NUR 265
Exam 3 Review
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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 immunocompromisedAIDs, 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 CSFbasal skull fracture) or Otorrhea (ear discharge same as rhinorrhea) -ICPchanges in mental status/LOC and/or orientation can progress to seizures -Systemic Inflammatory response Coagulopathy changes in vascular status if thrombi formsDIC, 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 (HSV1) and Varicella
S/S:
-Changes in mental status such as agitation, acute confusion, irritability or personality/behavioral changes -ICP -Neurological deficitsvision loss, seizures, muscle weakness, and paralysis. **these changes may last for weeks andmay be permanent.-photo and phonophobia
Management:
-Priority = Airway. Turn cough and deep breathe q2h UNLESS ICP present. If on vent and s/s of ICP suction
-Monitor Neuro Status:
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