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MeningitisInflammation of the membranes and the fluid space
surrounding the brain and spinal cordTypes
Septic due to bacteria (Streptococcus pneumoniae, Neisseria meningitidis)
Aseptic due viral infection, lymphoma, leukemia, or brain abscess
N. meningitidis is transmitted by secretions or aerosol contamination and infection is most likely in dense community groups such as college campuses
Manifestations include headache, fever, changes in LOC, behavioral changes, nuchal rigidity (stiff neck), projectile vomiting, positive Kernig's sign, positive Brudzinski’s sign, and photophobia, ? seizure.
Kernig’s Sign
When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended
Brudzinski’s Sign
When the patient's neck is flexed (after ruling out cervical trauma or injury), flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity
Assessment and Diagnostic Findings
Bacterial culture and Gram staining of CSF and blood are key diagnostic tests (Fischbach, 2002).
The presence of polysaccharide antigen in CSF further supports the diagnosis of bacterial meningitis
Medical Management Prevention by vaccination against
Haemophilus influenzae and S. pneumoniae for all children and all at-risk adults
Early administration of high doses of appropriate IV antibiotics (should cross BBB) for bacterial meningitis
Dexamethasone Treatment dehydration, shock, and seizures
Nursing ManagementFrequent/continual assessment including VS and
LOCProtect patient form injury related to seizure
activity or altered LOCMonitor daily weight, serum electrolytes, urine
volume, specific gravity, and osmolalityPrevent complications associated with immobility Infection control precautionsSupportive careMeasures to facilitate coping of patient and
family
Brain AbscessCollection of infectious material within brain tissueRisk is increased in immunocompromised patientPrevent by treating otitis media, mastoiditis, sinusitis,
dental infections, and systemic infections promptlyManifestations may include headache that is usually
worse in the morning, fever, vomiting, neurologic deficits, signs and symptoms of increased ICP
Diagnosis by MRI or CTCT-guided aspiration is used to identify the causative
organisms
Brain AbscessMedical management
Control ICPDrain abscessAdminister appropriate antibiotic therapy.
Corticosteroids may be used to treat cerebral edema
Nursing managementFrequent and ongoing neurologic assessment and
of responses to treatmentAssure patient safety and protect from injuryProvide supportive care
EncephalitisAcute, inflammatory process of the brain tissueCauses include viral infections (herpes simplex [HSV]), vector-
borne viral infections (West Nile, St. Louis), and fungal infections
Manifestations may include headache, fever, confusion, changes in LOC; rash, flaccid paralysis, Parkinson-like movements
Medical managementAcyclovir for HSV infection, amphotericin and/or other
antifungal agents for fungal infection Nursing management
Frequent and ongoing assessment Supportive care
Multiple Sclerosis (MS)A progressive immune-related demyelination
disease of the CNSClinical manifestations vary and have different
patternsFrequently, the disease is relapsing and remitting,
has exacerbations and recurrences of symptoms including fatigue, weakness, numbness, difficulty in coordination, loss of balance, pain, and visual disturbances
Medical managementDisease-modifying therapies; interferon -1a and
interferon -1b, glatiramer acetate (Copaxone), and IV methylprednisolone
Symptom management of muscle spasms, fatigue, ataxia, bowel and bladder control
Process of Demyelination
Clinical ManifestationsHas a relapsing remitting (RR) course. With each
relapse, recovery is usually complete.Quadriparesis, cognitive dysfunction, visual loss. Fatigue, depression, weakness, numbness,
difficulty in coordination, loss of balance, and pain. Visual disturbances due to lesions in the optic nerves or their connections may include blurring of vision, diplopia (double vision), patchy blindness (scotoma), and total blindness.
Spasticity (muscle hypertonicity) of the extremities
Multiple Sclerosis treatmentNo cure exists for MSTreatment directed toward to relieving the
patient's symptoms and provide continuing support.
Immunosuppressive agents
Myasthenia GravisAutoimmune disorder affecting the myoneural junctionAntibodies directed at acetylcholine at the myoneural
junction impair transmission of impulsesManifestations
Myasthenia gravis, a motor disorder Initially symptoms involve ocular muscles; diplopia and
ptosis Weakness of facial muscles, swallowing and voice
impairment (dysphonia), generalized weakness, weakness affects all the extremities and the intercostal muscles, resulting in decreasing vital capacity and respiratory failure.
Myasthenia Gravis
Normal ACh receptor siteACh receptor site in
myasthenia gravis
Medical ManagementPharmacologic therapy
Cholinesterase inhibitor: pyrostigmine bromide (Mestinon)
Immunomodulating therapyPlasmapheresisThymectomy
Guillain-Barré SyndromeAutoimmune disorder with acute attack of
peripheral nerve myelinRapid demyelination may produce respiratory
failure and autonomic nervous system dysfunction with CV instability
Most often follows a viral infection Manifestations are variable and may include
weakness, paralysis, paresthesias, pain, and diminished or absent reflexes starting with the lower extremities and progressing upward; tachycardia; bradycardia; hypertension; or hypotension
Guillain-Barré SyndromeMedical management
Requires intensive care management with continuous monitoring and respiratory support
Plasmapheresis used to reduce circulating antibodies
Recovery rates vary, but most patients recover completely
Bell’s PalsyFacial paralysis due to
unilateral inflammation of the 7th cranial nerve
Manifestations—unilateral facial muscle weakness or paralysis with facial distortion, increased lacrimation, and painful sensations in the face, may have difficulty with speech and eating
Most patients recover completely in 3–5 weeks and the disorder rarely recurs.
ManagementMedical
Corticosteroid therapy may be used to reduce inflammation and diminish severity of the disorder.
NursingProvide and reinforce information and
reassurance that stroke has not occurred. Protection of the eye from injury; cover eye
with shield at night, instruct patient to close eyelid, use of eye ointment, sunglasses.
Facial exercises and massage to maintain muscle tone.