NSG 430 EXAM 3 Questions with Correct Answers 100% Verified| Guaranteed Success
meningitis Inflammation of the meninges
- Bacterial most often caused by streptococcus pneumoniae (ear infection, sinus infection, head
trauma, dental therapy, etc)
S/S: Sudden onset headache, Kernig's sign (90 degree hip flexion followed by straighten of leg
causes pain), Brudzinski's sign (flexion of the neck causes flexion of the hips and knees), fever,
confusion, irritability, skin rashes
Diagnostics: CBC, CRP, blood cultures, lumbar puncture (cloudy CSF abnormal, WBC and protein
may be elevated, decreased glucose in bacterial meningitis)
Management: Droplet precautions at least for 24 hours, supportive care for viral infections,
anti-seizure medications, seizure precautions, steroids, monitor/decrease ICP
lumbar puncture - Requires informed consent
- Ask patient to empty bladder (must lay flat for 1 hour after)
- Positioning: Lateral recumbent preferred (can measure CSF pressure)
- Tripod or orthopneic position if LR contraindicated (higher risk of disc herniation, cannot
measure CSF pressure)
- Strict sterile technique
- Contraindicated in increased ICP if space-occupying lesions
Post-op care:
- Occlusive dressing (do not remove)
- Monitor for bleeding or CSF leakage
- Supine x 1 hour
- Push fluids to prevent headache
- Monitor I&O
- Alert provider immediately if leakage (may use blood patch)
Nursing considerations: Bedrest as ordered, monitor VS, quiet and nonstimulating environment,
antipyretics, antibiotics, analgesics, seizure precautions, monitor for increased ICP, isolation
precautions, elevate HOB 30 degrees and avoid neck flexion and extreme hip flexion
Prevention: Vaccine, prophylactic abx for close exposure
,- EBP recommends checking a head CT before a lumbar puncture to rule out space occupying
lesion
brain tumors - Classified as benign or malignant and primary or secondary
- Most commonly secondary tumors in the brain
S/S: Headache (severe, especially upon awakening), papilledema (swelling of optic disc),
seizures, increased ICP, unequal pupil size, bradycardia, HTN, N/V, hemiparesis, altered
mentation
Diagnostics: Neurological exam, EEG, LP, MRI, PET scan, biopsy
Treatment: Radiation, dexamethasone, chemo, dilantin (anti-seizure), mannitol (osmotic
diuretic), anticoagulants, surgery (gamma knife, craniotomy, stereotactic)
Complications: Increased ICP, herniation/ischemia, rupture/hemorrhage, seizures,
hydrocephalus, SIADH/DI/pituitary dysfunction, fluid/electrolyte imbalances
Care: Frequent neuro checks, monitor VS, pain management, positioning (upright unless
contraindicated), decrease stimuli, prevent increased ICP, aspiration risk, seizure precautions
spinal cord tumors - Classified based on anatomic location
Intramedullary: within the cord
Extramedullary: extradural, outside of the dural membrane
S/S: Pain, weakness, loss of motor and sensory function
Treatment: related to type of tumor and location, usually surgery and measures to relieve
compression (dexamethasone with radiation)
Nursing care: Oral hygiene before meals (to stimulate appetite), plan meals for comfortable
times, offer preferred foods, daily weights, dietary supplements
encephalitis Inflammation of the brain tissue itself (most often viral)
- May be caused by herpes simplex
S/S: Severe headache, fever, confusion, nausea/vomiting, alterations in LOC, bizarre behavior,
S/S of increased ICP
Hx: Recent illness, herpes simplex, west nile, EEE, warm climates
, Dx: MRI/CT (may show small hemorrhagic lesions), lumbar puncture, CBC, blood cultures,
throat cultures, EEG, brain biopsy
Care: Isolation precautions (droplet), supportive care, antibiotics if bacterial, pain/fever control,
steroids, monitor and decreased ICP, antivirals, maintain bedrest as ordered, nonstimulating
environment, neuro assessments every 2-4 hours, seizure precautions
head injuries primary injury: caused by the initial trauma
secondary injury: result of the damage of the initial insult
*assume patients with head injuries also have spinal injuries until ruled out*
skull fractures classified by type and location (linear, open depressed, basilar), may or may
not cause brain damaged, usually localized and persistent pain
basilar fracture Occurs at base of skull
- Bleeding from nose, pharynx, or ears
- Battle's sign- ecchymosis behind ear
- Halo sign: CSF leak- ring of fluid around the blood stain from drainage
- Raccoon eyes
concussion (mild TBI) - GCS 13-15
temporary loss of neurological function with no apparent structural damage (with or without
loss of consciousness)
S/S: Changes in LOC, memory difficulties, difficulty awakening, lethargy, dizziness, confusion,
irritability, behavioral changes, difficulty in speaking or movement, severe or worsening
headache, vomiting, seizures
Interventions: Rest and sleep, seek medical attention for repeated vomiting, worsening HA, loss
of consciousness, worsening confusion, seizure activity, weakness/numbness, changes in vision
contusion (major TBI) - GCS < 8
meningitis Inflammation of the meninges
- Bacterial most often caused by streptococcus pneumoniae (ear infection, sinus infection, head
trauma, dental therapy, etc)
S/S: Sudden onset headache, Kernig's sign (90 degree hip flexion followed by straighten of leg
causes pain), Brudzinski's sign (flexion of the neck causes flexion of the hips and knees), fever,
confusion, irritability, skin rashes
Diagnostics: CBC, CRP, blood cultures, lumbar puncture (cloudy CSF abnormal, WBC and protein
may be elevated, decreased glucose in bacterial meningitis)
Management: Droplet precautions at least for 24 hours, supportive care for viral infections,
anti-seizure medications, seizure precautions, steroids, monitor/decrease ICP
lumbar puncture - Requires informed consent
- Ask patient to empty bladder (must lay flat for 1 hour after)
- Positioning: Lateral recumbent preferred (can measure CSF pressure)
- Tripod or orthopneic position if LR contraindicated (higher risk of disc herniation, cannot
measure CSF pressure)
- Strict sterile technique
- Contraindicated in increased ICP if space-occupying lesions
Post-op care:
- Occlusive dressing (do not remove)
- Monitor for bleeding or CSF leakage
- Supine x 1 hour
- Push fluids to prevent headache
- Monitor I&O
- Alert provider immediately if leakage (may use blood patch)
Nursing considerations: Bedrest as ordered, monitor VS, quiet and nonstimulating environment,
antipyretics, antibiotics, analgesics, seizure precautions, monitor for increased ICP, isolation
precautions, elevate HOB 30 degrees and avoid neck flexion and extreme hip flexion
Prevention: Vaccine, prophylactic abx for close exposure
,- EBP recommends checking a head CT before a lumbar puncture to rule out space occupying
lesion
brain tumors - Classified as benign or malignant and primary or secondary
- Most commonly secondary tumors in the brain
S/S: Headache (severe, especially upon awakening), papilledema (swelling of optic disc),
seizures, increased ICP, unequal pupil size, bradycardia, HTN, N/V, hemiparesis, altered
mentation
Diagnostics: Neurological exam, EEG, LP, MRI, PET scan, biopsy
Treatment: Radiation, dexamethasone, chemo, dilantin (anti-seizure), mannitol (osmotic
diuretic), anticoagulants, surgery (gamma knife, craniotomy, stereotactic)
Complications: Increased ICP, herniation/ischemia, rupture/hemorrhage, seizures,
hydrocephalus, SIADH/DI/pituitary dysfunction, fluid/electrolyte imbalances
Care: Frequent neuro checks, monitor VS, pain management, positioning (upright unless
contraindicated), decrease stimuli, prevent increased ICP, aspiration risk, seizure precautions
spinal cord tumors - Classified based on anatomic location
Intramedullary: within the cord
Extramedullary: extradural, outside of the dural membrane
S/S: Pain, weakness, loss of motor and sensory function
Treatment: related to type of tumor and location, usually surgery and measures to relieve
compression (dexamethasone with radiation)
Nursing care: Oral hygiene before meals (to stimulate appetite), plan meals for comfortable
times, offer preferred foods, daily weights, dietary supplements
encephalitis Inflammation of the brain tissue itself (most often viral)
- May be caused by herpes simplex
S/S: Severe headache, fever, confusion, nausea/vomiting, alterations in LOC, bizarre behavior,
S/S of increased ICP
Hx: Recent illness, herpes simplex, west nile, EEE, warm climates
, Dx: MRI/CT (may show small hemorrhagic lesions), lumbar puncture, CBC, blood cultures,
throat cultures, EEG, brain biopsy
Care: Isolation precautions (droplet), supportive care, antibiotics if bacterial, pain/fever control,
steroids, monitor and decreased ICP, antivirals, maintain bedrest as ordered, nonstimulating
environment, neuro assessments every 2-4 hours, seizure precautions
head injuries primary injury: caused by the initial trauma
secondary injury: result of the damage of the initial insult
*assume patients with head injuries also have spinal injuries until ruled out*
skull fractures classified by type and location (linear, open depressed, basilar), may or may
not cause brain damaged, usually localized and persistent pain
basilar fracture Occurs at base of skull
- Bleeding from nose, pharynx, or ears
- Battle's sign- ecchymosis behind ear
- Halo sign: CSF leak- ring of fluid around the blood stain from drainage
- Raccoon eyes
concussion (mild TBI) - GCS 13-15
temporary loss of neurological function with no apparent structural damage (with or without
loss of consciousness)
S/S: Changes in LOC, memory difficulties, difficulty awakening, lethargy, dizziness, confusion,
irritability, behavioral changes, difficulty in speaking or movement, severe or worsening
headache, vomiting, seizures
Interventions: Rest and sleep, seek medical attention for repeated vomiting, worsening HA, loss
of consciousness, worsening confusion, seizure activity, weakness/numbness, changes in vision
contusion (major TBI) - GCS < 8
