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NUR 202 Week 9 > Meningitis, Encephalitis, & Brain Abscess > Flashcards

Meningitis, Encephalitis, & Brain Abscess Flashcards

1
Q

Viral

  • Most common causes are Enterovirus (intestine), Arbovirus (insects/mosquitoes/ticks), HIV, VZV, & HSV-2, mumps (paramyxovirus)
  • Most often spread through direct contact w/resp secretions
A

Bacterial

  • Streptococcus pneumoniae
  • Neisseria meningitidis
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2
Q

Viral Meningitis aka Aseptic meningitis

  • Usually presents as HA, fever, photophobia, & stiff neck
    > Fever may be moderate or high
  • Usually no sx’s of brain involvement
A
  • Diagnostic testing of CSF
  • Rapid dx w/Xpert EV test
    > Sample of CSF is evaluated for enteroviruses
    > Results avail within hrs
  • LP
    > CSF may be clear or cloudy
    > Lymphocytosis
    > Organisms not seen on Gram-stain or acid-fast smears
  • PCR to detect viral-specific DNA/RNA (is a highly sensitive method)
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3
Q
  • Treat w/abx >obtaining diag sample but before receiving test results
  • Symptomatic management
    > Rare sequelae incl persistent ha’s, mild mental impairment, & incoordination
  • Typical treatment of antiviral medications
  • Full recovery expected
A
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4
Q

Bacterial Meningitis

  • Acute inflammation of meningeal tissue surrounding brain & spinal cord
  • Usually occurs in fall, winter, or early spring
  • Often 2° to viral resp dz
  • Is a medical emergency
  • Untreated has a high mortality rate near 100%
A
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5
Q

Etiology & Pathophysiology

  • Vaccine for Haemophilus has greatly diminished most common cause of the past
  • Organisms enter CNS from resp tract or bloodstream
  • May enter through wounds of skull or fractured sinuses
A
  • Incr CSF production
  • Purulent secretions spread to other areas of brain through CSF
  • If process extends into parenchyma or if concurrent encephalitis is present, cerebral edema & incr ICP become problematic
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6
Q

Clinical Manifestations

! Key signs of meningitis
- Fever
- Severe HA
- N/V
- Nuchal rigidity (classic sign; neck stiffness & pain)

  • If the infecting organism is a meningococcus, a skin rash is common, and petechiae may be seen
A
  • Coma is assoc w/poor prognosis & occurs in 5-10% of cases
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7
Q

Other sx’s that may be present
- Photophobia
- ↓ LOC

A

Signs of ↑ ICP
> Seizures occur in 1/3 of all cases
> HA becomes progressively worse & may be accompanied by vomiting & irritability

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8
Q

Complications

  • Acute complication is ↑ ICP
  • Major cause of AMS
A
  • Residual neurologic dysfunction
  • CN’s III, IV, VI, VII, or VIII can become dysfunctional
  • Sequelae varies by CN
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9
Q

___ ___ (CN ___) is compressed by increased ICP

A

Optic nerve; II

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10
Q

Ocular movements affected w/irritation to nerves III, IV, & VI

  • Ptosis
  • Unequal pupils
  • Diplopia
A
  • CN V irritation results in sensory loss & loss of corneal reflex
  • CN VII irritation results in facial paresis
  • CN VIII causes tinnitus, vertigo, & deafness
    > Hearing loss may be permanent
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11
Q
  • Hemiparesis, dysphagia, & hemianopsia may occur & resolve over time
  • If resolution doesn’t occur, the following may be suspected:
    > Cerebral abscess, subdural empyema, or persistent meningitis
A

Acute cerebral edema may cause
- Seizures
- CN III palsy
- Bradycardia
- Hypertensive coma
- Death

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12
Q

Diagnostic Studies

  • Blood, urine, throat, &/or nose cultures
  • Diagnosis verified by LP & analysis of CSF
  • Protein lvls high (esp in bacterial)
  • Glucose conc commonly dec in bacterial but can be normal in viral
  • Specimens of CSF, sputum, nasopharyngeal secretions to identify causative organism
  • Gram-stained smear to detect bacteria
    > Presence of neutrophils
A
  • Variations in the CSF depend on the causative organism
  • X-rays of skull
    > Infected sinuses
  • MRI, CT scans
    > Show evidence of IICP or hydrocephalus
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13
Q

Collaborative Care

  • Rapid diagnosis crucial
  • Based on HPE as pt is usually critical when healthcare is initiated
  • Abx therapy instituted after collection of specimens & before dx is confirmed
    > Able to cross BBB
    > Dexamethasone (a corticosteroid) may also be prescribed before or w/the 1st dose of abx
A

Nursing Assessment

  • VS
  • Neurologic eval
  • Fluid I&O
  • Evaluation of lungs & skin
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14
Q

Planning

Overall goals
- Return to maximal neurologic functioning
- Resolve the infection
- Control pain & discomfort

A
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15
Q

Nursing Implementation: Health Promotion

  • Vaccination against resp infections
  • Meningococcal vaccines
    ____ - preferred for people ≤ 55
    ____ - licensed for people >55
  • Prophylactic abx for anyone exposed to bacterial meningitis
A

MCV4 (meningococcal conjugate vaccine)

MPSV4 (meningococcal polysaccharide vaccine)

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16
Q

Acute Interventions

Revolve around the nurses diagnoses of
* ↓ intracranial adaptive capacity
* Risk for ineffective cerebral perfusion
* ↑ fever
* Acute pain

A
  • Close observation & assessment
  • Provide relief for head & neck pain
  • Position for comfort
  • Darkened room & cool cloth over the eyes for photophobia
17
Q

> Minimize environmental stimuli
- Mental distortion & hypersensitivity are typical
- Convey caring & unhurried gentleness while providing efficient care
- Provide safety

> Observe & record seizures
- Prevent injury
- Administer anti-seizure medications

A

> Vigorously manage fever
- Fever incr cerebral edema & the freq of seizures
- Neurologic damage may result from high, prolonged fever

> Maintain therapeutic blood lvls of abx

  • Resp isolation until cultures are negative
    ! Meningococcal meningitis is highly contagious
18
Q

Ambulatory & Home Care

  • Provide for several wks of convalescence
  • Incr activity as tol
  • Stress adequate nutrition
    > High protein, high calorie diet
  • Encourage adequate rest & sleep
A
  • Progressive ROM exercises & warm baths for muscle rigidity
  • Ongoing assessment for recovery of vision, hearing, cognitive skills, motor, & sensory abilities
  • Tend to signs of anxiety & stress of family & caregivers
19
Q

Evaluation

Patient will…
- Demonstrate appropriate cognitive function
- Be oriented to person, place, & time
- Maintain body temp within normal range
- Report satisfaction w/pain control

A
20
Q

?

Swelling of the brain

A

Encephalitis

21
Q

Encephalitis

  • Acute inflammation of the brain
  • Serious, sometimes fatal dz
  • C/b a # of viruses
  • Some are endemic to spec geographic areas & seasons
    > Ticks or mosquitoes can transmit epidemic encephalitis
    > CMV encephalitis is common w/AIDS
A
  • Non-epidemic encephalitis may occur as a complication of measles, chickenpox, or mumps
  • HSV encephalitis is the most common cause of acute non-epidemic viral encephalitis
22
Q

Manifestations

Nonspecific onset
* Fever, HA, n/v

Signs appear in 2-3 days
* May vary from minimal alterations in mental status to coma
* Any CNS abnormality can occur

A

Diagnostic Studies
* Early dx & treatment are essential for favorable outcomes
- CT, MRI, PET
- PCR tests for HSV DNA/RNA
- Blood test for West Nile viral RNA

23
Q

Nursing Management

  • Mosquito control for prevention
    > Nursing management is symptomatic & supportive for care of cases of encephalitis incl West Nile virus infection
  • Intensive care may be req’d initially
A
  • Acyclovir (Zovirax), Ganciclovir (Cytovene), & Foscarnet (Foxcavir)
    > Reduce mortality rates but not necessarily neurologic complications
    > Start before onset of coma
  • Anti-seizure drugs for seizures
    > May be initiated prophylactically
24
Q

?

Is a purulent infection of the brain; pus can form in the extradural, subdural, or intracranial area of the brain

Usually result from a bacterial infection; some may be a complication of meningitis

A

brain abscess

25
Q
  • Organisms can travel to the brain from the ear, sinus, or mastoid area via cerebral veins
  • Bacteria can travel from the lungs, or from an injury/illness such as a knife wound, bullet wound, or neurosurgery; additionally, organisms can destroy bone & form a tract into the brain
A
  • Other ways that these can occur is for the organism to travel from a distant organ such as tonsils, or heart by way of a systemic infection
  • It creates a local infection in the brain & then within a few days necrosis of the tissue occurs & pus forms; streptococci are the most common organism found but many others have been found as well
26
Q
  • Similar care involves assessing for sx’s of ICP, & neurological functions
  • Diagnostics/labs, WBC, ESR, CT head, EEG, xrays, needle biopsies
A
  • Drug therapy - abx, shunts, if needed; anti-epileptic meds to prevent/treat seizures, pain meds for HA’s
  • Surgical intervention/craniotomy if needed, then pts may be d/c’d home if there are no persistent neurological deficits, or to a long-term/subacute rehab if they do

NUR 202 Week 9 (5 decks)

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