Neurologic System 1

This flashcard set covers the key concepts, pathophysiology, manifestations, and nursing priorities for meningitis, seizure disorders, Parkinson’s disease, brain tumors, and ADH imbalances (SIADH and DI) as presented in the NURS 423 lecture.

Status epilepticus

A neurologic emergency characterized by a seizure lasting longer than $5\,min$ or repeated seizures without recovery between events.

Meningitis

Inflammation of the meninges secondary to infection or other inflammatory processes. The pathophysiology involves the invasion of pathogens (bacterial, viral, or fungal) leading to an inflammatory response that increases the permeability of the blood-brain barrier, resulting in edema, increased intracranial pressure, and potentially brain injury.

Encephalitis

Inflammation of the brain tissue, differentiating it from meningitis.

Cushing’s Triad

A late sign of increased intracranial pressure and neurologic deterioration, characterized by three classic signs: hypertension, bradycardia, and irregular respirations.

Bacterial Meningitis CSF findings

Results from a lumbar puncture showing cloudy fluid, increased WBC, increased protein, and decreased glucose.

Viral Meningitis CSF findings

Results from a lumbar puncture showing clear fluid, mildly elevated WBC, and normal glucose.

Nuchal rigidity

Neck stiffness that, along with fever and headache, forms the classic triad of meningitis manifestations.

Meningococcemia

A condition indicated by a non-blanching petechial or purpura rash (Meningococcal rash), signaling a high risk for septic shock.

Normal ICP

The standard range for intracranial pressure, measured as $0-15\,mmHg$. Pathologic: 20+ mmHg.

Ceftriaxone

An empiric broad-spectrum antibiotic that covers many common causes of bacterial meningitis and should be administered promptly after cultures. Delays in treatments can increase mortality rates significantly.

Dexamethasone

A medication given to reduce meningeal inflammation and cerebral edema; it is most effective when given before or with the first antibiotic dose. Monitor blood glucose and signs of infection.

Primary Seizure

A seizure with an unknown cause; frequent occurrences leads to a diagnosis of epilepsy.

Secondary Seizure

A seizure with a known cause, such as electrolyte imbalances, hypoglycemia, hypoxia, or CNS infections.

Simple partial seizure

A focal seizure occurring in one hemisphere with no impairment of consciousness.

Complex partial seizure

A focal seizure involving impairment of consciousness, often from the temporal lobe, where automatisms are common. (automatically moving without knowing)

Absence seizure (petite mal)

A generalized seizure involving both hemispheres characterized by nonconvulsive disturbances in consciousness.

Atonic seizure

Commonly called 'drop attacks,' characterized by a sudden loss of muscle tone.

Tonic-Clonic seizure (grand mal)

A generalized seizure involving loss of consciousness, a tonic phase (rigid contraction), and a clonic phase (repeated contractions and relaxations).

Aura

A sensory disturbance, such as visual changes or unusual smells, that may serve as a warning sign before a seizure.

Post-ictal state

The period immediately following a seizure, often associated with a $250\%$ increase in ATP consumption and potential hypoxia or acidosis.

Phenytoin (Dilantin)

A medication for focal and generalized tonic-clonic seizures that requires monitoring of serum levels and can cause gingival hyperplasia.

Parkinson's Disease

A degenerative disorder of the basal ganglia involving the dopaminergic nigrostriatal pathway in the substantia nigra.

TRAP Mnemonic

A tool for the cardinal manifestations of Parkinson's: Tremor, Rigidity, Akinesia/Bradykinesia, and Postural instability.

Bradykinesia

Slowness in initiating movements and difficulty stopping quickly, often resulting in a shuffling gait.

Levodopa/Carbidopa (Sinemet)

The gold standard treatment for Parkinson's disease that replaces dopamine; it should not be taken with high protein meals.

Mass effect

The pressure and displacement of brain tissue caused by a tumor, leading to increased ICP.

Glioblastoma

A type of primary brain tumor that originates within the Central Nervous System (CNS).

Antidiuretic Hormone (ADH)

A hormone that signals the kidneys to save water, resulting in increased blood volume and concentrated urine.

Diabetes Insipidus (DI)

A condition of too little ADH or kidney non-responsiveness, resulting in massive amounts of dilute urine and hypernatremia ('Dry Inside').

SIADH

Syndrome of Inappropriate ADH, characterized by excessive ADH secretion, water reabsorption, and hyponatremia ('Soaked Inside').

Osmotic Demyelination Syndrome (ODS)

A risk of correcting hyponatremia (SIADH) too fast, causing water to leave brain cells and damaging the myelin sheath.

Desmopressin (DDAVP)

A synthetic ADH replacement used in the management of Diabetes Insipidus (DI).

Types of Meningitis

Meningitis can be categorized mainly into bacterial, viral, and fungal meningitis, each with distinct causes and treatment approaches.

Bacterial Meningitis Causes

Common bacteria causing bacterial meningitis include Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b.

Viral Meningitis Causes

Viral meningitis is often caused by enteroviruses, like Coxsackie virus and Echovirus, and, less commonly, by herpes simplex virus.

Clinical Features of Meningitis

Clinical features include fever, neck stiffness (nuchal rigidity), headache, photophobia, and altered mental status, forming the classic triad with fever and nuchal rigidity.

Risk Factors for Meningitis

Risk factors include age (infants and the elderly), close living quarters (like dormitories), immunocompromised states, and lack of vaccination.

Kernig Sign

A clinical sign of meningitis where the patient experiences pain when the thigh is flexed at the hip and knee, and then the knee is straightened.

Brudzinski Sign

A clinical sign of meningitis where flexing the neck causes involuntary flexion of the knees and hips, indicating meningeal irritation.

Clinical Judgment for CT before Lumbar Puncture

Do if:

-decreased LOC

-focal neurologic deficits

-signs of increased ICP

-papilledema

Initial Nursing Priorities of Meningitis

1. Droplet precautions

2. Assess airway and breathing

3. Obtain cultures

4. Start antibiotics

5. Frequent neuro checks and vital sign monitoring

   1. check pupils and motor response

Focal Seizure Brain Area Manifestations

Focal seizures manifest based on the brain area affected; for instance,

-occipital lobe seizures may cause visual changes

-frontal lobe seizures can lead to motor disturbances such as twitching or jerking

-temporal lobe seizures may also involve sensory hallucinations or déjà vu.

-sensory seizures may produce abnormal sensations in the affected area, like tingling or numbness.

Seizure Precautions

Implementing seizure precautions includes ensuring a safe environment by padding bed rails, keeping suction equipment nearby, and positioning the patient to prevent aspiration during a seizure.

Nursing Management Before a Seizure

Prepare the environment by ensuring safety, removing sharp objects, and having suction equipment ready. Inform the patient about seizure activity if applicable and educate them on maintaining medication adherence.

Nursing Management During a Seizure

Maintain patient safety by preventing injury, ensuring a clear airway, and turning the patient onto their side to allow for drainage. Do not restrain movements and time the duration of the seizure.

Nursing Management After a Seizure

Monitor the patient’s vital signs and neurological status, provide comfort measures, and facilitate rest. Assess for postictal symptoms and document the seizure episode, including duration and any triggering factors.

Levetiracetam

An anticonvulsant medication used to treat seizures in epilepsy. It works by modulating neurotransmitter release and is known for its relatively favorable side effect profile compared to other antiepileptics.