Chapt64 Neuro-Sum 10-NOTES

Chapter 64 Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies : 

Chapter 64 Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies

Infectious Neurologic Disorders : 

Infectious Neurologic Disorders Meningitis Brain abscesses Encephalitis Creutzfeldt-Jakob disease and variant Creutzfeldt-Jakob disease

Meningitis : 

Meningitis Inflammation of the meninges (membranes and the fluid space surrounding the brain and spinal cord) Types: Bacterial Viral N. meningitidis is transmitted by secretions or aerosol contamination, and infection is most likely in dense community groups such as college campuses Manifestations include headache, fever, changes in LOC, behavioral changes, nuchal rigidity (stiff neck), positive Kernig's sign, positive Brudzinski’s sign, and photophobia

Meningitis : 

Meningitis To test for Kernig sign, raise the child’s leg with the knee flexed. Then extend the child’s leg at the knee. If any resistance is noted or pain is felt, the result is a positive Kernig sign. This is a common finding in meningitis. To test Brudzinski sign, flex the child’s head while in a supine position. If this action makes the knees or hips flex involuntarily, a positive Brudzinski sign is present. This is a common finding in meningitis.

Meningitis : 

Meningitis Diagnosed: CBC, blood cultures, CT, LP Management: Initiate droplet precautions Antibiotics given for 7-21 days Corticosteroids Anticonvulsants and antipyretics Decrease stimuli Monitor for complications

Brain Abscess : 

Brain Abscess Collection of infectious material within brain tissue Manifestations include headache that is usually worse in the morning, fever, vomiting, neurologic deficits, and signs and symptoms of increased ICP Diagnosis by MRI or CT CT-guided aspiration is used to identify the causative organisms Medical management Control ICP Drain abscess Administer medications Nursing management Conduct frequent and ongoing neurologic assessment and responses to treatment Ensure patient safety and protect him from injury Provide supportive care

Encephalitis : 

Encephalitis Inflammation of the brain usually caused by a viral infection Manifestations include headache, fever, confusion, changes in LOC, flaccid paralysis Medical management Acyclovir for HSV infection, amphotericin and/or other antifungal agent for fungal infection May be on antibiotics until bacteria ruled out Nursing management Frequent and ongoing assessment Provide comfort measures

Creutzfeldt-Jakob Disease (CJD) and Variant Creutzfeldt-Jakob Disease (vCJD) : 

Creutzfeldt-Jakob Disease (CJD) and Variant Creutzfeldt-Jakob Disease (vCJD) Rare, degenerative, brain disorder that leads to dementia and, ultimately, death Cause of CJD is unknown but the cause of vCJD is from infected beef The disease is not spread by casual contact; may be contracted through ingestion of infected beef Manifestations include behavioral changes, memory problems, vision problems and poor muscle coordination progress quickly to dementia, coma and death No effective treatment: progressive and fatal Nursing management Prevention of disease transmission; blood and body fluid precautions Supportive care

Cranial Nerve Disorders : 

Cranial Nerve Disorders Trigeminal neuralgia (tic douloureux) Bell’s palsy

Trigeminal Neuralgia (Tic Douloureux) : 

Trigeminal Neuralgia (Tic Douloureux) Condition of the 5th cranial nerve characterized by attacks of pain along one or more of the branches of the trigeminal nerve. Vascular compression and pressure is the probable cause Patients may avoid eating, neglect hygiene, and may even isolate themselves to prevent attacks Medical Management: Medications Surgical treatment Nursing Management: Educate on ways to prevent triggers

Bell’s Palsy : 

Bell’s Palsy Facial paralysis caused by unilateral inflammation of the 7th cranial nerve. Manifestations: unilateral facial muscle weakness or paralysis, increased lacrimation, painful sensations in the face, numbess to face, and possible difficulty with speech and eating Medical Corticosteroid therapy Pain medication Nursing Provide and reinforce information and reassure patient that a stroke has not occurred Protect the eyes Implement facial exercises to maintain muscle tone