Neurological Conditions Flashcards
- What is meningitis?
- What are the 3 categories of meningitis?
- Which classification of meningitis is most worrisome / dangerous?
- Which classification of meningitis is most common?
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BOLD = IN RED
Meningitis: inflammation of the meninges that cover & protect the brain & spinal cord
Types:
* Bacterial
* Viral (aseptic)
* Fungal
- Bacterial is the most worrisome & needs to be treated with antibiotics
- Viral meningitis is most common
- What is the most dangerous form of meningitis?
- What is the most common form of meningitis?
- Most dangerous = bacterial
- Most common = viral
What are the classic signs & symptoms (triad) of meningitis?
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- Fever
- Headache
- Nuchal rigidity (neck tightness / sore neck)
What is Kernig’s sign?
Knee
- Knee is flexed at 90 degrees. When it’s slowly straightened, pain occurs
What is Brudzinksi’s Sign?
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Neck flexion also causes flexion of the hips & knees
Diagnostics & Assessments used for meningitis
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- Lumbar puncture
- CSF studies - Gram Stain
Medical Management of Meningitis
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- Prevention with meningococcal vaccination
- Anti-pyretics
- Anti-seizure medications
- IV fluids (for dehydration / shock)
What is the top priority for patients diagnosed with bacterial meningitis?
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EARLY administration of antibiotics
Nursing Management for Meningitis
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- Treatment is supportive & directed at symptom management
- Consult with epidemiology / infection control departments
- Monitor neuro status closely
What patient population has a higher rate of being diagnosed with a brain abscess?
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Immunocompromised
* indicative of underlying disease or use of immunosuppressive medications
Clinical Manifestations of Intracranial (brain) Abscess
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Progressive symptoms:
* fever
* nausea
* vomiting
* altered LOC
* focal neurological deficits
* seizures
* Headache (worse in the AM)
* Reduced vision
Clinical Manifestations of Intracranial Epidural Abscess
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- drainage from sinus or ears
- low grade fever
- mild headache
- Nuchal rigiditiy
What labs & other diagnostic tests are used in the assessment & diagnosis of neurological conditions?
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Labs
* ↑ WBC
* Blood cultures
Lumbar Puncture
* ↑ opening pressure
* ↑ protein level
* ↑ lymphocytes
Medical & Nursing Management of Brain Abscesses
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Medical Management
* start antibiotics ASAP
Nursing Management
* Monitor vitals & respiratory status
* Monitor neuro status
* Encourage rest
* Administer antipyretics
* Aminister antibiotics & analgesics
What is encephalitis? How is it managed?
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Encephilitis: acute, inflammatory process of brain tissue
Management
* Neuro Assessments
* Supportive Care (pain meds, seizure prevention, injury prevention & safety)
What is Multiple Sclerosis (MS)?
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Immune-mediated, DE-MYELINATING disease
- periods of relapses & remissions
Progressive MS = no periods of remission
Signs & Symptoms of Multiple Sclerosis (MS)
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- Weakness
- Spasticity
- Loss of coordination
- Gait ataxis (drunk walk)
- Loss of balance
- Cognitive changes
- Fatigue
Medical Management of Multiple Sclerosis
- Relapse Management
- Symptom Management
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NO CURE
Relapse Management
* Steroids (methylprednisolone & prednisone)
* Immune Suppressants
Symptom Management
* Bacolfen (Tx of choice for spasticity)
* Benzodiazepines (valium or dantrolene) - may also be used for spasticity
* Beta Blocker (inderol), Anti-seizure medications (neurotin, klonopin - tx of ataxia
What is Myasthenia Gravis (MG)?
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Auto-immune disorder that affects voluntary muscle groups…the muscle cannot contract fully or normally
- These muscle groups include ocular, oropharyngeal, facial, shoulder girdle, limbs
Occurs at neuromuscular junction
Clinical Manifestations of Myasthenia Gravis
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Generalized weakness can result in decreased vital capacity & respiratory failure
Bulbar MG
* breathing
* swallowing (dysphagia)
* speech (dysphonia)
Nursing Interventions for Myasthenia Gravis (MG)
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- Assess respirations
- Assess neuro status
- Assist with mobility
- Assess risk of impaired swallow & gag
What occurs during a Myasthenia Crisis? Specify the ABG imbalance that occurs.
- What medical interventions are used for a Myasthenia Crisis?
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Respiratory Acidosis
- failure of respiratory muscles to maintain ventilation
Medical Interventions
* IVIG
* Steroids
* Plasma Exchange
What is Gullian-Barre Syndrome (GBS)?
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Acute autoimmune disease that causes ascending weakness
- Since Schwann cells are NOT impacted, so the schwann cells can repair the damaged myelin sheath
- 80% recover; does NOT impact mental capacity
Signs & Symptoms of Gullian-Barre Syndrome (GBS)
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- ascending weakness
- dyskinesia (involuntary, erratic movements)
- paresthesia (numbness, tingling)
- hyperreflexia
Patient’s are at risk for aspiration!!!!!
Assessments & Diagnostic Testing used for Gullian-Barre Syndrome (GBS)
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Lumbar Puncture
* shows increased protein in CSF
Pulmonary Function Tests
* Vital capacity
* Negative inspiratory force (NIF)
Medical Management of Gullian-Barre Syndrome (GBS)
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Plasma exchange
* gets rid of circuating antibodies
Moinitor hemodynamic compromise
* ECG (tachycardia, bradycardia)
* BP (hypo- or hypertension)
* Fluid volume deficit / overload
Nursing Interventions for Gullian-Barre Syndrome
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Moinitor Respiratory Status
* RR, Pulse Ox, ABGs
* Vital capacity, NIF (negative inspiratory force)
Neuro exam
Vital Signs
Monitor for signs of increased weakness
