meningitis Flashcards
what is meningitis
inflammation of the meninges
what are the causative agents of meningitis
haemophilus influenza type B
neisseria meningitidis
streptococcus pneumoniae
MOT of meningitis
droplet
contact—-soiled secretions
incubation period of meningitis
2-10 days
diagnostic test for meningitis
lumbar puncture/ tap
spinal puncture/tap
quickenstedts test
s/sx of meningitis
nuchal rigidity
kernig’s sign
brudzinki’s sign
what is nuchal rigidity
inability to flex the neck forward
what is kernig’s sign
pt complains pain upon extension or straightening the KNEE/legs
What is brudzinki’s sign
flexion of the neck causes flexion of the knee
normal color of CSF
colorless, clear
normal amount of CSF
100-150ml (normal production 500ml)
normal glucose in CSF
50-80mg/dl (always decrease in meningitis)
normal protein in csf
20-50 mg/dl (always increase in any infection of the brain)
normal ICP in newborn
2-5mmHg
normal ICP in children
8-10 mmHg
normal ICP in adults
8-15 mmHg
signs of increase ICP
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
what is anisocoria
dilated pupils d/t compression of CN3 (occulomotor)
diplopia
this is d/t compression of CN6 (abducens) (longest CN therefore prone to compression)
initial sign of increase ICP
restlessness
normal ICP
75-180mmH2O or 0-15 mmHg
how many minutes do CEREBRAL CORTEXT tolerate HYPOXIA
4-6 mins (irreversible brain damage)
what do cerebral context tolerate?
HYPOXIA
what do MEDULLA OBLONGATA tolerates?
HYPOXIA
how many minutes do MEDULLA OBLONGATA tolerates hypoxia?
10-12 mins (beyond could result to irreversible brain damage)
Pharmacological management for meningitis
ANTIBIOTICS (penG)
OSMOTIC DIURETICS (mannitol)
CORTICOSTEROIDS (dexamethasone)
ANTICONVULSANT
PAIN RELIEVERS (codein) (may headache siya)
ANTACIDS (aluminum or magnesium based)
PPI (zantac/ranitidine)
why we need to give antibiotics (penG) to pt wd meningitis
bacteria siya eh
why we need osmotic diuretics? (mannitol)
to decrease cerebral edema
nursing responsibilities for osmotic diuretics in meningitis
Monitor urine output (5-10 mins)
WOF dizziness and hypotension since mag increase urine output niya
common side effect of ANTACIDS ALUMINUM BASED
constipation
common side effect of ANTACIDS MAGNESIUM BASED
diarrhea
what drug is to be given when a pt is taking dexamethasone
why we give PPI for pt with meningitis
to prevent ulcers
position during and after lumbar tap?
Lateral decubitus position:
hindi sure
purpose of lumbar tap
collect a sample of CSF
what color indicates:
Normal
Infection
Haemorrhage
clear and colorless
cloudt
bloody
restrict fluids to??
1000-1500 ml of water
where do they insert the needle in lumbar tap??
L3-L4, L4-L5, L5-S1
how many ml of CSF contains 1 sample?
1-2ml
how many sample of CSF to be placed in sterile test tubes?
3 samples
this is a test to subarachnoid obstruction
Queckenstedt’s Test
discuss Queckenstedt’s test
-to confirm increase ICP
-done by the physician
how they do queckenstedt’s test?
compresses the right jugular vein for 10 secs then same for the left jugular vein
manometer
rapid rise of pressure—— increase ICP
why there is an Increase BP in cushing’s triad for pt with meningitis?
it is a force of cardiac contractility in attempt to increase tissue perfusion
in cushing’s triad, there is an involvement of the ____
medulla oblongata
in any brain/neurologic disorder, the pulse pressure will??
widened
after lumbar puncture, the recommended position is?
flat on bed for 6-8 hours to prevent spinal headache
common SE or complication after lumbar pubcture??
post spinal headache
what is doll’s eye
dysconjugate movement of the eyes
why we give dexamethasone to patient with meningitis?
to decrease inflammation and the only corticosteroid drug that can cross the BBB
dexamethasone causes??
GI irritation and ulcers
if dexamethasone causes GI irritation and ulcers then give ___
antacids (aluminum and magnesium based)
PPI - zantac/ranitidine
anticonvulsants for meningitis
prevent seizures and convulsions
phenobarbital
tegretol
phenytoin/dilantin
DOC (anticonvulsants)
Phenytoin/dilantin
serum therapeutic level of dilantin
10-20 mcg/dl
if dilantin is given per orem??
give with food to prevent GI upset
if dilantin is given per IV??
prepare 10ml/cc of NSS because phenytoin readily crystallises in the veins
how to prevent crystallizes in the veins when giving phenytoin?
- first administer with 5ml NSS
- then phenytoin
- then flush with the last 5ml of NSS
Do’s and Dont’s when giving Dilantin Therapy
- 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
what is status epilepticus
a type of seizure occuring in rapid succession with no consciousness between seizures
can cause brain damage or coma
SE OF DILANTIN IF PER OREM
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
common SE of dilantin (Per orem)
GINGIVAL HYPERPLASIA
MANAGEMENT FOR -GINGIVAL HYPERPLASIA
- soft bristle toothbrush
- regular dental check up
- good oral care/hygiene
- massage gums
what is -GINGIVAL HYPERPLASIA
overgrowth of the gum tissues (swelling or bleeding)
MANAGEMENT OF ICP
- 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
factors that increase ICP
N/V
Valsalva maneuver
oversuctioning
enema
rectal exam
bending or stooping
