Unit 14 Metabolic Coma/Drugs Flashcards
When can coma occur?
When pressure is put on the brainstem
What is there an increased risk of with ICP Monitoring?
Infection
What is the 1st indicator of ICP/brain issue?
ALOC
What is the definition Encephalopathy or (Metabolic Coma)?
-Broad term for any brain disease that alters brain function or structure.
What are some causes of metabolic coma?
- Drug induced
- Diseases: Viral and bacterial
- Anoxia (absence of oxygen)
- Hypo/hyperglycemia
- Meningitis
- DKA
- Carbon monoxide poisoning
- SIADH
What are characteristics of metabolic coma?
Change in LOC
Absence of brain lesions/abnormalities
Lab values will show abnormality somewhere
What is Meningitis?
Inflammation of the arachnoid and pia matter of brain and spinal column. (spreads rapidly)
Bacteria and viral organisms (aseptic meningitis) are most often the cause.
What is the pathophysiology of Meningitis?
Most common cause?
Organism enters CSF via bloodstream and crosses the blood-brain barrier.
Can be caused by direct entry
-Infection is most common cause
Describe Bacterial Meningitis.
-Often related to Upper Respiratory Infection.
Pathogens - Pneumoniae, Neisseria meningitis (meningicoccal), H. Flu
- Contagious
- Has more favorable outcome if detected early and treatment is begun.
What are the symptoms of Bacterial Meningitis?
Fever (40-41C)*
Stiff neck/Nuchal Rigidity*
Headache*** (Hallmark signs of bacterial meningitis)
Purpuric Rash
Photophobia
Seizures
Cold extremities
N and V
What can be assessed in bacterial meningitis?
Nuchal rigidity
+ Kernig’s sign: PT flat on back, knee bent to 90 degrees then straightened up, if back pain then it is positive sign
+ Brudzinski’s sign: flat on back, when flexing head, knees automatically bend = + sign
What is the Diagnosis for Meningitis?
Analyze CSF by lumbar puncture (L3 and L4):
-Confirms
CT scan:
-to rule out other causes
What are complications of meningitis?
ICP
Seizures may occur
SIADH may occur
Shock
SIRS/SEPSIS
Septic emboli may lead to blocked circulation
Disseminated Intravascular Coagulation (DIC) may occur
What is the collaborative care for meningitis? What kind of precautions? What kind of feedings? What about those in close contact? What about ICP in Meningitis?
Broad spectrum antibiotics (penicillin, cephalosporins, vancomycin) until C and S result (do first): 10 days on antibiotics
Prophylactic treatment w/ rifampin (24-48hrs) for those in close contact
Droplet precautions
Treat and prevent elevated ICP w/corticosteriods
Monitor neuro status, GCS
Antipyretics
Maintain O2
Enteral feedings
Prevent constipation
Supportive care
Describe Viral Meningitis.
What will be obtained in the CSF culture?
Often associated to other viral illnesses such as: mumps, measles, varicella, herpes simplex
No organisms will be obtained in CSF culture.
What will be assessed in Viral Meningitis?
Nuchal rigidity
Fever
Photophobia
Lumbar puncture for CSF has no bacteria/cultures
What is the treatment of viral meningitis?
Symptom management
Possibly antivirals
Antipyretics
IV fluids
When should the vaccine for meningitis be given?
What are they called?
At 11-12 years of age
Booster at 16-24
Vaccines are: (meningiconjucate) Menactra, Menveo
Strep group b meningitis vaccine for teens and adults
What is Encephalitis?
Caused by?
Who’s most at risk?
Inflammation of the brain tissue and often meninges
Caused by: virus, bacteria, fungus, parasite
Elderly most at risk
What is the pathophysiology of Encephalitis?
Virus reproduces in brain tissue causing an inflammatory response
Edema and compression of blood vessels cause elevated ICP
What are specific diseases causing Encephalitis?
Herpes Simplex (most common)
West Nile Virus
MMR
Chicken pox
Rabies
What are the symptoms of Encephalitis (arbovirus)?
- Flulike symptoms
- Fever
- Confusion
- Coma
- Arthralgia
- Lethargy
- Rash
- Motor dysfunction
- Ataxia
- Photophobia
- Increases WBCs (normal if viral)
What test measures antibodies in the blood to check what’s causing Encephalitis(arbovirus)?
Elisa Test
What is used to diagnose Encephalitis?
Symptoms
Lumbar puncture to rule out meningitis
Elisa test
Serology testing
What is the collaborative care for Encephalitis?
- Care is supportive (virus)
- acyclovir or vidarabine IV for herpes simplex or varicella
- Treat the cause
What are nursing interventions for Encephalitis?
Assess LOC
I and Os
Prevent constipation
Droplet precautions
Maintain O2
Enteral feedings
What are preventions/teaching for Encephalitis(Arborvirus)?
Protection w/ DEET (bugspray)
Picaridin (insect repellent)
Oil of lemon eucalyptus
IR2525 (skin guard plus)
Long clothing
Mosquito management
Describe Alcohol in relation to Metabolic Coma.
CNS depressant
Affects all levels of brain function
Most common substance abuse
Crosses blood-brain barrier
Describe what happens with chronic alcohol use.
Can cause liver disorder/failure
Elevated NH3
Wernicke’s Encephalopathy - (depletion of thiamine- vitamin b1) causing confusion, ataxia, etc.)
Korsafoff’s Psychosis - Short term memory loss, possible hallucinations
What are mild to moderate symptoms of alcohol withdraw?
Tremors N and V Diaphoresis Dilated pupils Headache Palpations Anxiety/Depression Insomnia
What is the severe complication of alcohol withdraw?
Delirium Tremens: life threatening complication (~3 days in)
- Hallucinations
- High fever
- Intense agitation
- Tachycardia
- Tachypnea
- Seizures
What are nursing interventions/collaborative management for alcohol withdraw?
3’S’s of detox safety/sedation/supplements
- Monitoring of withdraw symptoms and safe environment
- Vitamins and minerals: B complex (thiamine replacement), C, Mg, and Calcium
- Refer to follow up/support group
What is the assessment tool for alcohol withdraw?
What is the criteria being assessed?
What are the score ranges?
CIWA (clinical institute withdrawal assessment)
Criteria:
- N and V
- Tremors
- Agitation
- Hallucinations
- VS
- Diaphoresis
- LOC
- Auditory disturbances
<8 = mild
8-15 = moderate
> 15 = severe
What is the treatment for alcohol withdraw?
Librium
Benzo’s
valproic acid (Depakote)
What is acute alcohol poisoning?
Depression of the CNS:
- Often die of hypothermia, aspiration, or ingestion of other CNS depressants.
- Brain stem and hypothalamus extremely depressed
- Irregular/Decreased RR
- No gag reflux
- Decreased LOC
- Fatal
What are ED nursing considerations when drawing Blood Alcohol Concentration?
No alcohol pad used
Chain of custody for specimen
Know laws of state
Document
What is acetaminophen overdose?
What are early symptoms?
What is the treatment of acetaminophen OD?
Extremely toxic to liver cells
Death can occur in 1-4 days
Early symptoms: N and V, diarrhea, abdominal pain
Treatment of OD:
-N-Acetylcysteine (mucomyst or NAC) oral or NGT - blocks absorption of acetaminophen
-Activated charcoal if presents within 1 hr of ingestion and stable consciousness
What is the acute care for drug OD?
- ABCs, Obtain VS, neuro checks, intubate if necessary
- Bloodwork: CBC, BMP, Glucose, toxic screen, ETOH, ABG
- Administer: IV meds: Thiamine, Narcan
- Gastric lavage, charcoal, cathartic (NGT)
- Treat w/specific antidote
What are the two acronyms for assessing a PT with an ALOA?
A lcohol E pilepsy I nsulin O piates U remia
T ruama I nfection P sych P oison S troke
What diagnoses tests would help w/ an unconscious patient in the ED?
Blood glucose
Urinalysis
History of state
VS
CT of head
Describe Persistent Vegetative Sate.
No awareness of self or environment
No evidence of purposeful response to visual, auditory, or tactile stimuli
Intermittent wakefulness
Incontinence
Preserved brainstem autonomic functions
Variable cranial and spinal reflexes
What is brain death?
Cessation and irreversibility of all brain functions including brain stem
Coma, apnea, pupils fixed and dilated
No ocular response
Flat EEG
Name some club drugs.
What are the intoxication/acute effects?
What is the collaborative treatment for OD?
Liquid X, Liquid Ecstasy
Intoxication/acute effects: euphoria, drowsiness, confusion, memory impairment, excited or aggressive behavior
Monitor cardiac conditions
Warming blanket for hypothermia
Institute seizure & aspiration precautions
Define CNS depressants. Name some.
What are intoxication symptoms?
What are overdose symptoms?
What is the treatment for OD?
Drugs that depress the central nervous system
Ex: Alcohol, Benzo’s, Barbiturates, Anti-convusants/depressants
Intoxication symptoms: Drowsiness, Confusion, Impaired coordination, Blurred vision
Overdose symptoms: Respiratory depression
Treatment: airway management
Give antidote: flumazenil for benzodiazepine overdose
