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Altered Cognitive F2

Meningitis Encephalitis SIADH Diabetes Insipidus

What is Meningitis? An organism gains access to subarachnoid space and meninges, resulting in exudate formation in the subarachnoid space and inflammation of the meninges occurs.
What are direct portals of entry for the occurrence of Meningitis? Bloodstream, middle ear, penetrating wound, catheter (Nasal surgery, or Ear surgery)
What are indirect portals of entry for the occurrence of Meningitis? Cerebral Abscess or encephalitis
What type of reported pain is seen with Meningitis? Significant. While the brain does NOT have pain receptors, the meninges DO.
What are some expected clinical manifestations of meningitis? Decrease of change in LOC, Disoriented to person, place, and year, Photophobia, Nystagmus, Abnormal eye movements. These symptoms may wax and wane.
What is a characteristic of symptoms in neuro problems? VERY exaggerated symptoms, and waxing and waning symptoms, to the extent that you could believe that the patient is faking it.
What is the progression of motor response in meningitis/encephalitis? Normal at first, then hemiparesis, hemiplegia, and decreased muscle tone, and finally cranial nerve disfunction, especially CN3,4,6,7&8.
What memory changes are seen in meningitis/encephalitis? Short attention span, personality/behavioral changes, emotional lability, bewilderment
What are some symptoms of meningitis/encephalitis? Severe, unrelenting headache (no relief from meds), generalized muscle aches and pains, n/v, fever and chills, tachycardia, red macular rash (looks like purpura, dots of purple - meningococcal meningitis)
What type of infection is meningococcal meningitis? Why is that bad? Bacterial infection. When we treat the bacteria with antibiotics, it dies and releases an endotoxin. That causes emboli in the microvascular circulation (purpura rash).
Is meningococcal meningitis contagious? Yes. It is a droplet infection. Most contagious to people who are in close proximity (military, dorm college student, scout camps).
What is the other name for Viral Meningitis? Aseptic Meningitis, common in locker room breakouts.
When was Streptococcus more prevalent? In neonates before vaginal cultures were mandatory
What is the significance of patients with Splenectomy? They receive the Pneumococcus vaccine, because for some reason they are very prone to pneumococcal meningitis or pneumococcal infection.
Which meningitis is common in children under the age of 5? Haemophilus influenzae, which is a bacteria. There is a vaccine now.
What is the consistent component of penetrating head injury, basal skull fracture, middle ear infection and ICP monitoring? We are introducing something dirty/yucky/or an opening, into a dark, moist, sugary environment. Ideal for infection.
One more time: Review Clinical Presentation of Meningitis or Encephalitis. Severe, persistent headache, meningismus, hyperthermia, convulsions, cranial nerve involvement, decreased sensorium, n/v, signs of IICP, skin rash, photophobia
How do you position a patient for a lumbar puncture? In a football hold, which opens the intervertebral spaces so that the physician can get the needle in.
What if a patient couldn't tolerate the traditional position for a lumbar puncture due to pregnancy or obesity. Sitting, bent, with arms over the bedside table.
What are Diagnostic tests for meningitis? History, physical exam, lumbar puncture, blood sugar, blood cultures, nasopharyngeal smear, electrolytes
Why would they do a systemic blood sugar and a blood sugar on the CSF? Because if you have bacteria in your CSF, the bacteria is eating the sugar and the sugar level in the CSF will be lower than the systemic blood sugar.
What is the treatment for meningitis? 10 days of IV antibiotics, control ICP, provide respiratory and circulatory support, reduce stimuli and darken the environment.
Why do we reduce the stimuli and darken the environment for a patient with meningitis? Because the patients are irritable due to inflammation of the brain. Need to reduce the cerebral metabolic demand.
When is meningitis most contagious? During the prodromal stage, when they do not know that they have an infection.
What are complications of meningitis? Scar tissue causes Mental Retardation and blindness.
What famous woman developed blindness, deafness, and mute after h. influenzae meningitis? Helen Keller
What are subjective data for the cognitive function assessment? Speak with the patient, family, support system, orientation (should know who THEY ARE), memory, reality testing
What are neuro illnesses with insidious onsets? Alzheimers, Parkinsons, Dementia,
If you can't tell if a patient is confused or has an aphasia, what can you do? Give them a command, like SIT DOWN. A confused person will sit down. A person who doesn't understand what you are asking will not.
What are objective data for the cognitive function assessment? ABCs & life threatening injuries, general appearance, behavior, communication pattern, interaction skills, motor activities and ADLs.
What is unique about appearance in neuro conditions? There is a neglect syndrome. The patient becomes slovenly, stops bathing, stops combing their hair
How does comfort vs fatigue or stress affect communication patterns in neuro patients? When a patient is comfortable and rested, they may communicate well. Whereas when they are fatigued, stressed, or at the end of the day, they may have trouble with communication. Speech may become thickened, difficulty finding the word, slurred.
How do Alzheimer's patients avoid diagnosis? They stop doing things that reveal the illness. ie. they stop getting their hair done because they don't remember where the shop is, but they say its because they don't like the smell there.
What is the biggest nursing key for a patient undergoing Neurosurgery? To obtain a thorough baseline assessment, so that after surgery you know where they were preoperatively. You need this to determine normal, progress, or deterioration.
Neuro uses alot of steroids, like Decadron. What are some things to be aware of? Watch for hyperglycemia. Treat with antacids/pepcid. Must be tapered off. Weight gain is common. Pt will be immunocompromised.
Post op responsibilities include: Elevate HOB 15-30 degrees, check head dressing freq for signs of drainage, check wound drains, provide care approp for pre-existing medical probs, maintain ventilation/oxygenation, fluid/electrolyte balance, B&B, skin integ, prevent deformity, normotherm.
Why are patients at RML trached vs intubated? Because a nurse can reinsert the cannula with an obturator, but only a doctor can re-intubate.
What are considerations for oxygenation? Breath sounds, pulse ox, ABGs, color, temp, respirations
What is an affect on oxygenation in an agitated patient? Drop in sats 20-30%
What is the #1 complication r/t oxygenation? Pneumonia
Why do we want to wean patients from ventilators? For a better quality of life
What are nursing considerations related to risk for aspiration? No straw. thickened liquids, chin tuck, use back of the throat when feeding, stroke under their chin to elicit the swallow reflex,
If an RN delegates the task of feeding a patient to axillary staff, what remain true? The outcome is the responsibility of the RN.
What are signs of a swallow problem? Drooling, weak cough, soft-faint voice, weight loss, pneumonias
When patients experience aspiration pneumonia repeatedly and they reach a level of wellness, but do not completely recover, they are at risk for what? An accumulating effect, Multi-system organ failure
What might be a coping mechanism that a patient involuntarily implements due to swallow difficulties? They may place themselves on a thickened liquid diet, by refusing other food offerings.
How do we assess for fluid status in patients with age related considerations, chronic illness considerations, cognitive disorders, and/or movement disorders? Look at skin turgor, mucous membranes, specific gravity, urine output, weight, etc.
Diabetes Insipidus neurologically originates where? In the pituitary, in the brain.
What are signs of Diabetes Insipidus? Increased urine output to several liters/hr, decreased specific gravity, decreased osmolar concentration, 24hr urine output >4000 mLs.
What is the major complication of Diabetes Insipidus? HYPERNATREMIA, because the patient is dumping water and hanging onto sodium, so sodium levels increase.
What is the treatment for Diabetes Insipidus? Aqueous pitressin (2-5U) subq; fluid replacement 1:1 plus insensible water loss; monitor electrolytes
Is there really too much sodium in the pt with Diabetes Insipidus? Not really. The patient is dumping so much water, that the sodium is Hemoconcentrated.
What is the opposite of Diabetes Insipidus (the yin for the yang)? Inappropriate ADH: Syndrome of Inappropriate Antidiuretic Hormone
What is an example from the local media of SIADH? The lady who wanted to win the Wii and literally drank herself to death!
Why won't Lasix work for SIADH? Because Lasix works on the intravascular system and SIADH hold water in the extracellular compartments.
Patients with SIADH have HYPONATREMIA? What are s/s? Disoriented, confused, seizures,
Why do they give patients with SIADH the antibiotic demeclocycline? Because it inhibits the antidiuretic action
What are characteristics of SIADH? Water retention, dilutional hypovolemia, increased GFR, volume expansion, suppression of renin-angiotensin-aldosterone secretion
What is seen clinically in SIADH? Excessive fluid in the extracellular compartment (centrally), lack of peripheral edema, increased urine osmolarity, HYPOnatremia
What are the treatments for SIADH? Water restriction or 500 mL NS IV, Replace sodium with 3% or 5% solution, demeclocycline
What are activity/exercise considerations? Risk for injury r/t unsteady gait, reduced memory & judgment, apraxia (doesn't know what a toothbrush is), fatigue. Self care deficit r/t apraxia, reduced attn span, fatigue, memory loss, impaired planning ability.
What are sleep considerations? Sleep pattern disturbance r/t fragmentation of diurnal rhythms and sleep-cycle disturbances. This is also hard on the caregivers.
What are temperature considerations? Due to the damage to the hypothalamus, patients may be hypo or hyperthermic. We treat both; tylenol or motrin or anticonvulsants.
Why might they treat a fever with an anticonvulsant? Because it is a neuro temp, so it is associated with seizure activity rather than an infectious process.
What is Expressive Aphasia? Patient understands language but is unable to use it appropriately.
What is Receptive Aphasia? Patient is unable to understand the significance of the spoken word.
If you can't tell the difference between Aphasia and confusion, what can you do? Give the patient a direction. Ask the patient to sit down. A confused patient will sit down. A Receptive Aphasic patient will not.
As the disease progresses and there are changes in the biochemistry of the brain, what could be observed? Hallucinations, need to assist pt to differentiate between their own thoughts and reality, use psych medications, provide diversional activities
What is a concern with safety and comfort r/t altered thought processes? Short term memory loss and reduced ability to tolerate frustration.
HUGE Caregiver issues r/t this disease process include: Knowledge deficit, information about the illness, new methods of interaction, ineffective family coping r/t isolation, lack of knowledge, resources, and support.
What are Self Esteem issues for these patients? Lack of independence, inability to control body functions, ineffective individual coping, ineffective family coping, loss of quality of life, expense
Primary Levels of Prevention in a patient who already has Alzheimers would include: Preventing falls, preventing injuries
General information on Alzheimers: Increased family history,
How much time can Aricept give a patient back? 8 months
Where is there NO Alzheimers? What do they think contributes to the complete LACK of Alzheimers? India, because their diet is high in tumeric/curry.
What negates the effect of Aricept? Paxil, anticholinergic
100% of children with what condition get Alzheimers? Down Syndrome
Mothers of children with Downs Syndrome before the age of 35, have a much higher risk of developing what? Alzheimers
What are two tests for determining Alzheimers or dementia? Read time on an analog clock, and give change for $1. If they cannot do that, that is 97% indicative of dementia.
What are signs of Parkinsons? They do not swing their arms when they are walking. They only blink 6x/min. They lose their sense of smell early on.
Treatment for Parkinsons incluses? Boosting the dopamine with Sinemet/L-dopa/Carbidopa, so that they have better synapses.
What is the side effect of giving dopamine? Development of addictive habits: gambling, food, drug, alcohol, sex. This is just like the effect of Methadone!!
Reglan can cause the EPS. When is it usually seen? After first dose
Things triggered by Group A strep infections OCD in childhood, anorexia nervosa, tourettes.
For more information about Group A strep infection developments google: PANDAs
Methadone releases dopamine thousands of times greater than occurs naturally. That is what creates the addiction. What is the consequence? The dopamine secretion in the brain the DESTROYED, so if the patient kicks Crystal Meth they no longer feel anything!
Created by: Kitty Groebli