Meningitis and Autoimmunes Flashcards by Emma Riddell

Viral Meningitis

more common, less serious, usually resolves in 7-10 days

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Bacterial Meningitis

acute inflammation of the meningeal tissues, infection of the arachnoid mater and CSF, very contagious, medical emergency

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Causes of Bacterial Meningitis

Neisseria or Strep- droplets or blood stream, crosses BBB, freshman college students are 3x greater risk

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S&S of Meningitis

nuchal rigidity, severe headache, N/V, fever, rash (Neisseria), photophobia, mental status changes, seizures are possible, petechiae and purpura, Brudzinski and Kernig

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Meningitis Diagnosis

Lumbar puncture, blood culture, neuro assessment

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Meningitis Treatment

IV steroids, IV antibiotics (Penicillin, Ampicillin, Cephalosporin, Vanco)

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Meningitis Nursing Care

Droplet precautions, O2, IV and oral fluids, rest, control fever, manage pain

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Meningitis Health Promotion

Menacta vaccine, treatment of infections

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Myelin

insulating layer that speeds up nerve transmission

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Multiple Sclerosis

autoimmune inflammatory disease- destruction of the myelin sheath that impairs transmission of nerve impulses

Irreversible damage, no cure

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Risk Factors of MS

Women, 25-35, genetics, exposure to Epstein Barre virus, smoking

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MS S&S

blurred vision, diplopia, patchy blindness, dysphagia (Optic neuritis), lack of coordination and balance (cerebelllar ataxia), numbness and tingling, spasticity, intention tremor, muscle pain, neuropathy, bladder dysfunction, fatigue, weakness, depression

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MS Dx

based on symptoms and hx, MRI confirms multiple plaques in white matter, lumbar puncture

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MS Meds

methylpredisolone, baclofen, cyclebenzaprine, tizanidine, diazepam (drowsiness/ sedation), gabapentin, copaxone, interferon therapy, tecfidera

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MS Treatment

daily exercises, ROM, PT/OT, hydrotherapy, prevent contrctures, gait and coordination training, use of cane or walker, safety at home, treating bladder incontinence and constipation, addressing pain, avoid respiratory infection, promotion of rest, use of eye patch

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Myasthenia Gravis

Autoimmune, motor disorder (weakness of voluntary muscles), no sensory impairment, Women < 40, Men > 60, rare condition

MG Patho

Antibodies form and block/ destroy acetylcholine receptors
 thymus gland may be larger than normal and
contribute to development of antibodies
 Impaired transmission of nerve impulses to
muscles&raquo_space;> muscles fail to contract
 Results in muscle weakness
 worsens with continued activity
 worsens later in the day

MG S&S

Ocular muscles affected (eye movements & eyelids)
 Diplopia
 Ptosis
 Weakness of facial muscles
 Weakness of throat muscles
 Impaired speech
 Dysphagia
 Generalized muscle weakness&raquo_space;> respiratory difficulty

MG Dx

(1) Tensilon Test (edrophonium)- blocks breakdown of acetylcholine
 this is an acetylcholinesterase inhibitor
 Positive Test confirms MG
 within 1-2 minutes of IV injection, facial muscle weakness & ptosis resolves
 can lead to bradycardia&raquo_space;> have atropine on hand
(2) Ice Test
 positive test present in MG
 ice pack over eyes x 1 minute, ptosis temporarily resolves
(3) Electromyelogram (EMG)
 decreased response to stimulation of the hand muscles
(4) MRI
 to detect enlarged thymus gland

MG Meds

pyridostigmine (Mestinon)
 inhibits breakdown of Acetylcholine
 is an acetylcholinesterase inhibitor
 can lead to bradycardia&raquo_space;> have atropine on hand (antidote)
 Timing is important….delay can exacerbate muscle weakness
Corticosteroids
 X 1-2 months
Immunosuppressants
 tacrolimus (Prograf), azathioprine (Imuran), rituximib (Rituxan)
IVIG
 is an intravenous immunoglobulin – Binds to antibodies that cause MG

Other treatments for MG

Therapeutic plasma exchange (TPE) a.k.a. “plasmapheresis”
 Plasma removed via catheter
 Blood cells & antibody-containing plasma are separated
 Blood cells are then re-infused along with plasma substitute
 Requires repeated treatments
 Temporary improvement in symptoms
Surgical management
 Thymectomy
 May result in complete remission
 Takes up to 3 years

MG Crisis

Severe muscle weakness
 involving respiratory muscles
 Usually precipated by:
 URI, infection, pregnancy
 tapering of MG medications or…
 not enough medication
 Requires intubation & mechanical ventilation
 Treatment:
 IV steroids
 TPE and/or IVIG infusion

MG Nursing Interventions

provide rest periods throughout day
 Plan for heavier activities in the morning
 Reduce aspiration risk: rest before meals, eat when meds are at peak
level, sit upright
 Patching of one eye to help with diplopia
 Avoid exacerbation of symptoms: emotional stress, infections, vigorous
physical activity, high environmental temperatures, missed doses of meds

Guillain Barre Syndrome

Autoimmune disorder
 Acute onset
 Rare condition
 Demyelination of peripheral nerves
 Impaired transmission of nerve impulses
 Causes muscle weakness
 Often precipitated by a viral infection
 Influenza, Epstein-Barr, mycoplasma pneumonia
 1-3 weeks prior to onset of symptoms
 Male > Female
 16-30

GB symptoms

Ascending muscle weakness, bilateral  Legs >>> Upward  May progress to respiratory muscles and eye muscles  May progress to paralysis  Parasthesias of hands & feet  Pain  Difficulty with bowel & bladder control  Tachycardia  Hypotension

GB Diagnosis

Difficult to diagnose  History of a viral illness in the previous weeks  Lumbar Puncture: Elevated protein levels, without increase in other cells

GB treatment

Medical Emergency  Patient usually in ICU  Mechanical ventilation often needed  Therapeutic Plasma Exchange (TPE)  IVIG (immunoglobulin therapy)  Beta-blockers  to control tachycardia  IV fluids to mange hypotension

GB Nursing Interventions

Prevention of respiratory complications  Need for mechanical ventilation  Monitor HR & BP  Prevention of DVT/PE  Pain management  opioids may be necessary  Enhance Mobility  ROM exercises, PT and OT  Speech Issues  Consult speech therapist  Emotional support

Trigeminal Neuralgia

Sudden, unilateral severe pain in trigeminal nerve – CN 5  Cheek, lips, gums, forehead  Stabbing, burning pain  Affects chewing, drinking, and talking  Etiology: chronic irritation of trigeminal nerve root  Women > Men

Trigeminal Neuralgia treatment

Medications: (AEDs)  carbamazepine (Tegretol)  slows electrical triggering  Periodic serum drug levels are needed  gabapentin (Neurontin)  for nerve pain Surgical Therapy:  last resort.... when meds do not work  Microvascular decompression or Radiosurgery – to relieve pressure around nerve and relieve pain  Partial Ligation of trigeminal nerve Chew on unaffected side, soft foods

Bell's Palsy

Unilateral facial paralysis involving CN 7  Due to lesion on CN 7 >>> may be due to virus, infection, tumor, meningitis  Usually temporary = most pts. recover fully

BP symptoms

inability to close eye, decreased corneal reflex, increased lacrimation, drooping mouth, speech difficulty, eating difficulty

BP treatment

NSAIDS, Steroids, Electrical stimulation, Recovery may take 3-5 weeks