Neuro Care part 2
Risk factors for meningitis
-Blood infection -Skull fracture -Surgical procedure that breaks the skull
Diagnostic testing for seizures
-Clinical signs -EEG
Management of meningitis
-Droplet isolation -Analgesics -Antipyretics -Antimicrobials
Presentation of meningitis
-Fever -Headaches -Altered LOC -Nuchal rigidity -Kernig sign -Brudzinski's sign -Lethargy -Photosensitivity -ncreased ICP -Seizures
Nonmodifiable risk factors for seizures
-Genetics -Prenatal injury -Head trauma -Brain tumor -Cerebral edema -Stroke -Drug toxicity or withdraw -Infection (meningitis) -Acute febrile state -Thiamine deficiency -Hyper/hyponatremia
Procedures for frequent seizures
-Lesionectomy -Neurotomy -Deep brain stimulation
Risk settings for meningitis
-Prisons -College dorms -Homeless shelters
What needs to be at the bedside when someone is on seizure precautions?
-Suction -O2 -Maybe Ativan if allowed
Patient education with seizures
-Take at exactly the same time every day -Phenytoin has a narrow therapeutic window and needs blood work -When to call 911(cyanosis, vomiting, longer than 5 minutes, back to back seizures)
Documentation for seizures
-Type -Time -Length -Preceding events
The nurse is caring for a client who presented to the emergency department exhibiting seizure-like activity. The provider has written orders. Which of the following orders is the priority and needs to be initiated first? A) Administer 1 mg lorazepam B) Get IV access C) Pad the side rails D) Place the client on seizure precautions
A A) Administer 1 mg lorazepam This client needs to have a benzodiazepine administered immediately, even if there is no IV access. The nurse can give lorazepam intramuscularly (IM). Everything else is of a lower priority. B) Get IV access Since lorazepam can be given IM, this is not the priority. C) Pad the side rails The side rails should be padded, but giving the client lorazepam to help stop the seizures is first. D) Place the client on seizure precautions Seizure precautions will be initiated, but the nurse must first administer the lorazepam to help the client stop seizing.
A client who has a seizure disorder has been prescribed carbamazepine for control of the seizures. Which information is most important for the nurse give to the client before starting this medication? A) Careful while driving B) Avoid eating foods that contain vitamin C C) Don't drink liquids with meals D) Avoid sodium
A A) Careful while driving The side effects of carbamazepine include dizziness and drowsiness. B) Avoid eating foods that contain vitamin C Carbamazepine does not interact with vitamin C. C) Don't drink liquids with meals Carbamazepine does not require a patient to limit liquid intake. D) Avoid sodium Carbamazepine has been known to cause low sodium levels, but not increased sodium levels.
Which of the following medication is used for absence seizures? A) Ethosuximide (Zarontin) B) Lorazepam (Ativan) C) Levetiracetam (Keppra) D) Carbamazepine (Tegretol)
A A) Ethosuximide (Zarontin) This is used for absence seizures. B) Lorazepam (Ativan) This is used for status epilepticus. C) evetiracetam (Keppra) Levetiracetam is used for tonic-clonic seizures D) Carbamazepine (Tegretol) Carbamazepine is also used for tonic-clonic seizures
A client with epilepsy has regular tonic-clonic seizures. Which precautions would the nurse use to modify the hospital environment that would most likely keep this client safe? A) Keep frequently used items nearby and within easy reach B) Require that the client keep the bathroom door open while she is using it C) Keep the foot of the bed lower than the head of the bed D) Provide written instructions for the client about what to do during a seizure
A A) Keep frequently used items nearby and within easy reach B) Require that the client keep the bathroom door open while she is using it However, the client should not lock the door to the bathroom, because the staff should be able to get in to assist if a seizure occurs. C) Keep the foot of the bed lower than the head of the bed The bed should be kept level for safety. If a seizure occurs, the client is at an increased risk of falling out of the bed if one end is lower than the other. D) Provide written instructions for the client about what to do during a seizure Written instructions are useless to a client who is having a seizure.
The nurse is caring for a client with a history of seizures. The client starts to actively seize. What is the very first thing the nurse should do? A) Maintain a patent airway B) Ensure the surroundings are safe C) Administer lorazepam D) Call for help
A A) Maintain a patent airway In any situation, the nurse should automatically go through the ABCs of prioritization. Airway is first. The nurse must ensure that this client's airway is patent, including turning the client to one side if they vomit, and NEVER inserting a bite block in their mouth, as they could choke on this. B) Ensure the surroundings are safe This is part of nursing management for a seizure, but is not the first action the nurse should take. C) Administer lorazepam This is part of nursing management for a seizure, but the nurse would not place administration of lorazepam above maintaining a patent airway. D) Call for help The nurse will call for help but will FIRST ensure the client has a patent airway. These actions will almost be done simultaneously, but airway is the priority.
A 36-year-old client with a history of epilepsy is in the hospital and experiences a seizure. For several minutes following the seizure, the client is calm but does not regain consciousness. The client then starts having another seizure. Which action is the first priority for the nurse? A) Maintain client airway and monitor oxygenation B) Contact provider for anticonvulsant medications C) Obtain blood samples to check electrolyte levels D) Pad the side rails in the event that the client has another seizure
A A) Maintain client airway and monitor oxygenation B) Contact provider for anticonvulsant medications This is an important intervention for the client who is at risk for seizures, but not the top priority for the nurse to perform first. C) Obtain blood samples to check electrolyte levels This is an important intervention for the client who is at risk for seizures, but not the top priority for the nurse to perform first. D) Pad the side rails in the event that the client has another seizure This is an important intervention for the client who is at risk for seizures, but not the top priority for the nurse to perform first.
The nurse is caring for a client who has a history of seizures and takes carbamazepine. Which of the following drugs does the nurse question for this client? A) Rifampin (Rifadin) B) Levothyroxine (Synthroid) C) Heparin D) Lisinopril (Prinivil)
A A) Rifampin (Rifadin) Rifampin (Rifadin) increases liver metabolism which causes antiepileptic medications to become metabolised quickly, thus decreasing the serum levels, leaving the client at a high risk for breakthrough seizures. B) Levothyroxine (Synthroid) This medication is not contraindicated in the client who takes seizure medication. C) Heparin This medication is not contraindicated in the client who takes seizure medication. D) Lisinopril (Prinivil) This medication is not contraindicated in the client who takes seizure medication.
Which best describes a Jacksonian seizure? A) The client experiences stiffness and tingling in one extremity with no loss of consciousness B) The client has a blank stare and twitching at the mouth C) The client falls, loses consciousness, and has general muscle spasms D) The client wanders aimlessly and picks at his skin
A A) The client experiences stiffness and tingling in one extremity with no loss of consciousness Clients who suffer from seizures may manifest various forms, which are classified according to their characteristics and behaviors that occur during the seizure. A Jacksonian seizure is one form in which the client experiences changes in one part of the body, often an extremity. The client may have numbness and tingling in the extremity and it often becomes stiff, but the client does not lose consciousness. B) The client has a blank stare and twitching at the mouth A blank stare is present with an absence seizure, but not a Jacksonian seizure. C) The client falls, loses consciousness, and has general muscle spasms This describes a tonic-clonic seizure, not a Jacksonian seizure. D) The client wanders aimlessly and picks at his skin This is not descriptive of seizure activity.
A nurse is caring for a client who has Streptococcus pneumoniae infection. Which best explains why the nurse must report this condition to public health officials? A) The condition leads to bloodstream infections and meningitis B) The condition is fatal when contracted C)The condition leads to severe skin infections spread by contact D) The condition is resistant to penicillin-based antibiotics
A A) The condition leads to bloodstream infections and meningitis Streptococcus pneumoniae infection is caused by the bacteria of the same name. Infection leads to pneumonia in the affected client, but it can also cause widespread bloodstream infections and meningitis. The bacteria is responsible for the deaths of more people in the U. S. every year than all other vaccine-preventable diseases combined. B) The condition is fatal when contracted Some people, particularly the very old, very young, and immune-compromised persons can die from the infection, but the disease is not fatal for all persons infected. C) The condition leads to severe skin infections spread by contact S. pneumoniae is not associated with severe skin infections. D) The condition is resistant to penicillin-based antibiotics S. pneumoniae are resistant to penicillins, but not all.
A 79-year-old client had a stroke and can no longer eat without help. Which of the following describes how the nurse could preserve the dignity of this client? Select all that apply. A) Facilitating communication with other caregivers B) Carrying out instructions from the provider C) Asking family members to talk to the client about feeding needs D) Providing pain medication and sedation E) Supporting the client's attempts at self-feeding
A&E A) Facilitating communication with other caregivers A client who can no longer perform certain activities of daily living may be struggling with feelings of shame over not being able to care for himself. The nurse can best protect this client's dignity by explaining the deficits and supportive measures to other caregivers, and continuing to care for the client as normal. B) Carrying out instructions from the provider This is appropriate nursing care management, but is not specifically related to preserving the client's dignity. C) Asking family members to talk to the client about feeding needs D) Providing pain medication and sedation The question does not state that the client is in pain, and this action is also is unrelated to preserving client dignity. E) Supporting the client's attempts at self-feeding The nurse should support the client to be successful when the client eats.
A nurse is setting up a sterile field to assist with a lumbar puncture on a client suspected of having meningitis. Which practices should the nurse perform during the client's procedure that would uphold the sterile technique? Select all that apply. A) The nurse confirms that the package of sterile instruments is intact before opening it B) The nurse opens the package by folding the flap opening toward him or herself first C) The nurse should get a new package is there is evidence of dried water marks on the package D) The nurse sterilizes the client's skin with isopropyl alcohol before starting E) The nurse uses the contents of the sterile package right away and does not leave them sitting out
A,C&D A) The nurse confirms that the package of sterile instruments is intact before opening it B) The nurse opens the package by folding the flap opening toward him or herself first A sterile package is opened facing away from the nurse, so the contents fall directly onto the sterile field. C) The nurse should get a new package is there is evidence of dried water marks on the package Dried water marks on the packaging may indicate a breach in the sterility. The package should be assumed to be non-sterile and replaced with a new package. D) The nurse sterilizes the client's skin with isopropyl alcohol before starting The client's skin is sterilized after the sterile field is set up. E) The nurse uses the contents of the sterile package right away and does not leave them sitting out Letting the contents sit exposed increases the chance that the items will become contaminated.
A nurse is caring for a client who had a seizure in his room. Which of the following critical thinking steps would the nurse utilize to respond to this situation? Select all that apply. A) Identify if there is a problem B) Assume that the situation needs to be reported C) Understand what information is important and what is irrelevant D) Set priorities for the client E) Evaluate the client's response
A,C,D&E A) Identify if there is a problem B) Assume that the situation needs to be reported This situation may be unnecessary to report if it is not the first time the client has had a seizure C) Understand what information is important and what is irrelevant D) Set priorities for the client E) Evaluate the client's response
A client who was recently diagnosed with a seizure disorder is discussing the condition with a nurse. The client says "I'm so afraid I'm going to have a seizure again. How do I prevent them from happening?" Which lifestyle changes should the nurse recommend that would contribute to a decreased risk of seizures? Select all that apply. A) Maintain a regular sleep schedule B) Limit alcohol to no more than two drinks per day C) Take all anti-seizure medications as prescribed D) Manage stress levels E) Minimize TV and computer time
A,C,D&E A) Maintain a regular sleep schedule B) Limit alcohol to no more than two drinks per day Alcohol and drugs should be avoided by the client with a seizure disorder. C) Take all anti-seizure medications as prescribed D) Manage stress levels E) Minimize TV and computer time A client who suffers from seizures may have triggers in the environment that increase the likelihood of a seizure event. The nurse can educate a client about what activities are likely to cause a seizure. While managing life situations will not prevent all seizures, it can reduce the number of seizure events the client experiences.
Transmission precautions for meningitis
Droplet precautions until patient has completed 24 hours of appropriate antibiotics
Diagnostics of meningitis
LP (Cloudy, Increased WBC, Decreased glucose)
Treatment for seizures
Stop seizures -Benzos (Ativan, diazepam) -Barbiturates (Phenobarbital) Prevent Seizures -Phenytoin -Fosphenytoin -Levetiracetam -Lacosamide