Unit 2 CH. 69
What does the medical management for MS consist of?
*no cure exist* -an individual treatment program is indicated to relieve the patients symptoms and provide continuing support --goals of treatment: delay the progression of the disease, manage chronic symptoms, and treat acute exacerbations -symptoms requiring intervention: spasticity, fatigue, bladder dysfunction, and ataxia
What does the medical management of myasthenia gravis consist of?
*there is no cure for myasthenia gravis, treatments do not stop the production of the acetylcholine receptor antibodies* -improving function and reducing and removing circulating antibodies therapeutic modalities: admin of acetylcholinesterase medications and immunosuppressive therapy, plasmapheresis (removing blood plasma), and thymectomy (removal of thymus gland)
What do the disease modifying medications for MS include?
*they reduce the frequency of relapse, duration, and number and size of plaque observed on MRI* -Interferon beta 1a (Rebif) & interferon beta 1b- subQ every other day -Interferon beta 1a (Avonex)- given IM once a week *side effects of all interferon's: flulike symptoms that can be managed w/acetaminophen and ibuprofen and resolve after a few months* -additional SE of interferon's include: potential liver damage, fetal abnormalities, depression *disease modifying agents should be started early in the course of the disease*
What do assessment and supportive measures include for myasthenic crisis?
-ABGs, serum electrolytes, input and output, daily weight are monitored -if the patient cannot swallow, enteral tubing feedings may be needed -sedative and tranquilizing agents are avoided, bc they aggravate hypoxia and hypercapnia (excessive carbon dioxide) and can cause resp and cardiac depression
What is used for a progressive fungal infection that does not respond to conventional drug therapy?
-Amphotericin B -dosing depends on the causative organisms and it is admin. IV
What is the medication of choice for treating spasticity?
-Baclofen (Lioresal) a gamma aminobutytric acid agonist -admin. orally or intrathecal *Benzodiazepines also: (diazepam (Valium), tizanidine (Zanaflex), and Dantrolene (Dantrium) *patients w/disabling spasms or contractures may require nerve blocks or surgical intervention*
What medication may be administered orally in conjunction w/ amphotericin B as maintenance therapy?
-Fluconazole (Diflucan) -Flucytosine (Ancobon) *most common adverse effect to Flucytosine is bone marrow depression, therefore pts. should have leukocyte and platelet counts monitored regularly*
What medication reduces the rate of relapse in the RR course of MS?
-Glatiramer acetate (Copraxone) -subQ daily, it may take 6 months for evidence of an immune response to appear
What is the key agent in treating acute relapse in RR course of MS?
-IV methylprednisone -it shortens the duration of relapse but has not been found to have long-term benefit -admin. as 1g IV daily for 3-5 days followed by oral taper of prednisone -SE: mood swings, weight gain, electrolyte imbalance
What is the therapy of choice for Gullain Barre syndrome?
-IVIG because it is associated with fewer sides effects when admin. appropriately *tachycardia and hypotension are treated with alpha blockers* *hypotension is managed by increasing the amount of IV fluid admin.*
What do the autoimmune NS disorders include?
-Multiple sclerosis (MS), myasthenia gravis, and Guillain-Barre syndrome *autoimmune: body's immune system attacks healthy cells*
What is another common symptom of MS that can contribute to social isolation?
-Pain caused by lesions on the sensory pathways -additional sensory manifestations: paresthesia, dysesthesia (pain on touch), proprioception loss
What does the medical management for meningitis consist of?
-Penicillin G in combo w/one of the cephalosporins (ceftriaxone sodium, cefotaxime sodium) is most often admin. IV w/in 30 mins. of hospital arrival -dehydration and shock are treated with fluid volume expanders -seizures are treated with phenytoin
What medication should patients w/myasthenia gravis avoid?
-Procaine (Novocaine)
What is the first line of therapy for myasthenia gravis?
-Pyridostigmine bromide (Mestinon) -an anticholinesterase medication -provides symptomatic relief by preventing the breakdown of acetylcholine and increasing the relative concentration of available acetylcholine -dose is gradually increased and admin in divided doses (4 times a day) -adverse effects: fasciculation's, abdominal pain, diarrhea, increased oropharyngeal secretions
What are the clinical manifestations of arthropod virus encephalitis?
-St. Louis and West Nile encephalitis most commonly affect adults -climate, summer and fall -occurs along a continuum w/some cases having flulike symptoms (HA & fever) but others progressing to specific neurologic manifestations -
What do secondary complications of MS include?
-UTI, constipation, pressure ulcers, contracture deformities, dependent pedal edema, pneumonia, reactive depression, and osteoporosis
What are brain abscesses?
-a collection of infectious material within the tissue of the brain *bacteria is the most common causative organism* -most common predisposing conditions for adults are : otitis media (inflammation of ear) and rhinosinusitis (inflammation of nasal passages)
What happens if the patient w/Gullain Barre syndrome cannot swallow bc of bulbar paralysis (immobility of muscles)?
-a gastrostomy tube may be placed to admin nutrition *the nurse carefully assesses the return of the gag reflex and bowel sounds before resuming oral nutrition*
What may fatigue that interferes with ADL's be treated w/ in the patient w/MS?
-amantadine (Symmetrel) -pemoline (Cyclert) -dalfampridine (Ampyra)
What test is used to diagnose myasthenia gravis?
-an acetylcholinesterase inhibitor test called Tensilon test -Edrophonium chloride (Tensilon) a fast acting acetylcholine inhibitor is admin IV, thirty seconds after injection, facial muscle weakness and ptosis should resolve for about 5 minutes, immediate improvement in muscle strength after admin of this agent represents a positive test and usually confirms diagnosis *Atropine should be available to control the effects of Tensilon which include bradycardia, sweating and cramping* -Ice test used instead for those who have cardiac conditions or asthma that may contraindicate the use of Tensilon
What is encephalitis?
-an acute inflammatory process of the brain tissue *Herpes simplex virus is the most common cause* -HSV-1 typically affects children and adults -HSV-2 typically affects neonates who acquire the disease from a mother who has active genital herpes at time of delivery
What is myasthenia gravis?
-an autoimmune disorder affecting myoneural junction -characterized by various degrees of weakness of the voluntary muscles -affects more women than men, after age 50 the gender distribution is more equal *purely a motor disorder w/no effect on sensation or coordination*
What is a myasthenic crisis?
-an exacerbation of the disease process characterized by severe generalized muscle weakness and respiratory and bulbar weakness that may result in respiratory failure -most common precipitators is respiratory infection, others include medication change & pregnancy -
What interventions may be used if the patient w/MS has vision problems?
-an eye patch or a covered eyeglass les may be used to block the visual impulses of one eye if the patient has diplopia -prism glasses may be helpful for patients who are confined to bed and have difficulty reading in the supine position -Individuals who are not able to read regular print materials are eligible for the free "talking book" services of the library
What is MS?
-an immune mediated, progressive demyelinating disease of the CNS demyelination: -destruction of myelin: the fatty and protein material that surrounds certain nerve fibers in the brain and spinal cord, results in impaired transmission of nerve impulses -may occur at any age, but the age of peak onset is 25-35yrs -affects women more than men -cause of MS is ongoing research -not genetically transmitted -environmental risks: smoking, lack of vitamin D exposure, exposure to the Epstein-Barr -life expectancy is 5-7yrs shorter than those w/o it
What is the patho of myasthenia gravis?
-antibodies directed at the acetylcholine receptor sites impair transmission of impulses across the myoneural junction -therefore fewer receptors are available for stimulation, resulting in voluntary muscle weakness that escalates w/continued activity
What medications may be prescribed for bowel and bladder problems associated with MS?
-anticholinergics, alpha blockers, antispasmodic agents
What should people in close contact with those with meningitis be treated with?
-antimicrobial chemoprophylaxis -Rifampin (Rifadin) -Ciprofloxacin hydrochloride (Cipro) -Ceftriaxone sodium (Rocephin) *therapy should be started w/in 24hrs of exposure* -Vaccination against Haemphilus influenza and S. pneumoniae should be encouraged for children and at risk adults
What does the medical management of (HSV-1) encephalitis include?
-antiviral agents -acyclovir (Zovirax) -ganciclovir (Cytovene) *to prevent relapse treatment should continue for up to 3 weeks* -slow IV admin. prevents crystallization of the med. in the urine *usual dose of acyclovir is decreased if the patient has renal insufficiency*
What may be prescribed to acidify the urine making bacterial growth less likely (UTI)?
-ascorbic acid (vitamin C)
What medications are used to treat ataxia?
-beta adrenergic blockers -propranolol (Inderal) -antiseizure agent, gabapentin (Neurontin) -benzodiazepines (clonazepam Klonopin)
How is N. meningitidis transmitted?
-by secretion or aerosol contamination -it concentrates in the nasopharynx
What is aseptic meningitis?
-cause is viral or secondary to cancer or having a weakened immune system such as HIV -most common causative organism is enteroviruses -occurs more frequently in summer and early fall
What is septic meningitis?
-caused by bacteria -Streptococcus pneumoniae and Neisseria meningitides are responsible for majority of cases
What is a cholinergic crisis?
-caused by overmedication w/cholinesterase inhibitors -rare -atropine sulfate should be on hand to treat bradycardia or respiratory distress
What does the nursing management of the patient with meningitis consist of?
-collaborative w/physician, respiratory therapist, etc. -infection control precautions until 24 hrs. after initiation of antibiotic therapy (oral and nasal discharge is considered infectious) -assisting w/pain management due to overall body aches and neck pain -assisting w/getting rest in a quiet, darkened room -Interventions to treated elevated temp. (antipyretics and cooling blankets) -Encourage patient to stay hydrated orally or peripherally -Close neurologic monitoring -Protection from injury due to LOC -Monitoring daily weight: serum electrolytes, urine volume, specific gravity, osmolality esp. if SIADH is suspected -Preventing complications associated w/immobility (pneumonia & pressure ulcers)
What does the nursing management for the patient w/a brain abscess consist of?
-continuing to assess the neurologic status: alerts the nurse to changes in ICP -administering medications: blood lab test results specifically blood glucose and serum K+ need to be monitored when corticosteroids are prescribed -assessing response to treatment -providing supportive care -patient safety: injury may result from LOC
What medications are used to treat myasthenia gravis if there is an inadequate response to steroids?
-cytotoxic medications -Azathioprine (Imuran) -inhibits T lymphocytes and B cell proliferation and reduces acetylcholine receptor antibody levels -therapeutic effects may not be evident for 3-12 months *leukopenia and hepatic toxicity are serious adverse effects, so monthly evaluation of liver enzymes and WBC is necessary*
What medications administered 30 minutes prior to giving amphotericin B may prevent flulike symptoms?
-diphenhydramine (Benadryl) -acetaminophen (Tylenol)
What does the medical management of fungal encephalitis consist of?
-directed at the causative fungus and the neurologic consequences of the infection -seizures are controlled by standard antiseizure meds. -increased ICP is controlled by repeated lumbar punctures or shunting of CSF -antifungal medication are admin. for a specific period to cure the infection in pts w/competent immune systems
What should the nursing management for fungal encephalitis include?
-early identification of ICP -administering nonopioid analgesics, limiting environmental stimuli, positioning -
What are the clinical manifestations of vCJD?
-early psychiatric symptoms -mean age of onset is 27 -presenting symptoms include: affective symptoms (behavioral changes), sensory disturbance, and limb pain, muscle spasms and rigidity, dysarthria, incoordination, cognitive impairment, and sleep disturbances follow *individuals survive an average of 22 months after clinical presentation*
What is the nursing management for myasthenia gravis?
-education on medication management, energy conservation, strategies to help w/ocular manifestations, and prevention and management of complications -patient can keep a diary to determine fluctuation of symptoms and to learn when the med is wearing off *any delay in admin. of medication can exacerbate muscle weakness* -if patient lives in a two story house nurse can recommend that frequently used items be kept on the same floor to conserve energy -patient is instructed to apply for a handicapped parker to conserve energy from walking from parking spaces -to minimize risk of aspiration meal times should coincide with peak effects of anticholinesterase medications *rest before meals is encouraged to reduce muscle fatigue* -suction should be available at home w/instructions for pt and family use -supplemental feedings may be needed for some -To prevent corneal damage when the eyelids do not close completely the patient is instructed to tape the eyes closed for short intervals and to regularly instil artificial tears
What is often the most disabling symptom of MS?
-fatigue -avoiding hot temperatures, effective treatment of depression and anemia, and occupational and physical therapies may help control fatigue -balance of rest and activities, good nutrition to avoid being overweight and obese, healthy lifestyle including avoidance of alcohol and smoking
What are the clinical manifestations of encephalitis?
-fever, headache, confusion, and hallucinations -focal neurologic symptoms reflect that areas of cerebral inflammation and necrosis and include fever, HA, behavioral changes, focal seizures, hemiparesis, altered LOC
What are the clinical manifestations of fungal encephalitis?
-fever, malaise, HA, meningeal spasms, change in LOC, or cranial nerve dysfunction
What are the adverse reactions associated w/amphotericin B?
-fever, n&v, anemia, uremia, and electrolyte abnormalities *renal insufficiency is a serious reaction*
What is the patho for fungal encephalitis?
-fungal spores enter the body via inhalation -initially infect the lungs, causing vague respiratory symptoms or pneumonitis, fungi may enter the bloodstream causing fungemia -If the fungemia overwhelms the persons immune system the fungus may spread to the CNS -Fungal invasion may cause meningitis, brain abscess, granuloma, or arterial thrombus
What are the clinical manifestations of meningitis?
-headache and fever initially *fever tends to remain high throughout the course of the illness, HA is usually steady or throbbing and very severe* -Neck immobility: stiff and painful neck -Positive Kernigs sign: when the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended, when Kernigs sign is bilateral meningeal irritation is suspected -Positive Brudzinski's sign: Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed -Photobia (extreme sensitivity to light) is common -Disorientation and memory impairment -lethargy, unresponsiveness, and coma
What are the clinical manifestations of brain abscess?
-headache that is usually worse in the morning -fever may or may not be present -vomiting and focal neurologic deficits occur also -focal deficits such as: weakness and decreasing vision reflect the area of the brain involved -symptoms of increased ICP occur such as decreasing LOC and seizures
What neurologic deficits does the patient w/a brain abscess have?
-hemiplegia: paralysis of one side of the body or part of it -Hemiparesis: weakness of one side of the body or part of it -seizures -visual deficits -cranial nerve palsies
What are the next agents used if Pyridostigmine does not improve muscle strength and control fatigue r/t myasthenia gravis?
-immunomodulating agents -goal is to reduce production of the antibody -corticosteroids suppress the patients immune system decreasing the amount of antibody *an initial dose of prednisone is given daily and maintained for 1-2 months, as symptoms improve the med it tapered*
What is meningitis?
-inflammation of the meninges which cover and protect the brain and spinal cord -3 major causes: bacterial, viral, and fungal infections -can be septic or aseptic
What are the clinical manifestations of myasthenia gravis?
-initially in 80% of patients symptoms involve the ocular muscles (eye) *Diplopia and ptosis (drooping of eyelids) is common* -weakness of face muscles, throat (bulbar symptoms) and generalized weakness -dysphonia (voice impairment) -dysphagia which increases the risk of choking and aspiration -generalized weakness affects all extremities and the intercostal muscles resulting in decreasing vital capacity and respiratory failure
What should the nurse do to help the patient who has MS w/nutrition?
-interventions to help promote healthy eating and weight reductions need to take into account that fatigue and mobility impairments are barriers -Include family members in interventions and nutrition education bc they are often the gate keepers for food preparation and selection
What is the medical management for Gullain Barre syndrome?
-it is a medical emergency bc of the possibility of rapid progression and neuromuscular resp failure -Resp. therapy or mechanical ventilation may be needed to support pulmonary function and adequate oxygenation -Plasmapheresis and IVIG are used to directly affect the peripheral nerve myelin antibody level *both therapies decrease circulating antibody levels and reduce the amount of time the patient is immobilized and dependent on mechanical ventilation*
What are characteristics that both CJD and vCJD share?
-lack of CNS inflammation -symptoms are progressive, no definitive treatment, and the outcome if fatal -prion crosses the blood brain barrier and is deposited in brain tissue and causes degeneration of brain tissue, cell death occurs, and spongiform changes are produced in the brain
What are the clinical manifestations of CJD?
-late psychiatric symptoms -mean age of onset is 65 -mental deterioration, ataxia, visual disturbance, memory loss, involuntary movement, paralysis, and mutism *individuals survive for less than a year after clinical presentation*
What does the patho of encephalitis involve?
-local necrotizing hemorrhage that becomes more generalized followed by edema -progressive deterioration of nerve cell bodies
What is arthropod borne virus encephalitis?
-maintained in nature through biologic transmission b/t susceptible vertebrae hosts by blood feeding arthropods (mosquitoes, psychodids, ticks) *mosquito is the main vector*
What does the pharmacologic therapy for MS consist of?
-medications prescribed for disease modification and symptom management
What do the infectious disorders of the NS include?
-meningitis -brain abscesses -various types of encephalitis (Creutzfeldt-Jakob disease; CJD), variant Creutzfeldt-Jakob disease (vCJD)
What are the prevention recommendations for meningitis?
-meningococcal vaccine be given to youth at 11-12 yrs. of age w/a booster dose at 16 yrs. of age *first year college students have a high chance of developing meningitis*
What medication can reduce the frequency of clinical relapses in patients w/secondary progressive or worsening RR MS?
-mitoxantrone (Novantrone) admin. via IV infusion every 3 months -there is a maximum lifetime dose that can be administered
What is spasticity?
-muscle hypertonicity, stiffness -occurs in 90% of patients w/MS -most often in the lower extremities and can include loss of abdominal reflexes
What are the assessment and diagnostic findings for brain abscess?
-neuroimaging with CT scanning is used most often to identify the size and location of the abscess -Aspiration of the abscess guided by CT or MRI, is often used to culture and identify the infectious organism -Blood cultures obtained if abscess is believed to arise from a distant source -Chest x-ray done to rule out predisposing lung infections, EEG may help localize the lesion
What does the nursing management of (HSV-1) encephalitis include?
-neurologic function is key -comfort measures to reduce HA, dimming lights, limiting noise and visitors, grouping nursing interventions, administering analgesics -Opioid analgesics may mask neuro symptoms therefore they are used cautiously -Nursing care addressing pt. and family anxieties is ongoing -monitoring of blood chem test and urinary output alert the nurse to renal complications associated w/ antiviral therapy
What does the medical management for CJD or vCJD consist of?
-no effective treatment -care of the patient is supportive and palliative -goals of care: prevention of injury r/t immobility and dementia, promotion of pt comfort, and provision of support and education for the family
What happens if paralytic ileus results from insufficient parasympathetic activity during Gullain Barre syndrome?
-nurse administers IV fluids and parenteral nutrition as a supplement and monitors for return of bowel sounds
What does the prevention of CJD or vCJD consist of?
-patient isolation is not necessary -the use of STANDARD precautions is important -institutional protocols are followed for blood and body fluid exposure and decontamination of equipment *in the OR it is recommended that disposable instruments be used and then incinerated (burned) bc conventional methods of sterilization does not destroy the prion*
What is plasmapheresis?
-plasma exchange -used to treat exacerbations -patients plasma and plasma components are removed through a centrally placed large bore double lumen catheter -the blood cells and antibody containing plasma are separated, after which the cells and a plasma substitute are reinfused -plasma exchange produces a temporary reduction in the level of circulating antibodies -typical course consists of daily or alternate day treatment and number of treatments is determined by patients response -Improvement only lasts a few weeks after treatment is completed -adverse effects include: infection from large bore IV catheter that must be inserted to admin
What are symptoms of myasthenic crisis?
-respiratory distress -varying degrees of dysphagia -dysarthria (difficulty speaking) -eyelid ptosis -diplopia -prominent muscle weakness *patient is placed in an ICU bc of associated intense and sudden fluctuations in clinical condition -if the abdominal, intercostal, and pharyngeal muscles are severely weak the pt cannot cough, take deep breaths, or clear secretions, chest physiotherapy including postural drainage to mobilize secretions and suctioning to remove secretions may have to be performed frequently *postural drainage should not be performed 30mins. after feeding*
What interventions are performed to enhance bladder and bowel control for the patient w/MS?
-sensation or the need to void must be heeded immediately, so the bedpan or urinal must be readily available -a voiding time schedule is set up (every 1.5-2hrs) initially w/gradual lengthening -pt. is instructed to drink a measured amount of fluid every 2hrs, then attempt to void 30 mins. after drinking -The use of a timer/wrist watch w/an alarm may be helpful for the patient who does not have enough sensation to signal the need to empty the bladder -nurse encourages the patient to take meds that treat bladder spasticity bc this allows greater independence -adequate fluids, dietary fiber, and a bowel retraining program are frequently effective in solving bowel problems such as constipation, fecal impaction and incontinence
What is the patho of MS?
-sensitized T and B lymphocytes cross the blood brain barrier, their function is to check the CNS for antigens and then leave -however, in MS, sensitized T cells remain in the CNS and promote infiltration of other agents that damage the immune system *the immune system attack leads to inflammation that destroys myelin and the oligodendroglia cells that produce myelin in the CNS* -Demyelination interrupts the flow of nerve impulses and results in a variety of manifestations, depending on the nerves affected
What are the clinical manifestations of MS?
-some patients have a benign course where symptoms are so mild that they don't seek treatment -fatigue, depression, weakness, numbness, difficulty in coordination, loss of balance, spasticity, and pain, blurred vision, diplopia (double vision), total blindness -osteoporosis development among women w/MS -ataxia (impaired coordination of movement) and tremor -bladder, bowel, and sexual dysfunction are common
What are the assessment and diagnostic findings for Gullain Barre syndrome?
-symmetric weakness, diminished reflexes, and upward progression of motor weakness *a history of viral illness in the previous few weeks suggest the diagnosis* -serum lab test are not useful, however elevated protein levels are detected in the CSF w/o increase in other cells
What are the characteristics of vCJD?
-the human variation of bovine spongiform encephalopathy (commonly known as mad cow disease) *results from ingestion by humans of prions in infected meat* -incubation period is less than 10 years
What is the diagnosis of MS based on?
-the presence of multiple plaques in the CNS observed with MRI
What are factors that increase the incidence of bacterial meningitis?
-tobacco use -viral upper respiratory infection bc they increase the amount of droplet production -otitis media and mastoiditis bc the bacteria can cross the epithelial membrane and enter the subarachnoid space
What is the medical management for brain abscess?
-treatment aimed at controlling ICP, draining the abscess, and providing antimicrobial therapy -Large IV doses of antibiotic agents are given to penetrate the blood brain barrier to reach abscess -antibiotics should be started asap -initial antibiotic started is ceftriaxone which will be adjust based on C&S -stereotactic CT guided aspiration may be used to drain the abscess and identify causative org. -Corticosteroids may help reduce inflammatory cerebral edema if pt. shows increasing neurologic deficit -antiseizure medications if needed
What are the clinical manifestations of Gullain Barre syndrome?
-typically begins w/muscle weakness, and diminished reflexes of the lower extremities -hyporeflexia and weakness may progress to tetraplegia -paresthesia in the hands and feet and pain r/t demyelination of sensory fibers -antecedent event usually occurs 1-3 weeks before symptoms begin -weakness may begin in the legs and progress upward -Maximum weakness (the plateau) varies in length but usually includes neuromuscular resp failure and bulbar weakness -progresses to peak severity within 2 weeks and no longer than 4 weeks *if progression is longer than pt is classified as having chronic inflammatory demyelinating polyneuropathy*
How long do patients w/fungal encephalitis who have compromised immune systems receive antifungal therapy?
-until the infection is controlled, after which they receive a maintenance dose of the medication for an indefinite period
What can the pt w/MS do to minimize spasticity and contractures?
-use warm packs *hot baths should be avoided bc of risk of burn injury secondary to sensory loss and increasing symptoms that may occur w/ elevation of temp.* -daily exercises for muscle strengthening -application of prescribed orthotics -a stretch, hold, relax routine is helpful -swimming and stationary bicycling are useful -progressive weight bearing can relieve spasticity in the legs -pt should not be hurried in any of these activities bc that increases spasticity
What are the characteristics of CJD?
-very rare and has no identifiable cause -may lie dormant before for decades before causing neurologic degeneration -not transmittable by typical human contact: some cases have resulted from contaminated neurosurgical instruments, cadaver derived growth factor, or corneal transplants
What has been shown to be beneficial as adjunct therapy in the treatment of acute bacterial meningitis and in pneumococcal meningitis if given 15-20 mins. before the first dose of antibiotic and every 6hrs. for the next 4 days?
Dexamethasone (Decadron) *research shows it improves the outcome in adults and does not increase the risk of GI bleeding
What is a unique feature of St. Louis encephalitis?
SIADH w/ hyponatremia -incubation period is from 5-15days -onset of symptoms is abrupt w/ fever, HA, dizziness, nausea, and malaise -if disease spreads to the CNS symptoms include: stiff neck, confusion, dizziness, tremors, seizures more common
What is Gullain-Barre syndrome?
an autoimmune attack on the peripheral nerve myelin -result is acute, rapid segmental demyelination of peripheral nerves and some cranial nerves, producing ascending weakness w/dyskinesia (inability to execute voluntary movements), hyporeflexia, and paresthesia ("pins and needles") -viral infection most often precipitates
How may organisms causing brain abscesses reach the brain?
by hematologic spread from the lungs, gums, tongue, heart or from a wound or intraabdominal infection
How can brain abscesses be prevented?
by promptly treating otitis media, mastoiditis, rhinosinusitis, dental infections, and systemic infections
What may alert the nurse to renal insufficiency during amphotericin B drug therapy?
increasing levels of serum creatinine and BUN *dose needs to be reduced*
What is the critical complication in myasthenic and cholinergic crisis?
neuromuscular respiratory failure -endotracheal intubation and mechanical ventilation may be needed -cholinesterase inhibitors are stopped when respiratory failure occurs and gradually restarted after the patient demonstrates improvement w/a course of plasmapheresis or IVIG
What are TSE's caused by?
prions, which are particles smaller than a virus that are resistant to standard methods of sterilization, the prion exist in lymphoid tissue and blood in both vCJD and CJD (both are believed to be bloodborne) *no method is available to screen blood for infectivity, therefore the American Red cross will not accept blood donation from anyone who has traveled to the UK or Europe for more than 3-6 months*
Where do meningeal infections generally originate?
through the bloodstream as a consequence of other infections or by direct spread such as might occur after a traumatic injury to the facial bones or secondary to invasive procedures
What group of degenerative infectious neurologic disorders does CJD and vCJD belong to?
transmissible spongiform encephalopathies (TSE)