Med surg Neuro chapters notes
Chapter 4 Neurologic Diagnos6c Procedures
Chapter 6 Meningi6s
Chapter 10 Brain tumors
Chapter 16 Stroke
Meningi6s
Meningi&s is an inflamma&on of the meninges, which are the membranes that protect the brain
and spinal cord.
Types
• Viral or asep&c is the most common form and resolves without treatment. (fluid, rest)
• Fungal meningi&s is common in pa&ents diagnosed with AIDs.(cyptococcus neoformans
from muds soil, animal)
• Bacterial meningi&s is the most contagious form, with a high mortality rate.
Health Promo&on and disease preven&on
• Haemophilus influenzae type b (HIB) vaccine
o Bacterial Meningi&s
o Four doses, ranging between 2 months & 12 – 15 months of age
• Pneumococcal polysaccharide vaccine (PPSV)
o Immunocompromised, Chronic Disease, CigareOe Smoking, Long Term Care
Facility Resident(more people)
o Adults > 65 years old
, • Meningococcal Vaccine (mcv4) (neisseria meningi&dis)
o Residen&al SeVngs in college.
o Adolescents — ini&al dose at 11 – 12 years old & booster at 16 years old
Risk Factors
• Immunosuppression
• Spinal Fluid Contamina&on
• Invasive Procedures, Skull Fractures, Penetra&ng Wounds
• Overcrowded Environments(concerts, busy ci&es, school, subway, jails)
• Viral meningi&s
o Viral Illnesses: mumps, measles, herpes, arboviruses (West Nile comes from
mosquitoes)
o NO VACCINE
• Fungal meningi&s
o Fungal organism Cryptococcus neoformans
• Bacterial meningi&s
o al micro-organisms Neisseria meningi&dis, Streptococcus pneumoniae,
Haemophilus influenzae (flu)
Findings
• Objec&ve Data
o Fever & Chills
o Nausea & Vomi&ng
o Altered Level of Consciousness
o Hyperac&ve Deep Tendon Reflexes
o Tachycardia
o Seizures
o Red Macular Rash (meningococcal meningi&s)
o Restlessness
o Irritability
• SUBJECTIVE DATA
o Excrucia&ng, Constant Headache
o Nuchal Rigidity (s&ff neck)
o Photophobia (light sensi&vity)
• Posi&ve Kernig’s Sign: resistance and pain with extension of the pa&ent’s leg from a
flexed posi&on(pain with flexion of legs)
, • Posi&ve Brudziniski’s Sign: flexion of the knees and hips occurring with delibera&ve
flexion of the pa&ent’s neck (neck uthauda knees flex)
• Laboratory tests & Diagnos&c Procedures
• LABS
o CBC — elevated WBCs(viral and bacterial)
o Culture & Sensi&vity (blood, nose(Strep), throat, urine(UTI))
• DIAGNOSTICS
o Cerebrospinal Fluid (CSF) Analysis
o CT scan or MRI
• Cerebrospinal fluid (CSF) Analysis
§ CSF is collected during a lumbar puncture by a provider.
§ Meningi&s Results:
§ CSF appearance either cloudy (bacterial) or clear (viral)
§ Elevated WBCs
§ Elevated Protein
§ Decreased Glucose (bacterial)
§ Elevated CSF Pressure
• Counterimmunoelectrophoresis (CIE) determines if meningi&s is viral or protozoa,
completed if an&bio&cs given
• Nursing Care
o Isolate Pa&ent ASAP
o Maintain Isola&on Precau&ons
Chapter 4 Neurologic Diagnos6c Procedures
Chapter 6 Meningi6s
Chapter 10 Brain tumors
Chapter 16 Stroke
Meningi6s
Meningi&s is an inflamma&on of the meninges, which are the membranes that protect the brain
and spinal cord.
Types
• Viral or asep&c is the most common form and resolves without treatment. (fluid, rest)
• Fungal meningi&s is common in pa&ents diagnosed with AIDs.(cyptococcus neoformans
from muds soil, animal)
• Bacterial meningi&s is the most contagious form, with a high mortality rate.
Health Promo&on and disease preven&on
• Haemophilus influenzae type b (HIB) vaccine
o Bacterial Meningi&s
o Four doses, ranging between 2 months & 12 – 15 months of age
• Pneumococcal polysaccharide vaccine (PPSV)
o Immunocompromised, Chronic Disease, CigareOe Smoking, Long Term Care
Facility Resident(more people)
o Adults > 65 years old
, • Meningococcal Vaccine (mcv4) (neisseria meningi&dis)
o Residen&al SeVngs in college.
o Adolescents — ini&al dose at 11 – 12 years old & booster at 16 years old
Risk Factors
• Immunosuppression
• Spinal Fluid Contamina&on
• Invasive Procedures, Skull Fractures, Penetra&ng Wounds
• Overcrowded Environments(concerts, busy ci&es, school, subway, jails)
• Viral meningi&s
o Viral Illnesses: mumps, measles, herpes, arboviruses (West Nile comes from
mosquitoes)
o NO VACCINE
• Fungal meningi&s
o Fungal organism Cryptococcus neoformans
• Bacterial meningi&s
o al micro-organisms Neisseria meningi&dis, Streptococcus pneumoniae,
Haemophilus influenzae (flu)
Findings
• Objec&ve Data
o Fever & Chills
o Nausea & Vomi&ng
o Altered Level of Consciousness
o Hyperac&ve Deep Tendon Reflexes
o Tachycardia
o Seizures
o Red Macular Rash (meningococcal meningi&s)
o Restlessness
o Irritability
• SUBJECTIVE DATA
o Excrucia&ng, Constant Headache
o Nuchal Rigidity (s&ff neck)
o Photophobia (light sensi&vity)
• Posi&ve Kernig’s Sign: resistance and pain with extension of the pa&ent’s leg from a
flexed posi&on(pain with flexion of legs)
, • Posi&ve Brudziniski’s Sign: flexion of the knees and hips occurring with delibera&ve
flexion of the pa&ent’s neck (neck uthauda knees flex)
• Laboratory tests & Diagnos&c Procedures
• LABS
o CBC — elevated WBCs(viral and bacterial)
o Culture & Sensi&vity (blood, nose(Strep), throat, urine(UTI))
• DIAGNOSTICS
o Cerebrospinal Fluid (CSF) Analysis
o CT scan or MRI
• Cerebrospinal fluid (CSF) Analysis
§ CSF is collected during a lumbar puncture by a provider.
§ Meningi&s Results:
§ CSF appearance either cloudy (bacterial) or clear (viral)
§ Elevated WBCs
§ Elevated Protein
§ Decreased Glucose (bacterial)
§ Elevated CSF Pressure
• Counterimmunoelectrophoresis (CIE) determines if meningi&s is viral or protozoa,
completed if an&bio&cs given
• Nursing Care
o Isolate Pa&ent ASAP
o Maintain Isola&on Precau&ons
