Adult Health II - Week 10 - Ch 64 Neurologic infections, autoimmune disorders and neuropathies

pnk-B

- photophobia
- nuchal rigidity (flexion difficult)
- kernig's sign - bend, extend, sciatic nerve pain
- brudzinski's sign - flex neck, knees bend

- vaccinate H. influenzae, S. pneumoniae
- prohpylactic antibiotics - rifampin, cipro, ceftriaxone

- vancomycin + cephalosporin (ceftriaxone)
- adjunct dexamethasone (anti-inflamm) 15-20 min before first dose of antibiotics
- treat dehydration, shock, seizures

phenytoin (dilantin)

- frequent VS and LOC assess
- monitor pulseox and ABG, inc ICP may cause resp distress
- monitor BP for shock, HF
- monitor temp, fever inc heart workload and brain metabolism

- seizure precautions
- immobility complications - pressure ulcers, pneumonia
- infection control - droplet precautions, until 24h post Ab therapy

- droplet precautions until 24h post initiation of Ab therapy

SS of inc ICP
- bradycardia
- irregular respirations
- widening pulse pressure/ htn

- collection of infected material in brain
- usually in immunocompromised patients, secondary to otitis media or rhinosinusitis

- morning HA, fever, vomiting, focal deficits ie weakness or vision problems
- cushing's triad (inc ICP)

- control ICP
- drain abcess
- antibiotic depends on organism
- corticosteriod reduce inflamm
- antiseizure phenytoin (dilantin)

viral
- HSV
- Arbovirus - vector-borne (west nile and St. louis)
- fungal

HSV - acyclovir
arbovirus - interferon
fungal - amphotericin B/ oral fluconazole

- renal insufficiency serious reaction
- flulike effects - administer dephenydramine (Benadryl) and acetominophen 30 min prior to prevent

- prions, developing spongiform encephalopathies
- resistnat to sterilization

vCJD - transmissible from beef
CJD - genetically acquired

no treatment available

- blood, corneal transplant
- beef

vCJD
- behavioral changes, sensory disturbance, limb pain
- msucle spasms, dysarthria, incoordination

CJD
- ataxia, visual disturbance
- memory loss, involn mvmt, paralysis, mutism

MS - progressive autoimmune demylenation, fatigue

myasthenia gravis
- autoimmune attack against acetylcholine receptors in neuromuscular junction
- diplopia, ptosis, generalized weakness, respiratory, bulbar

guillain-barre
- autoimmune ascending peripheral demyelination
- follows viral infection
- schwann cells spared, so complete recovery possible
- respiratory bulbar involvment

- promote physical activity to strengthen weakening muscles to point just short of fatigue
- minimize spasticity and contractures - warm baths may help, but be careful with temp due to sensory loss
- stretch-hold-relax to muscle spasticity

effects of immobiligy
- pressure ulcers
- ataxia --> walk with feet wide support
- aproprioception --> watch feet while walking

-dysphagia --> suctioning available, positioning for feeding

vision
- eye patch for diplopia
- prism glasses if confined to bed

bladder and bowel
- inability to empty bladder --> void 30 min after drinking
- constipation - adequate fluid and fiber

- extreme heat increases fatigue
- extreme cold increases spasticity

- edrophonium chloride (Tensilon) test
- is an acetylcholinesterase inhibitor, which relieves facial and weakness and ptosis for 5 minutes if positive
- atropine is antidote for overdose (bardycardia, sweating, cramping)

myasthenic crisis
- severe general weakness, respiratory and bulbar weakness
- usually due to respiratory infection
- may need intubatoni and mechanical ventilation

Cholinergic crisis
- severe muscle weakness and respiratory and bulbar weakness caused by OD of cholinesterase inhibitors

- acetylcholinesterase inhibitors
- IVIG
- plasmapharesis
- thymectomy

inability to move voluntarily

- ascending weakness
- dyskinesia
- paresthesia
- hyporeflexia
- may produce respiraory failure, bulbar involvement

- symmetci ascending weakness, hyporeflexia
- hx of viral illness previous few weeka
- elev CSF protein

- medical emergency due to rapid progression
- resp therapy, mechanical ventilation
- plasmapharesis, IVIG

respiratory depression
- monitorl
- mechanical vent, inubation, suctioning

bulbar paralysis (impaired swallow)
- suctioning
- gastrostomy tube

immobility - risk for DVT
- passive ROM 2x daily
- change of postion q2h
-adequate hydration, stockings, anticoag etc

paralytic ileus - TPN

communication
- cannot talk due to paralysis
- establish commincation system (picutres, blinking)

- trigeminal neuralgia
- pain usually V2 and V3 (maxillary and mandibular)
- antiseizure meds - tegretol, neurontin
- antispasmodic med - baclofen
-

- unilateral inflammation ov CNVII facial nerve

facial nerve - CNVII - motor (bell's palsy)

trigeminal nerve - CNV - sensory (tic doloreux - neuralgia)

- Baclofen
- Valium
- Dantrolene sodium