Ch. 17 Infectious disease infecting the nervous system

Prions are believed to cause ________ diseases.

neurodegenerative

Drag the images to their corresponding statement to test your knowledge of statistical information related to nervous system diseases. Fatality rate of EEE infection

70%

Drag the images to their corresponding statement to test your knowledge of statistical information related to nervous system diseases. Percentage of variant CJD cases that originated in the United Kingdom

98%

Match the statement to the disease that it most accurately describes to test your understanding of nervous system diseases caused by microorganisms. Tetanus

A neuromuscular disease caused by a spore-forming bacterium that produces a powerful neurotoxin that leads to spastic paralysis

Match the statement to the disease that it most accurately describes to test your understanding of nervous system diseases caused by microorganisms. Poliomyelitis

Acute enteroviral infection of the spinal cord that can cause neuromuscular paralysis

An 18-month-old male is admitted to the pediatric intensive care unit with concern of neurological disease. The patient's parents report a 2-week history of upper respiratory symptoms, progressing to lethargy, irritability, and poor oral intake. The patient had two episodes of vomiting at home on the day of admission. The RN assesses the patient and notes that he is hypertonic, restless, and appears to be turning away from the light. 2. What may the RN expect to be ordered immediately in the case of a patient with this differential diagnosis?

All of the choices are correct.

An RN is leading a public health education program about the West Nile virus. The community has had multiple cases of West Nile virus in the past month. The RN aims to provide teaching regarding transmission, symptoms, and prevention. 4. Which of the following methods of vector control should be emphasized in the community education program?

All of the choices are correct.

A telephone advice RN receives a phone call from a 75-year-old male who sustained a raccoon bite two hours ago. The patient reports pain at the site of injury but no other symptoms. 3. If the patient is diagnosed with this infectious disease, the RN anticipates that treatment of the patient will include which of the following?

All of these would be treatments.

A 31-year-old woman is 8 months pregnant with her first child. Her general health is completely normal, as is the health of her developing fetus. She works in an office as a data entry clerk. One day she develops a fever, nausea, and muscle aches. She decides to leave work early and rest at home. Her symptoms persist for 2 days but do not develop any further. Three weeks later, she realizes that the fetus is not as active as it had been in the days' prior. After 24 hours of virtually no movement, she calls her physician. In a whirlwind of panic, she undergoes a sonogram and is told a fetal heartbeat can no longer be detected. 1. Which of the following drugs should be used when listeriosis is first suspected?

Ampicillin and Trimethoprim-sulfamethoxazole

Select all of the statements that apply to acute encephalitis caused by arboviruses.

An arthropod bite is involved in transmission. Insect control is the main method of prevention. No satisfactory treatment exists.

Match the statement to the disease that it most accurately describes to test your understanding of nervous system diseases caused by microorganisms. Botulism

An intoxication, associated with eating poorly preserved foods, which results in flaccid paralysis

A telephone advice RN receives a phone call from a 75-year-old male who sustained a raccoon bite two hours ago. The patient reports pain at the site of injury but no other symptoms. 4. The RN advises the patient that without treatment, he is at risk of which of the following?

Fatal encephalitis

An RN is part of a team that has traveled to sub-Saharan Africa to volunteer in a medical clinic. The clinic is in an underdeveloped rural area. A 5-year-old boy is brought into the clinic with a high fever, sore throat, body aches, and weakness. Through the translator, the nurse finds out that the boy has been sick for about a week. He is noted to be barefoot and his mother reports he plays in area ponds to stay cool. How is the poliovirus transmitted?

Fecal-oral

Select the typical symptoms that are present in cases of meningitis, regardless of the causative agent.

Fever Headache Painful or stiff neck

our patient is a 54-year-old male who has recently completed a round of chemotherapy following successful surgery to remove a cancerous tumor from his colon. He complains of a stiff neck, severe headache, and chronic nausea. On taking a history of recent events, you discover his hobby is to race homing pigeons. You suspect meningitis and order a lumbar puncture to sample the spinal fluid, which you negatively stain. The results are shown here. A nitrate assimilation test on the sample was negative, and there was pigmentation on birdseed agar when cultured. How did the patient contract this form of meningitis?

He inhaled the fungal spores present in pigeon droppings; his recent chemotherapy rendered him susceptible.

An 18-month-old male is admitted to the pediatric intensive care unit with concern of neurological disease. The patient's parents report a 2-week history of upper respiratory symptoms, progressing to lethargy, irritability, and poor oral intake. The patient had two episodes of vomiting at home on the day of admission. The RN assesses the patient and notes that he is hypertonic, restless, and appears to be turning away from the light. 4. What is the most common bacterial cause of this disease in children younger than 2 years of age?

Neisseria meningitidis

Choose the microorganism that is the causative agent of the most serious acute form of bacterial meningitis to test your understanding of this disease.

Neisseria meningitidis

4. What is occurring with SSPE?

Neural invasion by persistent virus

A 75-year-old female is brought to the emergency department by ambulance after having a seizure at her home. The woman's son reports she has not been acting normally. She complained of a severe headache and he noted a hand tremor and an unsteady gait. The past few days, she developed a high fever. Upon assessment by the medical team, the woman is not responding verbally. The nurse collects the patient's history from her son, which is notable for a recent camping trip in the woods. The RN updates the patient's son on the plan of treatment. What is the most appropriate antibiotic to treat this illness?

No antibiotic therapy is indicated.

A 75-year-old female is brought to the emergency department by ambulance after having a seizure at her home. The woman's son reports she has not been acting normally. She complained of a severe headache and he noted a hand tremor and an unsteady gait. The past few days, she developed a high fever. Upon assessment by the medical team, the woman is not responding verbally. The nurse collects the patient's history from her son, which is notable for a recent camping trip in the woods. The patient's son is anxious about his mother's prognosis. He asks the RN if his mother will survive the infection. What is the best response by the nurse?

Unfortunately, we see about a 70% mortality rate for this disease. We are doing everything we can do to provide excellent care for your mother.

our patient is a 54-year-old male who has recently completed a round of chemotherapy following successful surgery to remove a cancerous tumor from his colon. He complains of a stiff neck, severe headache, and chronic nausea. On taking a history of recent events, you discover his hobby is to race homing pigeons. You suspect meningitis and order a lumbar puncture to sample the spinal fluid, which you negatively stain. The results are shown here. A nitrate assimilation test on the sample was negative, and there was pigmentation on birdseed agar when cultured. What treatment is available for this patient?

Weeks long treatment with amphotericin-B and fluconazole

Scott was 58 years of age and was taking corticosteroids to treat rheumatoid arthritis. He had no other health issues. He came in to the emergency room complaining of flulike symptoms. He had a fever and sore throat and complained of a severe headache with photophobia. He also complained of overwhelming fatigue and weakness. Scott's weakness was extreme. He had weakness in his lower extremities and found walking more than a couple of feet exhausting.

West Nile encephalitis is caused by a *virus*. The virus is spread to humans by *vector* transmission, specifically through the bites of mosquitoes. Prior to 1999, WNV was commonly found in *Africa*, the Middle East, and parts of Asia. From 1999 to 2008, it is estimated that approximately *1%* of the United States had experienced infection. The best prevention for West Nile encephalitis is *insect control.*

Mosquito eradication could change the epidemiology of ______. Check all that apply.

Zika infection West Nile encephalitis

A harmless PrP is converted into the infective PrP ________.

by an abnormal PrP which binds to the normal protein and causes it to become misfolded

Drag the images to their corresponding statement to test your knowledge of statistical information related to nervous system diseases. Percentage of U.S. population that is seropositive for past or present West Nile virus infection

1%

Drag the images to their corresponding statement to test your knowledge of statistical information related to nervous system diseases. Fatality rate of botulism cases

5%

Compare and contrast the two forms of poliovirus vaccine by completing each sentence. Then, arrange the sentences in a logical sequence.

1. *Poliomyelitis* is an acute enteroviral infection of the spinal cord that causes neuromuscular paralysis. 2. In the past, this disease often affected small children and was called *infantile paralysis*. 3. Because of this, *vaccination* is a mainstay of polio prevention today, and is started in infants at about 2 months of age. 4. There are *two* forms of vaccine utilized today. 5. *Inactivated&* poliovirus vaccine was developed by *Salk* in 1954 and is now the form used for all childhood vaccinations due to its low risk to individuals being vaccinated. 6. In contrast, oral polio vaccine (OPV), developed by *Sabin* in the 1960s, contains an *attenuated* virus and can be easily administered by mouth making it useful still in polio eradication programs in developing countries today. 7. It poses many risks, however, such as the attenuated virus can *multiply* in vaccinated people and spread to others or it can *revert* to a neurovirulent strain causing disease, making the OPV virtually unusable in the United States today.

Scott was 58 years of age and was taking corticosteroids to treat rheumatoid arthritis. He had no other health issues. He came in to the emergency room complaining of flulike symptoms. He had a fever and sore throat and complained of a severe headache with photophobia. He also complained of overwhelming fatigue and weakness. Scott's weakness was extreme. He had weakness in his lower extremities and found walking more than a couple of feet exhausting. 3. The incidence of West Nile encephalitis is over ______ times as high 60- to 69-year-olds as it is in the 40- to 49-year-old group.

2

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 2. Between which years did the greatest decrease in the incidence of Hib-related meningitis occur?

2005-2006

Drag the images and descriptions to the correct diseases to demonstrate your understanding of infectious diseases of the nervous system. Botulism

3 forms based on mode of transmission and affected population Flaccid paralysis

Drag the images to their corresponding statement to test your knowledge of statistical information related to nervous system diseases. Chance of transmission of toxoplasmosis from an infected pregnant woman to her fetus

33%

An RN is leading a public health education program about the West Nile virus. The community has had multiple cases of West Nile virus in the past month. The RN aims to provide teaching regarding transmission, symptoms, and prevention. 1. What is the most common mode of transmission for West Nile virus?

Arthropod bites

Drag the images and descriptions to the correct diseases to demonstrate your understanding of infectious diseases of the nervous system. Rabies

Bat Treatment is post exposure passive and active immunization

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 1. Which of the following is a correct statement based upon these data?

Both the Hib vaccine trial and the nationally introduced vaccine were effective at reducing the incidence of meningitis.

The statements below describe the manifestations of specific diseases of the nervous system. If patients presented with these signs and symptoms, how would you diagnose them as the treating physician? A 5-month-old with colic was given her pacifier dipped in honey to ease her crying and is now having difficulty sucking, is 'floppy', and has labored breathing.

Botulism

Drag the images and descriptions to the correct diseases to demonstrate your understanding of infectious diseases of the nervous system. Creutzfeldt-Jakob Disease

Caused by a prion Contaminated meat

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 3. Hib-related meningitis is treated with which of the following drugs?

Cefotaxime

Drag the statements to the correct disease to examine polio, tetanus, rabies, and botulism. Tetanus

Characteristics by spastic paralysis Prevention is the DTap vaccine, along with TD boosters every 10 years

Drag the statements to the correct disease to examine polio, tetanus, rabies, and botulism. Botulism

Characterized by flaccid paralysis treatment involves the use of a trivalent antitoxin to inactivate the exotoxin made by the causative bacterium

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 4. Which of the following is a correct statement regarding Hib vaccination in the United States today?

Children should be vaccinated at 2, 4, 6, and 12-15 months of age.

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 3. The patient's specimens were most likely cultured using which type of medium?

Chocolate agar

2. Which of the following states had the highest average incidence of neuroinvasive WNV infection from 1999 to 2015?

Colorado

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 2. Which of the following is a fungus associated with the development of meningitis?

Cryptococcus neoformans

our patient is a 54-year-old male who has recently completed a round of chemotherapy following successful surgery to remove a cancerous tumor from his colon. He complains of a stiff neck, severe headache, and chronic nausea. On taking a history of recent events, you discover his hobby is to race homing pigeons. You suspect meningitis and order a lumbar puncture to sample the spinal fluid, which you negatively stain. The results are shown here. A nitrate assimilation test on the sample was negative, and there was pigmentation on birdseed agar when cultured. What is your diagnosis of the infectious agent, given the patient history, the staining results, and the test results?

Cryptococcus neoformans

Select all of the statements that apply to the natural defenses present in the nervous system.

Defenses are mainly structural. Blood vessels that serve the brain have restricted permeability. Some nervous system cells have phagocytic capabilities.

The statements below describe the manifestations of specific diseases of the nervous system. If patients presented with these signs and symptoms, how would you diagnose them as the treating physician? A 68-year-old woman was bitten several times by mosquitoes while gardening and now has a fever, neck stiffness, and a severe headache.

Encephalitis

I was working in an assisted living facility. As an RN, I supervised the care of all the patients in the facility. My responsibilities included preparing and administering medications, performing daily patient assessments, and responding to changes in patient condition. I worked with a team of nursing assistants who helped residents with activities of daily living. Supervising a large number of patients was a challenge but I could depend on my team to keep me alerted if any of our residents needed immediate attention. One morning, a nursing assistant alerted me that Betty, an 86-year-old female, was lethargic and difficult to arouse. Betty was an active and cognitively appropriate resident. She had been diagnosed with a lower respiratory tract infection a few days prior. I was concerned when I entered her room and found her in bed and abnormally drowsy. She had a high temperature and seemed sensitive to the lights in the room. We called for emergency services to transport her to the hospital. 4. True or false: The doctor would have been even more concerned if he suspected viral meningitis.

F

Scott was 58 years of age and was taking corticosteroids to treat rheumatoid arthritis. He had no other health issues. He came in to the emergency room complaining of flulike symptoms. He had a fever and sore throat and complained of a severe headache with photophobia. He also complained of overwhelming fatigue and weakness. Scott's weakness was extreme. He had weakness in his lower extremities and found walking more than a couple of feet exhausting. 1. True or False: The incidence of invasive West Nile infection decreases with age.

F

Scott was 58 years of age and was taking corticosteroids to treat rheumatoid arthritis. He had no other health issues. He came in to the emergency room complaining of flulike symptoms. He had a fever and sore throat and complained of a severe headache with photophobia. He also complained of overwhelming fatigue and weakness. Scott's weakness was extreme. He had weakness in his lower extremities and found walking more than a couple of feet exhausting. 3. True or false: If the lumbar puncture would have shown microbial cells in the cerebrospinal fluid, this would have been further confirmation of West Nile encephalitis.

F

The CNS is an "immunologically privileged" site, which means that the immune response in these sites is enhanced.

F

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 3. True or False: Non-type B strains of Haemophilus influenzae cannot cause disease.

F

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 5. True or False: Based on the study, it appears that non-type B strains of this bacterium have taken over for Hib in causing meningitis in vaccinated countries.

F

An RN is leading a public health education program about the West Nile virus. The community has had multiple cases of West Nile virus in the past month. The RN aims to provide teaching regarding transmission, symptoms, and prevention. 2. The RN educates the community about symptoms of West Nile infection. Which of the following are initial symptoms of infection?

Fever, body aches, and rash

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 1. Which of the following is an accurate description of what was seen upon observing a Gram stain of the patient's CSF specimen?

Gram-negative bacilli

An 18-month-old male is admitted to the pediatric intensive care unit with concern of neurological disease. The patient's parents report a 2-week history of upper respiratory symptoms, progressing to lethargy, irritability, and poor oral intake. The patient had two episodes of vomiting at home on the day of admission. The RN assesses the patient and notes that he is hypertonic, restless, and appears to be turning away from the light. 5. What of the following describe the type of cells the RN would expect to be found upon staining of a specimen from a patient with this disease caused by Neisseria meningitidis?

Gram-negative cocci

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 2. Which of the following is a correct statement?

Hib was the leading cause of bacterial meningitis in children under the age of 5.

A 75-year-old female is brought to the emergency department by ambulance after having a seizure at her home. The woman's son reports she has not been acting normally. She complained of a severe headache and he noted a hand tremor and an unsteady gait. The past few days, she developed a high fever. Upon assessment by the medical team, the woman is not responding verbally. The nurse collects the patient's history from her son, which is notable for a recent camping trip in the woods. Multiple tests are performed, and the patient is diagnosed with Eastern Equine Encephalitis. What is the best initial treatment regimen?

Hydration, antiepileptic drugs, antipyretics

A 31-year-old woman is 8 months pregnant with her first child. Her general health is completely normal, as is the health of her developing fetus. She works in an office as a data entry clerk. One day she develops a fever, nausea, and muscle aches. She decides to leave work early and rest at home. Her symptoms persist for 2 days but do not develop any further. Three weeks later, she realizes that the fetus is not as active as it had been in the days' prior. After 24 hours of virtually no movement, she calls her physician. In a whirlwind of panic, she undergoes a sonogram and is told a fetal heartbeat can no longer be detected. 3. Which immunologic test could be used to determine the identity of the pathogen through the use of microscopy and fluorescently-tagged antibodies?

Indirect immunofluorescent staining

An RN is leading a public health education program about the West Nile virus. The community has had multiple cases of West Nile virus in the past month. The RN aims to provide teaching regarding transmission, symptoms, and prevention. 3. Which of the following is the most important topic of education regarding prevention of West Nile infection?

Insect control

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 1. Which of the following is a correct statement regarding Haemophilus influenzae?

It exists in 6 serotypes, named A through F

A 31-year-old woman is 8 months pregnant with her first child. Her general health is completely normal, as is the health of her developing fetus. She works in an office as a data entry clerk. One day she develops a fever, nausea, and muscle aches. She decides to leave work early and rest at home. Her symptoms persist for 2 days but do not develop any further. Three weeks later, she realizes that the fetus is not as active as it had been in the days' prior. After 24 hours of virtually no movement, she calls her physician. In a whirlwind of panic, she undergoes a sonogram and is told a fetal heartbeat can no longer be detected. 2. It is important to rapidly identify Listeria monocytogenes in pregnancy to save the life of the fetus. What characteristic of this pathogen hampered the diagnosis through routine culturing?

It is best cultured using cold enrichment methods

Select all of the statements that accurately describe the oral polio vaccine.

It is easily administered by mouth. It contains attenuated virus.

Select all of the statements that describe the inactivated polio vaccine.

It is the form of polio vaccine currently used in the United States. It contains inactivated virus.

A 31-year-old woman is 8 months pregnant with her first child. Her general health is completely normal, as is the health of her developing fetus. She works in an office as a data entry clerk. One day she develops a fever, nausea, and muscle aches. She decides to leave work early and rest at home. Her symptoms persist for 2 days but do not develop any further. Three weeks later, she realizes that the fetus is not as active as it had been in the days' prior. After 24 hours of virtually no movement, she calls her physician. In a whirlwind of panic, she undergoes a sonogram and is told a fetal heartbeat can no longer be detected. 3. Based upon this information, what is the patient's diagnosis, and what infection ended the life of the fetus?

Listeriosis; neonatal meningitis

1. What primary infection can result in SSPE or PIE?

Measles virus

A 31-year-old woman is 8 months pregnant with her first child. Her general health is completely normal, as is the health of her developing fetus. She works in an office as a data entry clerk. One day she develops a fever, nausea, and muscle aches. She decides to leave work early and rest at home. Her symptoms persist for 2 days but do not develop any further. Three weeks later, she realizes that the fetus is not as active as it had been in the days' prior. After 24 hours of virtually no movement, she calls her physician. In a whirlwind of panic, she undergoes a sonogram and is told a fetal heartbeat can no longer be detected. 1. Based upon all of the information obtained through specimen testing, along with the patient's symptoms, the pathogen is most likely _______.

Listeria monocytogenes

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 3. Based upon the data, which is the most valid hypothesis to explain the increase in the incidence of Hib-related meningitis in 2010 and 2011?

No vaccine was given during this period, breaking the immunity created during the years of the vaccine trial.

3. Which of the two conditions results from an inappropriate immune response?

PIE

5. Which one of these conditions rarely results from vaccination with the MMR vaccine?

PIE

2. Which represent typical timelines for these conditions? Check all that apply.

PIE; 1–2 weeks SSPE; years later

An RN is part of a team that has traveled to sub-Saharan Africa to volunteer in a medical clinic. The clinic is in an underdeveloped rural area. A 5-year-old boy is brought into the clinic with a high fever, sore throat, body aches, and weakness. Through the translator, the nurse finds out that the boy has been sick for about a week. He is noted to be barefoot and his mother reports he plays in area ponds to stay cool. Serological testing on the patient's cerebral spinal fluid confirms a diagnosis of polio. What is the best treatment modality?

Pain control and respiratory support

A 75-year-old female is brought to the emergency department by ambulance after having a seizure at her home. The woman's son reports she has not been acting normally. She complained of a severe headache and he noted a hand tremor and an unsteady gait. The past few days, she developed a high fever. Upon assessment by the medical team, the woman is not responding verbally. The nurse collects the patient's history from her son, which is notable for a recent camping trip in the woods. What components of the patient's history are most important for the nurse to collect during the initial triage assessment?

Past medical history, mosquito exposure, allergies, medications

An 18-month-old male is admitted to the pediatric intensive care unit with concern of neurological disease. The patient's parents report a 2-week history of upper respiratory symptoms, progressing to lethargy, irritability, and poor oral intake. The patient had two episodes of vomiting at home on the day of admission. The RN assesses the patient and notes that he is hypertonic, restless, and appears to be turning away from the light. 3. The RN ensures that chemotherapy begins as soon as possible. What is the initial drug the RN anticipates to be ordered for this patient?

Penicillin G

An RN is part of a team that has traveled to sub-Saharan Africa to volunteer in a medical clinic. The clinic is in an underdeveloped rural area. A 5-year-old boy is brought into the clinic with a high fever, sore throat, body aches, and weakness. Through the translator, the nurse finds out that the boy has been sick for about a week. He is noted to be barefoot and his mother reports he plays in area ponds to stay cool. Which of the following diseases should the nurse be most concerned about, considering the patient's presentation?

Polio

An RN is part of a team that has traveled to sub-Saharan Africa to volunteer in a medical clinic. The clinic is in an underdeveloped rural area. A 5-year-old boy is brought into the clinic with a high fever, sore throat, body aches, and weakness. Through the translator, the nurse finds out that the boy has been sick for about a week. He is noted to be barefoot and his mother reports he plays in area ponds to stay cool. The RN assists in educating the patient's mother about the diagnosis through a translator. What is the causative agent for polio?

Poliovirus

The abnormal form of the protein is designated _______.

PrPSc

A telephone advice RN receives a phone call from a 75-year-old male who sustained a raccoon bite two hours ago. The patient reports pain at the site of injury but no other symptoms. 1. Which of the following diseases is the greatest risk to the patient, considering the mechanism of injury?

Rabies

According to this figure, what nervous system disease would likely result in death to a person that contracts the disease but is not transmitted directly to other people? (pyramid diagram)

Rabies

The statements below describe the manifestations of specific diseases of the nervous system. If patients presented with these signs and symptoms, how would you diagnose them as the treating physician? A hunter in NC was bitten by a raccoon caught in his trap eight weeks ago, now displays agitation, disorientation and seizures.

Rabies

I was working in an assisted living facility. As an RN, I supervised the care of all the patients in the facility. My responsibilities included preparing and administering medications, performing daily patient assessments, and responding to changes in patient condition. I worked with a team of nursing assistants who helped residents with activities of daily living. Supervising a large number of patients was a challenge but I could depend on my team to keep me alerted if any of our residents needed immediate attention. One morning, a nursing assistant alerted me that Betty, an 86-year-old female, was lethargic and difficult to arouse. Betty was an active and cognitively appropriate resident. She had been diagnosed with a lower respiratory tract infection a few days prior. I was concerned when I entered her room and found her in bed and abnormally drowsy. She had a high temperature and seemed sensitive to the lights in the room. We called for emergency services to transport her to the hospital. 1. Why was meningitis suspected in Betty's case?

She exhibited several neurological symptoms.

Drag the statements to the correct disease to examine polio, tetanus, rabies, and botulism. Rabies

Slow progressive encephalitis transmitted by bites or droplets Treatment is post exposure active and passive immunization

Match the statement to the disease that it most accurately describes to test your understanding of nervous system diseases caused by microorganisms. Rabies

Slow, progressive zoonotic viral disease characterized by fatal encephalitis and with hydrophobia as a symptom

Drag the images and descriptions to the correct diseases to demonstrate your understanding of infectious diseases of the nervous system. Tetanus

Spastic paralysis Vaccine preventable disease caused by endospore forming rod

Choose the microorganism that is the most common cause of bacterial meningitis in adults to test your understanding of this disease.

Streptococcus pneumoniae

I was working in an assisted living facility. As an RN, I supervised the care of all the patients in the facility. My responsibilities included preparing and administering medications, performing daily patient assessments, and responding to changes in patient condition. I worked with a team of nursing assistants who helped residents with activities of daily living. Supervising a large number of patients was a challenge but I could depend on my team to keep me alerted if any of our residents needed immediate attention. One morning, a nursing assistant alerted me that Betty, an 86-year-old female, was lethargic and difficult to arouse. Betty was an active and cognitively appropriate resident. She had been diagnosed with a lower respiratory tract infection a few days prior. I was concerned when I entered her room and found her in bed and abnormally drowsy. She had a high temperature and seemed sensitive to the lights in the room. We called for emergency services to transport her to the hospital. 2. What was the likely causative agent of Betty's meningitis based on her medical history and age?

Streptococcus pneumoniae

3. True or False: Every state in the United States had at least one case of West Nile virus infection during the time period depicted in this map.

T

Disease symptoms are believed to be the result of dense aggregates of the abnormal protein.

T

In some inherited cases, the normal prion protein can convert spontaneously to the abnormal form, but at a slow rate.

T

Neonatal meningitis is almost always a result of an infection transmitted by the mother, either in utero or during the birthing process.

T

Scott was 58 years of age and was taking corticosteroids to treat rheumatoid arthritis. He had no other health issues. He came in to the emergency room complaining of flulike symptoms. He had a fever and sore throat and complained of a severe headache with photophobia. He also complained of overwhelming fatigue and weakness. Scott's weakness was extreme. He had weakness in his lower extremities and found walking more than a couple of feet exhausting. 2. True or False: The case patient, Scott, was at a greater risk because of his age.

T

T/F The neurotoxin produced by Clostridium tetani blocks the inhibition of muscle contraction resulting in spastic paralysis.

T

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 1. True or False: It is possible that the source of the patient's infection was the bacterium causing his initial middle ear infection.

T

While working on a pediatric unit, I was responsible for caring for Cody, a 7-year-old boy who had been admitted to the unit for treatment of a severe case of otitis media. Cody had been treated for an ear infection 2 weeks previously and had seemed to improve with oral antibiotic therapy. However, shortly after completing the antibiotic regimen, Cody became ill again, spiking a high fever and becoming dehydrated due to vomiting. He was admitted for rehydration and was started on antibiotics for a relapse of otitis media. 2. True or False: Refusal of the Hib vaccine increases susceptibility to a common, treatable disease.

T

The statements below describe the manifestations of specific diseases of the nervous system. If patients presented with these signs and symptoms, how would you diagnose them as the treating physician? A 73-year-old farmer gashed his hand on a barbed wire fence one week ago and is now experiencing uncontrollable muscle spasms in his jaw.

Tetanus

I was working in an assisted living facility. As an RN, I supervised the care of all the patients in the facility. My responsibilities included preparing and administering medications, performing daily patient assessments, and responding to changes in patient condition. I worked with a team of nursing assistants who helped residents with activities of daily living. Supervising a large number of patients was a challenge but I could depend on my team to keep me alerted if any of our residents needed immediate attention. One morning, a nursing assistant alerted me that Betty, an 86-year-old female, was lethargic and difficult to arouse. Betty was an active and cognitively appropriate resident. She had been diagnosed with a lower respiratory tract infection a few days prior. I was concerned when I entered her room and found her in bed and abnormally drowsy. She had a high temperature and seemed sensitive to the lights in the room. We called for emergency services to transport her to the hospital. 3. Why are higher and more frequent doses of antibiotics used to treat meningitis?

The antibiotics must cross the blood-brain barrier.

Which pathogen has evolved to make its rodent host less avoidant of cats?

Toxoplasma gondii

Examine the natural defenses present in the nervous system and the importance of its "immunologically privileged" status by completing each sentence.

The nervous system represents an organ system free of *normal biota*; the presence of microbes in nervous tissue indicates a deviation from the normal, healthy state of the body. To maintain its *sterile* environment, the nervous system possesses natural defense mechanisms. For example, *bony* structures of the skull are a structural barrier to the entry of pathogens. Although the *blood-brain barrier* restricts permeability of blood vessels in the brain and prohibits most microbes from entering, it also makes *drug* treatment in this area difficult if required. Phagocytic *microglia* cells and brain macrophages also provide antimicrobial activity in the nervous system, though their action is reduced compared to other areas of the body.

The statements below describe the manifestations of specific diseases of the nervous system. If patients presented with these signs and symptoms, how would you diagnose them as the treating physician? A woman gives birth to an infant with severe liver damage and hydrocephalus. She owns several cats.

Toxoplasmosis

Choose the statement that best describes the normal microbiota of the nervous system.

There are no normal biota present.

A 31-year-old woman is 8 months pregnant with her first child. Her general health is completely normal, as is the health of her developing fetus. She works in an office as a data entry clerk. One day she develops a fever, nausea, and muscle aches. She decides to leave work early and rest at home. Her symptoms persist for 2 days but do not develop any further. Three weeks later, she realizes that the fetus is not as active as it had been in the days' prior. After 24 hours of virtually no movement, she calls her physician. In a whirlwind of panic, she undergoes a sonogram and is told a fetal heartbeat can no longer be detected. 2. Based upon this identification, what was the most likely mode of transmission of this pathogen in the patient?

Vehicle transmission

An 18-month-old male is admitted to the pediatric intensive care unit with concern of neurological disease. The patient's parents report a 2-week history of upper respiratory symptoms, progressing to lethargy, irritability, and poor oral intake. The patient had two episodes of vomiting at home on the day of admission. The RN assesses the patient and notes that he is hypertonic, restless, and appears to be turning away from the light. 1. Based on the patient's clinical presentation, which of the following is the most accurate differential diagnosis(es)?

Viral meningitis and bacterial meningitis

Drag the statements to the correct disease to examine polio, tetanus, rabies, and botulism. Polio

Virus is transmitted by vehicles or the fecal oral route IPV is used for prevention today in the U.S.

Scott was 58 years of age and was taking corticosteroids to treat rheumatoid arthritis. He had no other health issues. He came in to the emergency room complaining of flulike symptoms. He had a fever and sore throat and complained of a severe headache with photophobia. He also complained of overwhelming fatigue and weakness. Scott's weakness was extreme. He had weakness in his lower extremities and found walking more than a couple of feet exhausting. 1. West Nile virus causes ________.

acute encephalitis

A 31-year-old woman is 8 months pregnant with her first child. Her general health is completely normal, as is the health of her developing fetus. She works in an office as a data entry clerk. One day she develops a fever, nausea, and muscle aches. She decides to leave work early and rest at home. Her symptoms persist for 2 days but do not develop any further. Three weeks later, she realizes that the fetus is not as active as it had been in the days' prior. After 24 hours of virtually no movement, she calls her physician. In a whirlwind of panic, she undergoes a sonogram and is told a fetal heartbeat can no longer be detected. 1. Based upon these results, the pathogen appears to be a ______.

bacterium

A 31-year-old woman is 8 months pregnant with her first child. Her general health is completely normal, as is the health of her developing fetus. She works in an office as a data entry clerk. One day she develops a fever, nausea, and muscle aches. She decides to leave work early and rest at home. Her symptoms persist for 2 days but do not develop any further. Three weeks later, she realizes that the fetus is not as active as it had been in the days' prior. After 24 hours of virtually no movement, she calls her physician. In a whirlwind of panic, she undergoes a sonogram and is told a fetal heartbeat can no longer be detected. 2. Based upon the staining results, the pathogen appears to be a(n) _______.

gram-positive bacillus

A telephone advice RN receives a phone call from a 75-year-old male who sustained a raccoon bite two hours ago. The patient reports pain at the site of injury but no other symptoms. 2. The RN advises the patient to seek medical attention ______.

immediately

Scott was 58 years of age and was taking corticosteroids to treat rheumatoid arthritis. He had no other health issues. He came in to the emergency room complaining of flulike symptoms. He had a fever and sore throat and complained of a severe headache with photophobia. He also complained of overwhelming fatigue and weakness. Scott's weakness was extreme. He had weakness in his lower extremities and found walking more than a couple of feet exhausting. 2. West Nile virus is spread by ________.

mosquitoes

Drag the images and descriptions to the correct diseases to demonstrate your understanding of infectious diseases of the nervous system. Arboviral Encephalitis

mosquitos West Nile virus

1. The term "incidence" refers to ________.

the number of new cases over a certain time period