T9: Inflammatory Brain and Peripheral Nerve Disorders Flashcards
Most common inflammatory conditions of the brain and spinal cord
*Brain abscesses
*Meningitis
*Encephalitis
brain abscess
collection of pus anywhere within the brain results from local or systemic infection
primary infective organisms for brain abscess
*Streptococci
*Staphylococcus aureus
*Manifestations of brain abscess
*Headache
*Fever
*Nausea and vomiting
*Similar to meningitis and encephalitis
Signs of increased ICP
*Drowsiness
*Confusion
*Seizures
what is used to diagnose a brain abscess
CT and MRI
treatment for brain absess
START ON ANTIBIOTICS RIGHT WAY unless proven other wise by a blood culture
*Symptomatic treatment for other manifestations
*Abscess may need to be drained or removed if drug therapy is not effective
Bacterial Meningitis
*Acute inflammation of meningeal tissue surrounding brain and spinal cord
what needs to happen if someone has bacterial meningitis
*Mandatory reporting to CDC (spreads very fact through the respiratory tract)
Leading causes of bacterial meningitis
*Streptococcus pneumoniae
*Neisseria meningitidis
*Replaced Hemophilus as flu vaccine emerged
*Organisms enter CNS through upper respiratory tract or bloodstream
*May enter through skull wounds or fractured sinuses
inflammatory response of bacterial meningitis
*↑ CSF production
*Purulent secretions spread to other areas of brain through CSF
*Cerebral edema and increased ICP become problematic
*Key signs of meningitis
*Fever
*Severe headache
*Nausea, vomiting
*Nuchal rigidity
*Photophobia
*↓ LOC
*Signs of ↑ ICP
*Seizures occur in 1/3 of all cases
*Headache worsens
*Vomiting and irritability may occur
If the infecting organism is a meningococcus, what might be present
*a skin rash is common, and petechiae may be seen on the trunk, lower extremities, and mucous membranes.
nuchal rigidity
stiffness in cervical neck area
Tumbler test
*done by pressing the base of a drinking glass against the rash.
*The rash does not blanch or fade under pressure.
Bacterial Meningitis Complications
*Hemiparesis, dysphagia, hemianopsia
*Seizures
*CN III palsy
*Bradycardia
*Hypertensive coma
*Death
Bacterial Meningitis Diagnostic Studies
*Blood culture
*CT scan
*Diagnosis verified
*Lumbar puncture
*Analysis of CSF
*Specimens of secretions are cultured to identify causative organism
*Gram-stain to detect bacteria
*Neutrophils are predominant WBC in CSF
*X-rays of skull
*CT scans
*MRI
Bacterial meningitis is a medical emergency, so…
*Rapid diagnosis crucial
*Patient usually critical when health care is initiated
*Antibiotic therapy instituted before diagnosis is confirmed
Bacterial MeningitisNursing Implementation
*Observe and record seizures
*Prevent injury
*Administer antiseizure medications
*Vigorously manage fever
*Fever increases cerebral edema and the frequency of seizures
*Neurologic damage may result from high, prolonged fever
*Position for comfort
*Darkened room and cool cloth over eyes for photophobia
*Minimize environmental stimuli
because of fever and high metabolic demand in bacterial meningitis…
*Assess for dehydration and give IV isotonic fluids
ambulatory care for meningitis
*Progressive ROM exercises and warm baths for muscle rigidity
*Ongoing assessment for recovery of vision, hearing, cognitive skills, motor and sensory abilities
*Tend to signs of anxiety and stress of family and caregivers
*Provide for several weeks of convalescence
*Increase activity as tolerated
*Stress adequate nutrition-high-protein, high-calorie diet small, frequent feedings.
*Encourage adequate rest and sleep
health promotion for meningits
**Vaccinations for pneumonia and influenza
*Meningococcal vaccines
*Early, vigorous treatment of respiratory tract and ear infections
*Prophylactic antibiotics for anyone exposed to bacterial meningitis
precautions for meningitis
*Respiratory isolation until cultures are negative
viral meningitis usually presents as
*headache, fever, photophobia, and stiff neck
*Fever may be moderate or high
Viral Meningitis diagnostic testing of CSF
*Rapid diagnosis with Xpert EV test
*Sample of CSF is evaluated for enterovirus
*Results available within hours
*PCR to detect viral-specific DNA/RNA
Viral meningitis treatment
*Treat with antibiotics after obtaining diagnostic sample but before receiving test results
*Symptomatic management
*Disease is self-limiting
*Full recovery expected
Encephalitis
inflammation of the brain
encephalitis is transmitted by
*West Nile, measles, chicken pox, mumps, HSV or CMV in immunocompromised
clinical manifestations of encephalitis
*Nonspecific symptom onset
*Fever, HA, N/V
*Altered LOC-mild or coma
*Many variation of neuro symptoms…
*Hemiparesis, seizures, nerve palsies, tremors
*Memory, personality, amnesia, dysphagia
patient care for encephalitis
*Patient care
*Antiviral medications-Acyclovir for HSV
*Antiseizure medications
*Prevention…
*Mosquito control
*Early treatment with antivirals and supportive care
Guillain-Barré syndrome (GBS)
acute inflammatory demyelinating polyradiculoneuropathy (AIDP), involves a rapidly progressive, ascending peripheral nerve dysfunction, which leads to paralysis that may produce respiratory failure.
before onset of Guillain Barre some patients report
*a viral infection 1 to 3 weeks before onset, usually involving the upper respiratory tract
interventions for guillain barre
*No Cure à Medical management
*Peaks at 2-4 weeks-regrowing of the myelin
*Plasmapheresis, Intravenous immune globulin (IVIG)
*Mechanical Ventilation-prevent complications
*Nursing management
*Support normal body functions
*Maintaining surveillance for complications-also immobility
*Autonomic Dysfunction à VS fluctuations and extremes
Amyotrophic Lateral SclerosisLou Gehrig’s Disease
*Progressive loss of Motor neurons
*Intact Cognition
*Muscle wasting
*Loss of muscle function
*Progressive respiratory insufficiency-mechanical ventilation
life expectance of ALS
2-5 year
patho for ALS
*Scarring of motor pathways
*Stops innervation of the muscle
*Progressive muscle wasting
early symptoms of ALS
*Tripping, weak hand grips, speech, swallowing,
*Pain, spasticity-fasciulations, drooling, constipation, gerd
*Falls, injury
late symptoms of ALS
*Aspiration
*Respiratory failure
*Supportive care from immobility
*Advance directives
*Nursing Diagnosis priorities for ALS
*Reducing aspiration/risk
*Communication facilitation
*Respiratory monitoring/effort/effectiveness
*Pain management from MSK
*Fall risk reduction
*Diversional activities and support cognitive function
