Chapter 69 - Neurologic Infections, Autoimmune Disorders, and Neuropathies.docx - Chapter 69 \u2013 p 2026-2033 \u2013 Management of Patients with Neurologic

Chapter 69 - Neurologic Infections, Autoimmune Disorders, and Neuropathies.docx

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Chapter 69 – p. 2026-2033 – Management of Patients with Neurologic Infections, Autoimmune Disorders, and Neuropathies Infectious Neurologic Disorders - Meningitis: o Inflammation of the meninges o Meninges cover and protect the brain and spinal cord o Causes: bacterial, viral, and fungal infections o N. meningitidis: outbreaks occur in dense community groups college campuses and military installations o Pathophysiology: Originate: Through the bloodstream through infections Direct spread after a traumatic injury to facial bones or secondary to invasive procedures N. meningitidis concentrates in the nasopharynx and is transmitted by secretion or aerosol contamination Inflammation causes increased ICP Acute presentation adrenal damage, circulatory collapse, and widespread hemorrhages Complications: Visual impairment Deafness Seizures Paralysis Hydrocephalus Septic shock o Clinical Manifestations: Headache and fever Neck immobility Positive Kernig’s sign cannot completely extend leg when lying with leg flexed on abdomen Positive Brudzinski’s sign knees and hips flex when neck is flexed Photophobia
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Disorientation and memory impairment Initial signs of increased ICP decreased LOC and focal motor deficits Acute fulminant infection: Occurs in 10% of pts Signs of overwhelming septicemia o Abrupt onset of high fever o Extensive purpuric lesions over face and extremities o Shock o Signs of disseminated intravascular coagulation (DIC) o Preventions: Vaccination If exposed to patient Rifampin (Rifadin) Ciprofloxacin hydrochloride (Cipro) Ceftriaxone sodium (Rocephin) o Tx within 24 hours after exposure o Medical Management: Penicillin G Dexamethasone (Decadron) Given 15-20 minutes before 1 st dose of antibiotic and q6h for 4 days o RN management: Continuously monitoring VS and neurologic signs Pulse ox and ABGs BP to monitor for shock Protect pt from secondary injury Monitoring daily weight, electrolytes, specific gravity Prevent complications of immobility, pneumonia, and pressure ulcers
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Brain Abscess: - Mostly dx in immunosuppressed people - Pathophysiology: o Collection of infectious material within brain tissue o Bacteria most common causative agent o Most common predisposing conditions otitis media and rhinosinusitis o Can result from intracranial surgery, penetrating head injury, or tongue piercing (I lucked out) - Clinical manifestations: o Result from alterations in intracranial dynamics Edema Brain shift Infection Location of abscess o Headache worse in A.M. ** o Vomiting and focal neurologic deficits - Medical managements: o Tx focused on Controlling increased ICP Draining abscess Antimicrobial therapy o Antibiotic: Ceftriaxone - RN Management: o Monitor:** Blood glucose Serum potassium levels o Monitor hemiplegia, hemiparesis, cranial nerve palsies Herpes Simplex Virus Encephalitis: - Most common cause of acute encephalitis - Pathophysiology: o Local necrotizing hemorrhage o Progressive deterioration of nerve cell bodies
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