Tca 5 1-30-08
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1-30-08
Mrs. Bradley
Meningitis •
Inflammation of the meninges (covering of the brain)
•
More common in immunocompromised
•
More common in group living situations, day care, schools
Three Types •
Bacterial
•
Viral-measles, mumps, chicken pox,
•
Tubercle -fungus
Signs and symptoms •
Severe headache
•
Nuchal rigidity
•
Fever
•
Chills
•
Photophobia (sensitivity to light)
•
Infants o
high pitched, shrill cry
o
petechie-rashes
Complications •
Increased ICP
•
Coma
•
Death
Nursing Management •
Decrease stimuli
•
Make it dark, quiet, calm
•
Limiting visitors
•
Lumbar puncture
•
Blood culture
•
Urine culture
•
Antibiotic therapy –priority-must be able to cross blood-brain barrier
•
Isolation for bacterial meningitis for the first 24 hours after starting antibiotic therapy
•
Pg. 1944 Kernix sign-knee to chest, can’t straighten leg, brudskinski-chin to chest
•
Treat family of bacterial meningitis with antibiotics o
Rifampin-urine may turn red
o
Take full dose of antibiotics
Parkinsons Disease •
Degenerative neurological disorder that cannot be cured
•
Mostly seen in elderly over 60 can be seen 40-60
•
Slow progression leads to disability
•
Imbalance between acetylcholine and dopamine (when dopamine decreases, acetylcholine increases)
Signs and symptoms •
Shuffling gait
•
Tremors – when they are at rest
•
Pill-rolling
•
Rigidity
•
Bradykinesia- slow movement
•
Heat intolerance
•
Impaired handwriting (small)
•
Monotonous, low pitch speech
1-30-08
Mrs. Bradley
•
Depression
•
Drooling
•
Dysphagia
Diagnosis •
Only way to truly diagnose is with autopsy
Medical Management •
Antiparkinsons drugs o
Amantadine (usually start with this drug) increases amount of dopamine-only works for a little while
o
Levodopa – crosses blood-brain barrier to increase dopamine
o
Toxicity
o
Sinemet
•
•
o
Benadryl
o
Cogentin
o
Artane
Dopamine agonist Requip
MAO inhibitor-anti-depressants-interact with just about every drug o
•
has levodopa + carbidopa(increases levodopa)
Anticholinergic meds – to decrease aceytylcholine levels
o •
Twitching and mood change
Selenigine
Anti-depressants o
Elavil-mood elevator
o
Prosac
o
Wellbutrin
•
Anti-histamines-to control drooling
Surgical Management •
Neural transplant
•
Deep brain stimulator
•
Thalamotomy
•
Palladotomy
Nursing Care •
Non-skid footwear
•
Items within reach
•
At risk for falls
•
Risk for aspiration
•
Thick liquids due to impaired swallowing
•
Self care deficit
Parkinsonian Crisis •
Due to withdrawal of medications abruptly
•
Not able to swallow, walk, tachycardia, etc.
Myasthenia Gravis •
Auto-immune disorder, antibodies attack receptor sites
•
Strictly motor-sensory disorder
•
Involves acetylocholine
•
Affects the myoneural junction
•
Voluntary muscles become weak
•
Chronic disease
Signs and symptoms •
Diploplia
1-30-08
Mrs. Bradley
•
Ptosis-usually first sign
•
Respiratory distress
•
Weakness of speech
•
Difficulty swallowing-dysphagia
•
Fatigue
•
Generalized weakness
Diagnostic Test •
MRI-shows enlarged thymus
•
Anticholinesterase test- Tensilon o
Pt. gets 2mg-10mg IV –will have improvement of symptoms
Treatment •
•
Anti cholinesterase o
Take an hour before eating
o
Mestinon
o
Prostigmin
Corticosteroid-decrease inflammation o
•
Prednisone
Chemo drugs o
Imuran
Complications •
•
Myasthenic Crisis o
Caused by stressors (infection, pregnancy, stress, weather)
o
Extreme muscle weakness
o
May have to put on a ventilator
Cholinergic Crisis
o
Receiving too much anticholesterase drugs
o
Give atropine
Treatment •
Thymectomy-thymus gland removed o
•
May take a year before patient sees full results
Plasmapherisis
Nursing Care •
Maintain airway
•
Teach energy conservation
Multiple Sclerosis •
Myelin sheath is interrupted, have sclerotic plaque in place of the myelin, nerve impulse interruption
•
Demylenization
•
Auto-immune disease
•
Don’t know the cause
Signs and Symptoms •
Weakness
•
Numbness
•
Ataxia
•
Visual disturbances
•
Emotional instability
•
Bowel/bladder problems
•
Intention tremors-tremors when active
•
Spotty vision
1-30-08
Mrs. Bradley
•
Opticneuritis
•
Diploplia-double vision
•
Urgency
•
Frequency
•
Incontinence
•
Retention
•
Positive Babinski reflex
•
Hyper-reflexes or absent reflexes
Treatment •
Corticosteroids-to decrease inflammation
•
Immunosuppresants o
•
Cytoxan
Balcofen for spacitity
Diagnosis •
Spinal tap shows increased GAMA globulin and decreased protein
•
MRI
Nursing Care •
Prevent injury (burns, falls)
•
Frequent rest periods
Guillian Barre •
Auto-immune attack of the peripheral nerves
•
70% have previous viral infection
•
Can be as a result of vaccination
•
May develop after pregnancy
•
Anti-bodies attack peripheral nerves (myelin) causing inflammation and
destruction •
Usually make full recovery over several months
Signs and symptoms •
Lower extremity weakness
•
Ascending weakness
•
May have blindness if cranial nerves are effected
•
May have cardiac repercussions
Diagnostic Tests •
Lumbar puncture shows increase in protein levels but no increase in other components
Treatment •
Plasmaphoresis
•
May be put on mechanical ventilation
Nursing •
Assess cardiac and respiratory status
•
On Bedrest assess for DVT
•
Mrs. Bradley
Meningitis •
Inflammation of the meninges (covering of the brain)
•
More common in immunocompromised
•
More common in group living situations, day care, schools
Three Types •
Bacterial
•
Viral-measles, mumps, chicken pox,
•
Tubercle -fungus
Signs and symptoms •
Severe headache
•
Nuchal rigidity
•
Fever
•
Chills
•
Photophobia (sensitivity to light)
•
Infants o
high pitched, shrill cry
o
petechie-rashes
Complications •
Increased ICP
•
Coma
•
Death
Nursing Management •
Decrease stimuli
•
Make it dark, quiet, calm
•
Limiting visitors
•
Lumbar puncture
•
Blood culture
•
Urine culture
•
Antibiotic therapy –priority-must be able to cross blood-brain barrier
•
Isolation for bacterial meningitis for the first 24 hours after starting antibiotic therapy
•
Pg. 1944 Kernix sign-knee to chest, can’t straighten leg, brudskinski-chin to chest
•
Treat family of bacterial meningitis with antibiotics o
Rifampin-urine may turn red
o
Take full dose of antibiotics
Parkinsons Disease •
Degenerative neurological disorder that cannot be cured
•
Mostly seen in elderly over 60 can be seen 40-60
•
Slow progression leads to disability
•
Imbalance between acetylcholine and dopamine (when dopamine decreases, acetylcholine increases)
Signs and symptoms •
Shuffling gait
•
Tremors – when they are at rest
•
Pill-rolling
•
Rigidity
•
Bradykinesia- slow movement
•
Heat intolerance
•
Impaired handwriting (small)
•
Monotonous, low pitch speech
1-30-08
Mrs. Bradley
•
Depression
•
Drooling
•
Dysphagia
Diagnosis •
Only way to truly diagnose is with autopsy
Medical Management •
Antiparkinsons drugs o
Amantadine (usually start with this drug) increases amount of dopamine-only works for a little while
o
Levodopa – crosses blood-brain barrier to increase dopamine
o
Toxicity
o
Sinemet
•
•
o
Benadryl
o
Cogentin
o
Artane
Dopamine agonist Requip
MAO inhibitor-anti-depressants-interact with just about every drug o
•
has levodopa + carbidopa(increases levodopa)
Anticholinergic meds – to decrease aceytylcholine levels
o •
Twitching and mood change
Selenigine
Anti-depressants o
Elavil-mood elevator
o
Prosac
o
Wellbutrin
•
Anti-histamines-to control drooling
Surgical Management •
Neural transplant
•
Deep brain stimulator
•
Thalamotomy
•
Palladotomy
Nursing Care •
Non-skid footwear
•
Items within reach
•
At risk for falls
•
Risk for aspiration
•
Thick liquids due to impaired swallowing
•
Self care deficit
Parkinsonian Crisis •
Due to withdrawal of medications abruptly
•
Not able to swallow, walk, tachycardia, etc.
Myasthenia Gravis •
Auto-immune disorder, antibodies attack receptor sites
•
Strictly motor-sensory disorder
•
Involves acetylocholine
•
Affects the myoneural junction
•
Voluntary muscles become weak
•
Chronic disease
Signs and symptoms •
Diploplia
1-30-08
Mrs. Bradley
•
Ptosis-usually first sign
•
Respiratory distress
•
Weakness of speech
•
Difficulty swallowing-dysphagia
•
Fatigue
•
Generalized weakness
Diagnostic Test •
MRI-shows enlarged thymus
•
Anticholinesterase test- Tensilon o
Pt. gets 2mg-10mg IV –will have improvement of symptoms
Treatment •
•
Anti cholinesterase o
Take an hour before eating
o
Mestinon
o
Prostigmin
Corticosteroid-decrease inflammation o
•
Prednisone
Chemo drugs o
Imuran
Complications •
•
Myasthenic Crisis o
Caused by stressors (infection, pregnancy, stress, weather)
o
Extreme muscle weakness
o
May have to put on a ventilator
Cholinergic Crisis
o
Receiving too much anticholesterase drugs
o
Give atropine
Treatment •
Thymectomy-thymus gland removed o
•
May take a year before patient sees full results
Plasmapherisis
Nursing Care •
Maintain airway
•
Teach energy conservation
Multiple Sclerosis •
Myelin sheath is interrupted, have sclerotic plaque in place of the myelin, nerve impulse interruption
•
Demylenization
•
Auto-immune disease
•
Don’t know the cause
Signs and Symptoms •
Weakness
•
Numbness
•
Ataxia
•
Visual disturbances
•
Emotional instability
•
Bowel/bladder problems
•
Intention tremors-tremors when active
•
Spotty vision
1-30-08
Mrs. Bradley
•
Opticneuritis
•
Diploplia-double vision
•
Urgency
•
Frequency
•
Incontinence
•
Retention
•
Positive Babinski reflex
•
Hyper-reflexes or absent reflexes
Treatment •
Corticosteroids-to decrease inflammation
•
Immunosuppresants o
•
Cytoxan
Balcofen for spacitity
Diagnosis •
Spinal tap shows increased GAMA globulin and decreased protein
•
MRI
Nursing Care •
Prevent injury (burns, falls)
•
Frequent rest periods
Guillian Barre •
Auto-immune attack of the peripheral nerves
•
70% have previous viral infection
•
Can be as a result of vaccination
•
May develop after pregnancy
•
Anti-bodies attack peripheral nerves (myelin) causing inflammation and
destruction •
Usually make full recovery over several months
Signs and symptoms •
Lower extremity weakness
•
Ascending weakness
•
May have blindness if cranial nerves are effected
•
May have cardiac repercussions
Diagnostic Tests •
Lumbar puncture shows increase in protein levels but no increase in other components
Treatment •
Plasmaphoresis
•
May be put on mechanical ventilation
Nursing •
Assess cardiac and respiratory status
•
On Bedrest assess for DVT
•
