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NSG 430 - Critical Care > T9: Inflammatory Brain and Peripheral Nerve Disorders > Flashcards

T9: Inflammatory Brain and Peripheral Nerve Disorders Flashcards

1
Q

Most common inflammatory conditions of the brain and spinal cord

A

*Brain abscesses
*Meningitis
*Encephalitis

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2
Q

brain abscess

A

collection of pus anywhere within the brain results from local or systemic infection

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3
Q

primary infective organisms for brain abscess

A

*Streptococci
*Staphylococcus aureus

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4
Q

*Manifestations of brain abscess

A

*Headache
*Fever
*Nausea and vomiting
*Similar to meningitis and encephalitis

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5
Q

Signs of increased ICP

A

*Drowsiness
*Confusion
*Seizures

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6
Q

what is used to diagnose a brain abscess

A

CT and MRI

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7
Q

treatment for brain absess

A

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

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8
Q

Bacterial Meningitis

A

*Acute inflammation of meningeal tissue surrounding brain and spinal cord

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9
Q

what needs to happen if someone has bacterial meningitis

A

*Mandatory reporting to CDC (spreads very fact through the respiratory tract)

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10
Q

Leading causes of bacterial meningitis

A

*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

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11
Q

inflammatory response of bacterial meningitis

A

*↑ CSF production
*Purulent secretions spread to other areas of brain through CSF
*Cerebral edema and increased ICP become problematic

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12
Q

*Key signs of meningitis

A

*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

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13
Q

If the infecting organism is a meningococcus, what might be present

A

*a skin rash is common, and petechiae may be seen on the trunk, lower extremities, and mucous membranes.

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14
Q

nuchal rigidity

A

stiffness in cervical neck area

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15
Q

Tumbler test

A

*done by pressing the base of a drinking glass against the rash.
*The rash does not blanch or fade under pressure.

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16
Q

Bacterial Meningitis Complications

A

*Hemiparesis, dysphagia, hemianopsia
*Seizures
*CN III palsy
*Bradycardia
*Hypertensive coma
*Death

17
Q

Bacterial Meningitis Diagnostic Studies

A

*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

18
Q

Bacterial meningitis is a medical emergency, so…

A

*Rapid diagnosis crucial
*Patient usually critical when health care is initiated
*Antibiotic therapy instituted before diagnosis is confirmed

19
Q

Bacterial MeningitisNursing Implementation

A

*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

20
Q

because of fever and high metabolic demand in bacterial meningitis…

A

*Assess for dehydration and give IV isotonic fluids

21
Q

ambulatory care for meningitis

A

*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

22
Q

health promotion for meningits

A

**Vaccinations for pneumonia and influenza
*Meningococcal vaccines
*Early, vigorous treatment of respiratory tract and ear infections
*Prophylactic antibiotics for anyone exposed to bacterial meningitis

23
Q

precautions for meningitis

A

*Respiratory isolation until cultures are negative

24
Q

viral meningitis usually presents as

A

*headache, fever, photophobia, and stiff neck
*Fever may be moderate or high

25
Q

Viral Meningitis diagnostic testing of CSF

A

*Rapid diagnosis with Xpert EV test
*Sample of CSF is evaluated for enterovirus
*Results available within hours
*PCR to detect viral-specific DNA/RNA

26
Q

Viral meningitis treatment

A

*Treat with antibiotics after obtaining diagnostic sample but before receiving test results
*Symptomatic management
*Disease is self-limiting
*Full recovery expected

27
Q

Encephalitis

A

inflammation of the brain

28
Q

encephalitis is transmitted by

A

*West Nile, measles, chicken pox, mumps, HSV or CMV in immunocompromised

29
Q

clinical manifestations of encephalitis

A

*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

30
Q

patient care for encephalitis

A

*Patient care
*Antiviral medications-Acyclovir for HSV
*Antiseizure medications
*Prevention…
*Mosquito control
*Early treatment with antivirals and supportive care

31
Q

Guillain-Barré syndrome (GBS)

A

acute inflammatory demyelinating polyradiculoneuropathy (AIDP), involves a rapidly progressive, ascending peripheral nerve dysfunction, which leads to paralysis that may produce respiratory failure.

32
Q

before onset of Guillain Barre some patients report

A

*a viral infection 1 to 3 weeks before onset, usually involving the upper respiratory tract

33
Q

interventions for guillain barre

A

*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

34
Q

Amyotrophic Lateral SclerosisLou Gehrig’s Disease

A

*Progressive loss of Motor neurons
*Intact Cognition
*Muscle wasting
*Loss of muscle function
*Progressive respiratory insufficiency-mechanical ventilation

35
Q

life expectance of ALS

A

2-5 year

36
Q

patho for ALS

A

*Scarring of motor pathways
*Stops innervation of the muscle
*Progressive muscle wasting

37
Q

early symptoms of ALS

A

*Tripping, weak hand grips, speech, swallowing,
*Pain, spasticity-fasciulations, drooling, constipation, gerd
*Falls, injury

38
Q

late symptoms of ALS

A

*Aspiration
*Respiratory failure
*Supportive care from immobility
*Advance directives

39
Q

*Nursing Diagnosis priorities for ALS

A

*Reducing aspiration/risk
*Communication facilitation
*Respiratory monitoring/effort/effectiveness
*Pain management from MSK
*Fall risk reduction
*Diversional activities and support cognitive function

NSG 430 - Critical Care (42 decks)

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