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Metabolic Coma
| Question | Answer |
|---|---|
| Metabolic Coma | Systemic disturbances produce a generalized depression of the nervous systems Doesn’t occur directly to the brain |
| Causes of Metabolic Coma | Hypoglycemia is an electrolyte imbalance that can cause metabolic coma Hepatic coma caused by liver failure which produces increased ammonia circulation can cause metabolic coma Increased BUN can cause metabolic coma AIADH causes decreased seru |
| Meningitis | Disease that causes metabolic coma Inflammation of arachnoid and pia mater (CSF between these) of brain and spinal column Bacterial and viral organisms are most often the cause but fungus and other organisms can cause too |
| Meningitis Pathophysiology | Often r/t septicemia organism enters CSF via bloodstream and crosses the blood-brain barrier because it is more permeable Now is free to circulate throughout the brain and spinal column Can be caused by direct entryo Surgeryo Lumbar punctureo |
| Viral Meningitis | not curable with antibiotics |
| Bacterial Meningitis | can tx with antibiotics |
| Viral Meningitis ( AKA Aseptic Meningitis) | Not contagious like bacterial meningitis Usually self-limiting because it is caused by a virus Often a sequela to other viral illnesses ( mumps, measles, varicella, but herpes simplex is the most common cause) No exudates forms, no organisms wi |
| Bacterial meningitis | Often related to URI Often caused by Strept. Pneumoniae (most common cause in adults) or Neisseria meningitidis ( meningococcal ) this is the one that causes epidemics; spreads quickly Causative agents vary by age This is the type that causes |
| Bacterial meningitis Presentation | there are 3 classic partso Fever (40-41C)o Stiff neck/HAo Followed by rapid deterioration in LOC Lethargy to stupor to coma May have seizures, be photophobic or have n/v |
| Bacterial meningitis Assessment | A through physical assessment is necessary along with history which you will see that a resp. inf. started this Meningeal irritation causes nuchal rigidity (stiffness or pain in neck) |
| Bacterial meningitis Complications | Generally with bacterial ICP is increased related to exudates (with bacterial), cerebral edema, hydrocephalus Seizures may occur related to irritation of cerebral cortex SIADH may occur because of abnormal stimulation of hypothalamic area Ve |
| Bacterial meningitis DX | Analyze CSF: Cell count, C&S and gram stain, protein (not normally in CSF) This is the definitive dx CSF should be clear but with bacterial meningitis will be white, cloudy CT scan: edema, hydrocephalus, abscess Find source of infection and |
| Bacterial meningitis Intervention & Mgt | Pt will be on resp isolation, - pressure room until causative agent is no longer cultured from nasopharyngeal secretions Monitor neuro status, GCS Treat and prevent elevated ICPo Ventricular shunto HOB 30*o Mechanical vent. VS frequently |
| Diagnosis and treatment of viral meningitis | Symptom management In a lumbar puncture CSF will be clear but pt will present w/ symptoms of bacterial meningitis Not contagious thru resp. tract Provide fever reduction, seizure control and comfort measures Serology testing of CSF Adults |
| Encephalitis | Inflammation of brain tissue and often meninges Can start with viral meningitis and turn into encephalitis Within the Cerebrum, brainstem, & cerebellum There is diffuse disturbance of the brain function Caused by virus, bacteria, fungi, para |
| Encephalitis Pathophysiology | Virus reproduces in brain tissue causing an inflammatory response No exudates Demyelination of axons in involved area Cerebral edema and compression of blood vessels cause elevated ICP Meningitis can go in to encephalitis o Present initial |
| Assessment of Encephalitis | Change in LOC Motor dysfunction Focal neuro deficitso One sided weakness o Pupillary response different Symptoms of elevated ICP Symptoms determine what area of the brain is being affected Pt may be left deaf or blind (visual hemipare |
| Encephalitis Diagnosis | Look at symptoms Lumbar puncture: Serology or antibodies present May use serum testing |
| Encephalitis Interventions | Care is supportive (virus) Acyclovir or vidarabine IV for herpes Prevention: take care of herpes before it turns into encephalitis |
| Encephalitis Prevention of Arbovirus | Protection with 30% DEET (to clothes) Long clothing Mosquito management Prevent areas of standing water |
| Drug Induced Metabolic Coma: Alcohol | 95% of alcohol is metabolized by liver Classified as a CNS depressant directly suppresses the CNS Affects all levels of brain function beginning with RAS and cerebral cortex As is accumulates in brain it depresses cerebral cortex, cerebellum, m |
| Drug Induced Metabolic Coma: Chronic use | Cirrhosis Peripheral neuritis Lowered testosterone Elevated estrogen related to inability to detoxify in liver Coagulopathies |
| Drug Induced Metabolic Coma: Wernicke-Korsakoff syndrome | Can develop with chronic use Heavy ETOH use interferes with metabolism of thiamineo Thiamine deficiency causes metabolic comao And Causes dementia/psychosis There is damage to the CNS and peripheral nervous system Causes dementia/psychosis |
| Drug Induced Metabolic Coma: Withdrawal symptoms | Withdrawal symptoms include seizures which can increase ICP and cause coma Delirium Tremens is a term used to denote severe withdrawal of life-threatening complications of withdrawal from EOTH Withdrawal symptoms you see within 6-8hrs after last d |
| Drug Induced Metabolic Coma: Nursing Interventions | 3-S’s of detoxification:o Secure/Sedation/Supplements Continuous monitoring of w/d manifestations, provide a safe environment Vitamins and minerals: B complex (contains thiamine), C, Mg, Calcium Refer for f/u |
| Drug Induced Metabolic Coma: Medications used during alcohol withdrawal | Benzodiazepines : less respiratory depression and hypertensiono Librium (chlordiazepoxide)/valium : long-actingo Ativan (lorazepam)/Serax (oxazepam) short-acting. Used in severe liver failure |
| Drug Induced Metabolic Coma: Acute alcohol poisoning | Bing drinking Depresses CNS: often die from hypothermia, aspiration, or ingestion of other CNS depressants along with ETOH |
| Drug Induced Metabolic Coma: ED Nursing | Blood Alcohol Level (BAL)o No alcohol pad usedo Chain of custody for specimeno Know laws of stateo BSL measured in mg or % |
| Substance abuse | Continued use of a psychoactive substance despite the occurrence of physical, psychological, social or occupational problems. |
| Addiction | A compulsive, loss of control, and progressive pattern of drug use characterized by behavioral changes. |
| Dependence | Body’s physical adaptation to drug whereby withdrawal symptoms will occur without drug/ Emotional need or craving for drug’s effects or to prevent withdrawal symptoms |
| Tolerance | State resulting from metabolic changes in cell function. Tissue reaction to drug declines and person needs to take increasing amounts to obtain the same effect |
| Withdrawal | Discontinuation of a substance by a person dependent on it. Overall health must be considered. |
| Amphetamines | Stimulate CNS; accelerate activity of hear & brain. o Metabolized by liver enzymes, excreted in urine. (cocaine)o Cardiac dysfunction/HTN/Fever/labile emotions paranoia/panic axno Management : monitor VS watch for cerebral hemorrhage & MIo |
| Opioids (heroin, MS, morphine) | o Immediate euphoria followed by dysphoria. o Resp. depression primary cause of deatho Narcan (caloxone) is antidoteo Withdrawal symptoms : anxiety, insomnia, elevated RR, yawning, sweating, tremors, dilated pupils, N/V |
| Barbiturates/benzodiazepines | CNS depressants/antianxiety agents: o used to treat insomnia, anticonvulsantso Acute toxicity: unsteady gait, slurred speech, sustained nystagmuso OD: CNS/resp., depression, supportive tx only.o W/D: Anxiety, tremors, N/V, insomnia, seizures aroun |
| Inhalants | hydrocarbon solvents (gas, glue), anesthetics (nitrous oxide) CNS depressants Death from asphyxiation Cross blood-brain barrier quickly S&S : Confusion, HA, ataxia |
| MDMA/Ecstasy | o synthetic, psychoactive drug with both stimulant and hallucinogenic (LSD-like) properties. It is neurotoxic to areas concerning thought and memory.o Risks and side effects are similar to cocaine and amphetamines: elevated HR/BP, musc, tension, anxiet |
| Ritalin (methylphenidate) | o As a Rx drug it is used for high level of activity or ADHD. Also used for narcolepsy. o CNS stimulant similar to but more potent than caffeine, less protein than amphetamines. Calming, “focusing” effect on hyperactive children.o Abused for stimul |
| Drug OD: Acute Care | Obtain VS. intubate if necessary CBC, SMA-6, Glucose, toxic screen, ETOH, ABG Administer: D50 IV (may be hypoglycemic), Thiamine(may be Wernicke-Korsakoff), Narcan (may be opiod OD), Gastric Lavage, charcoal, carthartic (NGT) Assess neuro statu |
| Vowel Tipps | Alcohol Epilepsy Insulin Opiates Uremia Trauma Infection Psych Poison Stroke |
| Outcomes of ALOA and Coma | Can be full recovery or… Recovery with residual damage or… More severe state (on vent. In nursing home) |
| Persistent vegetative state | Irreversible coma Continued function of brain stem and cerebellum but not cerebral cortex |
| Brain death | Cessation and irreversibility of all brain functions including brain stem Coma, apnea, pupils fixed and dilated No ocular response Flat EEG |
| Brudzinski’s sign | when neck is flexed there is spontaneous flexion of the knee |
| Kernig’s sign in bacterial meningitis | pain or flexion of the knee when the hip is flexed |
| West Nile Virus | o An arbor virus transmitted by tick and mosquitoes o Most people don’t develop encephalitis (increased risk w/ advanced age)o Symptoms: fever, weakness, GI symptoms, change in mental status, cranial nerve deficits, seizures, change in gaito Occurs |
| Herpes Simplex | o Most common cause of encephalitis (also causes viral meningitis)o Flu-like symptoms, headache, lethargy |
| Eastern Equine virus | o Arbor virus caused by mosquitoes and tickso Causes encephalitis |
| ETOH is distributed equally in all body tissues | larger persons can ingest larger amounts |
| Tolerance to ETOH occurs | so an alcoholic may have a high BAL and still be functioning |
Created by:
littlemina
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