Exam 4 Medsurg Spring 26

Meningitis

inflammation of the meninges , leads to deadly ICP

droplet precautions the first 24 hours

CT and the Lumbar Puncture

“ Viral” = Clear “ Bacterial” Cloudy

S/S of meningitis

headache / photosensitivity '

Mental status change - first sign

Stiff neck

High temperature

pediatrics : high pitched cry and bulging fontanelle

Concussions

Head trauma

Causing : headache , confusion , photosensitivity , blurred vision

Post concussion syndrome - swelling of the brain

Contusion

Risk - elderly, on blood thinners

Surface injury with surface hematoma

Kernig Sign

if it is painful to lay on back and raise the leg

associated with meningitis

Brudzinski’ sign

if the neck is flexed and the knees&hip flex upward as a response

Epidural hematoma

collection of blood between the dura and skull

increased ICP will reduce LOC , loss of consciousness with lucid state

may need burr holes to decrease ICP

Subdural Hematoma

Acute : hemiparesis , LOC , pupillary signs

Chronic : can take weeks or months , could be mistaken as a clot

craniotomy and ICP control

Intracerebral Hemorrhage

can be caused by trauma, Hypertension, or trauma

can be treated with fluids and antihypertensives

Epilepsy

Recurrent seizure disorder

infants more susceptible to drugs , 5-6 years with risk factors related to drug use , encephalopathy , and SGA

Partial Seizure

flushed , hypertensive, recurrent muscle contractions in 1 area

jacksonian march- movement across to adjacent areas

Complete Partial Seizure

Impaired LOC flasting hours , amnesia , “ Aura”, repeated non-purposeful movements “ automatisms

Absent seizures

impaired LOC , blank stare

common in children

sudden loss in all motor activity

Aura

what happens before a seizure begins

Blind/dark spots , tingling , fear

Tonic

Arched back TIGHT AND TENSE

Incontinence

Stiff

Epileptic Cry

Clonic

Frothy Saliva , blinking eyes , jerky movements

CONVULSIONS AND CONTRACTIONS

Postical

sleepy

exhaustion

weak limbs

Febrile

occurs in rapid increase in temp

entire body convulses

Status Epilepticus

more than 5 min

treat with benzos for long term care

dextrose to treat hypoglycemia

Non- Pharmacological Interventions for seizures

Avoid ginko

ketogenic diet , high in fats , low in carb and moderate in protein

tuberculosis

Chronic recurrent infections of mycobacterium tuberculosis

Extrapulmonary TB

spread via the blood and lymph system

Miliary TB

Hematogenous spread through the kidney , GI tract

risk factors of TB

recent travels

immigrants

crowded areas

HIV

s/s of tuberculosis

Blood cough , fever , chills , night sweats

Seizure Tiggers

Stress, Sleep Deprived , Strobe lights , Stimulants , and Low sugar

Tuberculin Mantoux test

small bleb injected intradermally

0-15 for high risk is positive

less than 5 is negative

15 is positive for high risk people

Tx of tuberculosis

Start with single drug , can move to multi

Isoniazid - side effects of peripheral neuropathy , anemia , and heptaoxicity

BGC vaccination

Txof seizures

Benzos either rectal or iv

EEG interventions

Wash hair

No caffeine for stimulants for 12-24 hours

no sleep

no seizure meds

Measures the electrical activity in the brain

seizure interventions

turn client to the side and prepare for suctioning

Benzos

Loosen restrictive clothing

padding the side rails

Cranial Nerve 1

Olfactory - smell

Cranial Nerve 2

Optic - vision

Optic Nerve 3

Ocularmotor - upward

Phenytoin

Anticonvulsant

long term protection against seizures , same time daily

“ last longs in the body and can become toxic at 20”

blood level monitored for liver function , can cause gingival hyperplasia NORMAL

Phenytoin toxicity

Ataxia - gait disturbance

hand tremor

slurred speech

other - skin rash , suicidal ideas

Optic Nerve 4

Trochlear - downward and inward eye movment

Optic Nerve 5

Trigeminal - facial sensation

Optic nerve 6

Abducens - outward eye movement

teaching for phenytoin

No contraceptives

do not stop abruptly ‘tale folic acid , vitamin d supplements

GSC

Glassglow Coma scale

less than 8 intubate , less than 3 brain dead

Decorticate

Flexor arms like “c”

problems with cervical and spinal tract

Decrebete

Extensor - Arms like “e”

Problem with midbrain or pons

Obtundation

Stupor

Doll like eyes ( Don’t track and focus when head is turned down )

Cerebral Perfusion

MAP - ICP pressure

Cushing’s Triad

Signs of increased intracranial pressure

Increased systolic BP

Decreased HR

Decreased RR

Brain Death Tests

Apnea Test

“ Flat line”

Unresponsive

Caloric Stimulation : Cold water flushed through ear , eyes should move toward the stimulation

Locked In syndrome

fully alert , communicate through eyes and paralysis of all voluntary muscles

Transient ICP Changes

sneezing

bending

vomiting

Monro-kellie hypothesis

limited space in the skull , mena s there will be in increase in one skull components creates a change in the other components to compensate . if one grows the other will decrease

Increased ICP in Children

downward turned eyes , headache , vertigo

Early signs of icp

vomiting without nausea

altered conscious

headache

late signs of ICP

dilation of pupils , neck rigidity , cheyne stokes respirations

brainstem : unequal and fixed pupils

Menopause

permanent cessation of menstruation for more than 12 months

S/S of menopause

Hot flashes

night sweats

vaginal dryness

mood changes

Nursing interventions for menopause

promote calcium and vit d supplements

vaginal lubricants

HRT ( must start it before reaching 10 years after menopause )

Infertility

Failure to conceive after 12 months of unprotected sex

Causes of infertility

Blockages

low sperm count

ovulation disorders

poor motility

Nursing interventions for menopause

emotional support

ovulation timing education

Erectile dysfunction

caused by medications

vascular disease

diabetes

Nursing interventions for erectile dysfunction

medications ending in “ fil” can cause severe hypertension

Avoid Nitrates

HPV

most common STI

can cause genital warts and cervical cancer

Syphilis

Painless ulcer , highly contagious

treat with penicillin

Chlamydia

Often Asymptomatic

can cause PID and infertility

S/S of chlamydia

Dysuria vaginal discharge

( azithromycin and doxycycline)

genital herpes

Painful blisters and ulcer in the private area with recurrent outbreaks

Antivirals ( ending in vir)

virus is lifelong

levetiracetam

Anticonvulsent , binds to vesicles in brain

Dizziness , irritability , and weakness can be a side effect

DO NOT stop abruptly , monitor for mood or behavior changes

Phenobarbital

can prevent and control seizure activity

depresses CNS by increasing GABA

watch for suicidal thoughts , and extreme confusion

Asses the BP and HR