Neuro I Ken PDF

Nursing 2640 NEURO I thinkBrain Spinal cod a sensation Cognitive Kelly Craft MSN,RN 0  Anatomy and Physiology Review Understand the structure and functio...

Nursing 2640 NEURO I thinkBrain Spinal cod a sensation Cognitive Kelly Craft MSN,RN 0  Anatomy and Physiology Review Understand the structure and function of the central nervous system and peripheral nervous system CNS- brain and spinal cord PNS- spinal nerves, cranial nerves and autonomic nervous system Autonomic Nervous system (ANS)- sympathetic and parasympathetic nervous system  Neurologic Changes with Ageing Motor affect mobility + Sensory Slow movement Decreased response time and sensory perception falls , balance issues can't laten themselves like we could Sensory Loading… , 2CtOily LIFGADLS Fallrisk Pupil changes dec restricts light. (Dont See as Wall) Cant adapt to light as wall Hearing loss Touch sensation manno t something is there realize Cognitive (loss of cerebral neurons) Cant store , perceive , or use information (challenging Memory deficits normal part of aging Disability or Infection Disease on top of this -> makes worse  Arosides (Right to left) Assessment Develop and establish basding Normal or new ? ↳ Neuro frequent Neuro impact assesments (to see if something has changed) Appearance Do then turn t look at you ? Not looking at you ? Speech how do then talk Siurred speech facial movement (facial droop ?) not good expression Confused ? Vision PERRLA ? Vision issues ? Oriented ? what is affect like ? appropriate What is there level of or non appropriate ? consciousness Mobility Response time can thou walk ? unstead gait grip strength push-pull Medical and Family history Weakness ? migranes · · huntingsons Disease  Know the Forms - Assessment why you here ! What happened Mental Status/Orientation Memory/Attention loss of memory (snort term) Loading… ↳ early sign of neuro prob Tell them something - 10 min la for , don't Babinski Inot normal in saults) Wumbness Sensory Function Prw/spinal cord/spinal newvanjury Spinal cord know whal Youre talking ad Proprioception Tumor/infor trauma Tingling loss of this - loss of position sens a lability (brain To control Contralateral sensation on the Or Spinal cora prop limbs W/8 actually looking at loss of Opposite sid of the body Them)  Assessment Weurologist Al this tests cranial Nervos Will test CNs function Motor Function grip strength Dusn/bull Decortication ] posturing Boutcome = possib a anoxic brain ins Decerebration Exposedto Painful Stimulus Isternal rub) Pronator drift havopt hold arms up test if At hes upper extremity Weakness (palms up) sidary weakness will pronate or turn inward t fall-positive common in strolle Cerebellar Function , DTS gaittequilibraum in ambulatory patient Reflexes Babinski signStrokebottomoffoot toesflair  Both abnormal When painful Stimulus is applied Assessment posturing ① outcomes Neuroprob Decortication of booly "pullarms into care the Plantar Flexion of feet Decerebration ↳ extends arm out (pronation) Planter flexion of feet 0 Frequantassessmentofneuro Assessment identify change Rapid Neurologic Assessment or “neuro check” Quickly verse LOC Orientation Movement of extremities strength PERRLA GCS (Glasgow Coma Scale)Testing Patients (O Assessment Describe assessLOC higher the LOL number-more Neurologically infact lower-less Neuro function  Laboratory Assessment BMP, COMP panels dectrolytes Isoolium , Glucose) CBC bleedingtimes HH inf ? (WBC) ABG imbalances Locimpairment Resp acidosis = holding onto Coz (sedated) Blood culture passBBBtinbrain Septic ? blood inf ?  Imaging Assessment Skull and spine X-ray trauma bonecrosion curvature fractures & Cerebral angiography (blockages) Cerebral circulation IV Our used (neck allergies Ct Scan/MRI Kidneys ~ contrast bleeding infarction Mrl-better worwo Loading… Tumors , , , DefinitiveDX worwlo contrast more$ hudrocephalus stoolsEcerebrofluid EMG/EEG chromyography · Nerve-musc > electrical activity in the brain (seizures) disorders Lumbar Puncture Spinal tap AKAISubarachnoid Space Withdrawi carebrospinal Fluid Diagnostic  affects patients + family life altering laisabling Disorders of the CNS all affeCT - which controls mobility + Sensory CWS Cognition Headache Seizure Epilepsy Meningitis Increased ICP Encephalitis Parkinson's disease Huntington’s disease 0 Headaches Definition—diffuse pain in the head Classification Migraine Classic (Migraine with aura) Common (Migraine without aura) Atypical (Menstrual and Cluster headache) dlss2010 0 Migraine Headache More common in females than males Begin in adolescence or early adulthood Additional common causes: Neuronal hyperexcitability Vascular changes Hormonal Environmental factorssmoking ·vanen May have positive family history May have genetic basis 0  Pathophysiology of Migraines Serotonin drops ! Functional changes in the trigeminal nerve system a major pain pathway in your nervous system, and by imbalances in brain chemicals, including serotonin, which & regulates pain messages going through this pathway. During a headache, serotonin levels drop. Causes the trigeminal nerve to release substances called neuropeptides, which travel to your brain's outer covering. There they cause blood vessels to become dilated and inflamed. The result is headache pain. 0 Triggers….. Triggers Stress/Anxiety Hormonal changes estrogen/ progesterone Ingestion of certain foods Fooddiarywhat its to find out Chocolate linked to Caffeine Red wine MSG Artificial Sweeteners Sensory stimulus bright lights Cold/ not Physical slep factors exercise lackOf Tired Changes in environment 0  Benavior changes Classic Migraine cravings Weird food AKA: Migraine with an Aura First phase Auras coming feel it Several minutes up to an hour before your headache begins. Usually involve visual changes Diplopia Sparkling flashes of light Dazzling zigzag lines in your field of vision Slowly spreading blind spots in your vision Neurological changes include Numbness of lips or tongue Tingling, pins-and-needles sensations in one arm or leg--Unilateral weakness Drowsiness Vertigo Rarely Confusion Aphasia diff Speaking. Weirdchangeinbehaviorfoodcraving 0  Classic Migraine AKA: Migraine with an Aura Second phase Third phase -Nausea -Pain changes -Vomiting from throbbing -Pain begins in to dull ache the temple -Throbbing within an hour 0  Common Migraine want lay down darkroom closeS AKA: Migraine without an Aura Moderate to severe pain Unilateral pain Some experience pain on both sides Pulsating or throbbing quality Pain that worsens with physical activity Pain that hinders your regular daily activities Nausea and/or without vomiting Photophobia or sensitivity Phonophobia to light Duration- 4-72 hours 0 Atypical Migraine Less common Include menstrual and cluster migraines Headache lasting more than 72 hours Facial pain mod-sovere Abdominal issues W cramping Neurological effects resemble Stroke arm paralysis (temporary) dlss2010 0 Nursing Interventions Manage Pain priorityassoonasyouexperiencesisof * gaffe Abortive and preventative Abortive therapy (first) &arly TX alleviating pain during the early aura phase Acetaminophen and NSAIDs are usually effective for mild migraine headaches Ergotamine derivatives (Ergotamine, Cafergot) ↳ More severa Triptans (Imitrex, Zomig) ↳ risk of rebound headache Lusually more severe) 0 Preventive Medications Inc effectiveness Of abortive therapy as wall Beta blockers Eine Propranolol (Inderol) Timolol (Blocadren) Calcium channel blockers (will BD dont get up fast + HHR am in Verapamil (Calan) monitor Tricyclic Antidepressants bcof serotonin drop Do not use in older adults long half-life Amitriptyline Nortriptyline (Pamelor) Protriptyline (Vivactil) 0 Prevention Dont Stress Keep a diary justfoodbutwhatyouweredoingbefore startedhappeningexercis something Avoid triggers Exercise regularly Reduce the effects of estrogen HRT normone replacement therapy OC’s Oral contraceptives Quit smoking Rest and relax Starthavingauragododarkquiteroom 0  Cluster Headache most painful Rare occurs in cyclical pattern Cluster) Risk factors More common in men Small or no genetic link or family link Not linked to diet Cause unknown Abnormal function of hypothalamus Increased activity Abnormal levels of hormones Melatonin, testosterone 0  Signs and Symptoms · pisodic onceadaysametimeaday Miosis pupil Constriction Unilateral severe, burning of or excruciating pain Facial sweating Seasonal Eyelid edema Spring and fall Episodic Radiating to forehead, Occurs same time a temple and cheek day for 4-12 weeks Ipsilateral tearing of the eye Side pain is on Duration minutes to Rhinorrhea Runny nose hours may have remission Ptosis for a ma 0  Management of Cluster H/A Drug Therapy O not effective Same as migraine Triptans, ergotamine, antiepileptic drugs Calcium Channel blockers During attack periods Sunglasses Oxygen 100% thru mask-quicker relief Surgical management truing to put painful may not feel certain Norve toSlep Percutaneous stereotactic apply heat via dectrode pain (algor tooth pain) rhizotomy (PSR) for no sec (lauterize) 0 mayhave to be repeated  Simple or Complex Seizures and Epilepsy dapenas On area of brain Seizure: abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain; may result in alteration in consciousness, motor or sensory ability, and/or behavior Excessive electrical naurous temporary abnormal Sensation or visual disturbances chronic Epilepsy: Two or more seizures; a chronic disorder with recurrent unprovoked seizures at least 24 hours apart 0 Seizures and Epilepsy Epilepsy affects over 3 million Americans of all ages as common as breast cancer 80 % control them with medications Three broad categories of seizure disorders Generalized Seizures Partial Seizures Unclassified Seizures 0  Generalized Seizures lose concsiousness Affectsentirebrain unaware of surroundings Affect the entire brain—both cerebral hemispheres Sumptoms bodyaffect entire Types Tonic-Clonic Tonic Loading… Clonic Absence Myoclonic Atonic 0  favor Eout with drawl ·trolytes meds Benzowithdrawl Blood sugar Illegal drugs withdrawl Tonic-Clonic seizure causedbyabnormalelectricalactivity throughout thebrainso sisaffectthe entirebody Sometimes called "grand mal" seizure Last 2-5 minutes Tonic phase Loss of consciousness occurs Stiffening/rigidity of muscles Particularly arms and legs Clonic phase The muscles go into rhythmic contractions, alternately flexing and relaxing. 0  When did it start ? how did it last ? long Symptoms ? Whatdidyousee Tonic-clonic seizure Howweretheyinthepostictalperiod Symptoms: Bite tongue Incontinent Dowlbladder Unresponsiveness after convulsions postictal period 10+5 min post Seizure Fatigue, acute confusion and lethargic lasting up to 1 hour Severe headache 0  tonic then clonic Sets Tonic seizure Abrupt increase in muscle tone Loss of consciousness 30 seconds to several minutes 0 Clonic seizure CanhavechangeinLOCas well Rhythmic jerking of the muscles Lasts several minutes 0  Dunderlying Absence seizure cause Sometimes called "petit No confusion but no memory of mal" seizure the incident Most common in childhood Tend to run in families May last from a few seconds to a minute Blank stare Appears to be daydreaming Automatisms involuntary behavior (smacking · lips aut fluttering pulling at Returns to baseline , , clothes) immediately after seizure 0 Myoclonic seizure "Slopjerk" 11.45 Quick muscle jerk or stiffening Usually of arms or legs Symmetrical Asymmetrical Often occurs early in the morning Short lasting Usually does not cause loss of consciousness May be triggered by lack of sleep or too much alcohol 0 Atonic (Akinetic) seizure helmets to protect nodd A sudden loss of muscle tone that makes a person drop to the floor “Drop Seizure”happensw owarning Commonly associated with injury from falls Rare and are usually confined to childhood May last a few seconds Postictal confusion Poor response to drug therapy 0  Generalized Seizures https://www.youtube.com/watch?v=w5Jv0SZRwwk 0 Partial Seizures (focal or local) Abnormal electrical discharge takes place only in a limited area of the brain A cerebral hemisphere either One A lobe of the brain Types Simple partial Complex partial 0 Depends on What part of brain 0 Complex partial seizure: Often involves the temporal lobe & called psychomotor seizures temporal lobe seizure May lose consciousness & (syncope, "Black out”) lasting 1-3 minutes Automatisms non-purposeful movements rubbing hands smacking lips fidgeting with objects grinding teeth May or may not be able to recall any of the events that happened during the seizure---Amnesia May progress to a generalized tonic-clonic seizure, tonic or clonic 0 Simple partial seizure Can't move or can to progress Sprach complex or generilized Consciousness is not altered awale + can remember May have an aura Brief changes in how things look, taste, feel or sound “déjà vu” Last a few seconds May involve body movement Asymmetrical Experience an unusual sensation Autonomic changes Increase in heart rate Flushing Epigastric discomfort 0 Complex partial seizure and Simple partial seizure http://www.youtube.com/watch?v=e10FSjHvV74&NR=1 0 Unclassified Seizure or idiopathic Donotfit inothercategories Account for half of all seizure activity Unknown cause 0  non compliant ? see too low ↳ more or too nigh ? seizures Anticonvulsants Tropt bra Seizures Medications Needltherapeutic range Valproate (Depakote) Phenobarbital (Barbita, Luminal) Determineranger dependent Primidone (Mysoline) goingon on whats Clonazepam (Klonopin) Valproic acid (Depakene) Ethosuximide (Zarontin) Carbamazepine (Tegretol) Gabapentin (Neurontin) Oxcarbazepine (Trileptal) Lamotrigine (Lamictal) Topiramate (Topamax) Phenytoin (Dilantin)lotsofdruginteractions * * Level 10-20 mcg/ml t fnEtafel rhhigae 1 1 8 8 ftp.Yetjs AED Levels & Tegretol 4-12 mcg/ml * Dilantin 10-20 mcg/ml Depakene 50-100 mcg/ml Zarontin 40-100 mcg/ml Mysoline 5-12 mcg/ml 0  Risk Factors Brain lesionstumor Éitidepressants Toxins Benzodiazapine Head Injury Overdose or abrupt Stroke withdrawal from some prescription drugs or Metabolic alcohol Disturbances Altered levels of Infections sodium, calcium, or Meningitis magnesium Encephalitis Hypoglycemia HIV Hypoxiaanoxicbraintissueinjury High Fevergrowoutof it Hepatic/Renal failure can't filter Toxins build up 0 Risk factors New onset in Elderly HTN, Cardiac disease, DM, Stroke, Alzheimer's Genetic Considerations Defective genes Cerebral Palsy lack of oxygen, infection, or trauma during birth or infancy. Febrile Seizures only a few develop epilepsy Triggers Alcohol consumption, physical activity, emotional stress, excessive fatigue hormonal changes of the menstrual cycle, sleep deprivation, flickering or flashing light 0 Obtaining Patient History Ask lots of questions trying to figure what Patient's age Kind Family historyAnyfamilyhaveaseizure Aura (preictal phase)Couldtheyfeelitcomingon History of any previous provoked seizure Time of dayTonicclonicholdsbreathemayturnbluecyanoticneedtotimeseizurestoo Status epilepticus Deadly Prescribed medications Trauma anad inguru ETOH/Illicit drug abuse Jiri 0  Diagnostic identify CT scan cause mac for blooding tumors hydrocephalus MRI , , nowonsat PET scan If patient has had cancer mak for mots Laboratory studies Metabolic or other disorders that may contribute to disorder Electroencephalogram (EEG) Snortorextended Simple and painless stra Brain activity recorded under normal conditions Then the person is exposed to various stimuli, such as bright or flashing lights, to try to provoke a seizure. truing to provold Start a saizure 0 During a seizure, electrical activity in the brain accelerates, producing a jagged wave pattern. Such recordings of brain waves help identify a seizure disorder. Different types of seizure have different wave patterns 0 Interventions Antiepileptic/anticonvulsant Drugs Never stop aDrupHy Introduce one at a time until achieve seizure controlmayaddanother Blood levels therapentic ranges so important are Food and drug interactions Citrus fruits Grapefruit Drug-Drug interactions & Do not give Warfarin and Dilantin In efficacy of these MGQS Prmight get Toxic blood to thin 0  Care of the patientNEVERforcemouthopen Protect the patient from injury- clear the area around the patient of anything hard or sharp Turn him or her gently onto one side prevent aspiration If not possible to turn the whole patient turn the head Do not try to force the mouth open with any hard object or with fingers Efforts to hold the tongue down can injure teeth or jaw. A person having a seizure CANNOT swallow his tongue Apply Oxygen-Maintain airway Prevent cyanosis may need intubation Suction patient if necessary Isecrations/vomit) Monitor VS Keep calm and reassure other people who may be nearby Don't hold the person down or try to stop his movements Loosen any restrictive clothing 0 Seizure Precautions Oxygen and suctioning equipment with an airway should be readily available INTlock may be necessary IVINMEOS) Saline Side rails vs Padded side rails Follow agency policy Place bed in lowest position Bed rest Never insert padded tongue blades into the patient’s mouth during a seizure 0 Nursing Observation and Documentation Date, time, and duration of seizure Describe the seizure---Typecansaywhattypewethinkit is Sequence of Seizure Familycalledmeintoroom Observations during seizureurinaryincont Seizure preceded by an aura Patient activity after seizure How long for patient to recover—allow pt to rest HowweretheyinthePost ff fÉgdidthis periodlast 0  Status Epilepticus Medical emergency Continuous clinical or electrical activity lasting at least 30 minutes Common causeslabswillcapture Withdrawal from Antiepileptic drugs Infections Withdrawal of alcohol or drugs Head trauma Cerebral edema Metabolic disturbances 0 Status Epilepticus Treatment 0Establish an airway throughthe done May need to intubation9may and oxygen nose Establish IV access Labs- ABG—metabolic disorder Check AED levels Toxic For continuous monitoring, admit pt to intensive care unit If untreated brain damage or death may occur 0 Treatment continued… Statusepileticusorseizureoccurring 5-10 mg Diazepam (Valium) IV push or rectal Diastat (Diazepam Rectal Gel) repeat if needed at 10-15 min intervals up to 30 mg 4 mg Lorazepam (Ativan) IV over 2 min may be repeated to a total of 8mg Benzodiazipine to try and stop the Then:once558 Seizure 8 Loading dose of Phenytoin (Dilantin) IV at 50 mg/min (faster may cause cardiac arrest) & Check serum drug level at 6 and 12 hours and 2 wks after oral medication started OR cardiogenic affect less Fosphenytoin (Cerebyx) 100-150 mg/min IVPB 0 Surgical Management VAGAL NERVE not for generalized Seizures STIMULATORWill stilltakeanticonvulsants magnetithem alltimes Control of continuous simple or complex partial & seizures. - Patient experiences the aura and rubs the magnet over the VNS device, resulting in aborting the seizure2040 oftime Under Left Collarbone around Nerve wireswrapped vagus 0  0  Due to avirus or Infants and daerly-higher risk Dacterial that Meningitis Started somewhere as in the pooly lears upper respins) ,. Inflammation of the meninges of the brain and spinal cord managed home Viral- Self limiting with complete recovery Bacterial- Potentially life Need to isolate anyone whos Brain the bacterial damage threatening so wa can been around The patient disability Start them Hezas to take hearing loss on the right ABX ABX Needto TN quickly or 18999 to Oath 301 http://www.youtube.com/watch?v=xDeraSNI33w&feature=player_detailpage 0  Enterscas through the blood Stream ot the blood brain barrier Possible causes of Meningitis Predisposing condition Populations Otitis media Immunosuppressed Pneumonia Chronic debilitating Sinusitis disease Sickle cell anemia Ispleen enlargement Tongue piercing Increase the likelihood of Tooth Abscess developing meningitis Brain or spinal surgery Penetrating trauma Ruptured cerebral abscess Skull fracture 0 Meningitis same symptoms for viral or bacterial moresevere Meningitis is inflammation of the meninges that results in the occurrence of meningeal symptoms Headache Nuchal rigidity (Stiff nock) tuckchintochest Photophobia Pleocytosis ↳ increased number of white blood cells in the cerebrospinal fluid (CSF), Increased intracranial pressure (ICP) normal ICP is 5 - 15 mmHg decreased LOC from9in CP 0 Viral Meningitis caused by other Viruses Most common & Clinical manifestations Affects the cerebral cortex Fever (white matter) and the meninges Photophobia Aseptic meningitis (no URI symptoms exudate) Headache cloudyCSF No organisms found in CSF Myalgias (muscle aches) Associated with varicella Nausea/vomiting zoster virus, mumps, herpes simplex virus and HIV Treatment Associated with Enteroviruses Glvirus palliative Sumptom management ↳ Maculopapular rash * 0 Bacterial meningitis AKA Meningococcal meningitis medical emergency (may die within 24 hours) Meningococcal meningitis mortalityrate Affects the meninges, subarachnoid space and brain tissue Occurs in outbreaks (highly contagious) vortagions *College dorms, military barracks, crowded living spaces *Fall and winter Types *Streptococcus pneumoniae (vaccine) meningitis *Neisseria meningitis * & Droplet precautions glores gown mak Neisseria meningitis and H. influenza (vaccine) 0 History Bacterial Symptoms more serve History of exposure to a patient with a similar illness Fever, headache, neck stiffness, photophobia, nausea, vomiting, and signs of cerebral dysfunction lethargy, confusion, coma Elicit a history of sexual contact Geographic location and a travel history 0  Watch LOC ! Clinical manifestations Fever Cranial nerve dysfunction III, IV, VI, VII, VIII Severe headache Nuchal rigidity Generalized muscle aches May have changes in LOC if ICP is and pain Weakness numbness increased long sidea) Hemiparesis, hemiplegia, and Exudate causes cerebral edema - decreased muscle tone ache Seizures With Dacterial Nausea and Vomiting Risk for saienres ! IP Eyes changes Tachycardia Photophobia Nystagmus fluttering Red macular rash Eye movements (Meningococcal meningitis) Need good and assessments Followfingerceyes If 0follow ICP http://www.youtube.co m/watch? v=eT71xfZ7P2k&feature=player_detailpage 0 Red macular rash Givirus or meningococcal meningitis (face, Chest Can be anywhere , 0  Cranial Nerve Assessment Nerve Name Function Test I Olfactory Smell Have patient smell a familiar odor II Optic Visual Acuity Have Patient identify fingers Visual Field Check peripheral vision kIII Oculomotor Pupillary Reaction Shine Light in the eye ↳IV Trochlear Eye Movement Follow finger without moving the head V Trigeminal Facial Sensation Touch the face Motor Function Have Patient hold mouth open k VI Abduces Motor Function Lateral Eye movements *VII Facial Motor Function Smile, wrinkle face, puff cheeks Sensory Tastes *VIII Acoustic Hearing Snap fingers by the ear Balance Rhomberg's Test IX Glossopharyngeal Swallowing and Voice Swallow and say "AH" X Vagus Gag Reflex Use tongue depressor XI Spinal Accessory Neck Motion Shoulder shrugging XII Hypoglossal Tongue Movement and Stick out tongue apply resistance with 0 a Strength tongue depressor  Clinical manifestations cont… Vascular Septic emboli Bacteria in blood can cause Hands and feet blockage to the hands feat ↳ cuts of circulation to hands+feat Increased Intracranial pressure Seizures Cranial nerve deficits Decreased LOC Papilledema Enlarged resses back in the ue ICP of the Left untreated increased ICP can lead to hydrocephalus or herniation and or deathHerniationdownwillpushonbrainstemwhichcontrolsHRrespirationsetc Shifting http://www.youtube.com/watch?v=kRf7qFXe2VM&feature=player_detailpage 0 Papilledema 0  Lumbar puncture Insertion of spinal needle into the subarachnoid space (between the third and fourth lumbar vertebrae) Contraindicated in clients with increased intracranial & pressure Octo Shifting (brain Tissue herniation) Empty bladder Position lateral recumbant side Knees drawn up to abdomen 0 0 Lumbar puncture Send the CSF specimens to the laboratory immediately i Instruct the patient to lie flat for several hours to reduce chance of headache.LittleleakofCSFcanirritatelyingflatshouldhelpsealoffto chance Monitor the patient carefully following the procedure. fluids Give the patient increased fluids for at least 24 hours after the procedure. Inform the patient that the physician will report the results of the lumbar puncture as soon as they are available. Spinal headache possible side effect Want to seal it off Du lying Flat 0 Laboratory Assessment of Meningitis Finding Bacterial Viral Lumbar Puncture Cerebrospinal fluid analysis Appearance Cloudy Clear exudate Computed tomography (CT) scan of brain prior to LPICP WBC Increased Increased Blood cultures Complete blood countbleedingtimesp.ttINR Protein Increased Increased Slightly Serum electrolytes Elevated Dilutional hyponatremia as a result of SIADH (often a complication of Glucose Decreased Normal bacterial meningitis) CSF pressure Elevated Varies 0 Nursing Care Meningitis ABC HOB elevated 30 degree VS q 2-4hrs Position-prevent pressure ulcers Neuro checks 2 4hr5 ROM q 4 hours Glasgow Coma Scale LOC Isolation Cranial nerve Droplet (Bacterial meningitis) Vascular assessment q 4 or Monitor and prevent complications more often septic emboli ICP Pain management HAmuscleaches Fluid and electrolyte imbalances IV fluids Seizures I&O and daily weight— Shock assess fluid retention and overload Monitor lab results and report as needed 0  Medical Treatment Wil 1-2 hr arrival to hospital Antibiotics (Bacterial) Tylenol Broad spectrum IV antibiotics might change Fever or headache until bacterial identifical then you have to Patients with increased ICP ABX and seizures Antiemetic's Phenergan Hyperosmolar agents Mannitol diuretic affect Zofran Anticonvulsants Preventative familyfriendshealthcare exposed workers Dilantin Neisseria meningitis - Steroids Cerebral Rifampin Gaama Cipro or Rocephin Decadron Haemophilus influenzae & Rifampin 0  31.56 Encephalitis learning disabilities Seizures Acute inflammation of the brain tissue and often surrounding the meninges Affects cerebrum, brain stem and cerebellum Usually caused by a virus can be caused by bacteria, fungi, parasite The virus travels to the CNS via the blood stream along then PNS or Cranial nerves or meninges Inflammation extends over the cerebral cortex, the white matter and the meninges causing demyelination of the neurons of the cortex= white matter destroyed This leads to hemorrhage, edema (can cause ICP with herniation and death), necrosis and development of small hollow cavities within the cerebral hemispheres. SCOC 0 ↳ alertness confusion 0 Encephalitis Patients are usually exposed to viruses resulting in encephalitis Arboviruses Mosquitoes West Nile Typically mild Few do develop the disease 2-15 days incubation Other possible sources of West Nile transmission if not bitten -Organ transplant -Blood products -Breast milk Ticks Public health concern in Europe and Asia 0 Encephalitis Amebic Meningoencephalitis Enteroviruses Fresh water ponds and lakes Coxsackievirus nasally enters Poliovirus Echovirus Herpes zoster H of forer blisters Most common non epidemic type (HSV1 high mortality rates) Cala sores 0  Manifestations of Encephalitis High fever Confused Changes in mental status—agitation (Herpes) Focal (specific) neurological deficits Motor dysfunctions Dysphagia, muscle tremors, spasticity, ataxic gait, increased deep tendon reflexes, mild weakness to hemiplegia, Meningeal irritation=Stiff neck Photophobia/ phonophobia Seizures Severe headache, N,V Joint pain 0  Manifestations of Encephalitis Symptoms associated with increased ICP Cranial nerve involvement Ocular paralysis, facial weakness, nystagmus Herpes zoster lesions Rash, severe pain, itching, burning or tingling 0  Diagnosis of Encephalitis Lumbar Puncture * PCR test (polymerase chain reaction) viral DNA or RNA in CSF Electroencephalography (EEG) Brain imaging edmalfinia Loading… CT scan or MRI Blood testing West Nile Virus 0 Nursing Care of Encephalitis Remember ABC’s-patient Palliative care airway Supportive care Assess LOC Decrease environmental Vital Signs q 2hr stimuli Seizure precautions Care coordination Usually not the same person 0 after Medical Management of Encephalitis Tylenol Steroids Fever and headache Decadron Antiemetics IV Antivirals Phenergan Acyclovir (Zovirax) Zofran used specifically for herpes encephalitis Anticonvulsants Dilantin 0  Parkinson Disease gets worse over time Progressive disease * 4 Cardinal Features--tremor, muscular rigidity, bradykinesia or akinesia and loss of postural reflexes Diagnosis in older adults but 4% of cases are