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Chapter 69 – p. 2026-2033 – Management of Patients with Neurologic Infections, Autoimmune Disorders, and NeuropathiesInfectious Neurologic Disorders-Meningitis:oInflammation of the meningesoMeninges cover and protect the brain and spinal cordoCauses:bacterial, viral, and fungal infectionsoN. meningitidis:outbreaks occur in dense community groups college campuses and military installationsoPathophysiology:Originate:Through the bloodstream through infections Direct spread after a traumatic injury to facial bones or secondary to invasive proceduresN. meningitidisconcentrates in the nasopharynx and is transmitted by secretion or aerosol contaminationInflammation causes increased ICPAcute presentation adrenal damage, circulatory collapse, andwidespread hemorrhagesComplications:Visual impairmentDeafnessSeizuresParalysisHydrocephalusSeptic shockoClinical Manifestations:Headache and feverNeck immobilityPositive Kernig’s signcannot completely extend leg when lying with leg flexed on abdomenPositive Brudzinski’s signknees and hips flex when neck isflexedPhotophobia
Disorientation and memory impairmentInitial signs of increased ICP decreased LOC and focal motor deficitsAcute fulminant infection:Occurs in 10% of ptsSigns of overwhelming septicemiaoAbrupt onset of high feveroExtensive purpuric lesions over face and extremitiesoShockoSigns of disseminated intravascular coagulation (DIC)oPreventions:VaccinationIf exposed to patientRifampin (Rifadin)Ciprofloxacin hydrochloride (Cipro)Ceftriaxone sodium (Rocephin)oTx within 24 hours after exposureoMedical Management:Penicillin GDexamethasone (Decadron)Given 15-20 minutes before 1stdose of antibiotic and q6hfor 4 daysoRN management:Continuously monitoring VS and neurologic signsPulse ox and ABGsBP to monitor for shockProtect pt from secondary injuryMonitoring daily weight, electrolytes, specific gravityPrevent complications of immobility, pneumonia, and pressure ulcers
Brain Abscess:-Mostly dx in immunosuppressed people-Pathophysiology:oCollection of infectious material within brain tissueoBacteria most common causative agentoMost common predisposing conditions otitis media and rhinosinusitisoCan result from intracranial surgery, penetrating head injury, or tongue piercing (I lucked out)-Clinical manifestations:oResult from alterations in intracranial dynamicsEdemaBrain shiftInfectionLocation of abscessoHeadache worse in A.M.**oVomiting and focal neurologic deficits-Medical managements:oTx focused on Controlling increased ICPDraining abscessAntimicrobial therapyoAntibiotic:Ceftriaxone-RN Management:oMonitor:**Blood glucoseSerum potassium levelsoMonitor hemiplegia, hemiparesis, cranial nerve palsiesHerpes Simplex Virus Encephalitis:-Most common cause of acute encephalitis-Pathophysiology:oLocal necrotizing hemorrhageoProgressive deterioration of nerve cell bodies