Neurology

Question 1

Routes of Entry for Central Nervous System Infections

Answer 1

Blood Stream
Direct extension
Cerebrospinal fluid
Nose or mouth
In utero

Question 2

Meningitis

Answer 2

Inflammation of the meninges that surround the brain and spinal cord, caused by either bacterial or viral infection.

Question 3

Bacterial Meningitis

Answer 3

serious infection spread by direct contact with discharge from the respiratory tract of an infected person

Question 4

Viral Meningitis

Answer 4

Also called aseptic meningitis, is more common and rarely serious. It usually presents with flu-like symptoms, and patients recover in 1 to 2 weeks.

Question 5

Most common bacteria that cause meningitis

Answer 5

-Neisseria meningitidis -Streptococcus pneumoniae
-Group B Streptococcus, and
-Haemophilus influenzae type b (Hib).

Question 6

Meningitis Prevention

Answer 6

Vaccines
Prophylactic treatment

Question 7

Meningitis S/S

Answer 7

-Nuchal rigidity
-Positive Kernig and Brudzinski signs
-Fever
-Photophobia
-Petechial rash on skin and mucous membranes
-Encephalopathy
-No appetite or thirst
-Severe headache

Question 8

Meningitis Complications

Answer 8

Cranial nerve damage
Seizures
hearing, vision, or cognitive deficits

Question 9

Meningitis Diagnostic Tests

Answer 9

Lumbar puncture with cerebrospinal fluid, analysis, culture and sensitivity (C&S)

Complete blood count (CBC)

C&S nose and throat

Question 10

Meningitis Therapeutic Measures

Answer 10

Antimicrobials (if bacterial)

Seizure precautions

Antipyretics

Pain management

Reduction of environmental stimuli

Education

Droplet isolation if contagious

Question 11

Encephalitis
Pathophysiology

Answer 11

inflammation of brain tissue. Nerve cell damage, edema, and necrosis cause neurologic findings in the areas of the brain affected.

Question 12

Encephalitis Etiology

Answer 12

Virus (West Nile, Mumps, Mono, Ticks)
-HSV (most common)

Question 13

Encephalitis S/S

Answer 13

Headache
General malaise
N/V
fever over several days
nuchal rigidity
confusion
decreased LOC
seizures
photophobia
ataxia
abnormal sleep patterns
tremors
hemoparesis

Question 14

Encephalitis Complications

Answer 14

Cognitive disabilities
Behavioral changes
Ongoing seizures
Motor deficits
blindness

Question 15

Encephalitis Diagnostic Tests

Answer 15

Ct Scan
MRI
Lumbar puncture to obtain CSF
EEG

-CSF shows: increased WBC and protein level, with NML glucose

Question 16

Encephalitis Therapeutic Measures

Answer 16

Neuro vitals
Anticonvulsants
Antipyretics
Analgesics
Corticosteroids
Sedatives
Antivirals

Question 17

Increased Intracranial Pressure
Pathophysiology

Question 18

IICP Risk Factors

Answer 18

Infection (meningitis)
Aneurysm
Seizures
Tumors
Stroke

Question 19

IICP S/S

Answer 19

*Vomiting

*Headache

*Dilated pupil on affected side

*Hemiparesis or hemiplegia

*Decorticate then decerebrate posturing

*Decreasing level of consciousness

*Increasing systolic blood pressure

*Increasing then decreasing pulse rate

*Rising temperature

Question 20

IICP Diagnostics

Answer 20

ICP monitoring
Glasgow Coma Scale
Brain Oxygenation

Question 21

IICP Treatment

Answer 21

Diuretics
Anticonvulsants
Corticosteriods

Question 22

IICP Therapeutic Interventions

Answer 22

Immobilize head if a neck injury is suspected.
-maintain HOB at 30 degrees
-Adm stool softeners
-Avoid endotracheal suction for >10 seconds

Question 23

IICP patient education

Answer 23

Avoid:
coughing
sneezing
blowing nose
bending over/flexing at the hips

Question 24

Seizure Precautions

Answer 24

*Pad side rails of hospital bed with commercial pads or bath blankets folded over and pinned in place.

*Keep call light within reach.

*Assist patient when ambulating.

*Keep suction and oral airway at bedside.

Question 25

Nursing Care During a Seizure

Answer 25

*Stay with patient.

*Do not restrain patient.

*Protect from injury (move nearby objects).

*Loosen tight clothing.

*Turn to side when able to prevent occlusion of airway or aspiration.

*Suction if needed.

*Monitor vital signs when able.

*Be prepared to assist with breathing if necessary.

Question 26

IICP Patient Education

Answer 26

The nature and focus of teaching depend on the patient’s LOC and cognitive status. When appropriate, include both the patient and family members in the education process

Question 27

IICP Prevention

Answer 27

1. Keep head of bed elevated 30 degrees unless contraindicated.
2. Avoid flexing the neck; keep head and neck in midline position
3. Administer antiemetics and antitussives as necessary to prevent vomiting and cough.
4. Administer stool softeners.
5. Minimize suctioning. If absolutely necessary, oxygenate first and limit suction passes to one or two.
6. Avoid hip flexion.
7. Prevent unnecessary noise and startling the patient.
8. Space care activities to provide rest between each disturbance.

Question 28

Seizure Disorders

Answer 28

A seizure can be a symptom of epilepsy or other neurologic disorders such as a brain tumor or meningitis