-L4, L4-L5, L5-S1

39
Q

how many ml of CSF contains 1 sample?

A

1-2ml

40
Q

how many sample of CSF to be placed in sterile test tubes?

A

3 samples

41
Q

this is a test to subarachnoid obstruction

A

Queckenstedt’s Test

42
Q

discuss Queckenstedt’s test

A

-to confirm increase ICP
-done by the physician

43
Q

how they do queckenstedt’s test?

A

compresses the right jugular vein for 10 secs then same for the left jugular vein

44
Q

manometer

A

rapid rise of pressure—— increase ICP

45
Q

why there is an Increase BP in cushing’s triad for pt with meningitis?

A

it is a force of cardiac contractility in attempt to increase tissue perfusion

46
Q

in cushing’s triad, there is an involvement of the ____

A

medulla oblongata

47
Q

in any brain/neurologic disorder, the pulse pressure will??

A

widened

48
Q

after lumbar puncture, the recommended position is?

A

flat on bed for 6-8 hours to prevent spinal headache

49
Q

common SE or complication after lumbar pubcture??

A

post spinal headache

50
Q

what is doll’s eye

A

dysconjugate movement of the eyes

51
Q

why we give dexamethasone to patient with meningitis?

A

to decrease inflammation and the only corticosteroid drug that can cross the BBB

52
Q

dexamethasone causes??

A

GI irritation and ulcers

53
Q

if dexamethasone causes GI irritation and ulcers then give ___

A

antacids (aluminum and magnesium based)

PPI - zantac/ranitidine

54
Q

anticonvulsants for meningitis

A

prevent seizures and convulsions

phenobarbital
tegretol
phenytoin/dilantin

55
Q

DOC (anticonvulsants)

A

Phenytoin/dilantin

56
Q

serum therapeutic level of dilantin

A

10-20 mcg/dl

57
Q

if dilantin is given per orem??

A

give with food to prevent GI upset

58
Q

if dilantin is given per IV??

A

prepare 10ml/cc of NSS because phenytoin readily crystallises in the veins

59
Q

how to prevent crystallizes in the veins when giving phenytoin?

A
  • first administer with 5ml NSS
  • then phenytoin
  • then flush with the last 5ml of NSS
60
Q

Do’s and Dont’s when giving Dilantin Therapy

A
  • avoid driving (causes drowsiness)
  • monitor glucose level (dilantin inhibits insulin release) (you could have HYPERGLYCEMIA)
  • dilute with NSS and not dextrose sol (bec dextrose could cause PRECIPITATION)
  • avoid IM injection (could irritate tissues)
  • avoid alcohol
  • monitor CBC (causes bone marrow depression)
  • contraindicated in pregnancy (it has teratogenic effect)
  • gradual withdrawal of phenytoin to prevent STATUS EPILEPTICUS
61
Q

what is status epilepticus

A

a type of seizure occuring in rapid succession with no consciousness between seizures

can cause brain damage or coma

62
Q

SE OF DILANTIN IF PER OREM

A

BRANG

-red urine
-ataxia (involuntary movement of the extremities)
-nystagmus (involuntary eye movement)
-bone marrow depression (leukopenia, anemia, thrombocytopenia — decrease platelet count kaya prone to BLEEDING, ECCHYMOSIS, BRUISING)

-GINGIVAL HYPERPLASIA

63
Q

common SE of dilantin (Per orem)

A

GINGIVAL HYPERPLASIA

64
Q

MANAGEMENT FOR -GINGIVAL HYPERPLASIA

A
  • soft bristle toothbrush
  • regular dental check up
  • good oral care/hygiene
  • massage gums
65
Q

what is -GINGIVAL HYPERPLASIA

A

overgrowth of the gum tissues (swelling or bleeding)

66
Q

MANAGEMENT OF ICP

A
  • position: SEMI FOWLER’s (promotes lung expansion, improves cerebral tissue perfusion)
  • elevate HOB - 30-40 degree maximum of 45 defrees
    ** do not attempt to elevate to 90— it will cause brain herniation then can further lead to Increase ICP or hemorrhage
  • fluid restriction to 1L to 1.5L to limit CSF production
67
Q

factors that increase ICP

A

N/V
Valsalva maneuver
oversuctioning
enema
rectal exam
bending or stooping

CD part 2 (29 decks)

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