Unit vii

DISEASES AFFECTING THE NERVOUS SYSTEM

MENINGITIS – CEREBROSPINAL FEVER

Is the inflammation of the meninges of the brain and spinal cord as a result of bacterial infection.

ETIOLOGIC AGENT

Pneumococcus,Staphylococcus, Streptococcus and tubercle bacillus.

Neisseria meningitides (Meningococcus) Incubation period: 1-10 days Mode of transmission: Respiratory Droplet

ETIOLOGIC AGENT

Diagnostic test: Lumbar puncture X ray of spinal cord Gram staining Smear and blood culture Smear from petichiae Urine culture

CLASSIFICATIONS

1. Acute meningococcemia Invade the blood stream without involving the

meninges Nasopaharyngitis Petichial purpuric or ecchymotic hemorrhages

scatter over the entire body Adrenal lesions Adrenal medullary haemorrhage Water house-

Friderichsen syndrome Fulminnt type

CLASSIFICATIONS

2. Aseptic Menigitis3. A. syndrome characterized by

headache,fever,vomiting and meningeal symptoms

4. Fever 40 oC

CLASSIFICATIONS

5. Signs of meningeal irritation Stiff neck or nuchal rigidity Opisthotonus + Brudzinki sign + kernig’s sign Exaggerated and symmetrical deep tendon

reflexes

CLASSIFICATIONS

6. Sinus arrhythmia, irritability, photophobia, diplopia and other visual problems

7. Delirium, deep stupor and coma8. Signs of intracranial pressure

bulging fontanels in infants nausea and vomiting (projectile) blurring of vision alteration in sensorium

COMPLICATIONS MENINGITIS

1. Subdural effusion2. Hydrocephalus3. Deaf-mutism4. Blindness of either one or both eyes5. Otitis media and mastoiditis6. Pneumonia or bronchitis7. Subdural effusion8. Hydrocephalus9. Deaf-mutism10. Blindness of either one or both eyes11. Otitis media and mastoiditis12. Pneumonia or bronchitis

MODALITIES OF TREATMENT

1. If meningitis is left untreated it has a mortality rate of 70-100%

2. Treatment includes appropriate antibiotic theraphy and vigorous supportive care

3. IV antibiotics are usually given for two weeks and are followed by oral antibiotics such as

ampicillin cephalosporins (ceftriaxone) aminoglycosides


4. Digitals glycoside (digoxin) is administered to control arrhythmias

5. Mannitol is given to decrease cerebral edema

6. An anticonvulsant or sedative is needed to reduce restlessness and convulsions

7. Acetaminophen us helpful in relieving headache and fever

NURSING MANAGEMENT

1. Assess neurologic signs often. Observe the patient’s level of consciousness and check for increased intracranial pressure (ICP) (signs include plucking at bedcovers, vomiting, seizures and changes in motor functions and vital signs).

2. Watch out for the deterioration of the patient’s condition, which may signal an impending crisis.

3. Monitor fluid balance. Maintain adequate fluid intake to avoid dehydration, but avoids fluid overload because of the danger of cerebral edema. Measure central venous pressure and intake and output.

NURSING MANAGEMENT

4. Watch out for anyh adverse reaction to the antibiotics and/or other drugs. Avoid infiltration and phlebitis

5. Position the patient carefully to prevent joins stiffness and neck pain. Turn the patient often avoid pressure sores and respiratory complications. Assist with ROM.

6. Maintain adequate nutrition and elimination7. Ensure the patient’s comfort

NURSING MANAGEMENT

8. Provide reassurance and support to the patient and the family

9. Follow strict aseptic technique when treating patients with head wounds or skull fractures

10. Isolation is necessary, especially if nasal culture is positive

PREVENTATION

1. Several caccines are available to protect against ceratin types of meningitis

2. Teach client with chronic sinusitis or other chronic infections the importance of proper and prompt medical treatment

3. Give rifampicin as prophylaxis , as ordered by the physician

4. Implement the universal precaution

RABIES

Hydrophobia/Lyssa a specific acute viral infection;

communicated to man by the saliva of an infected animal

RABIES

Causative Agent Rhabdovirus

Incubation Period 1 week to seven –and –a half in dogs Ten days to fifteen years in human

Incubation depends on the following factors Distance of the bite to the brain Extensiveness of the bite Species of the animal Richness of the nerve supply in the area of the bite Resistance of the host

RABIES

Period of Communicability 5 days before the onset off symptoms Mode of Transmission: Bite of a rabid animal Break on the skin

CLINICAL MANIFESTATIONS

1. Prodromal /Invasive phase A. fever,anorexia=,malaisesorethroat,copious

salivation,lacrimation,irritability,hyperexcitability Apprehensiveness,restlessness There is pain at the original site of bite Sensitive to light Pain and aches in different parts of the body Anesthesia, numbness and tingling burning and

cold sensations may be felt Mild to difficulty in swallowing.


2. Excitement or neurological phase Marked excitation and apprehension Delirium associated with nuchal rigidity Maniacal behaviour Severe painful spasm of the muscles of the

mouth Aerophobia Profuse drooling Tonic contractions of the muscles Death may occur


3. Terminal /paralytic phase Quiet and unconscious Bowel and urinary control Sapsms cease and there is progressive paralysis Tachycardia and labored irregular respiration Death occurs due to paralysis, circulatory

collapse

DIAGNOSTIC PROCEDURES

Fluorescent rabies antibody [presence of negri bodies in the dogs brain


1. Wash the wounds from the bite and scratches with soap and running water for at least three minutes

2. Check the patient immunization status . 3. Tetanus antiserum infiltrated around the

wound or IM after neg. skin test4. Give anti-rabies vaccines both passive and

active depending on the site and size of the bite.

NURSING MANAGEMENT

1. Isolate the patient2. Give emotional and spiritual support3. Provide optimum comfort4. Darken the room and provide a quiet

environment5. Should not bathed and there should not be

running water in the room or within the hearing distance of the patient

6. If IV fluid has to be given , it should be wrapped.

7. Concurrent and terminal disinfection should be carried out.

PREVENTION AND CONTROL

1. Vaccination of all dogs2. Enforcement of regulation for the pick-up

and destruction of stray dogs3. Ten-to fourteen day confinement of any dog

that has bitten a person4. Availability of laboratory facilities for

observation and diagnosis5. Providing public education especially to

children on the avoidance and reporting of all animals that appear sick.

POLIOMYELITIS

INFANTILE PARALYSIS /HEINE –MEDIN Disease Is an acute infectious diseases characterized

by changes in the CNS which may result in pathologic reflexes, muscle spasms, and paresis or paralysis.

POLIOMYELITIS

Causative Agent Brunhilde Lansing Leon Incubation period 7-21 days for paralytic cases Period of Communicability 3days 3 months of illness

POLIOMYELITIS

Mode of Transmission:Person to person

Direct contact with infected oropharyngeal secretions and feces

Indirectly through flies,contaminated water,food untensils and other articles.

Predisposing causes of Poliomyelitis Age 60% are under 10 years of age Sex. Males are more prone to the disease Heredity not hereditary Environmental and hygienic condition

POLIOMYELITIS

Types of Poliomyelitis1. The abortive

Not invade the CNS Headache and sorethroat Slight and moderate fever Occasional vomiting Low lumbar pain The patient usually recovers within 72 hours Accounts of 4-8%

POLIOMYELITIS

2. Non paralytic A. all the signs of the abortive type are observed Types of spasm of thew muscles of the hamstring Changes in deep and superficial reflexes Pain in the neck back arms leghs and abdomen Inability to place the head in between the knees Positive pandy’s test Transient paresis may occur Meningeal irritation persisting for about 2 weeks

POLIOMYELITIS

3. Paralytic Positive Hoynes sign Paralysis occurs Less tendon reflexes Positive kernig’s sign Weakness of the muscles Hypersensitivity to touch

PARALYTIC

Spinal paralytic Paralysis occurs in muscles innervated by the

motor neurons of the spinal cord

Bulbar

Bulbospinal

TETANUS

Tetanus is an infectious disease caused by Clostridium tetani, which produces a potent exotoxin with prominent systematic neuromuscular effects such as generalized spas modic contarctions of the skeletal musculator

TETANUS

INCUBATION PERIOD three days to three weeks in adults and three to

thirty days in the new born

CAUSATIVE AGENT Clostridium tetani Sources of infection : Animal and human feces Soil dust Plaster of paris unsterile sutures pins and

scissors and rusty materials

TETANUS

Mode of transmission Rugged , traumatic wounds and burns Umbilical stump Babies delivered to mothers without tetanus

toxoid immunization Dental extraction circumsion and ear piercings Unrecognized wounds


1. Neonate Feeding and difficulties and sucking difficulties Cry excessively cry is short and voiceless Suck results in spasms and cyanosis Fever due to infection and dehaydartion Jaw becomed so stiff that the babay cannot suck

or swallow Tonic or rigid muscular contractions, spasms or

convulsions are provoked by stimuli Cyanosis and pallor develop Severe cases may end in flaccidity exhaustion

and finally death


2. Older children and adulta) Tetanus remains localized signs of onset are

spasm and increased muscle tone near the wound

b) If it becomes systemic or generalized signs include

If hypertonicity , hypereactive deep tendon reflexes tachycardia , profuse sweating, low grade fever and painful involuntary muscle contractions

Neck and fatal muscle rigidity ( trismus) Grinning expressions ( risus sardonicus) –

pathognomonic sign of the disease Board like abdomen/abdominal rigidity

OPISTHOTONUS

Intermittent tonic convulsions lasting from several minutes which may result in cyanosis and sudden death.

In severe cases Laryngospasm is followed by the accumulation of secretions in the airways.

Fracture of the vertebrae may occur during spasms.

OPISTHOTONUS

COMPLICATIONS :Laryngospasm:

Hypostatic Pneumonia Hypoxia due to laryngospasm and decreased

oxygen Atelectasis and pneumothorax Traumatic glositis and mecroglossia


1. Specific Within 72 hours after punctured wound, the patient

should receive ATS,TAT or TIG especially if the patient not have previous immunization

Tetanus Toxoid .5 cc IM PEN G Na. Muscle relaxant

2. Non specific Oxygen inhalation NGT Feeding Tracheostomy Adequate fluid , electrolyte and caloric intake

GOOD NURSING CARE

Maintain an adequate airway Provide cardiac monitoring Maintain an IV line for medication and

emergency care if necessary Carry out efficient wound care Avoid stimulation : warn visitors not to upset

or overl;y stimulate the patient Prevent contractures and pressure sore Watch out for urinary retention Closely monitor vital signs and muscle tone Provide optimum comfort measures.

PREVENTION

Active Immunization DPT for babies and children

Health & Medicine

Unit vii