NUR 265 EXAM 3 REVIEW
MENINGITIS
Patho: Inflammation of the inner meninges Usually caused by:
1. Autoimmune reaction
2. Adverse reaction to medication or procedure (Spinal or Brain) direct route of entry
3. Infection:
a. Bacterial: Most common Strep. Pneumoniae and Neisseria Meningitids...
nur 265 exam 3 review meningitis patho inflammation of the inner meninges usually caused by 1 autoimmune reaction 2 adverse reaction to medication or procedure spinal or br
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NUR 265 EXAM 3 REVIEW
MENINGITIS
Patho: Inflammation of the inner meninges Usually caused by:
1. Autoimmune reaction
2. Adverse reaction to medication or procedure (Spinal or Brain) direct route of entry
3. Infection:
a. Bacterial: Most common Strep. Pneumoniae and Neisseria Meningitids Highly contagious (see risks)
b. Viral: Most common herpes, Varicella (chicken pox/shingles)
c. Fungal: Usually seen in pts w/ AIDs
Risks:
- Infections of eye, ear, mouth (like a tooth abscess) and neck are at increased risk a/r close anatomic proximity
- Pts ages 16-21 at highest risk for bacterial meningitis. Vaccinate @11-12 y/o then booster @16.
- Pts living in high density populations (dorms, barracks, crowded living areas) have increased risk for
bacterial meningitis as well. Initial or booster vaccination is advised for these adults.
- Pts who are immunocompromised AIDs, Cancer Rx tx, or pts receiving immunosuppressant tx for organ transplant or
autoimmune disease.
S/S:
- Classical Triad: Headache, Fever, Neck pain (nuchal rigidity)
- Kerning’s sign (may or may not be present) back pain when flexing knee beyond 90 degrees w/ pt in supine position
- Brudzinski’s sign (may or may not be present) flexing the head when pt is in supine position results in automatic
flexion of legs and/or hips
- Photo and Phonophobia
- Rhinorrhea (nasal discharge of CSF basal skull fracture) or Otorrhea (ear discharge same as rhinorrhea)
- ICP changes in mental status/LOC and/or orientation can progress to seizures
- Systemic Inflammatory response Coagulopathy changes in vascular status if thrombi forms DIC, gangrene
- Other usual s/s of infection may or may not be present (like tachycardia, fever, chills etc.)
Dx:
CT – if pt is >60, immunocompromised, or have s/s of ICP then CT first all other LP.
LP – If viral CSF is usually clear and if bacterial usually cloudy. All other findings such as glucose, WBC and protein are
usually the same.
Management:
- Priority = Airway Breathing and Circulation + Monitoring + documenting neuro status (q2-4h)
- Seizure precautions
- BS AB tx until LP results then specific Rx tx.
- Managing ICP Mannitol and Antiepilectic rx
- If bacterial meningitis DROPLET + STANDARD
- prophylaxis tx for close contact
- Decrease stimuli + keep HOB elevated at 30 degrees.
ENCHEPALITIS
Patho: Inflammation of the brain and surrounding meninges. Most commonly caused by viral infections such as Herpes
(HSV1) and Varicella
S/S:
-Changes in mental status such as agitation, acute confusion, irritability or personality/behavioral changes
-ICP
-Neurological deficits vision loss, seizures, muscle weakness, and paralysis. **these changes may last for weeks and may
be permanent.
- photo and phonophobia
Management:
-Priority = Airway. Turn cough and deep breathe q2h UNLESS ICP present. If on vent and s/s of ICP suction
-Monitor Neuro Status:
-Glasgow Coma Scale max score of 15, min of 3 (totally dependent) Any change >2 notify MD
-Any change in neuro status such as increasingly dilated pupils or decreased responsiveness to light, new onset of
bradycardia, widening pulse pressure (basically s/s of increasing ICP) or irregular resp effort notify MD
, -Medication viral = acyclovir
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