Medications & Treatment
Treatment for this condition would include:
hypertonic saline
3% mannitol (osmotic diuretic)
Increased ICP
•Nursing Interventions and Assessment, Nursing interventions r/t diagnostic testing
•Seizure precautions
•BP and ICP monitoring
•Nutritional support
•Management of pain and anxiety
•Treatment
•Medical – sedation, hypothermia, mild hyperventilation, ventilator, hypertonic saline
•Nursing – elevate HOB
•Medications -mannitol (osmotic diuretic)
Signs and Symptoms may include:
fever
headache
confusion
personality changes
hallucinations
seizures
stupor
coma
Complex Neurological Problems:
(herpes simplex) Encephalitis
•Diagnosis
•CSF examination
•EEG
•Neuroimaging
• Clinical Manifestations
•Fever
•Headache
•Confusion
•Seizures
•Stupor
•Coma
•Hallucinations
•Personality changes
TX
•Nursing Interventions and Assessment, Nursing interventions r/t diagnostic testing
•Comfort measures – cluster care, dim lights, low noise and visitors
•Seizure precautions
•Neuro checks
•Treatment
•Medications- acyclovir (zovirax)
Your patient is no longer able to autoregulate and comes in with a change in LOC (earliest sign of increased ICP), decreased pulse and respirations, and an increase in BP.
What might be going on here?
IICP: Cushing’s Triad
No longer able to autoregulate
•Change in LOC (earliest sign of IICP)
•Change in VS: decrease Pulse and Resp, increase BP
•Grave situation
•May herniate: decrease cerebral blood flow=ischemia=brain death
Causes:
•Head trauma
•Tumor
•Infection: viral encephalopathies, abscess
TX
•Decrease edema
•Lower CSF
•Decrease blood volume while maintaining perfusion
•
Medical Interventions:
Osmotic diuretics (Mannitol), hypertonic saline (3%)
Restrict fluids
Drain CSF
Control fever (decreases metabolic needs)
Maintain BP
Decrease metabolic demands: sedatives or barbiturates (comatose state)
Burr holes
Craniotomy(replace bone)/Craniectomy(leave open): watch for increasing BP
CM include:
Headache
Fever (steady, throbbing, severe)
Sore neck
Pain when extending knees
Meningitis
Initial symptoms Headache and fever Steady, throbbing, severe o Neck immobility (nuchal rigidity) o Kernig sign Pain when extending knee o Brudzinski sign More sensitive sign Flex the neck while lying flat; hips and knees will flex too o Photophobia o Rash Petechial rash to ecchymosis o Disorientation and memory impairment, seizures, increased ICP, sepsis
ranges 3-15
15 is the best.
What is the Glasgow Coma Scale?
See table 38-2 in our book for further information
8 or less is a comatose client
3 - totally unresponsive
What is the recommended antimicrobial chemoprophylaxis for meningococcal meningitis within 24 hours of exposure?
a) Penicillin G
b) Ceftriaxone
c) Dexamethasone
d) Penicillin G in combination with cephalosporin (Ceftriaxone IV)
d) Penicillin G in combination with cephalosporin (Ceftriaxone IV)
The recommended antimicrobial chemoprophylaxis for meningococcal meningitis within 24 hours of exposure is Penicillin G in combination with cephalosporin (ceftriaxone IV). This combination is effective in preventing the spread of the infection and is the recommended treatment protocol.
What is the primary manifestation (think later stages) of Amyotrophic Lateral Sclerosis (ALS)?
The primary manifestation of Amyotrophic Lateral Sclerosis (ALS) is impaired speech, swallowing, and breathing, which occurs following weakness and wasting of the upper extremities. ALS is a progressive disease affecting both the upper and lower motor neurons, and it typically occurs between 40 to 60 years, affecting men more than women.
"A condition characterized by severe hypertension and autonomic nervous system overreaction." Could describe what disease process?
What is autonomic dysreflexia?
Change in level of consciousness
What is the normal range for Cerebral Perfusion Pressure (CPP)?
70-100mmHg
Treatment for this condition if caught early enough might include:
bedrest/sedation and a reverse anticoagulant initially
Once stabilized medications like:
acetaminophen
and other meds like metoprolol, lisinopril, or losartan
What is this condition? And What types of meds are those?
The condition is cerebral aneurysm/AVM
acetaminophen is aspirin-used as an antipyretic and analgesic also as an anticoagulant (some pts may use 81mg low dose aspirin daily)
metoprolol-beta blocker used for CHF and HTN reducing the hearts demand for oxygen by blocking epinephrine and norpinphrine to the heart. "lol" will be your beta blockers
lisinopril-ACE inhibitor. This drug relaxes the blood vessels in your body. This reduces stress on your heart and lowers your blood pressure.
losartan-ARBs angiotensin II receptor blocker. it works by decreasing preload and afterload to the heart.
The importance of these medications is to maintain homeostasis and pressure throughout the body and specifically the brain.
ETIOLOGY for cerebral aneurysm/AVM: high blood pressure, acute intoxication, recreational drug use (especially cocaine), or congenital defects.
Usually preceded by a viral infection, the etiology for this disease is a rapid demyelination of peripheral nerves and some cranial nerves.
The etiology of Guillain-Barre Syndrome (GBS) is the rapid demyelination of peripheral nerves and some cranial nerves, usually preceded by a viral infection. This results in bilateral ascending weakness with dyskinesia and other manifestations such as hyporeflexia and paresthesia.
Your student nurse is discussing the difference between decorticate and decerebrate posturing in head injuries. When she states the following, you know she's talking about ____________ posturing.
"Stiff with legs held out straight. Fists clenched. Arms bent to hold the hands on the chest."
Decorticate: stiff with legs held out straight, fists clenched, arms bent to hold the hands on the chest;
Decerebrate: arms and legs held straight out, toes being pointed downward, head and neck being arched backward
The clinical manifestations of this disorder include specific trigger points where pain signals are amplified, generalized muscle pain, and fatigue to name a few.
The clinical manifestations of fibromyalgia include trigger points where pain signals are amplified, fatigue, cognitive disturbances, and generalized muscle pain. These symptoms can lead to functional impairment and sleep disturbances.
***Nursing management for patients with fibromyalgia involves holistic care, pain management, and support for the patient. This includes listening to the patient's concerns, providing encouragement, and implementing non-invasive treatments such as acupuncture, Tai Chi, hydrotherapy, and medications like Pregabalin, Duloxetine, Gabapentin, and Amitriptyline.
2-4mm (in light)
*think neuro exam*
What is normal pupil size?
What is the recommended management for encephalitis caused by Herpes Simplex virus?
The recommended management for encephalitis caused by Herpes Simplex virus is the administration of antiviral agents such as Acyclovir or Cytovene. These agents inhibit viral replication and are administered over a period of 3 weeks to prevent the progression of the disease. Close neurologic assessment is also essential in the management of this condition.
You are able to diagnose your patient with Cushing's Triad because of which of the following issues? Select all that apply.
a)decreased pulse
b)increased pulse
c)increased respirations
d)decreased respirations
e)increased BP
f)decreased BP
What might be the causes for this?
A, D,E
-decreased pulse
-decreased respirations
-increased BP
Causes:
-head trauma
-tumor
-infection (i.e.-viral encephalopathies-infection in the brain itself, abscess)
What is the etiology of Myasthenia Gravis?
Myasthenia Gravis is an autoimmune disorder affecting the myoneural (neuromuscular) junction, leading to varying degrees of weakness of voluntary muscles. Antibodies are directed at acetylcholine receptor sites, resulting in fewer receptor sites available for stimulation and voluntary muscle weakness that worsens with continued activity.
**Pt has DM II and had a recent ear infection**
CM include:
Headache (worse in the morning)
Fever
Vomiting
Trouble seeing to drive
Brain Abscess
Etiology
• Usually occur in immunosuppressed patients
• Many come from otitis media or rhinosinusitis
• Can also occur after intracranial surgery, trauma, tongue piercing
• Collection of infectious material in brain tissue
Clinical manifestations
• Headache (worse in the morning)
• Fever
• Vomiting
• Focal neurological deficits
• Weakness
• Decreased vision
• Increased ICP
• Seizures
Women are more likely to have this disorder than men. 25% have other rheumatologic conditions (i.e. rheumatoid arthritis, SLE, ALS)
What is fibromyalgia?
CM include:
•Trigger points
•Predictable pain response
•Fatigue
•Cognitive
•Generalized muscle achiness/stiffness
•Sleep disturbances
•Functional impairment
The following medications might be prescribed as part of holistic care for this disease/disorder:
Pregabalin, Duloxetine, Gabapentin, and Amitriptyline.
Just for fun- Which medication has the Brand Name Lyrica? Which medication has the brand name Neurontin?
The other two drugs fall under the category of Antidepressants. One is an SNRI and the other is a tricyclic. They are ___________ & ___________. Which one is which?
What is fibromyalgia?
Which medication has the Brand Name Lyrica?
Pregabalin
Which medication has the brand name Neurontin?
Gabapentin
SNRI- Duloxetine (Cymbalta)
Tricyclic-Amiytriptyline (Elavil)
CM include:
-severe heading (pounding)
-HTN
-Diaphoresis
-Nausea
-Nasal congestion
-Bradycardia
Autonomic Dysreflexia
Nursing Management • Promote Airway clearance and breathing • Improving mobility • Preventing injury • Maintaining skin integrity • Maintaining GI/GU elimination • Provide Comfort Measures • Mental Health/Emotional Support (Depression) • Recognize Autonomic Dysreflexia (severe hypertension, remove stimulus, including bowel and bladder fullness)
This devastating disease falls under the category of spinal cord and peripheral nerve disorders.
Its pathophysiology includes premature death of cells in the striatum (caudate and putamen of the basal ganglia)
It is genetic.
What is this disease and what would be your course of treatment?
Spinal Cord and Peripheral Nerve Disorders:
Huntington’s Disease
•Pathophysiology/etiology
•Premature death of cells in the striatum (caudate and putamen of the basal ganglia). Genetic.
•Assessment
•Symptom Triad: Chorea, Cognitive Impairment, and Behavioral Features-Apathy-Blunted Affect
Diagnosis
•Based on Clinical Presentation
•Positive Family History
•Known Presence of Genetic Marker CAG in HTT
•MRI
Medical Management
•No Specific Treatment; focus to optimize quality of life
Symptomatic Treatment
•Supportive Care (patient and family)
Medications:
•SSRIs (Fluoxetine)
•Tricyclic Antidepressants (Amitriptyline)
C4 or above may require help with ADLs initially
(vent support in more severe cases)
Spinal cord injury
Spinal Cord Injury • Etiology • Males 3 to 4x more likely • Usually traumatic • motor vehicle accidents • falls • penetrating wounds (usually gunshot) • sports injuries • Cord may be compressed, transected, or contused • Secondary injury may result from hemorrhage, swelling, ischemia, inflammation • Spinal shock occurs immediately • characterized by temporary loss of reflexes below the level of injury • Manifestation depend on type and level of injury
A 65-year-old male patient has partial thickness burns to the front and back of the right and left leg, front of right arm, and anterior trunk. Using the Rule of Nines, calculate the total body surface area percentage that is burned?
is this burn sustainable with life?
58.5%
Why is this?
What has been burned?
-front & back of the right and left leg- 18%x2 = 36%
-front of the right arm- 4.5%
-anterior trunk- 18%
is this burn sustainable with life?
•Major burn injuries: those that affect 30% TBSA produce local and systemic effects:
–Burn wound edema, generalized edema in non-injured tissue, increased metabolic rate, increased oxygen and glucose consumption, catabolism of muscle and bone, immune dysfunction, insulin resistance, impaired organ perfusion