Meningitis/Epilepsy Flashcards
1
Q
What are the 3 layers of meninges from top to bottom?
A
- Dura
- Arachnoid
- Pia Mater
2
Q
Most common type of of meningitis? Is this serious? What is the common cause?
A
- Viral
- Usually self limiting (within) 7 to 10 days
- enteroviruses
3
Q
Enteroviruses that can cause Viral meningitis?
A
- Flu
- Measles/Mumps
- Herpes - simplex, epstein-barr, varicella/zoster (chickenpox/shingles)
4
Q
what is the classification of N. meningitidis (meningococcus)? Who is at risk and why?
A
- Bacterial
- ages 16-21
- Occurs in large scale outbreaks in crowded areas such as colleges/dorm rooms.
5
Q
Leading cause of meningitis in children under 5? What is the classification?
A
- streptococcus pneumoniae
* bacterial
6
Q
Most common form of fungal meningitis? Who is at risk?
A
- Cryptococcus neoformans
* Immunocompromised people
7
Q
Meningitis of any kind can lead to what five complications?
A
- Hearing loss/Visual impairment
- Learning issues/disabilities
- Seizures
- Septic shock
- Death
8
Q
5 signs/symptoms of meningeal irritation
A
- Severe Headache
- Fever/Chills
- Stiff Neck (Nuchal rigidity)/Muscle pain
- Change in LOC
- Photophobia
9
Q
Earliest signs/Symptoms of meningeal irritation?
A
- Cold Hands/Feet
- Pale/mottled skin
- Muscle pain
10
Q
Signs/symptoms of meningeal irritation
A
- Severe Headache
- Fever/Chills
- Stiff Neck (Nuchal rigidity
- Change in LOC/drowsy/confusion
- Photophobia
- Red/purple rash - specific to Meningococal infection
- positive Kernig/Bruzinsky sign
- Tachycardia
- seizures
11
Q
Positive Kernigs sign.
A
- Knee cannot extend when hip is at 90 degrees due to pain and stiffness
- remember Kerning makes 90K (90 degrees and K for knee)
12
Q
Positive Brudzinskys sign.
A
- Stiff neck causes hips and knees to flex when neck is flexed
- remember B is for BEND neck, knees and hips flex
- B is for Beach chair and the flexion that occurs makes the patient look like they’re sitting in a beach chair but on their back.
13
Q
Diagnostics for meningitis?
A
- First a CT scan to rule out ICP
* Then Lumbar puncture for a definitive diagnosis
14
Q
In meningococcal infection, what does the early vs late rash look like?
A
- Early - Non-blanchable, faint pink rash, pinpricks, red/purple blotches
- Late - Spreads rapidly, purple bruises/hemorrhages all over body.
15
Q
How is a pt positioned for a lumbar puncture? How and where is the skin prepared for procedure?
A
- Fetal position on side with legs drawn up to stomach (or sitting on edge of bed leaning over)
- Skin at L3/L4 is numbed with lidocaine
16
Q
Where is the needles inserted in a lumbar puncture? What happens after?
A
- Inserted into subarachnoid space
* CSF pressure recorded, sample withdrawn for analysis, bandage over site.
17
Q
What would a Bacterial CSF analysis look like.
A
- Cloudy
- Protein increased (protein Pumped up)
- Glucose decreased (glucose Goes down)
- CSF pressure elevated
18
Q
Post lumbar puncture nursing care?
A
- Vital signs and Nuero checks immediately post procedure, then once every 2 hours.
- Check puncture site every hour for 4 hours, then every 8 hours for 24 hours - look for CSF, bleeding, inflammation
- remove dressing following day
19
Q
general interventions for meningitis?
A
- Vital signs
- Droplet precautions
- Low light - photophobia
- Low noise - headache
- Low pressure - Assess LOC, HOB 30 degrees, ICP
- Low pain - treat pain
- Low temp - decrease fever antipyretics/cooling blankets
20
Q
Which agents causing meningitis require droplet precautions?
A
- Meningococcus (Neisseria meningitidis)
- HIB- Haemophilus influenzae
- All the other ones are standard.
21
Q
For bacterial meningitis, when should antibiotic treatment be started and for how long?
A
- As soon as possible
* 1 to2 weeks
22
Q
preventative viral meningitis vaccines and their schedules?
A
MMR vaccine - 12-15 months, then age 4-6
Varicella vaccine - 12-15 months, then age 4-6
Flu vaccine - yearly
23
Q
Preventative vaccines for bacterial meningitis and their schedules?
A
- Meningococcal - 1st dose 11-12, booster at 16
- Pneumococcal - 2, 4, 6 months. Booster at 12 to 15
- HIB - 2, 4, 6 months. Booster at 12 to 15
24
Q
An abnormal, sudden excessive uncontrolled electrical discharge of neurons within the brain that may result in change of LOC, motor or sensory ability and/ behaviour.
A
Seizure
25
Epilepsy is a neurological disorder in which a person has ____ or more seizures that occur more than _____apart. This is a chronic condition when?
* 2 or more
* 24 hours
* Seizures are unprovoked and not caused by any known medical conditions.
26
Seizures may be caused by these two things?
* Abnormality in electrical neuronal activity
* Imbalance of neurotransmitters (especially GABA)
* could be a combo of both
27
Parts of a seizure?
* Prodrome - signs and symptoms start
* Aura - visual disturbances right before seizure
* Ictus - Seizure phase
* Postictal - after seizure, symptoms like confusion
28
How long do Tonic-Clonic (Generalized) seizures last? What occurs in the tonic phase? What occurs in the Clonic phase? What happens afterwards?
* 2-5 minutes
* Tonic- Stiffness/Rigidity of muscles (especially arms/legs) and immediate LOC.
* Clonic -convulsions/jerking of all extremities, may bite tongue and may become incontinent
* Fatigue and confusion may last up to an hour after seizure
29
what type of seizure causes BRIEF and sudden jerking or stiffening of the extremities.
Myoclonic seizure - (generalized)
30
what type of seizure causes a sudden loss of muscle tone, lasting for seconds, followed by postictal confusion?
Atonic (Akinetic) -( generalized )
31
Generalized seizures affects what?
Both sides of the brain
32
what type of seizure causing brief sudden lapses in attention? who is this most common in?
* absence
| * children
33
focal, or local seizures begin in a part of the brain of one cerebral hemisphere.
Partial (also known as focal)
34
S/S of a complex partial seizure?
* May lose consciousness/syncope for 1-3 minutes
* AUTOMATISMS - unusual and repetitive behaviors (e.g lip smacking, rubbing hands)
* Autonomic symptoms such as sweating//flushing, HR change, epigastric discomfort.
35
S/S of simple partial seizure
* Remains conscious
* Aura prior to seizure
* Deja vu
* Unilateral movement of extremity
* Unusual sensations/autonomic symptoms
36
account for half of all seizure activity.
unclassified or idiopathic seizures
37
not associated with any brain lesion or specific cause- most likely genetic
primary or idiopathic seizure/epilepsy
38
seizure due to underlying brain lesion. Examples?
* Secondary/epilepsy
* Brain tumor/trauma are most common
* Metabolic d/o, Alcohol withdrawal/substance abuse, E-lyte imbalance, Head injury, increased fever, heart disease.
39
Lab studies are done when diagnosing seizures for what reason?
rule out metabolic disorders
40
Common diagnostics for seizures?
* EEG
* PET SCAN
* MRI
* CT SCAN
41
4 Nursing interventions/ Seizure precautions?
* Suction/02
* Bed in lowest position/AT LEAST 3 padded side rails
* Patent saline lock
* No restraints and Nothing in mouth
42
Common risk factors for seizures/status eplipticus?
* Illness (especially CNS related e.g. bacterial meningitis )
* Fever/Infection
* Electrolyte/metabolic issues (hypoglycemia, acidosis)
* ETOH/drug withdrawal
* Brain injury/STROKE/congenital brain defects/tumors/cerebral edema
43
Electrolyte imbalances causing seizures?
* Sodium and magnesium
| * calcium
44
Medication treatment for emergency status epilepticus? What can be used if these meds don't work?
* IV push of diazepam or lorazepam (enhance inhibitory effects of GABA)*May use diazepam rectal gel*
* Phenytoin
* USE PHENOBARBITOL if these meds dont work
45
Drug given After emergency status epilepticus has been resolved?
When are drug levels checked after loading dose?
* Loading dose of phenytoin and PO after emergency resolved.
| * 6-12 hours after loading dose, then 2 weeks after PO pophenytoin has started
46
What is the criteria for determining if a person is experiencing status epilepticus?
*Seizure lasting longer than 5 minutes
OR
*More than 1 seizure within a 5 minute period w/o returning to normal level of consciousness.
47
Vagus nerve stimulator- Where is it implanted? What does it do? When and how does a patient activate it? How can you tell if vagus nerve has been stimulated?
* Upper left chest
* Electrode is wrapped around vagus nerve to be stimulated
* Patient activates with magnet when aura is experienced
* Change in voice quality signifies activation
48
Most common type of surgical procedure for seizures?
Resection of temporal and frontal lobe
49
4 Complications from status epilepticus?
* Hypotension
* Hypoxia,
* Brain damage
* Death
50
Pharmacologic effects of AED therapy?
* Reduce stimulation of nerves
| * Suppress and slow nerve impulses
51
what are expected side effects of Phenytoin that wouldnt cause discontinuation of medication.
* Gingival hyperplasia (prevent with meticulous oral care and inform dentist about medication)
* Hypotension and bradycardia
52
Two barbituates used for seizure treatment? Theraputic levels?
* Phenobarbitol and Primidone
| * 10-40 mcg/ml
53
What are side effects of anticonvulsants that would require intervention or discontinuation.
* Rash (steven-johnsons syndrome)
| * Suicidal thoughts
54
Theraputic drug levels for pheytoin? Why must be this be monitored (If too low/too high)
* 10-20 mcg/ml
| * If too low, increased risk for seizures, if too high increased risk for hepatotoxicity
55
3 key points to remember when administering pheytoin IV?
* SLOWLY into LARGE vein w/ LARGE gauge cath (20 or larger), irritates veins
* Diluted in normal saline/saline flush
* Use filter
56
What decreases absorption of pheytoin? How can this be avoided?
* Enteral feedings
| * Stop feedings 2 hours before/after administration of drug.
57
Why does phenytoin increase risk for osteoporosis?
-Alters vitamin D metabolism
58
what are two things that pheytoin and carbamazapine DECREASES that patients should be aware of?
* Warfarin levels
| * Effectiveness of oral contraceptives
59
3 side effects of carbamazapine?
* Ataxia
* Photosensitivity
* Steven-johnsons syndrome/rash
60
Most PO antiepileptic medications should be taken how?
* With food
| * At the same time everyday, and do not d/c abruptly
61
What labs are needed for AEDs? Which one has a high risk of hepatotoxicity thrombocytopenia?
* CBC and Liver function
| * Valproic Acid
62
What are therapeutic levels for valproic acid?
50-100
63
Medications used in emergency seizure situations? What about the route of administration makes these better for an emergency?
* Diazepam/Lorazepam
* Pheytoin
* Phenobarbital
* They can be administered IV and/or IM, when its unsafe for client to take anything by mouth.
64
4 key points/summary of nursing interventions
* SAMP*
* SAFETY
* AIRWAY
* MEDICATION ADHERENCE/Education
* PSYCHOSOCIAL SUPPORT
65
______is an antiepileptic drug used for the treatment of uncomplicated absence seizures. What kind of drugs does this interact with?
* Ethosuximide
| * Hepatic Enzyme inducing drugs
66
which drug's serum concentrations correlate better with seizure control and toxicity
* Phenytoin
* Phenobarbital
* Primidone
* Carbamazapine
67
How do you position a patient during a seizure? Why?
* Turn onto either side (Left is best)
| * Prevents aspiration of vomit/saliva
