Meningitis and Autoimmunes

Question 1

Viral Meningitis

Answer 1

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

Question 2

Bacterial Meningitis

Answer 2

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

Question 3

Causes of Bacterial Meningitis

Answer 3

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

Question 4

S&S of Meningitis

Answer 4

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

Question 5

Meningitis Diagnosis

Answer 5

Lumbar puncture, blood culture, neuro assessment

Question 6

Meningitis Treatment

Answer 6

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

Question 7

Meningitis Nursing Care

Answer 7

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

Question 8

Meningitis Health Promotion

Answer 8

Menacta vaccine, treatment of infections

Question 9

Myelin

Answer 9

insulating layer that speeds up nerve transmission

Question 10

Multiple Sclerosis

Answer 10

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

Irreversible damage, no cure

Question 11

Risk Factors of MS

Answer 11

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

Question 12

MS S&S

Answer 12

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

Question 13

MS Dx

Answer 13

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

Question 14

MS Meds

Answer 14

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

Question 15

MS Treatment

Answer 15

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

Question 16

Myasthenia Gravis

Answer 16

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

Question 17

MG Patho

Answer 17

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

Question 18

MG S&S

Answer 18

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

Question 19

MG Dx

Answer 19

(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

Question 20

MG Meds

Answer 20

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

Question 21

Other treatments for MG

Answer 21

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

Question 22

MG Crisis

Answer 22

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

Question 23

MG Nursing Interventions

Answer 23

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

Question 24

Guillain Barre Syndrome

Answer 24

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

Question 25

GB symptoms

Answer 25

Ascending muscle weakness, bilateral
 Legs&raquo_space;> 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

Question 26

GB Diagnosis

Answer 26

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

Question 27

GB treatment

Answer 27

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

Question 28

GB Nursing Interventions

Answer 28

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

Question 29

Trigeminal Neuralgia

Answer 29

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

Question 30

Trigeminal Neuralgia treatment

Answer 30

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

Question 31

Bell’s Palsy

Answer 31

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

Question 32

BP symptoms

Answer 32

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

Question 33

BP treatment

Answer 33

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