NUR 265 Exam 3 Review

NUR 265 Exam 3 Review MENINGITIS Patho: Inflammation of the inner meninges Usually caused by: 1. Autoimmune reaction 2. Adverse reaction to medication or procedure (Spinal or Brain)  direct route of entry 3. Infection: a. Bacterial: Most common Strep. Pneumoniae and Neisseria Meningitids Highly contagious (see risks) b. Viral: Most common herpes, Varicella (chicken pox/shingles) c. Fungal: Usually seen in pts w/ AIDs Risks: - Infections of eye, ear, mouth (like a tooth abscess) and neck are at increased risk a/r close anatomic proximity - Pts ages 16-21 at highest risk for bacterial meningitis.  Vaccinate @11-12 y/o then booster @16. - Pts living in high density populations (dorms, barracks, crowded living areas) have increased risk for bacterial meningitis as well.  Initial or booster vaccination is advised for these adults. - Pts who are immunocompromised  AIDs, Cancer Rx tx, or pts receiving immunosuppressant tx for organ transplant or autoimmune disease. S/S: - Classical Triad: Headache, Fever, Neck pain (nuchal rigidity) - Kerning’s sign (may or may not be present)  back pain when flexing knee beyond 90 degrees w/ pt in supine position - Brudzinski’s sign (may or may not be present)  flexing the head when pt is in supine position results in automatic flexion of legs and/or hips - Photo and Phonophobia - Rhinorrhea (nasal discharge of CSF  basal skull fracture) or Otorrhea (ear discharge same as rhinorrhea) - ICP  changes in mental status/LOC and/or orientation  can progress to seizures - Systemic Inflammatory response  Coagulopathy  changes in vascular status if thrombi forms  DIC, gangrene - Other usual s/s of infection may or may not be present (like tachycardia, fever, chills etc.) Dx: CT – if pt is 60, immunocompromised, or have s/s of ICP then CT first all other LP. LP – If viral CSF is usually clear and if bacterial usually cloudy. All other findings such as glucose, WBC and protein are usually the same. Management: - Priority = Airway Breathing and Circulation + Monitoring + documenting neuro status (q2-4h) - Seizure precautions - BS AB tx until LP results then specific Rx tx. - Managing ICP  Mannitol and Antiepilectic rx - If bacterial meningitis  DROPLET + STANDARD - prophylaxis tx for close contact - Decrease stimuli + keep HOB elevated at 30 degrees. ENCHEPALITIS Patho: Inflammation of the brain and surrounding meninges. Most commonly caused by viral infections such as Herpes