Louis Streb
Unit 7
Gullian-Barre Syndrome - response to epsteine barr virus, bacterial infx, live vaccines,
trauma/surgery
*does not affect LOC, cognition, pupillary changes*
plasmapheresis - tx
ascending muscle weakness
starts at toes work way up
worry about death r/t resp failure
assessment of cerebellar function (pg 824)
run heel down the shin of other leg
place hands palm p, then palm down on each thigh, repeating as fast as possible
with arms out at the side, touh figer to nose 2-3 x, with eyes open, and eye closed, alternate
arms.
gait.
know GCS & KNOW GCS < 8 INTUBATE
page 866
Meninginties is inflammation of the meniniges
causes pressure into the brain/spinal cord
bacterial and viral
bacterial = bad news = most contageous
viral = very common - most tested
penetrating trauma, surgical procedures on brain/spine, ruptured brain abscess, basilar skull fx,
cavity, tooth abscees, otitis media, acute/chronic sinusitis
*know s/s of CSF leaking* otorrhea, rhinorrhea
can do “halo test” - kernig sign = lay on back, straighten leg, very painful.
brudzinski = neck flex and then hip & knee flexes.
common viruses that cause meningtitis, enterovirus, hepres simplex virus, varicella xoster,
mumps, HIV
meningococcal meninitis is a medical emergency! high mortality rate w/in 24 hrs!
menigococcal menigitis:@ r/f: immunocomprised, college students in dorms, jails, poor
countries, milirary barracks, crowded living
s/s: photophobia, nystagms, red macular rash, increased ICP
nuchal rigidity, postive kernig & brudzinski signs, chills, temperature
H - h/a & photophobia
H - hard stiff neck “nuchal rigidity”
H - high temp “fever”
LP is used to diagnosed meningitis
(encephalitis presents like meningitis (fatigure, light, noise sensitivty, pupil changes (decrease
size)
intererventions:
droplet precautions
neruo assessments q2-4 hrs to look for early neurological changes (szs, coma)
drugs: mannitol, antiepileptic drugs
*people who have been in contact w/ someone who has meningitis should take rifampin
ciprofloxacin, ceftriazone.
Low BP will kill!
Low noise- quiet room
Low light r/t photphobia
, Low pressure (no sneezing, coughing, bending) HOB 30* +
early s/s of increased ICP: altered LOC, restless, irritability, agitation; decreased mental status
Spinal cord Injury pg 877
ALS
starts @ head & goes down!
no established treatment or cure for ALS
only supportive care/pallative care/end of life stuff is important
100% fatal.
priority is respiratory failure
muscle atrophy
twitching of face/tongue
fatigure
dysphagia & dysarthia
SCI
it can be complete/incomplete
the higher up, the more problematic
cervical - paralysis below neck!! monitor breathing!!
quadriplegoa = 4 limbs paralyzed
thoracic - T for trunk of body, paralegic (2 legs)
Legs & pelvic organs
Lumbar - think of double L’s
legs & leaky bladder
**DVT/VTE, bone breaking, fall risk*
mental health issues
strategies to prevent VAP
adequete hydration
monitor s/s neurogenic shock/autonomic dysreflexia
Dextran plasma expander, increasecap blood flow w/in spinal cord & prevent/tx hypotension
atropine given for bradycardia, < 50-60 bpm
Dopamine if hypotension severe
spinal immobilization - skeletal traction
halo device - worn 6-12 weeks. screws go into skull to immobilize spine
need to do bolt care
PT SHOULD ALWAYS HAVE SPECIAL WRENCH ON THEM INCASE OF EMERGENCY AND NEED TO
GET THEM OUT OF THE HALO (ex. CPR is needed) tape the wrench to vest.
monitor for s/s of infx
patient will need to use straw. no driving until halo is removed. cut meats/foods small for
patient.
support head with small pillow.
wrap pins with cloth to prevent metal getting cold before going outside in cold temps.
wash under vest.
increase fiber & fluids.
PPI like Pantoprazole - prevent stress ulcers
centrally acting muscle relaxer - Tizanidine
seizures/hallucinations may occur if TB is suddenly withdrawn
monitor for pressure injuries - sensory perception is decreased
mobility decreased
sexuality is a concern - may need LTC
Unit 7
Gullian-Barre Syndrome - response to epsteine barr virus, bacterial infx, live vaccines,
trauma/surgery
*does not affect LOC, cognition, pupillary changes*
plasmapheresis - tx
ascending muscle weakness
starts at toes work way up
worry about death r/t resp failure
assessment of cerebellar function (pg 824)
run heel down the shin of other leg
place hands palm p, then palm down on each thigh, repeating as fast as possible
with arms out at the side, touh figer to nose 2-3 x, with eyes open, and eye closed, alternate
arms.
gait.
know GCS & KNOW GCS < 8 INTUBATE
page 866
Meninginties is inflammation of the meniniges
causes pressure into the brain/spinal cord
bacterial and viral
bacterial = bad news = most contageous
viral = very common - most tested
penetrating trauma, surgical procedures on brain/spine, ruptured brain abscess, basilar skull fx,
cavity, tooth abscees, otitis media, acute/chronic sinusitis
*know s/s of CSF leaking* otorrhea, rhinorrhea
can do “halo test” - kernig sign = lay on back, straighten leg, very painful.
brudzinski = neck flex and then hip & knee flexes.
common viruses that cause meningtitis, enterovirus, hepres simplex virus, varicella xoster,
mumps, HIV
meningococcal meninitis is a medical emergency! high mortality rate w/in 24 hrs!
menigococcal menigitis:@ r/f: immunocomprised, college students in dorms, jails, poor
countries, milirary barracks, crowded living
s/s: photophobia, nystagms, red macular rash, increased ICP
nuchal rigidity, postive kernig & brudzinski signs, chills, temperature
H - h/a & photophobia
H - hard stiff neck “nuchal rigidity”
H - high temp “fever”
LP is used to diagnosed meningitis
(encephalitis presents like meningitis (fatigure, light, noise sensitivty, pupil changes (decrease
size)
intererventions:
droplet precautions
neruo assessments q2-4 hrs to look for early neurological changes (szs, coma)
drugs: mannitol, antiepileptic drugs
*people who have been in contact w/ someone who has meningitis should take rifampin
ciprofloxacin, ceftriazone.
Low BP will kill!
Low noise- quiet room
Low light r/t photphobia
, Low pressure (no sneezing, coughing, bending) HOB 30* +
early s/s of increased ICP: altered LOC, restless, irritability, agitation; decreased mental status
Spinal cord Injury pg 877
ALS
starts @ head & goes down!
no established treatment or cure for ALS
only supportive care/pallative care/end of life stuff is important
100% fatal.
priority is respiratory failure
muscle atrophy
twitching of face/tongue
fatigure
dysphagia & dysarthia
SCI
it can be complete/incomplete
the higher up, the more problematic
cervical - paralysis below neck!! monitor breathing!!
quadriplegoa = 4 limbs paralyzed
thoracic - T for trunk of body, paralegic (2 legs)
Legs & pelvic organs
Lumbar - think of double L’s
legs & leaky bladder
**DVT/VTE, bone breaking, fall risk*
mental health issues
strategies to prevent VAP
adequete hydration
monitor s/s neurogenic shock/autonomic dysreflexia
Dextran plasma expander, increasecap blood flow w/in spinal cord & prevent/tx hypotension
atropine given for bradycardia, < 50-60 bpm
Dopamine if hypotension severe
spinal immobilization - skeletal traction
halo device - worn 6-12 weeks. screws go into skull to immobilize spine
need to do bolt care
PT SHOULD ALWAYS HAVE SPECIAL WRENCH ON THEM INCASE OF EMERGENCY AND NEED TO
GET THEM OUT OF THE HALO (ex. CPR is needed) tape the wrench to vest.
monitor for s/s of infx
patient will need to use straw. no driving until halo is removed. cut meats/foods small for
patient.
support head with small pillow.
wrap pins with cloth to prevent metal getting cold before going outside in cold temps.
wash under vest.
increase fiber & fluids.
PPI like Pantoprazole - prevent stress ulcers
centrally acting muscle relaxer - Tizanidine
seizures/hallucinations may occur if TB is suddenly withdrawn
monitor for pressure injuries - sensory perception is decreased
mobility decreased
sexuality is a concern - may need LTC
