NSG 430 EXAM 3
1. meningitis Inflammation of the meninges
-Bacterial most often caused by streptococcus pneumoniae (ear
infection, sinus infection, head trauma, dental therapy, etc)
S/S: Sudden onset headache, Kernig's sign (90 degree hip flexion
followed by straighten of leg causes pain), Brudzinski's sign (flexion of
the neck causes flexion of the hips and knees), fever, confusion,
irritability, skin rashes
Diagnostics: CBC, CRP, blood cultures, lumbar puncture (cloudy CSF
abnormal, WBC and protein may be elevated, decreased glucose in
bacterial meningitis) Management: Droplet precautions at least for 24
hours, supportive care for viral in- fections, anti-seizure medications, seizure
precautions, steroids, monitor/decrease ICP
2. lumbar puncture - Requires informed consent
-Ask patient to empty bladder (must lay flat for 1 hour after)
-Positioning: Lateral recumbent preferred (can measure CSF pressure)
-Tripod or orthopneic position if LR contraindicated (higher risk of disc
herniation, cannot measure CSF pressure)
-Strict sterile technique
-Contraindicated in increased ICP if space-occupying
lesions Post-op care:
-Occlusive dressing (do not remove)
-Monitor for bleeding or CSF leakage
-Supine x 1 hour
-Push fluids to prevent headache
-Monitor I&O
-Alert provider immediately if leakage (may use blood patch)
Nursing considerations: Bedrest as ordered, monitor VS, quiet and
nonstimulating environment, antipyretics, antibiotics, analgesics, seizure
precautions, monitor for increased ICP, isolation precautions, elevate
HOB 30 degrees and avoid neck flexion and extreme hip flexion
Prevention: Vaccine, prophylactic abx for close exposure
, NSG 430 EXAM 3
-EBP recommends checking a head CT before a lumbar puncture to
rule out space occupying lesion
3. brain tumors - Classified as benign or malignant and primary or secondary
-Most commonly secondary tumors in the brain
S/S: Headache (severe, especially upon awakening), papilledema
(swelling of optic disc), seizures, increased ICP, unequal pupil size,
bradycardia, HTN, N/V, hemiparesis, altered mentation
Diagnostics: Neurological exam, EEG, LP, MRI, PET scan, biopsy
Treatment: Radiation, dexamethasone, chemo, dilantin (anti-seizure),
mannitol (osmotic diuretic), anticoagulants, surgery (gamma knife,
craniotomy, stereotac- tic)
Complications: Increased ICP, herniation/ischemia, rupture/hemorrhage,
seizures, hydrocephalus, SIADH/DI/pituitary dysfunction, fluid/electrolyte
imbal- ances
Care: Frequent neuro checks, monitor VS, pain management, positioning
(upright unless contraindicated), decrease stimuli, prevent increased ICP,
aspiration risk, seizure precautions
4. spinal cord -Classified based on anatomic
tu- mors
location Intramedullary: within the
cord
Extramedullary: extradural, outside of the dural
membrane S/S: Pain, weakness, loss of motor and
sensory function
Treatment: related to type of tumor and location, usually surgery and
measures to relieve compression (dexamethasone with radiation)
Nursing care: Oral hygiene before meals (to stimulate appetite), plan
meals for comfortable times, otter preferred foods, daily weights, dietary
supplements
5. encephalitis Inflammation of the brain tissue itself (most often viral)
-May be caused by herpes simplex
, NSG 430 EXAM 3
S/S: Severe headache, fever, confusion, nausea/vomiting, alterations in
LOC, bizarre behavior, S/S of increased ICP
1. meningitis Inflammation of the meninges
-Bacterial most often caused by streptococcus pneumoniae (ear
infection, sinus infection, head trauma, dental therapy, etc)
S/S: Sudden onset headache, Kernig's sign (90 degree hip flexion
followed by straighten of leg causes pain), Brudzinski's sign (flexion of
the neck causes flexion of the hips and knees), fever, confusion,
irritability, skin rashes
Diagnostics: CBC, CRP, blood cultures, lumbar puncture (cloudy CSF
abnormal, WBC and protein may be elevated, decreased glucose in
bacterial meningitis) Management: Droplet precautions at least for 24
hours, supportive care for viral in- fections, anti-seizure medications, seizure
precautions, steroids, monitor/decrease ICP
2. lumbar puncture - Requires informed consent
-Ask patient to empty bladder (must lay flat for 1 hour after)
-Positioning: Lateral recumbent preferred (can measure CSF pressure)
-Tripod or orthopneic position if LR contraindicated (higher risk of disc
herniation, cannot measure CSF pressure)
-Strict sterile technique
-Contraindicated in increased ICP if space-occupying
lesions Post-op care:
-Occlusive dressing (do not remove)
-Monitor for bleeding or CSF leakage
-Supine x 1 hour
-Push fluids to prevent headache
-Monitor I&O
-Alert provider immediately if leakage (may use blood patch)
Nursing considerations: Bedrest as ordered, monitor VS, quiet and
nonstimulating environment, antipyretics, antibiotics, analgesics, seizure
precautions, monitor for increased ICP, isolation precautions, elevate
HOB 30 degrees and avoid neck flexion and extreme hip flexion
Prevention: Vaccine, prophylactic abx for close exposure
, NSG 430 EXAM 3
-EBP recommends checking a head CT before a lumbar puncture to
rule out space occupying lesion
3. brain tumors - Classified as benign or malignant and primary or secondary
-Most commonly secondary tumors in the brain
S/S: Headache (severe, especially upon awakening), papilledema
(swelling of optic disc), seizures, increased ICP, unequal pupil size,
bradycardia, HTN, N/V, hemiparesis, altered mentation
Diagnostics: Neurological exam, EEG, LP, MRI, PET scan, biopsy
Treatment: Radiation, dexamethasone, chemo, dilantin (anti-seizure),
mannitol (osmotic diuretic), anticoagulants, surgery (gamma knife,
craniotomy, stereotac- tic)
Complications: Increased ICP, herniation/ischemia, rupture/hemorrhage,
seizures, hydrocephalus, SIADH/DI/pituitary dysfunction, fluid/electrolyte
imbal- ances
Care: Frequent neuro checks, monitor VS, pain management, positioning
(upright unless contraindicated), decrease stimuli, prevent increased ICP,
aspiration risk, seizure precautions
4. spinal cord -Classified based on anatomic
tu- mors
location Intramedullary: within the
cord
Extramedullary: extradural, outside of the dural
membrane S/S: Pain, weakness, loss of motor and
sensory function
Treatment: related to type of tumor and location, usually surgery and
measures to relieve compression (dexamethasone with radiation)
Nursing care: Oral hygiene before meals (to stimulate appetite), plan
meals for comfortable times, otter preferred foods, daily weights, dietary
supplements
5. encephalitis Inflammation of the brain tissue itself (most often viral)
-May be caused by herpes simplex
, NSG 430 EXAM 3
S/S: Severe headache, fever, confusion, nausea/vomiting, alterations in
LOC, bizarre behavior, S/S of increased ICP
