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NSG 210 Ch. 64

Mgmt of Pt w/ Neurologic Inf, Autoimmune Dis, Neuropathies

Impaired coordination of mvmts is defined as ataxia
diplopia is double vision
dyskinesia is defined as impaired ability to execute voluntary mvmts
Difficulty swallowing is termed dysphagia
voice impairment or altered voice is dyphonia
paresthesia is sensation of numbness/tingling
________ is an inflammation of the lining around the brain and spinal cord caused by bacteria or viruses. Meningitis
septic meningitis is caused by? aseptic meningitis is caused by? bacteria virus or secondary to brain abscess, lymphoma, leukemia Lyme Disease can lead to it
Meningitis has s/s of stiff/painful neck, + Kernig's sign, + Brudzinski's sign, photophobia, rash in some types, disorientation, memory impairment, seizures
What are the key diagnostic tests for Meningitis Bacterial culture and gram stain of CSF usually done by lumbar puncture(LP)
Who is at risk for meningitis? college students in dorms
what is a + Kernig's sign? + Brudzinski's sign? ker: Pt lying with thigh flexed on abd, leg cannot be fully extended Brud: when neck flexed, knees/hips flex
In tx of meningitis, what two things are administered with one being an adjunct to the first. Antibiotics like vancomycin, Cipro, Rocephin and adjunct is Dexamethasone(Decadron)- watch for stress ulcer for GI bleed
Brain Abscess s/s? Medical Mgmt? Nsg Mgmt? s/s: HA(worse in morn), V, seizures, focal weakness, confusion, irritability Med: needle biopsy, antibiotics, antiseizures Nsg: neuro assess, pt safety
what is most common cause of acute encephalitis? Name two types Herpes Simplex Virus (HSV) HSV1- children/adults HSV2 - neonates
HSV Encephalitis s/s? Med Mgmt? Nsg Mgmt? fever, HA, confusion, change in behavior Acyclovir(Zovirax)ganciclovir(Cytovene limit noise, avoid opiates, seizures
Viral Encephalitis s/s? Med mgmt? nsg mgmt? caused by mosquito, s/s: fluish, ICP manage seizures prevent injury(falls, seizures)
Fungal Encephalitis s/s? Med mgmt? nsg mgmt? meningitis s/s amphotericin B Give diphenhydramine(Benadryl) and acetaminophen 30 min prior
Transmissable Spongiform encephalopathy refers to what disease? Med mgmt? Creutzfeldt-Jakob palliative
Name the three autoimmune nervous system disorders multiple sclerosis, myasthenia gravis, Guillain-Barre
In MS what is causing the impaired transmission of nerve impulses on the central nervous system, spinal cord and brain stem? Plaques on demyelinated axons
MS s/s? what cranial nerve disease is common in MS? fatigue, depression, numbness, weak, diplopia, pain, sexual, relational issues, ataxia 5th Cranial Nerve Disease(Trigeminal Neuralgia)
Disease modifying drugs to help reduce freq of relapse in MS are the "ABCs" interferon beta 1a: Rebif, Avonex interferon beta 1b: Betaseron Copaxone....all subq
What IV med is given q 3mos to reduce relapse in MS? Mitoxantrone(Novantrone)
Again to treat spasicity is what drug? Fatigue is treated with what drugs? Ataxia is treated with? Spas: Baclofen, valium, dantrium fat: amantadine, pemoline atax: Inderal(BB), benzos
What is impaired and not working in Myasthenia Gravis? weak voluntary muscles r/t receptor sites for acetylcholine being attacked by immune system.
Myasthenia Gravis s/s? s/s from top down "Myacetyl gravity" ocular weakness, swallowing probs,voice impairment
Diagnostic tests for Myasthenia Gravis Tensilon(anticholinesterase) test IV to see if too much cholinergic or not enuf, same s/s. Tensilon prevents breakdown of acetylcholine so it's available for the neuro jx. If pt gets better than it's MG
MG pts often have thymus tumors so what tx would help this? thymectomy. The thymus is the place where the acetylcholine receptor antibodies are produced
What tx is used in MG to eliminate the acetylcholine receptor antibodies? plasmaphoresis
What is key nsg mgmt with MG give anticholinesterase meds on time to prevent swallowing or even resp muscle weakness exacerbations
Guillain-Barre is an autoimmune attack on what? peripheral nerve myelin
what is affected in GB? ascending weakness with dyskinesia, hyporeflexia, paresthesias usually from an event like a viral infection
s/s of GB? muscle weakness and diminished reflexes of lower extrimities. Does not affect LOC
How is MG dx? symmetric weakness, diminished reflexes, upward progression of motor weakness, recent viral infection
Med mgmt for Guillain barre? mechanical ventilation plasmaphoresis IVIG...both decr antibody levels No vaccinations with a virus in them, like flu, can trigger exacerbation
What are nsg mgmt intv? resp failure, so maintain resp fx, enhance physical mobility, adequate nutrition, decr fear/anxiety, cardiac dysrhythmias, DVT
Which cranial nerve is affected by trigeminal neuralgia? 5th
What is key distinguishing factor in trigeminal neuralgia? unilateral pain shooting/stabbing in cheek and jaw area, and ends as abruptly as starts and cause mouth twitching, sudden closing of the eye, thus name Tic Douloureux
What is medical mgmt for trigeminal neuralgia? antiseizure meds: tegretal, neurontin, baclofen(chill out nerve endings). Surgery can be option
The 7th cranial nerve is the facial nerve
the 7th cranial nerve, when inflammed unilaterally, causes facial paralysis/weakness known as Bells' Palsy
What is medical mgmt for Bells Palsy? Nsg Mgmt? prednisone for inflammation Nsg mgmt: Reassure pt not stroke, help excercises to strengthen facial muscles(blow, massage, whistling)
Peripheral nerves transmit motor impulses (to, from) brain and relay sensory impulses (to, from) brain? motor from brain, sensory to brain
Created by: palmerag