brain abscess.pdf

Adult Nursing Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd. Brain Abscess Lecturer: Dr. Mohammad Mahdi Saeed Learning Outcomes: Define brain abscess Enumerate types and clinical manifestations Identify risk factors...

Adult Nursing Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd. Brain Abscess Lecturer: Dr. Mohammad Mahdi Saeed Learning Outcomes: Define brain abscess Enumerate types and clinical manifestations Identify risk factors and causes and common complications Medical managements and medications 1 Brain Abscess Introduction Brain abscesses are rare in people who are immunocompetent; they are more frequently diagnosed in people who are immunosuppressed as a result of an underlying disease or the use of immunosuppressive medications. Pathophysiology A brain abscess is a collection of infectious material within the tissue of the brain. Bacteria are the most common causative organisms. The most common predisposing conditions for abscesses among adults who are immunocompetent are otitis media and rhinosinusitis. It is estimated that 40% of brain abscesses are otogenic in origin. An abscess can result from intracranial surgery, penetrating head injury, or tongue piercing. Organisms causing brain abscess may reach the brain by hematologic spread from the lungs, gums, tongue, or heart, or from a wound or intraabdominal infection. Clinical Manifestations The clinical manifestations of a brain abscess result from alterations in intracranial dynamics (edema, brain shift), infection, or the location of the abscess. Headache, usually worse in the morning, is the most prevalent symptom. Mental status changes may occur. Fever is present 53% of the time. Vomiting and focal neurologic deficits occur as well. Focal deficits including weakness and decreasing vision reflect the area of brain that is involved. As the abscess expands, symptoms of increased ICP such as decreasing LOC and seizures occur. Assessment and Diagnostic Findings Neuroimaging with CT scanning with contrast is used most often to identify the size and location of the abscess. Cerebritis is a small infection in the brain that can progress to an abscess if not detected or treated. Aspiration of the abscess, guided by CT or MRI, is often used to culture 2 and identify the infectious organism. MRI is the preferred study, because it provides higher resolution of the lesion and assists with identification of additional lesions if present. Medical Management Treatment is aimed at controlling increased ICP, draining the abscess, and providing antimicrobial therapy directed at the abscess and the main source of infection. Large IV doses of antibiotic agents are given to penetrate the blood– brain barrier and reach the abscess. The choice of the specific antibiotic medication is based on culture and sensitivity testing and directed at the causative organism. Antibiotics should be started as soon as possible; the initial antibiotic started typically is ceftriaxone combined with metronidazole, which will be adjusted based on the culture and sensitivity results. A stereotactic guided aspiration may be used to drain the abscess and identify the causative organism. Surgical excision is not the preferred method, except in cases where the abscess is large and multilobulated. Corticosteroids may be prescribed to help reduce the inflammatory cerebral edema if the patient shows evidence of an increasing neurologic deficit. Anticonvulsant medications may be prescribed to prevent or treat seizures. Nursing managements Nursing managements are according to the signs and symptoms appeared, lobes involved, inflammatory processes if present, monitoring of neurological status and administration of medications as prescribed. If the health condition becomes deteriorated the other supportive nursing interventions for patient and his family are implemented. 3 4