Neuro Conditions Flashcards
inflammatory conditions of the brain
brain abscesses, meningitis, encephalitis
bacterial meningitis
acute inflammation of meningeal tissue surrounding brain and spinal cord
when does bacterial meningitis occur
fall, winter, or early spring
what is bacterial meningitis typically r/t
a viral respiratory disease
what are the leading causes of bacterial meningitis
streptococcus pneumonial, neisseria, meningitis
pathophysiology of bacterial meningitis
organisms enter CNS through upper respiratory tract/bloodstream; may enter through skull wounds/fractures
inflammatory response of bacterial meningitis
increased cerebrospinal fluid production; purulent secretions spread to other areas of brain through CSF; cerebral edema and increased ICP becomes problematic (if extends to parenchyma)
key signs of bacterial meningitis
fever, severe headache, nausea, vomiting, nuchal rigidity
2 ways to check for bacterial meningitis
tuck chin in, light sensitivity, and fever
when would a coma be associated with a poor prognosis
photophobia; decreased level of consciousness
signs of increased intracranial pressure
seizure occurs in 1/3 cases; headache worsens; vomiting and irritability
complications of bacterial meningitis
increased ICP; residual neurologic function; optic nerve (CN II) compressed by increased ICP; ocular movements affected with irritation to CN III, IV, VI; CN V irritation; inflammation of CN VII; irritation of CN VIII; hemiparesis, dysphagia, hemianopsia; cerebral abscess, subdural empyema, subdural effusion, or persistent meningitis occurs if everything doesn’t happen
increased ICP s/s
major cause in change in mental status
residual neurologic function s/s
cranial nerves II, III, IV,V, VI, VII, VIII can become dysfunctional
optic nerve (CN II) compressed by increased ICP s/s
papilledema with possible blindness
ocular movements affected with irritation to CN III, IV, and VI s/s
ptosis, unequal pupils, diplopia
CN V irritation s/s
sensory loss and loss of corneal reflex
inflammation of CN VII s/s
facial paresis
irritation of CN VIII s/s
tinnitus, vertigo, deafness; hearing loss may be permanent
what might acute cerebral edema cause
seizures, CN II palsy, bradycardia, hypertensive coma, death
diagnostic studies for neuro condition
blood culture; CT scan; neutrophils are predominant WBC in CSF; x-rays of the skull; MRI
how can the diagnosis of bacterial meningitis be verified
lumbar puncture; analysis of CSF; specimen of secretions are cultured to identify causative; gram-stain to detect bacteria
interprofessional care for bacterial meningitis
rapid diagnosis is crucial; this is a medical emergency
what is started before diagnosis is confirmed for bacterial meningitis
broad spectrum antibiotics
what should the initial assessment should include for bacterial meningitis
vital signs; neurological assessment; I&Os; evaluation of lungs and skin
nursing diagnoses of bacterial meningitis
decreased intracranial adaptive capacity; ineffective tissue perfusion; hyperthermia; acute pain
overall nursing goals for bacterial meningitis
return to maximum neurological functioning; resolve the infection; control pain and discomfort
health promotion (implementation) for meningitis
vaccinations for pneumonia and influenza; meningococcal vaccines; early, vigorous treatment of respiratory infections; prophylactic antibiotics for anyone exposed to bacterial meningitis
acute care (implementation) bacterial meningitis
close observation and assessment; provide relief for head and neck pain; position for comfort; darkened room and cool cloth over eyes for photophobia; minimize environmental stimulus (delirium and hallucinations may occur); provide safety
observe and record seizures (implementation) bacterial meningitis
prevent injury; give anti-seizure drugs as ordered
vigorously mange fever (implementation) bacterial meningitis
fever increases cerebral edema and risk of seizures; neurologic damage may result from high, prolonged fever
ambulatory care (implementation) bacterial meningitis
provide for several weeks of recovery; increased activity as tolerated (stress adequate nutrition and encourage adequate rest/sleep); progressive ROM exercises and warm baths for muscle rigidity; ongoing assessment for recovery of vision, hearing, cognitive skills, motor, and sensory abilities; be aware of anxiety and stress felt by family and caregivers
other nursing implementations for bacterial meningitis
assess for dehydration; follow designed antibiotic schedule to maintain therapeutic blood levels; respiratory isolation until cultures are negative
nursing evaluations for bacterial meningitis
patient will: have appropriate cognitive function; AAOx3; maintain body temp within normal range; report satisfaction with pain control
viral meningitis
treat with antibiotics after obtaining diagnostic sample but while awaiting test results
what are the most common causes for viral meningitis
enterovirus, arbovirus, HIV, and HSV
how is viral meningitis spread
direct contact with respiratory secretions
how does viral meningitis present
headache, fever, photophobia, and stiff neck
transient ischemic attack
a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, but without acute infraction of brain
brain tumor
occur in any part of brain, benign and malignant, primary vs. secondary
what does the brain tumor do
apply pressure to surrounding brain tissue causing decreased overflow of CSF resulting in increased ICP, cerebral edema, neurodeficits
clinical manifestations of a brain tumor
dysarthria, dysphagia, positive romberg and babinski sign, vertigo, hemiparesis, loss of gag reflex
manifestations of supratentorial tumors
severe headache, visual changes, seizures, loss of movement, cognitive function, paralysis
manifestations of infratentorial tumors
hearing loss, facial drooping, dysphagia, hemiparesis, and ataxia
diagnostics for brain tumors
CBC, x-ray, LP, cerebral biopsy, CT, MRI, renal, endocrine, lab work, and electrolyte status
nursing management for brain tumors
maintain airway, safety and seizure precautions; administer O2; monitor lung sounds, neurological status
medications for brain tumors
analgesics, steriods, anticonvulsants, antiemetic, H2 antagonists
other treatment options for brain tumors
chemo, radiation, craniotomy
complications
SIADH
SIADH
fluid retained due to overproduction of vasopressin or antidiuretic hormone; hypothalamus is damaged
s/s of complications
disorientation, headache, vomiting, muscle weakness, decreased LOC, irritability, weight fain, seizures, coma
treatment for complication
fluid restriction; treat hypnotremia
CSW
complication of CNS disease; causes hypnotremia and hypovolemia; monitor electrolytes, I&O, weight, fluid balance, hydration
