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Chapter 5

Unit 2: Nursing care of clients with neurosensory disorders

QuestionAnswer
Meningitis (Pg. 53) Inflammation of the meninges (membranes that protect the brain and spinal cord)
What is the most common type of meningitis? Viral (aseptic); resolves w/o tx
Which type of meningitis has a high mortality rate? Bacterial (septic), it's contagious
Are there meningitis vaccines? (Pg. 53) Yes 3; one is available for high-risk populations; college students
Is there a vaccine against viral meningitis? & risks No. Risks to getting; mumps, measles, herpes, west nile
Bacterial meningitis risks Immunosuppression, invasive procedures, skull fractures, penetrating head wound, overcrowding living
Patient complaints: Excruciating, constant headache Nuchal rigidity (stiff neck) Photophobia (sensitivity to light)
Signs/symptoms: Fever/chills, nausea/vomiting, altered LOC, positive kernig's sign, positive brudzinski's sign, hyperactive DTR's, tachycardia, seizures, red macular rash, restless, irritable
Positive kerning's sign: Resistance & pain w extension of the client's leg from flexed position
Positive brudzinski;s sign Flexion of extremities occurring w deliberate flexion of the client's neck
LABS Urine, throat, nose & blood C&S -not definitive for meningitis but can guide initial antimicrobial (broad) tx CBC- elevated WBC's
Dx meningitis: (pg. 55) CSF analysis: by lumbar puncture, most definitive -cloudy CSF (bacterial), clear (viral) -^ WBC, protein & CSF pressure, and low glucose,
Nursing: precautions Isolate as soon as suspected -Droplet precautions; private room, con't until abx con't for 24hrs & when oral.nasal secretions no longer infectious
Nursing: Fever, stimuli, bed rest, ICP Fever reducing; cool blanket Low stimuli; low lights, quiet Bed rest head ^ 30 degrees If ^ ICP; avoid cough/sneeze
Nursing: Seizures, fluids, Replace as indicated by labs, seizure precautions
Medications to treat Meningitis Ceftriaxone (Rocephin) or Cefotaxime (Claforan) in combination w/ Vancomyin -Give until C&S available
Med if seizures or ^ ICP Anticonvulsants; Phenytoin (Dilantin)
Analgesics for headaches and/or fever Acetaminophen (tylenol) or Ibuprofen (Motrin) -Nonopioids to avoid changing LOC
S/S of ^ ICP (complication of meningitis) Decreased LOC, pupillary changes, impaired extraocular movements
Interventions to reduce ICP Positioning & avoiding coughing/sneezing/straining
Complication of Meningitis: SIADH: syndrome of inappropriate ADH -d/t abnormal stimulation of the hypothalamic area (excess secretion of ADH)
S/S SIADH & tx -Dilute blood, concentrated urine -Restrict fluids and administer Demeclocycline (Declomycin)
Septic emboli (another complication) Can lead to DIC -Mostly travel to hands & feet.. could develop into gangrene
Created by: mary.scott260!