265 Exam #3
Math 8.4ml/hr, post-surgery if not urinating call HCP
Neuro
Meningitis-
Bacteria or Virus enters the CNS via blood
o Penetrating trauma
o Surgical procedures- not being sterile
o Brain abscess
o Basilar skull fracture- at base of the head
o Infection can also cause- eyes, ears, mouth
Bacteria- cloudy
o Occurs in “outbreak” such as dorm rooms
o Caused by Neisseria meningitides and streptococcus pneumoniae
o High mortality rate
Virus- clear, no WBC present
o Caused by virus such as Herpes Simplex, Varicella Zoster, mumps, HIV
o Low mortality rate
S/SX
Fever/chils
Nuchal rigidity- Bacterial place in droplet precautions
Photo/phonophobia
Headache
N/V
Rash
Altered LOC
Increased ICP
Muscle aches
SIRS/DIC/SIADH
Seizures
TX and DX
Lumbar puncture or CSF and C&S
o Virus- no organism found
o Bacteria- WBC
Culture everything:
o Blood/sputum/throat/urine cultures
Broad spectrums abx for bacteria
o Do not delay treatment waiting on results
Anti-viral for virus infections
,Encephalitis
Typically, a virus
Bacteria, fungus, parasites
Inflammatory response
Denegation of neurons
Demyelination of axons
Hemorrhage
Edema
Cell death of necrosis
Death
S/SX
Fever
Nuchal rigidity
Photo/phonophobia
Headache
N/V
Rash
Altered LOC
increased ICP
Fatigue
Joint pain
Vertigo/ataxia
Tremors/spasms
TX and DX
Antiviral acyclovir
Prevention of mosquito bites
o Limits outside time between dusk and dawn
o Wear protective clothing
o DEET- repellant
o Remove standing water
Lumbar puncture and DX- will be clear
EEG- checking brain waves to see if cells have started dying of
CT scan- see if any edema in brain
Nursing considerations for Meningitis/Encephalitis
Maintain ABC’s
Reduce stimuli
Treat the symptoms
Monitor
o Vitals and neuro q2-4hr and PRN
o Increased ICP
o LOC
o CSF from nose/ears
, Bacterial place in droplet precautions
Viral place in standard precautions
Encourage vaccinations for N. Meningitis
Spinal Cord Injury
Causes:
Car accident
Diving accident
Primary
Hyperflexion- chin to chest
Hyperextension- head to back of shoulders
Axial loading
Excessive rotation
Secondary- result of primary
Hemorrhage
Ischemia
Hypovolemia
Neurogenic shock
S/SX:
Complete- everything below the injury is paralyzed
Incomplete- partial cut, will have symptoms but will vary
Below the level of injury
o Numbness
o Tingling
o No sensation
General symptoms
o Bradycardia
o Hypotension
o Hypothermia
o Breathing problems
Initial Treatment- rehab paraplegic, If I’m hearing you… tell me more
ABC’s- cervical collar then intubate
Hypothermia- 89-93 degrees for 1-2 days
Treat hypovolemic shock with fluids- warm fluids, warm blankets
Decrease ICP- keep in cool room
Corticosteroids
Treat neurogenic shock
Muscle relaxers for spasms
Surgery
o Spinal cord stabilizations
o Wires and rods
o 2Spinal infusion
o Halo applied
Nursing Considerations
ABC’s
Math 8.4ml/hr, post-surgery if not urinating call HCP
Neuro
Meningitis-
Bacteria or Virus enters the CNS via blood
o Penetrating trauma
o Surgical procedures- not being sterile
o Brain abscess
o Basilar skull fracture- at base of the head
o Infection can also cause- eyes, ears, mouth
Bacteria- cloudy
o Occurs in “outbreak” such as dorm rooms
o Caused by Neisseria meningitides and streptococcus pneumoniae
o High mortality rate
Virus- clear, no WBC present
o Caused by virus such as Herpes Simplex, Varicella Zoster, mumps, HIV
o Low mortality rate
S/SX
Fever/chils
Nuchal rigidity- Bacterial place in droplet precautions
Photo/phonophobia
Headache
N/V
Rash
Altered LOC
Increased ICP
Muscle aches
SIRS/DIC/SIADH
Seizures
TX and DX
Lumbar puncture or CSF and C&S
o Virus- no organism found
o Bacteria- WBC
Culture everything:
o Blood/sputum/throat/urine cultures
Broad spectrums abx for bacteria
o Do not delay treatment waiting on results
Anti-viral for virus infections
,Encephalitis
Typically, a virus
Bacteria, fungus, parasites
Inflammatory response
Denegation of neurons
Demyelination of axons
Hemorrhage
Edema
Cell death of necrosis
Death
S/SX
Fever
Nuchal rigidity
Photo/phonophobia
Headache
N/V
Rash
Altered LOC
increased ICP
Fatigue
Joint pain
Vertigo/ataxia
Tremors/spasms
TX and DX
Antiviral acyclovir
Prevention of mosquito bites
o Limits outside time between dusk and dawn
o Wear protective clothing
o DEET- repellant
o Remove standing water
Lumbar puncture and DX- will be clear
EEG- checking brain waves to see if cells have started dying of
CT scan- see if any edema in brain
Nursing considerations for Meningitis/Encephalitis
Maintain ABC’s
Reduce stimuli
Treat the symptoms
Monitor
o Vitals and neuro q2-4hr and PRN
o Increased ICP
o LOC
o CSF from nose/ears
, Bacterial place in droplet precautions
Viral place in standard precautions
Encourage vaccinations for N. Meningitis
Spinal Cord Injury
Causes:
Car accident
Diving accident
Primary
Hyperflexion- chin to chest
Hyperextension- head to back of shoulders
Axial loading
Excessive rotation
Secondary- result of primary
Hemorrhage
Ischemia
Hypovolemia
Neurogenic shock
S/SX:
Complete- everything below the injury is paralyzed
Incomplete- partial cut, will have symptoms but will vary
Below the level of injury
o Numbness
o Tingling
o No sensation
General symptoms
o Bradycardia
o Hypotension
o Hypothermia
o Breathing problems
Initial Treatment- rehab paraplegic, If I’m hearing you… tell me more
ABC’s- cervical collar then intubate
Hypothermia- 89-93 degrees for 1-2 days
Treat hypovolemic shock with fluids- warm fluids, warm blankets
Decrease ICP- keep in cool room
Corticosteroids
Treat neurogenic shock
Muscle relaxers for spasms
Surgery
o Spinal cord stabilizations
o Wires and rods
o 2Spinal infusion
o Halo applied
Nursing Considerations
ABC’s
