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NURSING 232- Exam 1 > Meningitis/Epilepsy > Flashcards

Meningitis/Epilepsy Flashcards

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1
Q

What are the 3 layers of meninges from top to bottom?

A
  • Dura
  • Arachnoid
  • Pia Mater
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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
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3
Q

Enteroviruses that can cause Viral meningitis?

A
  • Flu
  • Measles/Mumps
  • Herpes - simplex, epstein-barr, varicella/zoster (chickenpox/shingles)
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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.
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5
Q

Leading cause of meningitis in children under 5? What is the classification?

A
  • streptococcus pneumoniae

* bacterial

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6
Q

Most common form of fungal meningitis? Who is at risk?

A
  • Cryptococcus neoformans

* Immunocompromised people

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7
Q

Meningitis of any kind can lead to what five complications?

A
  • Hearing loss/Visual impairment
  • Learning issues/disabilities
  • Seizures
  • Septic shock
  • Death
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8
Q

5 signs/symptoms of meningeal irritation

A
  • Severe Headache
  • Fever/Chills
  • Stiff Neck (Nuchal rigidity)/Muscle pain
  • Change in LOC
  • Photophobia
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9
Q

Earliest signs/Symptoms of meningeal irritation?

A
  • Cold Hands/Feet
  • Pale/mottled skin
  • Muscle pain
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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
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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)
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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.
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13
Q

Diagnostics for meningitis?

A
  • First a CT scan to rule out ICP

* Then Lumbar puncture for a definitive diagnosis

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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.
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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
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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.

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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
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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
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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
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20
Q

Which agents causing meningitis require droplet precautions?

A
  • Meningococcus (Neisseria meningitidis)
  • HIB- Haemophilus influenzae
  • All the other ones are standard.
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21
Q

For bacterial meningitis, when should antibiotic treatment be started and for how long?

A
  • As soon as possible

* 1 to2 weeks

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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

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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
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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

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25
Q

Epilepsy is a neurological disorder in which a person has ____ or more seizures that occur more than _____apart. This is a chronic condition when?

A
  • 2 or more
  • 24 hours
  • Seizures are unprovoked and not caused by any known medical conditions.
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26
Q

Seizures may be caused by these two things?

A
  • Abnormality in electrical neuronal activity
  • Imbalance of neurotransmitters (especially GABA)
  • could be a combo of both
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27
Q

Parts of a seizure?

A
  • Prodrome - signs and symptoms start
  • Aura - visual disturbances right before seizure
  • Ictus - Seizure phase
  • Postictal - after seizure, symptoms like confusion
28
Q

How long do Tonic-Clonic (Generalized) seizures last? What occurs in the tonic phase? What occurs in the Clonic phase? What happens afterwards?

A
  • 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
Q

what type of seizure causes BRIEF and sudden jerking or stiffening of the extremities.

A

Myoclonic seizure - (generalized)

30
Q

what type of seizure causes a sudden loss of muscle tone, lasting for seconds, followed by postictal confusion?

A

Atonic (Akinetic) -( generalized )

31
Q

Generalized seizures affects what?

A

Both sides of the brain

32
Q

what type of seizure causing brief sudden lapses in attention? who is this most common in?

A
  • absence

* children

33
Q

focal, or local seizures begin in a part of the brain of one cerebral hemisphere.

A

Partial (also known as focal)

34
Q

S/S of a complex partial seizure?

A
  • 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
Q

S/S of simple partial seizure

A
  • Remains conscious
  • Aura prior to seizure
  • Deja vu
  • Unilateral movement of extremity
  • Unusual sensations/autonomic symptoms
36
Q

account for half of all seizure activity.

A

unclassified or idiopathic seizures

37
Q

not associated with any brain lesion or specific cause- most likely genetic

A

primary or idiopathic seizure/epilepsy

38
Q

seizure due to underlying brain lesion. Examples?

A
  • 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
Q

Lab studies are done when diagnosing seizures for what reason?

A

rule out metabolic disorders

40
Q

Common diagnostics for seizures?

A
  • EEG
  • PET SCAN
  • MRI
  • CT SCAN
41
Q

4 Nursing interventions/ Seizure precautions?

A
  • Suction/02
  • Bed in lowest position/AT LEAST 3 padded side rails
  • Patent saline lock
  • No restraints and Nothing in mouth
42
Q

Common risk factors for seizures/status eplipticus?

A
  • 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
Q

Electrolyte imbalances causing seizures?

A
  • Sodium and magnesium

* calcium

44
Q

Medication treatment for emergency status epilepticus? What can be used if these meds don’t work?

A
  • 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
Q

Drug given After emergency status epilepticus has been resolved?
When are drug levels checked after loading dose?

A
  • Loading dose of phenytoin and PO after emergency resolved.

* 6-12 hours after loading dose, then 2 weeks after PO pophenytoin has started

46
Q

What is the criteria for determining if a person is experiencing status epilepticus?

A

*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
Q

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?

A
  • 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
Q

Most common type of surgical procedure for seizures?

A

Resection of temporal and frontal lobe

49
Q

4 Complications from status epilepticus?

A
  • Hypotension
  • Hypoxia,
  • Brain damage
  • Death
50
Q

Pharmacologic effects of AED therapy?

A
  • Reduce stimulation of nerves

* Suppress and slow nerve impulses

51
Q

what are expected side effects of Phenytoin that wouldnt cause discontinuation of medication.

A
  • Gingival hyperplasia (prevent with meticulous oral care and inform dentist about medication)
  • Hypotension and bradycardia
52
Q

Two barbituates used for seizure treatment? Theraputic levels?

A
  • Phenobarbitol and Primidone

* 10-40 mcg/ml

53
Q

What are side effects of anticonvulsants that would require intervention or discontinuation.

A
  • Rash (steven-johnsons syndrome)

* Suicidal thoughts

54
Q

Theraputic drug levels for pheytoin? Why must be this be monitored (If too low/too high)

A
  • 10-20 mcg/ml

* If too low, increased risk for seizures, if too high increased risk for hepatotoxicity

55
Q

3 key points to remember when administering pheytoin IV?

A
  • SLOWLY into LARGE vein w/ LARGE gauge cath (20 or larger), irritates veins
  • Diluted in normal saline/saline flush
  • Use filter
56
Q

What decreases absorption of pheytoin? How can this be avoided?

A
  • Enteral feedings

* Stop feedings 2 hours before/after administration of drug.

57
Q

Why does phenytoin increase risk for osteoporosis?

A

-Alters vitamin D metabolism

58
Q

what are two things that pheytoin and carbamazapine DECREASES that patients should be aware of?

A
  • Warfarin levels

* Effectiveness of oral contraceptives

59
Q

3 side effects of carbamazapine?

A
  • Ataxia
  • Photosensitivity
  • Steven-johnsons syndrome/rash
60
Q

Most PO antiepileptic medications should be taken how?

A
  • With food

* At the same time everyday, and do not d/c abruptly

61
Q

What labs are needed for AEDs? Which one has a high risk of hepatotoxicity thrombocytopenia?

A
  • CBC and Liver function

* Valproic Acid

62
Q

What are therapeutic levels for valproic acid?

A

50-100

63
Q

Medications used in emergency seizure situations? What about the route of administration makes these better for an emergency?

A
  • Diazepam/Lorazepam
  • Pheytoin
  • Phenobarbital
  • They can be administered IV and/or IM, when its unsafe for client to take anything by mouth.
64
Q

4 key points/summary of nursing interventions

A
  • SAMP*
  • SAFETY
  • AIRWAY
  • MEDICATION ADHERENCE/Education
  • PSYCHOSOCIAL SUPPORT
65
Q

______is an antiepileptic drug used for the treatment of uncomplicated absence seizures. What kind of drugs does this interact with?

A
  • Ethosuximide

* Hepatic Enzyme inducing drugs

66
Q

which drug’s serum concentrations correlate better with seizure control and toxicity

A
  • Phenytoin
  • Phenobarbital
  • Primidone
  • Carbamazapine
67
Q

How do you position a patient during a seizure? Why?

A
  • Turn onto either side (Left is best)

* Prevents aspiration of vomit/saliva

NURSING 232- Exam 1 (5 decks)

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