Nursing Management of Neurologic Patients
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Questions and Answers

What is the recommended frequency for assessing neurologic status and vital signs in a patient with a brain abscess?

  • 2-4 hours (correct)
  • Every 6 hours
  • Every hour
  • Once a day

    • It is acceptable to overhydrate a patient to prevent cerebral edema.

    False

    What should be monitored daily in a patient suspected of SIADH?

    Body weight, serum electrolytes, urine volume, specific gravity, and osmolality

    It is important to manage a patient's high fever to reduce the load on the _____ and _____ from oxygen demands.

    <p>heart, brain</p> Signup and view all the answers

    Match the following nursing management activities with their corresponding purposes:

    <p>Assess neurologic status = Detect deterioration Monitor daily weight = Manage fluid balance Institute infection control = Prevent spread of infection Reduce high fever = Decrease oxygen demand</p> Signup and view all the answers

    What should be monitored closely to prevent I.V. fluid overload?

    <p>Intake and output</p> Signup and view all the answers

    Administering opioids is recommended to manage pain in patients with a decreasing level of consciousness.

    <p>False</p> Signup and view all the answers

    What type of diuretic is administered to help manage cerebral edema?

    <p>mannitol</p> Signup and view all the answers

    Elevating the head of the bed is recommended to decrease ______ and reduce pain.

    <p>ICP</p> Signup and view all the answers

    Match the nursing interventions with their purposes:

    <p>Assess neurologic status = To identify changes in patient condition Monitor CVP = To manage fluid balance Elevate the head of the bed = To decrease ICP Implement rehabilitation interventions = To promote recovery of function</p> Signup and view all the answers

    Which of the following is an appropriate first step in assessing a patient before a lumbar puncture?

    <p>Conduct a CT or MRI scan</p> Signup and view all the answers

    Elevated WBCs in cerebrospinal fluid (CSF) can indicate an infection.

    <p>True</p> Signup and view all the answers

    What is the role of dexamethasone in the management of patients with cerebral edema?

    <p>It acts as a corticosteroid to reduce inflammation.</p> Signup and view all the answers

    Which nursing diagnosis indicates a concern related to brain function due to inadequate blood supply?

    <p>Ineffective Tissue Perfusion (cerebral)</p> Signup and view all the answers

    Antibiotics are typically given in the form of _____ injection for managing bacterial infections.

    <p>intravenous</p> Signup and view all the answers

    Administering I/V mannitol is a measure taken to reduce fever.

    <p>False</p> Signup and view all the answers

    Match the following pharmacological treatments with their primary purpose:

    <p>Vancomycin hydrochloride = Antibiotic therapy for bacterial infections Phenytoin (Dilantin) = Control of seizures Mannitol = Treatment of increased intracranial pressure Acetaminophen = Antipyretic for fever management</p> Signup and view all the answers

    What is a common assessment sign that may indicate increased intracranial pressure (ICP)?

    <p>Decreased level of consciousness (LOC)</p> Signup and view all the answers

    The nursing diagnosis 'Hyperthermia' is related to the infectious process and __________.

    <p>cerebral edema</p> Signup and view all the answers

    Match the nursing management interventions to their respective goals:

    <p>Assess LOC, vital signs, and neurologic parameters frequently = Enhancing Cerebral Perfusion Administer antimicrobial agents on time = Reducing Fever Monitor intake and output closely = Maintaining Fluid Balance Institute cooling measures like a hypothermia blanket = Reducing Fever</p> Signup and view all the answers

    Which of the following layers is NOT part of the meninges?

    <p>Cerebrospinal fluid</p> Signup and view all the answers

    Bacterial meningitis affects the normal structure of the brain.

    <p>True</p> Signup and view all the answers

    What are the three layers of the meninges?

    <p>Dura mater, arachnoid, pia mater</p> Signup and view all the answers

    The _____ mater is the outermost layer of the meninges.

    <p>dura</p> Signup and view all the answers

    Match the following meninges layers with their characteristics:

    <p>Dura mater = Thick, tough outer layer Arachnoid = Middle layer with a web-like structure Pia mater = Thin, delicate inner layer adhering to the brain</p> Signup and view all the answers

    What is a common risk factor for meningitis in individuals under age 20?

    <p>Skipping vaccinations</p> Signup and view all the answers

    Viral meningitis occurs exclusively in adults.

    <p>False</p> Signup and view all the answers

    What is the primary way that meningitis infections generally originate?

    <p>Through the bloodstream or direct extension after traumatic injury.</p> Signup and view all the answers

    Increased intracranial pressure (ICP) can result from excessive release of ______.

    <p>ADH</p> Signup and view all the answers

    Match the following conditions with their related factors:

    <p>Bacterial meningitis = Common in individuals under age 20 Viral meningitis = Occurs in children younger than age 5 AIDS = Opportunistic infections Diabetes = Compromised immune system</p> Signup and view all the answers

    Which of the following is a common clinical manifestation of meningococcal meningitis?

    <p>Extreme sensitivity to light</p> Signup and view all the answers

    Lethargy and unresponsiveness may develop as the illness progresses.

    <p>True</p> Signup and view all the answers

    What type of rash is commonly associated with N. meningitidis infection?

    <p>Petechial rash with purpuric lesions</p> Signup and view all the answers

    An abrupt onset of high fever and extensive purpuric lesions are signs of _____.

    <p>septicemia</p> Signup and view all the answers

    Match the following complications of meningococcal meningitis with their descriptions:

    <p>Hearing loss = Possible result of complications from meningitis Memory difficulty = Can be a long-term effect of the infection Seizures = Due to irritability in the brain Shock = May occur with septicemia leading to critical conditions</p> Signup and view all the answers

    What is a common early sign of meningeal irritation?

    <p>Nuchal rigidity</p> Signup and view all the answers

    Photophobia is defined as extreme sensitivity to sound.

    <p>False</p> Signup and view all the answers

    What are the two positive signs associated with meningeal irritation?

    <p>Kernig's sign and Brudzinski's sign</p> Signup and view all the answers

    _________ is the term used for involuntary flexion of the knees and hips when the neck is flexed.

    <p>Brudzinski's sign</p> Signup and view all the answers

    Match the following symptoms with their descriptions:

    <p>Nuchal rigidity = Stiff neck Photophobia = Extreme sensitivity to light Seizures = Areas of irritability in the brain Rash = Petechial or ecchymotic lesions</p> Signup and view all the answers

    Which of the following types of meningitis is caused by bacteria?

    <p>Bacterial meningitis</p> Signup and view all the answers

    The aseptic form of meningitis can only be caused by viral infections.

    <p>False</p> Signup and view all the answers

    Name one bacteria that can cause bacterial meningitis.

    <p>Streptococcus pneumonia</p> Signup and view all the answers

    One risk factor for meningitis is skipping __________.

    <p>vaccinations</p> Signup and view all the answers

    Match the following types of meningitis with their characteristics:

    <p>Viral meningitis = Usually less severe and self-limiting Bacterial meningitis = Can be life-threatening and requires immediate treatment Fungal meningitis = Occurs mainly in individuals with weakened immune systems Parasitic meningitis = Often results from parasitic infections</p> Signup and view all the answers

    Study Notes

    Nursing Management

    • Continuous assessment of neurologic status and vital signs (every 2-4 hours).
    • Evaluate oxygenation using arterial blood gas values and pulse oximetry.
    • Monitor blood pressure as it may indicate impending cardiac/respiratory failure.
    • Rapid IV fluid replacement may be necessary, but avoid overhydration to reduce cerebral edema risk.
    • Control high fever to lessen oxygen demand on heart and brain.
    • Protect patients from injury due to seizures or altered level of consciousness (LOC).
    • Regular monitoring of body weight, serum electrolytes, and urine metrics, especially if SIADH is suspected.
    • Minimize complications related to immobility, including pressure ulcers and pneumonia.
    • Implement infection control measures for 24 hours after antibiotic therapy starts.
    • Communicate updates about the patient’s condition to family and facilitate visitations appropriately.

    Nursing Diagnosis

    • Ineffective Tissue Perfusion (cerebral) due to infection and cerebral edema.
    • Hyperthermia linked to infectious processes and cerebral edema.
    • Risk for Fluid Volume Imbalance from fever and reduced intake.
    • Acute Pain associated with meningeal irritation.
    • Impaired Physical Mobility from extended bed rest.

    Enhancing Cerebral Perfusion

    • Frequent assessment of LOC, vital signs, and neurologic parameters.
    • Check for signs of increased intracranial pressure (ICP) like decreased LOC and pupil dilation.
    • Maintain a calm environment to prevent agitation, which can raise ICP.
    • Prepare for lumbar puncture to evaluate cerebrospinal fluid (CSF), which may be followed by neuroimaging.
    • Report any signs of deterioration, such as rising temperature or altered respirations.
    • Administer IV mannitol as needed.

    Reducing Fever

    • Timely administration of antimicrobial agents is crucial to keep optimal blood levels.
    • Frequent or continuous temperature monitoring.
    • Use cooling measures like hypothermia blankets if required.
    • Give antipyretics such as paracetamol as ordered.

    Maintaining Fluid Balance

    • Prevent IV fluid overload to avoid worsening cerebral edema.
    • Closely monitor intake and output, and frequently check central venous pressure (CVP).

    Diagnostics

    • Use CT or MRI scans to assess shifts in brain contents prior to a lumbar puncture.
    • Key diagnostic tests include bacterial culture and Gram staining of CSF and blood.
    • White blood cell (WBC) count may reach 30,000/mm³ with elevated neutrophils.

    Pharmacological Management

    • Administer antibiotics like Vancomycin with cephalosporins or IV penicillins.
    • Use corticosteroids like Dexamethasone.
    • Manage dehydration and shock with fluid volume expanders.
    • Control seizures with phenytoin (Dilantin).
    • Treat increased ICP with mannitol and other relevant medications.

    Clinical Manifestations

    • Common signs include photophobia, muscular rigidity, disorientation, and potential behavioral changes.
    • Severe cases may show symptoms of septicemia, including high fever and purpuric lesions.
    • Complications can result in hearing loss, kidney failure, seizures, and potential death.

    Risks and Pathophysiology

    • Risk factors for meningitis include age (young children and teens), community living, pregnancy, and compromised immune status.
    • Meningitis often originates from bloodstream infections or direct extension from facial injuries.
    • Disease process includes inflammatory response in meninges leading to increased ICP and excessive ADH release, causing fluid retention and hyponatremia.

    Clinical Signs of Meningitis

    • Headache and fever are initial symptoms; headaches are typically severe due to meningeal irritation.
    • Notable signs include nuchal rigidity, positive Kernig's and Brudzinski's signs.
    • As infection progresses: lethargy and seizures may occur, along with signs of increased ICP.

    Types of Meningitis

    • Meningitis can be classified into viral, bacterial, fungal, and parasitic varieties.
    • Bacterial meningitis is often caused by pathogens like Streptococcus pneumoniae and Neisseria meningitidis.

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    Description

    This quiz focuses on the essential nursing management practices for patients with neurologic concerns, including monitoring vital signs, oxygenation, and preventing complications. It also addresses key nursing diagnoses such as ineffective tissue perfusion. Test your knowledge on optimal care strategies and patient communication techniques in neurologic nursing.

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