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

 Twitching and mood change

o Sinemet-

 has levodopa + carbidopa(increases levodopa)

• Anticholinergic meds – to decrease aceytylcholine levels

o Benadryl

o Cogentin

o Artane

• Dopamine agonist

o Requip

• MAO inhibitor-anti-depressants-interact with just about every drug

o 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