NUR 265 EXAM THREE STUDY GUIDE.

NUR 265- EXAM THREE STUDY GUIDE

UNIT 7

ENCEPHALITIS
 Inflammation of the brain tissue- the ventricles. – affects the cerebrum, the brain stem,
and the cerebellum
 Normally caused by a virus
o Herpes
o Polio
o Mosquito borne viruses- west Nile
o Tick borne viruses
o Rabies
o Childhood viruses
 Signs/symptoms:
o High fever
o Nuchal rigidity- occurs only if brain stem infected
o Photophobia
o Phonopobia
o Headache
o N/V
o Altered LOC
o s/s of increased ICP
o fatigue
o joint pain
o vertigo
o muscle spasms
o ataxia
o tremors
 diagnosing:
o history of  any viruses, mosquito bites, or swimming in lakes- all within the last
month
o lumbar puncture
 analyze CSF
 PCR test to detect viral DNA
o EEG for brain wave activity or seizure
o CT scan- hydrocephalus
o Blood cultures- viruses
 Assessment:
o Q 4-hour neuro checks

,  Glasgow coma scale
 Cranial nerve assessment
 Change in LOC or orientation
 Nursing considerations
o Maintain airway
o Monitor for increased ICP
o Monitor for vitals and neuro frequently
o Reduce stimuli- darken the room, turn down TV, put them at the end of the hall
o Treat the symptoms
 Treatment
o Acyclovir- antiviral
 Need to begin as early as possible
o Prevention
 Using DEET spray on self
 Avoid people with herpes outbreak, etc.
MENINGITIS
 Inflammation of the meninges (layers covering brain) specifically the pia mater and
arachnoid
 Can be viral or bacterial- bacterial is much worse
 People ages 16-21 have highest rate of bacterial meningitis. CDC recommends initial
vaccine at 11-12 and a booster at 16. Adults are advised to get initial or booster vaccine
if living in a shared residence like a dorm, traveling or residing in a foreign country which
disease is common, or are immunocompromised due to a damaged or surgically
removed spleen. It is safe to receive booster 8 weeks after initial vaccine incase initial
vaccine status not known.
 Bacterial
o Occurs in outbreaks such as dorm rooms
o Caused by Neisseria meningitides and streptococcus pemoniae
o High mortality rate
o Droplet precautions- CONTAGIOUS!
o Private room
 Viral
o Non-contagious
o Caused by mumps, HIV, herpes zoster, etc.
o Low mortality rate
o Standard precautions
 Symptoms
o Fever
o Nuchal rigidity- THIS IS A CLASSIC SIGN!!!
o Photophobia

, o Phonophobia
o Headache
o N/V
o Change in LOC
o s/s increased ICP
o muscle aches
o maculopapular rash
o petechial rash
o seizures
o SIADH
o SIRS/DIC
 Diagnosing:
o Lumbar puncture for CSF
 Virus- clear, normal pressure and no organism found
 Bacterial- cloudy, turbid, increased WBC! Increased protein, decreased
glucose, and elevated CSF pressure
o Gram stain- done to see which bacteria it is
o Counterimmunoelectrophoresis (CIE)- preformed to determine presence of virus
o Kerning’s sign- when doctor forces the patent’s head up, the patient’s knees will
flex inward toward the core involuntarily
 Nursing considerations
o Bacterial patient must be on droplet precautions. Stay 3 feet away from patient
unless you are wearing a mask. Teach patient and visitors about need to wear a
mask
o Neuro checks Q 4 hours
o Monitor for ICP
o Reduce stimuli
o Treat the symptoms
 Treatment:
o Do NOT delay treatment while waiting to preform tests or obtaining test results
o If meningitis’s is suspected, broad spectrum antibiotic immediately!
o Decreased external stimuli- keep ICP down
o Treat symptoms like fever
o Prevent complications- DVT, PE, ICP, seizures.

TRIGEMINAL NEURALGIA
 Disorder that affects the trigeminal nerve- the fifth cranial nerve
 Trigeminal nerve has 3 branches- sensation in person’s eye, upper eyelid, and forehead,
lower eyelid, cheek, nostril, upper lip, and upper gum, jaw sensations lower lip, lower
jaw, and muscles for chewing

,  Trigeminal nerve basically controls the middle of the face
 Chronic pain syndrome in those areas of the face.
 Pain is described as excruciating, sharp, shooting piercing, burning, etc.
 Triggers- like brushing teeth, light touch stimulation, change in facial expressing
(smiling), chewing,
 Fear of pain stops them from talking, smiling, eating, or attending to hygienic tasks
 Priority is pain management!
 Medications
o Carbamazepine- first choice drug- anti-epileptic.
o Muscle relaxants
 Percutaneous sterotactic rhizotomy- PSR- a heated needle through the inside of the
patient’s cheek to trigeminal nerve and is heated up to destroy some of the nerve fiber
o The entire nerve isn’t destroyed and provides long-term pain relief
o Teach the patient who has had a PSR to not rub the eye on the affected side
because the protective mechanism of pain will no longer warn of injury. Instead
insect eye daily for redness or irritation and report to HCP of blurriness. Stress
the importance of regular dental examinations because the absence of pain
might not warn patient of potential dental problems.

BELL’S PALSY
 Acute paralysis of cranial nerve 7- facial cranial nerve.
 Causes paralysis of the eye, forehead, and cheek
 Pain above the ear on the affected side preceded paralysis for a few hours or days before
paralysis
 Acute paralysis lasts for 2-5 days
o Patient can’t close eye, wrinkle forehead, smile, whistle, or grimace. Face
appears almost mask like.
 Caused by herpes HSV-1 laying dormant
 Treatment- corticosteroids for 30-60 days. Antivirals for 7-10 days after onset of
symptoms.
 Nursing considerations
o Because the eye doesn’t close, the cornea must be protected. Teach the patient
to manually close eye at intervals. Instill tears during the day and apply ointment
and patch/tape close eyelid at bedtime
o May not be able to chew, swallow, etc. at meal times. Encourage patient to use
the unaffected side of the mouth and eat high calorie snacks if nutritional needs
aren’t met.
o Use CAM therapies like massage, application of warm, moist heat and facial
exercises to manage pain.

BRAIN ABSCESS