Presentation on theme: "Neurological Diseases"— Presentation transcript:
1Neurological Diseases NURSEJerry Carley MSN, RN, CNEUniversity of Southern NevadaAdult Health IISummer 2010MeningitisAdult Health IINeurological Diseases
2Defined:…an inflammation of the arachnoid and pia mater of the brain and spinal cord and cerbrospinal fluid (CSF).Three Major Categories:ViralFungalBacterial
3Viral Meningitis A. The most commonly encountered form of meningitis. B. Sequela to viral illnesses such as measles, mumps, herpes simplex, herpes zoster.C. Fever, photophobia, headache, myalgias, nausea.D. Treatment is symptomatic.
4Fungal MeningitisA. Typically seen in immunosuppressed individuals, usually HIVB. Cryptococcus neoformans is the usual culprit.C. Clinical presentation varies, depending upon how intact the individual’s immune system is. Headache, nausea, decreased mental status.D. Treatment: Symptomatic; IV antifungals.Cryptococcus neoformans
5Bacterial Meningitis A. MEDICAL EMERGENCY MORTALITY RATE ~ 25% USA Cases: ~ 17,500 / yearStrep. pneumoniaeNeisseria meningitidisMeningococcal meningitis occurs in outbreaks: areas of high population density.Meningococcal vaccine (Menomune)Becky Werner: Developed flu-like illnessIn February, Died within 48 hours.
7*With Symptoms of Meningitis, always assume the worst, and treat for meningococcal meningitis immediately.*If you wait for the culture results, and they show / grow meningococcal meningitis or other bacterial meningitis, it is already too late!
8Physical Assessment:Signs of meningeal Irritation / Inflammation: headache, nausea, vomiting, fever. Photophobia.Nuchal rigidity.+ Kernig’s, + Brudzinski’s signs (~ 10%) of casesSeizures, decreased mental statusSigns of increased intracranial pressure (IICP)
9Laboratory / Diagnostics: 1. Lumbar Puncture:-CSF for gross appearance, WBC’s, Glucose, pressure-Gram stain-Culture & Sensitivity2. CBC with Diff3. Blood cultures4. CT or MRI
10Nursing Care:Monitor Neurologic Status (“Neuro Checks”)**Particular attention to cranial nerves, especially CN III, IV, VI,& VIIIObserving for signs & symptoms of Increased intracranial pressureSeizure precautionsSeptic shock & DICMedications:Broad-spectrum antibiotic, changed to appropriate one after gram-stain and C&S.Others symptomatic
11Patient Care, Client with Meningitis -Vital signs at least q2-4 hours.-Neuro checks, particularly Cranial Nerves, especially CH III, IV, VI, VII, & VIII-Pain management-I&O-Decrease environmental stimuli-Bedrest, HOB elevated 30*-Isolation precautions-Prevent Complications:IICPVascular dysfunctionF & E ImbalanceSeizuresShock
12Incidence of Meningococcal Meningitis 500 cases per 100,000 people annually46 cases per 100,00 people annually3 cases per 100,000 people annuallyIncidence of meningococcal meningitis