NUR 265 EXAM THREE STUDY GUIDE. A GRADED.UNIT 7
ENCEPHALITIS
• Inflammation of the brain tissue- the ventricles. – affects the cerebrum, the brain
... [Show More] stem, and the cerebellum
• Normally caused by a virus
o Herpes
o Polio
o Mosquito borne viruses- west Nile
o Tick borne viruses
o Rabies
o Childhood viruses
• Signs/symptoms:
o High fever
o Nuchal rigidity- occurs only if brain stem infected
o Photophobia
o Phonopobia
o Headache
o N/V
o Altered LOC
o s/s of increased ICP
o fatigue
o joint pain
o vertigo
o muscle spasms
o ataxia
o tremors
• diagnosing:
o history of any viruses, mosquito bites, or swimming in lakes- all within the last month
o lumbar puncture
analyze CSF
PCR test to detect viral DNA
o EEG for brain wave activity or seizure
o CT scan- hydrocephalus
o Blood cultures- viruses
• Assessment:
o Q 4-hour neuro checks
Glasgow coma scale
Cranial nerve assessment
Change in LOC or orientation
• Nursing considerations
o Maintain airway
o Monitor for increased ICP
o Monitor for vitals and neuro frequently
o Reduce stimuli- darken the room, turn down TV, put them at the end of the hall
o Treat the symptoms
• Treatment
o Acyclovir- antiviral
Need to begin as early as possible
o Prevention
Using DEET spray on self
Avoid people with herpes outbreak, etc.
MENINGITIS
• Inflammation of the meninges (layers covering brain) specifically the pia mater and arachnoid
• Can be viral or bacterial- bacterial is much worse
• People ages 16-21 have highest rate of bacterial meningitis. CDC recommends initial vaccine at 11-12 and a booster at 16. Adults are advised to get initial or booster vaccine if living in a shared residence like a dorm, traveling or residing in a foreign country which disease is common, or are immunocompromised due to a damaged or surgically removed spleen. It is safe to receive booster 8 weeks after initial vaccine incase initial vaccine status not known.
• Bacterial
o Occurs in outbreaks such as dorm rooms
o Caused by Neisseria meningitides and streptococcus pemoniae
o High mortality rate
o Droplet precautions- CONTAGIOUS!
o Private room
• Viral
o Non-contagious
o Caused by mumps, HIV, herpes zoster, etc.
o Low mortality rate
o Standard precautions
• Symptoms
o Fever
o Nuchal rigidity- THIS IS A CLASSIC SIGN!!!
o Photophobia
o Phonophobia
o Headache
o N/V
o Change in LOC
o s/s increased ICP
o muscle aches
o maculopapular rash
o petechial rash
o seizures
o SIADH
o SIRS/DIC
• Diagnosing:
o Lumbar puncture for CSF
Virus- clear, normal pressure and no organism found
Bacterial- cloudy, turbid, increased WBC! Increased protein, decreased glucose, and elevated CSF pressure
o Gram stain- done to see which bacteria it is
o Counterimmunoelectrophoresis (CIE)- preformed to determine presence of virus
o Kerning’s sign- when doctor forces the patent’s head up, the patient’s knees will flex inward toward the core involuntarily
• Nursing considerations
o Bacterial patient must be on droplet precautions. Stay 3 feet away from patient unless you are wearing a mask. Teach patient and visitors about need to wear a mask
o Neuro checks Q 4 hours
o Monitor for ICP
o Reduce stimuli
o Treat the symptoms
• Treatment:
o Do NOT delay treatment while waiting to preform tests or obtaining test results
o If meningitis’s is suspected, broad spectrum antibiotic immediately!
o Decreased external stimuli- keep ICP down
o Treat symptoms like fever
o Prevent complications- DVT, PE, ICP, seizures.
TRIGEMINAL NEURALGIA
• Disorder that affects the trigeminal nerve- the fifth cranial nerve
• Trigeminal nerve has 3 branches- sensation in person’s eye, upper eyelid, and forehead, lower eyelid, cheek, nostril, upper lip, and upper gum, jaw sensations lower lip, lower jaw, and muscles for chewing
• Trigeminal nerve basically controls the middle of the face
• Chronic pain syndrome in those areas of the face.
• Pain is described as excruciating, sharp, shooting piercing, burning, etc.
• Triggers- like brushing teeth, light touch stimulation, change in facial expressing (smiling), chewing,
• Fear of pain stops them from talking, smiling, eating, or attending to hygienic tasks
• Priority is pain management!
• Medications
o Carbamazepine- first choice drug- anti-epileptic.
o Muscle relaxants
• Percutaneous sterotactic rhizotomy [Show Less]