Nur 4227: Adult 2 Exam 1 Part 2 (Neuro) UPDATED ACTUAL
Questions and CORRECT Answers
What are the most common inflammatory conditions of Brain abscesses, meningitis, and encephalitis
the brain and spinal cord?
What are some important things to know about - It is an acute inflammatory condition of the brain and spinal cord
meningitis? - Caused by bacteria, viruses, fungi, and chemicals
- Occurs in fall, winter, or early spring.
- College students, older adults, and people living in institutions are at higher
risk (close quarters)
- Older adults and those immunocompromised have higher mortality rates
- Mortality is 10-15%; it can cause long-term neurodeficits
Why does meningitis occur mostly in the fall, winter, or This time of year, sneezing and coughing are more prevalent.
early spring?
What is the most common bacterial form of meningitis? Streptococcus pneumoniae or Neisseria meningitidis (these are highly
contagious and fatal; people die the most from these)
What is the patho of bacterial meningitis? - Organisms enter the CNS through the upper respiratory tract, or bloodstream
(can enter via penetrating skull wound, fractured sinuses, or basilar skull
fracture)
- Inflammation leads to an increase in CSF production, leading to increased
ICP
- Purlent secretion quickly moves to other areas of the brain through CSF
Once purulent secretion quickly moves to other areas Cerebral edema --> increased ICP --> herniation
of the brain through CSF if it extends to the brain
parenchyma or if concurrent encephalitis is present.
What becomes a huge problem?
What are some clinical manifestations of bacterial/viral Key signs
meningitis? - Nuchal rigidity!!
- (fever, severe HA, N/V,
Additional signs
- Photophobia
- Decreased LOC
- Signs of increased ICP
- Petechia on trunk
- Lower extremities and mucous membranes
What is nuchal rigidity? If you can not physically put your chin to your chest (if flexion is painful but
possible, it is NOT this).
, How is bacterial meningitis dx? - H&P
- CBC (increased WBC bacterial), coag studies, CMP
- Blood cultures
- Lumbar puncture (CSF analysis, protein, WBC, glucose, gram stain, culture)
- Head CT (rules out)
What is the purpose of a lumbar puncture? - Measure ICP (meningitis)
- Collect CSF for cultures and cytology (meningitis, cancer)
- Infusion of chemo (cancer)
- Anesthetics (childbirth)
- Contrast injection for CNS radiographic studies
What are the results of bacterial meningitis? - Increased ICP Increased leukocytes (purulent), increased protein, decreased
glucose
What is the nurse's role for a patient receiving a lumbar - Educate: about the procedure
puncture? - Prep the pt: (make sure the provider has adequate access to inject in between
L3 +L4)
- Support pt: allow them to hold on to your waist
What does the pt have to do POST lumbar puncture? LIE DOWN ON BACK FOR 1HR; so the CSF can clot up
- If they are sitting up after the hr, they may be having a CSF leak
How is bacterial meningitis treated? Nonpharmacological:
- Rest
- IV fluid
- Hyperthermia
Pharmacological:
- IV abx (ampicillin, penicillin, cephalosporin)
- Codeine (for HA)
- Dexamethasone (steroids for inflammation)
- Tylenol
- IV phenytoin (seizure prevention)
What are some nursing implications for bacterial - Assess for signs of neurological decompensation/seizures (feq neuro
meningitis? checks/seizure precautions)
- Low lighting
- Pain/fever management
- Abx/steroid admin
- DROPLET PRECAUTIONS/ ISOLATION
- Vaccine awareness--death is common
What are the causes of viral meningitis? - Enterovirus: ie, Coxsackie (hand foot mouth)
- Herpes Simplex Virus (HSV)
- Mumps
- HIV
- Varicella-Zoster: ie, chicken pox
- Influenza
Questions and CORRECT Answers
What are the most common inflammatory conditions of Brain abscesses, meningitis, and encephalitis
the brain and spinal cord?
What are some important things to know about - It is an acute inflammatory condition of the brain and spinal cord
meningitis? - Caused by bacteria, viruses, fungi, and chemicals
- Occurs in fall, winter, or early spring.
- College students, older adults, and people living in institutions are at higher
risk (close quarters)
- Older adults and those immunocompromised have higher mortality rates
- Mortality is 10-15%; it can cause long-term neurodeficits
Why does meningitis occur mostly in the fall, winter, or This time of year, sneezing and coughing are more prevalent.
early spring?
What is the most common bacterial form of meningitis? Streptococcus pneumoniae or Neisseria meningitidis (these are highly
contagious and fatal; people die the most from these)
What is the patho of bacterial meningitis? - Organisms enter the CNS through the upper respiratory tract, or bloodstream
(can enter via penetrating skull wound, fractured sinuses, or basilar skull
fracture)
- Inflammation leads to an increase in CSF production, leading to increased
ICP
- Purlent secretion quickly moves to other areas of the brain through CSF
Once purulent secretion quickly moves to other areas Cerebral edema --> increased ICP --> herniation
of the brain through CSF if it extends to the brain
parenchyma or if concurrent encephalitis is present.
What becomes a huge problem?
What are some clinical manifestations of bacterial/viral Key signs
meningitis? - Nuchal rigidity!!
- (fever, severe HA, N/V,
Additional signs
- Photophobia
- Decreased LOC
- Signs of increased ICP
- Petechia on trunk
- Lower extremities and mucous membranes
What is nuchal rigidity? If you can not physically put your chin to your chest (if flexion is painful but
possible, it is NOT this).
, How is bacterial meningitis dx? - H&P
- CBC (increased WBC bacterial), coag studies, CMP
- Blood cultures
- Lumbar puncture (CSF analysis, protein, WBC, glucose, gram stain, culture)
- Head CT (rules out)
What is the purpose of a lumbar puncture? - Measure ICP (meningitis)
- Collect CSF for cultures and cytology (meningitis, cancer)
- Infusion of chemo (cancer)
- Anesthetics (childbirth)
- Contrast injection for CNS radiographic studies
What are the results of bacterial meningitis? - Increased ICP Increased leukocytes (purulent), increased protein, decreased
glucose
What is the nurse's role for a patient receiving a lumbar - Educate: about the procedure
puncture? - Prep the pt: (make sure the provider has adequate access to inject in between
L3 +L4)
- Support pt: allow them to hold on to your waist
What does the pt have to do POST lumbar puncture? LIE DOWN ON BACK FOR 1HR; so the CSF can clot up
- If they are sitting up after the hr, they may be having a CSF leak
How is bacterial meningitis treated? Nonpharmacological:
- Rest
- IV fluid
- Hyperthermia
Pharmacological:
- IV abx (ampicillin, penicillin, cephalosporin)
- Codeine (for HA)
- Dexamethasone (steroids for inflammation)
- Tylenol
- IV phenytoin (seizure prevention)
What are some nursing implications for bacterial - Assess for signs of neurological decompensation/seizures (feq neuro
meningitis? checks/seizure precautions)
- Low lighting
- Pain/fever management
- Abx/steroid admin
- DROPLET PRECAUTIONS/ ISOLATION
- Vaccine awareness--death is common
What are the causes of viral meningitis? - Enterovirus: ie, Coxsackie (hand foot mouth)
- Herpes Simplex Virus (HSV)
- Mumps
- HIV
- Varicella-Zoster: ie, chicken pox
- Influenza
