Meningitis
What nursing management are indicated for patients with meningitis?
droplet precautions; antipyretic agents/cooling blanket; stay hydrated; dim lights; side rail padding; monitor daily weight and I&Os
Is there a cure for multiple sclerosis?
YES OR NO
NO cure.
What is used to prevent corneal damage when eyelids do not close completely?
eye drops
What is Guillian-barre syndrome?
also known as acute idiopathic polyneuritis, is an autoimmune attack on the peripheral nerve myelin.
NOTE: "pins and needles" sensation
What is the medical goal when treating for a patient with this disease?
treatment directed toward controlling symptoms and maintaining functional independence because NO medical or surgical approaches in current use prevent progression.
List the three types of meningitis.
bacterial, viral, fungal
What nursing interventions are in place with patients diagnosed with this condition?
promote physical activity: activity and rest, nutrition, minimize spasticity and contractures
prevent falls
manage fatigue
strengthen coping mechanisms
What is myasthenia gravis?
-an autoimmune disorder affecting the myoneural junction, is characterized by varying degrees of weakness of voluntary muscles
NOTE: disease is a motor disorder with NO effect on sensation or coordination
what cranial nerves does the bulbar muscle weakness demyelination affect?
glossopharyngeal and vagus nerve (inability to swallow or clear secretions)
- vague nerve demyelination results in autonomic dysfunction, manifested by instability of the cardiovascular system
What are the FOUR cardinal manifestations?
T- tremor (pill rolling or tremor dominant/nondominant)
R- rigidity (early indication = complain of shoulder pain)
A- akinesia or bradykinesia
P- postural instability (shuffling gait)
Other: dysphagia; psychiatric changes; hypokinesia; dysphonia
Clinical manifestations of meningitis
fever/chills, neck immobility, positive Kernig sign, positive Brudzinski sign, photophobia, rash (petechial rash with purpuric lesions to large areas of ecchymosis
What condition can arise from multiple sclerosis?
Amyotrophic lateral sclerosis (degenerative neurologic disorder of upper and lower motor neurons, resulting in progressive paralysis)
What are the two types?
1. ocular - eye muscles are involved - diplopia and ptosis
2. generalized - patients experience weakness of the muscles results in a bland facial expression (causes dysphonia & dysphagia or intercostal weakness resulting in decrease vital capacity and respiratory failure)
Are serum laboratory test useful for diagnoses?
YES or NO
NOT USEFUL
What diagnostic study confirms that a patient has the disease?
Lumbar puncture is indicated to get CSF.... what is the difference between bacterial and viral results?
Viral = clear appearance; glucose normal; increased protein and WBC; gram stain -
Clinical manifestations of multiple sclerosis
fatigue, depression, ataxia, coordination difficulty, spasticity
visual disturbances --> blurred vision, diplopia, scotoma, total blindness, nystagmus
tinnitus, vertigo
bladder, bowel, sexual dysfunction
What diagnostic tests are preformed for myasthenia graves?
Acetylcholinesterase inhibitor test: performed by administering Edrophonium chloride IV; 30 seconds after injection, facial muscle weakness and ptosis should resolve for about 5 min. (NOTE: if patient worsens [cholinergic crisis] give atropine)
Ice test: held over pts eye for 1 min; ptosis should temporarily resolve
Repetitive nerve stimulation: demonstrates a decrease in successive action potentials
what are the subtypes?
1. pt experiences weakness in lower extremities, which progresses upwards and has a potential for resp. failure
2. purely motor with no altered sensation
3. called descending GBS (more difficult to diagnose; mostly affects the head and neck muscles)
4. Rare - Miller-FIsher variant (includes s/s of ocular muscles, ataxia, areflexia
What does it mean when a patient experiences on-off syndrome when taking levodopa?
off effect- near immobility
on-effect- effectiveness of medication
Penicillin G in combination with one of the cephalosporins (cefriaxone, cefotaxime) is most often administered IV, within 30 min of being in ED.
Dexamethasone - treats acute bacterial meningitis and pneumococcal meningitis if it is given before or concurrently with the first dose of antibiotic and every 6 hours for the next 4 days.
Dehydration and shock give fluid volume expanders.
Seizures treated with anticonvulsants.
What are the medications given to a pt with multiple sclerosis?
Avonex
Glatiramer acetate (Copaxone)
IV methylprednisolone (short term corticosteroid use bc risk for exacerbations)
mitoxantrone (novantrone)
What medication is used to treat exacerbations?
plasmapheresis
IVIG (intravenous immune globulin)
What medications are used to directly affect the peripheral nerve myelin antibody level?
therapeutic plasma exchange and IVIG (intravenous immune globulin)
(Increase/Decrease) dopamine levels while acetylcholine levels (Increase/Decrease)
decrease; increase