Neurologic Disorders Flashcards
Bacteria reaches the meninges via the bloodstream from a nearby infection (or if an open wound like a neuro procedure)
CSF: sugar and water
Risk: septic, facial surgeries, ear infections, immunizations, trauma to brain
Infections grow easily in CSP
Increased ICP s/s
What will our CSF look like?
Most commonly caused by:
See in kids
Kernig
Brudzinski
Diagnosis: blood cultures if infect, CBC, cultures, LP - often done
Nursing interventions
Medications
Complications:
Prevention!
Bacterial meningitis
Increase in WBC and protein
Decrease in sugar
We now also have WBC in the CSF
Cloudy
WBCs = lot
Happens quickly - growing crazy - hard get in there but once there crazy - do lumbar puncture - fund bacteria in there and fluid cloudy and decreased amounts sugar because bacteria ate it - increased WBC
Lyse bacteria - WBC - creating protein - increased protein
No longer neutral now in acidic
Meninges flared and unhappy - lot neurologic effects
What will our CSF look like? - Bacterial meningitis
Neisseria meningitidis (Meningococcal) - past newborn phase often these
Streptococcus pneumoniae (pneumococcal) - past newborn phase often these
Haemophilus influenzae (Hib) - past newborn phase often these
Escherichia coli - no vaccine; common in neonates
Most commonly caused by: - Bacterial meningitis
Fever, cold hands and feet
Fretful, dislike being handled
Rapid breathing or grunting
Unusual cry, moaning
Stiff neck, dislike bright lights
Refusing food and vomiting
Drowsy, floppy, unresponsive
Pale, blotchy skin, spots/rash
Tense, bulging fontanelle
Photosensitivity, neck stiffness, look sick
High pitched cry
Seizures/convulsions
First 18 months: - See in kids - Bacterial meningitis
Fever, cold hands and feet
Drowsy, diff to wake
Severe muscle pain
Severe headache
Dislike bright lights
Vomiting
Confusion and irritability
Pale, blotchy skin, spots/rash
Stiff neck
Photosensitivity, neck stiffness, look sick
Seizures/convulsions
Older: - See in kids - Bacterial meningitis
Straighten knee
Painful - so ball up
Inflamed meninges
Kernig - Bacterial meningitis
Pull knees up when head is pulled up
Brudzinski - Bacterial meningitis
Droplet precautions
Monitor
Head circumference - lot inflammation in brain; monitor fontanels
Environment
Comfort measures
Safety
Down foramen magnum - brain herniation - cannot help
Seizures - seizure precautions - decrease stimuli - bring temp down - tepid bath - no ice directly on them - fan in there
Nursing interventions - Bacterial meningitis
Steroid- reduce body’s response to infection - reducing inflammation - not want herniation
Antibiotic- treat infection
Analgesics- pain meds - in pain
Give fluid
Edema or fluid overload going on in brain - with brain trauma - no mannitol - brain starving - infection eaten all sugar - little left for brain to consume - even more fluid away from brain - much as possible so as much sugar left for brain
Medications - Bacterial meningitis
Hearing loss
Neurologic deficit
Seizures
Visual impairment
Behavioral problems
CP = e coli in first couple weeks life = not good
Complications: - Bacterial meningitis
Seizure precautions - pad sides, suction, oxygen, loose clothing, educate parents
During a seizure - time it unless lasting longer than 5 min - meds like phenobarbitol; turn on side
Post seizure - turn on side; recovery position; slowly reorient; let rest
Keep lights down and talk quietly
Seizures
What is the best way to prevent bacterial meningitis?
Vaccines
Prevention! - Bacterial meningitis
Acute encephalopathy and fatty liver disease
Typ always seen after viral infection (often flu) and given aspirin
Present sim to meningitis - do LP to ensure
Do support measures - not many interventions can do - monitor I&O, hydration, no flexion - no bending head or overbending of body
Reye syndrome primarily affects the liver and brain, causing liver dysfunction and cerebral edema.
The cause of Reye syndrome is not understood.
The prognosis for the client who has Reye syndrome is best with early recognition and treatment which includes ruling out other illnesses that have manifestations similar to Reye syndrome.
Manifestations include:
A lumbar puncture should be done to rule out meningitis due to similarity in manifestations.
Reye syndrome
Association between using aspirin (salicylate) for treating fevers caused by viral infections
Reye syndrome typically follows a viral illness (influenza, gastroenteritis, varicella)
The cause of Reye syndrome is not understood. - Reye syndrome
Lethargy
Irritability
Combativeness
Confusion
Delirium
Profuse vomiting
Seizures
Loss of consciousness
Manifestations include: - Reye syndrome
This seizure is characterized by blank staring, eye fluttering, and picking at clothes
Absence seizure
This is a prolonged seizure that lasts more than 5 minutes
Status epilepticus
This seizure causes a loss of muscle tone and often results in falling
Atonic seizure
This is the most common seizure disorder in children
Febrile
Most common
Usually under the age of 5
Shift leads to it
Body not used to it - is quick rise in temp
Quick rise in temperature
Usually less than 5 minutes
Generalized, transient, non-progressive: typ no long-term effects
EEG normal within 2 weeks
Care of family - parents scarred for life; kid at increased risk for future - give antipyretic for every fever
Will grow out of it
Safety measures
Febrile seizure
Teach parent about what to do during and after seizure
Prioritize prevention
Teach about seizure precautions and what to do
Last longer than 5 mins - not need call EMS - but do follow-up
Safety measures - Febrile seizure
Common
Often have long-lasting impacts
The result of any mechanical force to the skull, scalp, meninges, or brain.
What increases the risk of a head injury?
2 priorities:
Minor head trauma findings:
Blurred vision, Nausea, LOC - go to doc; brain rest; gradually back to activities
Early Assessment findings of severe head trauma:
Late Assessment Findings:
Interventions
Head injury
Concussions
Lacerations
Fractures
Hematomas (subdural, epidural)
Diffuse axonal injury - shaken baby syndrome
Typ have primary (blow/fall on/shaken) and secondary injury (how brain/trauma impacted that brain healing) - do things to prevent swelling from getting worse
The result of any mechanical force to the skull, scalp, meninges, or brain. - Head injury
Lack of supervision
Doing unsafe things
Not using appropriate sports equipment
Diving into shallow end
What increases the risk of a head injury? - Head injury
Protect airway
Stabilize that neck
Want decrease pressure increases
Bed 30 degrees - avoid suctioning; head midline; avoid sedating medications in first few hours to days following impact - confused with loss of LOC
Passed out - need know how long out - longer means more severe injury
2 priorities: - Head injury
Possible loss of consciousness (amount of time is significant)
Temporary period of confusion
Vomiting
Pallor
Irritability
Lethargy
Drowsiness
Minor head trauma findings: - Head injury
Infant: bulging fontanel, separation of cranial sutures, irritability, restlessness, increased sleeping, high-pitched cry, poor feeding, setting-sun sign - pushing eyes down and see white, distended scalp veins
Children: nausea, headache, forceful vomiting, blurred vision, increased sleeping, inability to follow simple commands, decline in school performance, seizures
Early Assessment findings of severe head trauma: - Head injury
Alterations in pupillary response, posturing (flexion and extension), bradycardia, decreased motor response, decreased response to painful stimuli, Cheyne-Stokes respirations, optic disc swelling, decreased consciousness, coma
Seen in younger and older kids
Late Assessment Findings: - Head injury
Monitor
Withhold
Seizure precautions - increased risk because pressure
Medications
Concussions
Interventions - Head injury
Vital signs
Neurological function (assess level of consciousness closely).
Monitor for signs of increased ICP
Monitor for signs of brainstem involvement - worried about brain herniation - open it and remove part of it
Monitor for signs of epidural hematoma
Asymmetrical pupils may indicate a neurosurgical emergency that requires evacuation of the hematoma.
Monitor
Sedating medications during the acute phase of the injury
Food (NPO)
Withhold
Acetaminophen for headache, anticonvulsants for seizures
Corticosteroid or osmotic diuretic may be prescribed to reduce cerebral edema.
Mannitol to decrease pressure
Medications
