-
s/sx of meningitis
- nuchal rigidity
- severe headache
- fever
- photophobia
- petechial rash
- positive kernigs and brudzinskis signs
- nausea and vomiting
- encephalopathy
-
kernigs sign
- flexion of pt hip to 90 degrees then extend knee
- pain in hamstring indicates meningeal infection
-
brudzinski's sign
flexion of both hips when pts neck is flexed indicates meningeal infection
-
nursing care for pt with meningitis
- avoid coughing and don't hold breath during turning
- monitor for signs of increasing ICP
- lower body temp to reduce metabolic rate
- elevate HOB
- risk for seizure and fall precautions
-
s/sx of encephalitis
- directly related to area of brain affected
- fever
- nuchal rigidity
- headache
- nausea
- vomiting
- tremors
- photophobia
- cofusion
- delirium
- agitation and restlessness
- comatose or exhibition of aphasia
- hemiparesis
- facial weakness
-
encephalitis
- inflammation of the brain causing necrosis, edema and nerve cell damage
- usually caused by insects or herpes simplex type 1
-
initial signs of increased ICP
- restlessness
- irritability
- decreased LOC
-
late signs of increased ICP
- blown pupil on affected side
- cushings triad
- vomiting
- headache
- rising temperature
- decorticate then decerebrate posturing
-
cushings triad
- widening pulse pressure
- irregular breathing
- bradycardia
-
treatment for pt with increased ICP
- HOB at least 30 degress to promote drainage
- mannitol
- corticosteroids
- controlled hyperventilation
- avoid flexing neck and keep it in midline position
- antiemetics and anittussives
- stool softeners
- minimal suctioning
- avoid hip flexion to minimize thoracic pressure
- low stimulus environment
-
mannitol
- hyperosmolar diuretic used to decrease ICP
- draws fluid from tissue into blood stream
- pt urine output should be increased
-
purpose of corticosteroids for a person with ICP or cerebral edema
dexamethasone will decrease ICP and cerebral edema
-
concussion
- mild brain injury
- characterized by nausea and vomiting, headache and dizziness
- may have amnesia before or after event
- loss of consciousness for 5 minutes or less
-
epidural hematoma
- arterial bleeding between dura mater and skull
- pt loses consciousness right after injury
- regains consciousness and is briefly coherent
- rapidly deteriorates
- must initiate airway management and control ICP immediately
- develops dilated pupils and extraocular muscles
-
epidural hematoma tx
- mannitol
- mechanical hyperventilation constricts blood vessels
- therapeutic coma
-
spinal shock
- spinal cord is damaged
- cord below damage causes loss of reflex and flaccidity in extremities
- urine and feces are retained
- vasodilation, hypotension and bradycardia
-
autonomic dysreflexia
- complication of injury above T6
- commonly cause by bladder distension, wrinkled sheets or ingrown toe nails
-
s/sx of autonomic dysreflexia
- cool, pale skin below injury with gooseflesh
- b/p rapidly rises to 300
- bradycardia as low as 30
- pounding headache and nasal congestion secondary to dilated blood vessels
-
purpose of crutchfield and gardener-wells tongs
keeps head and neck immobile while fusion and healing take place
-
multiple sclerosis
- progressive degenerative disorder
- myelin sheath of neurons become inflamed and block signals
-
s/sx of multiple sclerosis
- aggravated by extreme heat and cold, fatigue, infection and physical and emotional stress
- difficulty with concentration or forgetfullness
- muscle weakness
- diplopia
- slurred speech
- muscle spasticity
- numbness and tingling
- vertigo
-
MS has periods of exacerbation and remission, what are some factors that can exacerbate the condition
- extreme heat and cold
- fatigue
- infection
- physical and emotional stress
-
MS tx
- interferon therapy
- steroids
- immunosuppressants
- anticonvulsants
-
myasthenia gravis
- weakness of the voluntary or skeletal muscles of the body
- body attacks and destroys ACh receptors
- muscle contractions cant be stimulated by ACh
- muscle strength is reduced
- associated with thymus disorders
-
s/sx of myasthenia gravis
- increased muscle weakness during activity and improvement in muscle strength after rest
- often present with ptosis
- voice fades after long conversation
- stress exacerbates condition
-
tensilon test
- for myasthenia gravis pts
- inject with tensilon
- if muscle strength increases dramatically; diagnosed with myasthenia gravis
-
myasthenic crisis
- sudden onset of muscle weakness
- not enough medication taken; meds must be taken on schedule
-
cholinergic crisis
- too much anticholinisterase drugs
- causes increasing muscle weaknes
- dyspnea
- salivation
- lacrimation
- urination
- sweating
-
ALS
- progressive degenerative condition that affects motor neurons
- primary symptoms are progressive muscle weakness
- pt may have inappropriate emotional outburst of laughing and crying
- pts usually die from respiratory complications
-
guillain-barre syndrome
- short term muscle weakness that either ascends or descends and progresses to paralysis
- may require intubation and artificial ventilation
- pts recover within a few months to a year
-
trigeminal neuralgia
- intense recurring pain described as sudden, jabbing or knife like
- triggered by slight touch, cold breeze, talking or chewing
- anticonvulsants and alcohol injections help with pain
-
bells palsy
- affects facial nerve
- present in pregnant, hiv, diabetes, herpes
- pain behind the ear followed by facial paralysis
- facial sling helps
- prednisone decreases inflammation
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