Neuro Flashcards
Meningitis
Inflammation of the meninges
Pia mater and arachnoid
Viral meningitis.
Most common type
Aseptic meningitis
Bacterial meningitis
High mortality rate within 24 hours
Highly contagious
High population (college dormitories, military barracks, crowded living areas)
16-21 years old highest rates of getting it
Assessment and clinical manifestations of meningitis
Fever Headache Photophobia Indications of ICP Unchallenged rigidity (stiff neck) Positive Kernigs, Brudzinski's sign Decreased mental status Focal neurologic deficits N/V Cranial dysfunction : CN III, IV, VI, VII, VIII Short attention span Tachycardia Red macular rash
Labatory assessment of meningitis
CSF analysis CT scan Blood cultures Counterimmunoelectrophoresis: presence of viruses Polymerase chain reaction CBC:usually elevated X-ray to determine presence of infection
CSF analysis of bacterial meningitis
Appearance: cloudy WBC: increased Protein: increased GLucose: decreased CSF pressure: elevated
CSF analysis of viral meningitis
Appearance: clear WBC: increased Protein: slightly increased GLucose: most often normal CSF pressure: normal or elevated
Interventions for meningitis
Obtain vaccinations (Hib, pneumococcal, mumps, varicella, meningococcal)
Hand washing
accurately monitor and document their neurologic status
Pupillary. Shape and accommodation to light
Care of a patient with meningitis
ABC's Vs q 2-4 hours Cranial nerve assessment I&O Body weight Positioning Range of motion q 4 hours Decrease stimuli (quiet, dim lights, maintain bed rest, with head elevated 30 degrees) Droplet precautions Prevent complications (ICP, vascular dysfunction, fluid and electrolyte imbalance, seizures, shock)
Encephalitis
Inflammation of brain tissue and surrounding meninges
Affects cerebrum, brainstem and cerebellum
White matter destroyed
Arboviruses
Transmitted to humans through bite of an infected mosquito or tick
West nile virus
Incubation period is 2-15 days
Assessment of encephalitis
High fever Stiff neck N/V Agitation Motor dysfunction (dysphagia) Focal neurologic deficits Photophobia Phonophobia Fatigued decreased LOC Joint pain Headache Vertigo Muscle tremors
Protecting family and patient from West nile
Limit time outside between dusk and dawn
Wear protective clothing long sleeves and pants
Use insect repellent
Remove areas of standing water
Check windows and door screens for holes that need repaired
Keep hot tubs and pools clean and properly chlorinated
Parkinsons disease
Progressive neurodegenerative disease Most common Affecting motor skills Tremors Muscle rigidity Bradykinesia( slow movement) Postural instability Effect on the peripheral and autonomic systems
Genetic and environmental factors of Parkinson’s disease
Exposure to pesticides Herbicides Industrial chemicals and metals Drinking well water Being older than 40 years old Having reduced estrogen levels
Assessment finding of Parkinson’s disease
Stooped posture Slow and shuffling gait Bradykinesia: slow movement Pill rolling movement Mask like face Uncontrolled drooling Dysarthria Echolalia (repetition) Hypophonia (soft voice) Seborrhea Depressed Easily upset Akinesia: no movement
Interventions for Parkinson’s disease
Patient extra time to respond to questions Administer medications promptly Provide medication for pain Monitor side effects to medications PT and OT Perform ADL's Schedule activities late in the morning Teach patient to speak slowly and clearly Provide high-protein, high-caloric foods
Drug therapy for Parkinson’s disease DOPAMINE agonists
most effective during first 3-5 years of use; decrease dyskinesias ----mirapex, Neupro, reequip Orthostatic hypotension!! Hallucinations Drowsiness Avoid operating heavy machinery Wont prescribe very often because of adverse effects Mobility, cognition, quality of life!!
Drug therapy with parkinsons disease
Sinemet: combination- levadopa-carbidopa; give with meals
Less expensive than dopamine agonists
COMTs
MAOIs: avoid foods with tyramine(cheese, smoked, cured foods and sausage, red wine) continue restrictions for 14 days after med is discontinued
Drug toxicity treatment With Parkinson’s disease
Changes in cognition (acute confusion)
Reduction in drug dosage
Change in drug or in frequency
A drug holiday: lasts up to 10 days; recieves no drug therapy for PD
Risks for dementia
Age Women Family history African Americans Herpes zoster Herpes simplex Zinc Copper Head injury
Early stage of dementia assessment
Independent in ADLs No social problems Forgets name Short term memory loss Less engaged in social relationships Decreased performance Unable to travel alone Decreased sense of smell
Middle stage of dementia assessment
Impairment of all cognitive functions Unable to handle money Disorientation to time, place Agitated Gets lost Speech and language deficits Incontinent Wandering
Late stage of dementia assessment
Bedridden Totally dependent in ADLs Motor and verbal skills lost Neurologic deficits Agnosia (loss of facial recognition)
Factors that. Can worsen dementia
Stroke Tumor Decrease in blood supply MI Hypoglycemia Impaired renal and hepatic fxn. Infection Impaired vision or hearing Pain Drugs Restraints Hematoma
Communication with. Patients with. Dementia
Simple direct questions (yes or no) Provide instructions with pictures in a place they can read them Simple, short sentences and one step instructions Gestures to help patient understand Validate patients feelings Limit choices Never assume patient is totally confused Try to anticipate patients needs
Prevent wandering with patients with dementia
Identify patients most at risk Provide appropriate supervision Place patient in area that provides max observation (NOT in nurses station) Use family members to monitor patient Keep patient away from stairs Do not change rooms on them Avoid restraints Assesspain Re-orientation methods Provide frequent toileting Prevent overstimulation
Minimizing behavioral probelms with patients with dementia
Remove small area rugs Replace floors with non-slippery floors Arrange furniture for safety Install night lights Smoke alarms Install bells outside of home Place single date calendar on wall Place complete outfits for days Maintain a routine Crowds be small
Reducing Caregiver stress with dementia
Maintain realistic expectations Take each day one at a time Find positive aspects of each incident Use humor Use resources Explore alternative care settings Establish advanced directives Set aside time each day for rest Seek respite care Take care of yourself-diet, exercise, rest Be realistic Use relaxation techniques
Huntington disease
Hereditary disorder Autosomal dominant trait at the time of conception Inherited by one parent 30-50 begin No known cure
First drug to be approved to decrease chorea associated with HD is
Tetrabenazine
Work by depleting the monoamines
May cause suicide ideations and depression
Care for a patient. With Huntington disease
Speech language pathologist: helps with communication, drooling, and swallowing
Dietician
PT and OT
Nurses or home health who provide support
Case manager and social worker
Help with ADLs
Lumbosacral back pain preventative measures
Good posture Proper lifting Exercise:walking, swimming Ergonomics:prolonged sitting or standing Equipment that can be used: ceiling lifts
Nonsurgical management for lumbosacral back pain
Positioning
Drugs therapy: acetaminophen Or NSAIDS, corticosteroids
Heat therapy:20-30minutes 4 times daily
PT
Weight control: 10%
Complementary and alternative therapies: chiropractic, PT,
Minimally invasive surgery spinal cord
Percutaneous lumbar diskectomy
Thermodiskectomy
Laser-assisted laparoscopic diskectomy
Obese, and people who smoke most likely have pain
Smokers doctors wont let them do back surgery
