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Neurology

Neurology. Chapter 64 Management of Patients with neurologic infection, autoimmune disorders and neuropathies. Meningitis. Pathophysiology Meningitis Infection/ inflammation of the meninges Encephalitis Infection/inflammation of the brain tissue. Meningitis. Pathophysiology

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Neurology

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  1. Neurology Chapter 64 Management of Patients with neurologic infection, autoimmune disorders and neuropathies

  2. Meningitis • Pathophysiology • Meningitis • Infection/ inflammation of the meninges • Encephalitis • Infection/inflammation of the brain tissue

  3. Meningitis Pathophysiology • Meningitis/ encephalitis  • Infection  • Immune response  • Swelling/edema  • I –ICP  • Etc.

  4. Meningitis Is meningitis a disorder of the CNS, PNS or both? • CNS • PNS • Both CNS & PNS

  5. Meningitis The most common bacterial pathogens are: • Haemonphili influenzai • Affected kids < 5 yrs • H influenzae vaccine (Hib) • Streptococcus pneumoniae • Affects age 19-59 • Neisseria meningitides • Easily transmitted to others • Least lethal

  6. Meningitis Two ways the infectious agent can inter the meninges • Blood stream • Most common • Usually d/t URI • Direct extension • TBI • Invasive procedures

  7. Meningitis • The viral type of meningitis is usually • Self limiting • Benign • Bacterial meningitis is potentially • Fatal

  8. Meningitis Clinical manifestations • Onset: • Abrupt • General S&S • Nuchal rigidity • Positive Kernig's • Positive Brudzinski’s • Photophobia

  9. Meningitis Clinical Manifestations • S&S of infection • Fever • Chills

  10. Meningitis Clinical manifestations • S&S of I-ICP • H/A • i LOC • Vomiting • Papilledema • Hydrocephalus

  11. Meningitis Clinical manifestations • N. Meningitidis • Rash • Petechial • Purpuric lesion • Ecchymosis

  12. Meningitis Clinical manifestations • Infants/young children • Seizures • High-pitched cry • Bulging fontanels

  13. Meningitis • Mr. Jones has encephalitis. Would you expect his signs and symptoms to be more or les severe than a person with meningitis? • More severe • Less severe Encephalitis signs and symptoms are more severe with delirium & seizures.

  14. Meningitis Diagnosis • Lumbar tap • C&S of CSF • Positive Kernig’s • Positive Brudzinski

  15. Meningitis Treatment • Broad spectrum antibiotics • Penicillin • Cephalosporin's • Intrathecally • Early intervention crucial!

  16. Meningitis Nursing interventions • Isolation • ? Causative agent • Assessment • V/S • Neuro check • Cranial nerve involvement • Abn sleep patterns • Behavioral changes • ABG’s • Opisthotonus

  17. Meningitis Nursing management • I-ICP protocol • I&O • Quiet environment: Dark • Limit visitors • Nutrition • No constipation • Pad side rails • Emotional support • Alkalosis

  18. Meningitis Prevention • Haemonphilus vaccine • HiB • meningococcal conjugate vaccine • persons aged 11 to 55 years.  • designed to offer protection against four serogroups of Neisseria meningitidis (A, C, Y, W-135), which account for approximately 70 percent of cases in the United States. 

  19. Meningitis Complications • Thrombosis • i cerebral blood flow • Brain damage • Death

  20. Meningitis • What do bulging fontanel’s in an infant indicate? • What type of meningitis occurs most frequently and is considered the milder form? • What are the symptoms of meningitis? • To facilitate performing the lumbar puncture, on the patient who may have meningitis, it is best for the nurse to place the patient in what position? • After the lumbar puncture has been performed, it is best for the nurse to do

  21. Meningitis • What standard vaccine is administered to infants to prevent meningitis? • Identify the bacteria most commonly associated with meningitis • What is the most severe form of meningitis? • What affect does meningitis have of the physiology of the brain? • Name six signs and symptoms of bacteria meningitis • Is meningitis a disease of the CNS or PNS

  22. Brain Abscess Pathophysiology • A collection of infectious material within the tissue of the brain • Infection  • I-ICP  • Brain shift

  23. Brain Abscess 2 ways infection can enter the brain • Direct invasion • Spread from nearby sight • Sinuses • Ears • Teeth

  24. Tongue piercing causes brain abscess • 13 December 2001 New Scientist • Parents now have another reason to frown on tongue piercing - a potentially fatal brain abscess suffered by a young woman in Connecticut. • The woman's tongue became sore and swollen two or three days after it was pierced, and she reported a foul-tasting discharge from the pierced region. The infection healed in a few days after she removed the stud from her tongue, but a month later she suffered severe headaches, fever, nausea and vomiting. • A scan at the Yale University hospital revealed the brain abscess, which physicians drained. She recovered after six weeks of intravenous antibiotic treatment.

  25. Brain Abscess Clinical manifestations • I-ICP • Infection • Fever? • Sometimes • Sometimes not!

  26. Brain Abscess Diagnostic findings • CT • MRI

  27. Brain Abscess Medical Management • Antimicrobial therapy • Large IV doses • Surgery • Anti-convulsant

  28. Brain Abscess Nursing management • I-ICP protocol • Neuro assessment • Safety protocol • seizures

  29. Brain Abscess • Who is most at risk for brain abscesses? • Describe the medical treatment for a patient with a brain abscess? • Is a brain abscess a diseases of the CNS, PNS or both?

  30. Multiple Sclerosis Pathophysiology • Autoimmune disease • Demyelination of the myelin covering that protects the neurons of the brain and spinal cord

  31. Multiple Sclerosis • Demyelination • Destruction of the myelin sheath • Impaired transmission of nerve impulses • Both the axon & myelin are attacked

  32. Multiple Sclerosis • Is multiple sclerosis a disorder of the CNS, PNS or both? • CNS • PNS • Both CNS & PNS

  33. Multiple Sclerosis Etiology / Contributing factors • Unknown cause • Men vs women • Men < women • Age of onset • 20-40

  34. Multiple Sclerosis Clinical manifestations • Usually slow, progressive disease • Relapsing-remitting course • Patient may experience remission & exacerbation’s • Exacerbation of symptoms  • Partial/full remission  • Symptoms return

  35. Multiple Sclerosis Clinical Manifestations • Episodes of motor, visual or sensory disturbance • Visual disturbances • Diplopia • Blurred vision • Paresthesia • Fatigue • Dizziness

  36. Multiple Sclerosis Clinical Manifestations • Emotional disturbances • Scanning speech • Incontinence • Sexual disorders • Spasticity • Muscle hypertonicity

  37. Multiple Sclerosis Diagnosis • MRI • Sm. Plaque • Patches • CT scan • Lumbar puncture • Immunoglobulin abnormalities

  38. Multiple Sclerosis Medical management • No cure • Goal • Delay progress • Manage symptoms

  39. Multiple Sclerosis Pharmaceutical • Interferons • ABC&R

  40. Multiple Sclerosis Pharmaceutical • Skeletal muscle relaxants • Baclofen/lioresal • i transmission of impulses from the spinal cord to the skeletal muscle  • i spasticity • S/E • Drowsiness, weak

  41. Multiple Sclerosis Pharmaceutical • Corticosteriods • Immunosuppressants • Dexamethasone, prednisone • Action • Decreased imflammation • S/E • Poor wound healing • Na+ & H20 retention • h glucose levels

  42. Multiple Sclerosis Nursing Interventions • Individualized • B&B management • Avoid stress • Stress • Fatigue • Extreme temp. • Exercise • Fluids • Diet • High roughage

  43. Multiple Sclerosis Complications • Pneumonia • Decubitis ulcers • Contractures • Dependency

  44. Multiple Sclerosis • What is the pathophysiology of MS? • Is MS a disease of the CNS, PNS, or both? • Explain what demyelination refers to. • What role does temperature play in multiple sclerosis? • Identify 5 common signs and symptoms of MS.

  45. Multiple Sclerosis • What classifications of medications are used in treating MS? • What is the progression of multiple sclerosis • What is the most common symptom associated with MS? When does the individual usually seed medical help? • What can exacerbate MS? • What is a long term goal for a patient with MS?

  46. Myasthenia Gravis Pathophysiology • Auto-immune • Progressive disease • Remission & exacerbation • Flaw in transmission of impulses from the nerve to the muscle • Neuro-muscular junction • Most often affects the muscles regulated by the cranial nerves

  47. Myasthenia Gravis Pathophysiology • Specifically attacks receptors for acetylcholine  • Prevents muscle contraction  • Progressive weakness & fatigue

  48. Myasthenia Gravis • Is myasthenia Gravis a disorder of the CNS, PNS or both? • CNS • PNS • Both CNS & PNS

  49. Myasthenia Gravis Clinical manifestations • Onset • Gradual • Early • Ptosis • Diplopia • Progressive • May be fast or slow • With or without remission • Dysphonia • Difficulty chewing & swallowing • Extreme muscle weakness

  50. Myasthenia Gravis Clinical manifestations • Resp. paralysis (Bulbar paralysis) • Vital capacity • i • Resp. failure  • Deathmosis

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