234652147 MS Nursing Reviewer

8/9/2019 234652147 MS Nursing Reviewer

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MEDICAL SURGICAL REVIEWER

Nervous System

Central NS Peripheral NS Autonomic NS

Brain & spinal cord 31 spinal sympathetic NS

Parasympathatic NS

Somatic NS

C- 8 ex. Breakfast 8am – diaphragm, chest wall muscles, shoulder’s & arms

T- 12 ex. Lunch 12nn – upper body, GI functions

L- 5 ex. Dinner 5pm (napaa aga haha) – lower body, bladder, bowel

S- 5 ex. Dinner ulit kasi matakaw

C- 1 ex. Midnight snack 1am

SNS (involved in fight or aggression response / LABAN)

Release of norepinephrine (adrenaline –

cathecolamine)

Adrenal medulla (potent vasoconstrictor)

Increases body activities

Except GIT – decrease GIT motility Why GIT is not increased = GIT is not important!

Increase blood flow to skeletal muscles, brain &

heart.

Effects of SNS (anti-cholinergic/adrenergic)

1. Dilate pupil – to aware of surroundings

- medriasis

2. Dry mouth

3. BP & HR= increased- bronchioles dilated to take more oxygen

4. RR increased

5. Constipation & urinary retention

I. Adrenergic Agents – Epinephrine (adrenaline)

SE: SNS effect

II. PNS: Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in –‘lol’)

Blocks release of norepinephrine.

Decrease body activities except GIT (diarrhea)

Ex. Propanolol, Metopanolol

Sie effects:B – broncho spasm (bronchoconstriction)

E – elicits a decrease in myocardial contraction

T – treats HPN

A – AV conduction slows down

-

Given to angina & MI – beta-blockers to rest heart

Anti HPN agents:

1. Beta blockers (-lol)

2. Ace inhibitors (-pril)

Ex. ENALAPRIL, CAPTOPRIL

3.

Calcium antagonist

Ex. CALCIBLOC or NEFEDIPINE

S/E- of Anti-HPN drugs:

1. orthostatic hpn

2.

transient headache & dizziness.

Mgt. Rise slowly. Assist in ambulation.

Parasympathetic Nervous System: (Cholinergic / BAWI) Effect of PNS: (cholinergic/ opposite ng SNS) Involved in fly or withdrawal response 1. Meiosis – contraction of pupils

Release of acetylcholine (ACTH) 2. Increase salivation

Decrease all bodily activities except GIT (diarrhea) 3. BP & HR decreased

4. RR decrease – broncho constriction

I. Cholinergic agents 5. Diarrhea – increased GI motility

Ex. Mestinon 6. Urinary frequency

Antidote – anti cholinergic agents Atropine Sulfate – S/E – SNS

CENTRAL NS (brain & spinal cord)


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I. Cells – A. Neurons – 10 billion

o Properties and characteristics

a.

Excitability – ability of neuron to be affected in external environment.

b. Conductivity – ability of neuron to transmit a wave of excitation from one cell to another

c. Permanent cells – once destroyed, cant regenerate (ex. heart, retina, brain, osteocytes)

Regenerative capacity

Labile – once destroyed cant regenerate

Epidermal cells, GIT cells, resp (lung cells). GUT

Stable – capable of regeneration BUT limited time only ex salivary gland, pancreas cells cell of liver, kidney cells

Permanent cells – retina, brain, heart, osteocytes can’t regenerate.

*Neuroglia – attached to neurons.

o Supports neurons. Where brain tumors are found.

Types:

1.

Astrocyte

2. Oligodendria

Astrocytoma – 90 – 95% brain tumor from astrocyte. Most brain tumors are found at astrocyte, most common.

*Astrocyte – maintains integrity of blood brain barrier (BBB).

BBB – semi permeable / selective

Toxins that can pass in BBB:

1.

Ammonia - liver cirrhosis.2.

Carbon Monoxide – seizure & parkinsons.

3. Bilirubin - jaundice, hepatitis, kernicterus/hyperbilirubenia.

4. Ketones –DM.

*OLIGODENDRIA – Produces myelin sheath – wraps around a neuron – acts as insulator facilitates rapid nerve impulse transmission.

No myelin sheath – degenerates neurons

Damage to myelin sheath – demyellenating disorders

**DEMYELLENATING DISEASES

1. ALZHEIMER’S DISEASE – atrophy of brain tissue due to a deficiency of acetylcholine.

S/S: FOUR A’s

A – amnesia – loss of memory A – apraxia – unable to determine function & purpose of object

A – agnosia – unable to recognize familiar object

A – aphasia –

o Expressive – brocca’s aphasia – unable to speak

o Receptive – wernickes aphasia – unable to understand spoken words

Common to Alzheimer – receptive aphasia

Drug of choice – ARICEPT (taken at bedtime) & COGNEX.

Mgt: Supportive & palliative.

*MICROGLIA – stationary cells, engulfs bacteria, engulfs cellular debris.

II. Compositions of Cord & Spinal cord

80% - brain mass

10% - CSF

10% - blood

*MONROE KELLY HYPOTHESIS: The skull is a closed vault. Any increase in one component will increase ICP.

Normal ICP: 0-15mmHg

BRAIN MASS


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1. Cerebrum – largest part

Corpus collusum - connects R & L cerebral hemisphere.

Function:

1. S - Sensory

2. I - Integrative

3. M – Motor

4.

**LOBES

1.) Frontal

a. Controls motor activityb. Controls personality development

c. Where primitive reflexes are inhibited

d. Site of development of sense of umor

e. Brocca’s area – speech center

Damage - expressive aphasia

2.) Temporal –

a. Hearing

b. Short term memory

c. Wernickes area – gen interpretative or knowing Gnostic area

Damage – receptive aphasia

3.) Parietal lobe – appreciation & discrimation of sensory imp

- Pain, touch, pressure, heat & cold

4.) Occipital - vision

6.) Rhinencephalon/ Limbec

- Smell, libido, long-term memory

2. BASAL GANGLIA – areas of gray matteR located deep within a cerebral hemisphere

Extra pyramidal tract

Releases dopamine

Controls gross voluntary unit

**TRIVIA

Decrease dopamine – (Parkinson’s) pin rolling of extremities & Huntington’s Dse.

Decrease acetylcholine – Myasthenia Gravis & Alzheimer’s

Increased neurotransmitter = psychiatric disorder Increase dopamine – schizo

Increase acetylcholine – bipolar

3. MID BRAIN – relay station for sight & hearing

Controls size & reaction of pupil 2 – 3 mm

Controls hearing acuity

CN 3 – 4

Isocoria – normal size (equal)

Anisocoria – uneven size – damage to mid brain

PERRLA – normal reaction

4. DIENCEPHALON - between brain

Thalamus – acts as a relay station for sensation

Hypothalamus – (thermoregulating center of temp, sleep & wakefulness, thirst, appetite/ satiety center, emotionalresponses, controls pituitary function.

5. BRAIN STEM –

a. Pons – or pneumotaxic center – controls respiration

Cranial 5 – 8 CNS

b. Medulla Oblangata - controls heart rate, respiratory rate, swallowing, vomiting, hiccups/ singutus

Vasomotor center, spinal decuissation termination, CN 9, 10, 11, 12

6. CEREBELLUM – lesser brain


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Nursing priority:

1.) Maintain patent a/w & adequate ventilation

a. Prevention of hypoxia – (decrease tissue oxygenation) & hypercarbia (increase in CO2 retention).

o Hypoxia – cerebral edema - increase ICP

o Hypoxia – inadequate tissue oxygenation

Late symptoms of hypoxia ----------- B – bradycardia

E – extreme restlessness

D – dyspnea

C – cyanosis**Early symptoms --------- R – restlessness

A – agitation

T – tachycardia

Increase CO2 retention/ hypercarbia – cerebral vasodilatation = increase ICP

Most powerful respiratory stimulant increase in CO2 ----- remember this!

Hyperventilate decrease CO2 – it excretes CO2 kaya nga dapat i-“brown bag” to retain CO2

Respiratory Distress Syndrome (RDS) – decrease Oxygen

*Suctioning – 10-15 seconds, max 15 seconds.

o Suction upon withdrawal

*Ambu bag – pump upon inspiration

** Assist in mechanical ventilation

1. Maintain patent airway

2. Monitor VS & I&O

3. Elevate head of bed 30 – 45 degrees angle neck in neutral position unless contra indicated to promote venous drainage

4. Limit fluid intake 1,200 – 1,500 ml/day

(side note: FORCE FLUID means = Increase fluid intake/day – 2,000 – 3,000 ml/day) - not for inc ICP.

5. Prevent complications of immobility

6. Prevent increase ICP by:

a. Maintain quiet & comfy environment

b. Avoid use of restraints – lead to fractures

c. Siderails up

d. Instruct patient to avoid the ff:* Avoid valsalva maneuver or bearing down, avoid straining of stool

(give laxatives/ stool softener Dulcolax/ Duphalac)

* Avoid Excessive cough – antitussive

Ex. Dextrometorpham

* Avoid Excessive vomiting – anti emetic (Plasil – brand name sa pinas) / Phenergan

* Avoid Lifting of heavy objects

* Avoid Bending & stooping

* Avoid clustering of nursing activities

7. Administer MEDS as ordered:

1.) Osmotic diuretic – Mannitol./Osmitrol - promotes cerebral diuresis by decompressing brain tissue

Nursing considerations:

o Monitor BP – SE of hypotension

o

Monitor I&O every hr. report if < 30cc out put

o Administer via side drip

o Regulate fast drip – to prevent formation of crystals or precipitate

2.) Loop diuretic - Lasix (Furosemide)

Nursing Mgt:

o Same as Mannitol except

o Lasix is given via IV push (expect urine after 10-15mins) should be in the morning. If given at 7am. Pt will urinate at 7:15

o Immediate effect of Lasix within 15 minutes. Max effect – 6 hrs due (7am – 1pm)

**S/E of Lasix


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1. Hypokalemia (normal K-3.5 – 5.5 meg/L)

S&Sx

Weakness & fatigue

Constipation

() “U” wave in ECG tracing

Nursing Mgt:

o Administer K supplements – ex Kalium Durule, K chloride

o

Potassium Rich food:ABC’s of K

Vegetables Fruits

A - asparagus A – apple

B – broccoli (highest) B – banana – green

C – carrots C – cantalope/ melon

O – orange (highest) –for digitalis toxicity also.

o Vit A – squash, carrots yellow vegetables & fruits, spinach, chesa

o Iron – raisins

o Food appropriate for toddler – spaghetti! Not milk – increase bronchial secretions

o Don’t give grapes – may choke

2. Hypocalcemia (Normal level Ca = 8.5 – 11mg/100ml) or Tetany:

S&Sx

weakness

Paresthesia

(+) Trousseau sign – pathognomonic – or carpopedal spasm. [Put bp cuff on arm = hand spasm.]

(+) Chevostek’s sign - nerve hyperexcitability (tetany) [FACE will contract or twitch kapag haplusin mo]

Arrhythmia

Laryngospasm

Administer – Ca gluconate – IV slowly

*Ca gluconate toxicity: Sx – seizure – administer Mg SO4

*Mg SO4 toxcicity – administer Ca gluconate

B – BP decreaseU – urine output decrease

R – RR decrease

P – patellar reflexes absent

3. Hyponatremia – (Normal Na level = 135 – 145 meg/L)

S/Sx

Hypotension

Signs of Dehydration: dry skin, poor skin turgor, gen body malaise.

Early signs – Adult: thirst and agitation / Child: tachycardia

Mgt: force fluid

Administer isotonic fluid solution

4. Hyperglycemia – increase blood sugar level

P – polyuria

P – polyphagia

P – polydipsia

Nsg Mgt:

Monitor FBS (N=80 – 120 mg/dl)

5.) Hyperurecemia – increase serum uric acid.


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- Tophi- urate crystals in joint.

- kidney stones- renal colic (pain), cool moist skin

- Gouty arthritis - Sx: joint pain & swelling usually at great toe.

Nsg Mgt of Gouty Arthritis

a.) Cheese - dairy products may lower your risk. (Not good if pt taking MAOI – tyramine may lead to HTN crisis)

b.) Force fluid

c.) Administer meds – Allopurinol/ Zyloprim – inhibits synthesis of uric acid – drug of choice for gout

Colchicene – excretes uric acid. Acute gout drug of choice.

d.) Avoid sardines, anchovies, organ meat

**Kidney stones – renal colic (pain). Cool moist skin

Mgt:

o Force fluid

o Meds – narcotic analgesic

o Morphine SO4

SE of Morphine SO4 toxicity

o Respiratory depression (check RR 1st

)

o Antidote for morphine SO4 toxicity –Narcan (NALOXONE)

o Naloxone toxicity – tremors

**BALIK TAYO INCREASE ICP ------------------------------------------------------------------------------------------------------------------

Increase ICP meds:

3.) Corticosteroids - Dexamethsone – decrease cerebral edema (Decadrone)

4.) Mild analgesic – codeine SO4. For headache.

5.) Anti consultants – Dilantin (Phenytoin)

Question: Increase ICP what is the immediate nsg action?

Administer Mannitol as ordered --- mannitol kagad basta ordered

Elevate head 30 – 45 degrees

Restrict fluid

Avoid use of restraints

Question: Pt suffering from epiglotitis. What is nsg priority?

a.

Administer steroids – least priority

b. Assist in ET – n/a

c. Assist in tracheotomy – permanent (Answer)

d. Apply warm moist pack? Least priority

Rationale: Wont need to pass larynx due to larynx is inflamed. ET can’t pass. Need tracheostomy only

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Drug Monitoring

Drug N range Toxicity Classification Indication

D – digoxin 0.5 – 1.5 meq/L 2 cardiac glycosides CHF

L - lithium 0.6 – 1.2 meq/L 2 antimanic bipolar

A – aminophylline 10 – 19 mg/100ml 20 bronchodilator COPD

D – Dilantin 10 -19 mg/100 ml 20 anticonvulsant seizures

A – acetaminophen 10 – 30 mg/100ml 200 analgesic osteoarthritis

Digitalis – increase cardiac contraction = increase CO // Digitalis toxicity – antidote - DigivineNursing Mgt

1.

Check PR, HR (if HR below 60bpm, don’t giveDigoxin)

a. Anorexia -initial sx. GIT


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b. nausea/vomiting

c. Diarrhea

d.

Confusion

e. Photophobia

f. Changes in color perception – yellow spots

(Ok to give to pts with renal failure. Digoxin is metabolized in liver not in kidney .)

L – lithium (lithane) - decrease levels of norepinephrine, serotonine, acetylcholine

Antimanic agent

S/Sx -a.) Anorexia

b.)

Diarrhea

c.) Dehydration – force fluid, maintain Na intake 4 – 10g daily

d.) Hypothyroidism

(CRETINISM – the only endocrine disorder that can lead to mental retardation)

A – Aminophyline (theophylline) – dilates bronchioles.

Take bp before giving aminophylline.

S/Sx : Aminophylline toxicity:

1.

Tachycardia

2.

Hyperactivity – restlessness, agitation, tremors

Question: Avoid giving food with Aminophylline

a. Cheese/butter – food rich in tyramine, avoided only if pt is given MAOI

b.

Beer/ wine -

Hot chocolate & tea – caffeine – CNS stimulant, can cause tachycardia

c. Organ meat/ box cereals – anti parkinsonian

**MAOI – antidepressant // 3 – 4 weeks - before MAOI will take effect

m AR plan

n AR dil Avoid tyramine rich foods, can lead to CVA or hypertensive crisis

p AR nate

Anti Parkinsonian agents – Vit B6 Pyridoxine reverses effect of Levodopa

D – dilatin (Phenytoin) – anti convulsant/seizure

Nursing Mgt:

1.

Mixed with plain NSS or .9 NaCl to prevent formation of crystals or precipitate

Do sandwich method

Give NSS then Dilantin, then NSS!

2. Instruct the pt to avoid alcohol – bec alcohol + dilantin can lead to severe CNS depression

Dilantin toxicity:

S/Sx:

G – gingival hyperplasia – swollen gums

Oral hygiene – soft toothbrushMassage gums

H – hairy tongue

A - ataxia

N – nystagmus – abnormal movement of eyeballs

A – acetaminophen/ Tylenol – non-opoid analgesic & antipyretic – febrile pts

Acetaminophen toxicity :

Hepato toxicity

Monitor liver enzymes

**SGPT (ALT) – Serum Glutamic Piruvate Tyranase

**SGOT- Serum Glutamic Acetate Tyranase

Monitor BUN (10 – 20)

Creatinine (.8-1)


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Acetaminophen toxicity can lead to hypoglycemia

T – tremors, Tachycardia

I – irritability

R – restlessness

E – extreme fatigue

D – depression (nightmares) , Diaphoresis

Antidote for acetaminophen toxicity – Acetylcesteine =

causes outporing of secretions. Suction.

Prepare suctioning apparatus.

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PARKINSONS (parkinsonism) chronic, progressive disease of CNS char by degeneration of dopamine producing cells in substancia nigra at mid brain &

basal ganglia

Function of dopamine: controls gross voluntary motors.

Predisposing Factors:

o Poisoning (lead & carbon monoxide). Antidote for lead = Calcium EDTA

o Hypoxia

o Arteriosclerosis

o Encephalitis

o High doses of the ff:

a. Reserpine (serpasil) anti HPN, Side Effect – 1.) depression 2.) breast cancer

b. Methyldopa (aldomet)

c. Haloperidol (Haldol)- anti psychotic

d. Phenothiazide - anti psychotic

**SE of anti psychotic drugs – Extra Pyramidal Symptom Over meds of anti psychotic drugs – neuroleptic malignant syndrome char by tremors (severe)

S/Sx: Parkinsonism –

1. Pill rolling tremors of extremities – early sign

2. Bradykinesia – slow movement

3.

Over fatigue

4. Rigidity (cogwheel type)

a. Stooped posture

b. Shuffling – most common

c.

Propulsive gait

5. Mask like facial expression with decrease blinking eyes

6. Monotone speech

7. Difficulty rising from sitting position

8.

Mood labilety – always depressed – suicide

Nsg priority: Promote safety

9. Increase salivation – drooling type

10. Autonomic signs:

Increase sweating

Increase lacrimation – iyakin!

Seborrhea (increase sebaceous gland) – oily!

Constipation

Decrease sexual activity

**Nsg Mgt:

1. Anti parkinsonian agents

Levodopa (L-Dopa) – short acting

Carbidopa (Sinemet) – long acting Amantadine Hcl (Symmetrel) – eto hindi ko alam haha

Mechanism of action

Increase levels of dopa – relieving tremors & bradykinesia

*S/E of anti parkinsonian

o Anorexia

o n/v

o Confusion

o Orthostatic hypotension

o Hallucination

o Arrhythmia

*Contraindication:

o Narrow angled closure glaucoma o Pt taking MAOI (Parnate, Marplan, Nardil)


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*Nsg Mgt when giving anti-parkinsonian:

Take with meals – to decrease GIT irritation

Inform pt – urine/ stool may be darkened

Instruct pt- don’t take food Vit B6 (Pyridoxine) cereals, organ meats, green leaf y veg

Cause B6 reverses therapeutic effects of levodopa

Give INH (Isoniazide-Isonicotene acid hydrazide.) SE-Peripheral neuritis.

2. Anti cholinergic agents – relieves tremors

o Artane

o

Cogentin

3. Antihistamine – Diphenhydramine Hcl (Benadryl)

S/E: Adult – drowsiness, – avoid driving & operating heavy equipt. Take at bedtime.

Child – hyperactivity CNS excitement for kids.

4. Dopamine agonist

Bromotriptine Hcl (Parlodel) – respiratory depression. Monitor RR.

**Nsg Mgt – Parkinson

1.) Maintain siderails

2.) Prevent complications of immobility

o

Turn pt every 2ho Turn pt every 1 h – elderly

3.) Assist in passive ROM exercises to prevent contractures

4.) Maintain good nutrition

CHON (protein) – in am

CHON (protein) – in pm – to induce sleep – due Tryptopan – Amino Acid

5.) Increase fluid in take, high fiber diet to prevent constipation

6.) Assist in surgery – Sterotaxic Thalamotomy

Complications in sterotaxic thalmotomy- 1.) Subarachnoid hemorrhage 2.) aneurism 3.) encephalitis

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MULTIPLE SCLEROSIS (MS) - myelin sheathChronic intermittent disorder of CNS – white patches of demyelenation in brain & spinal cord.

Remission & exacerbation

Common – women, 15 – 35 yo cause – unknown

Predisposing factor:

1. Slow growing virus

2. Autoimmune – (supportive & palliative treatment only)

*Normal Resident Antibodies:

Ig G – can pass placenta – passive immunity. Short acting.

Ig A – body secretions – saliva, tears, colostrums, sweat

Ig M – acute inflammation

Ig E – allergic reactions

IgD – chronic inflammation

**S & Sx of MS: (everything down)

1. Visual disturbances

a. Blurring of vision

b. Diplopia/ double vision

c. Scotomas (blind spots) – initial sx

2. Impaired sensation to touch, pain, pressure, heat, cold

a. Numbness

c. Paresthesia – tingling sensation

3. Mood swings – euphoria (sense of elation )

4. Impaired motor function:

a. Weakness

b. Spasiticity –“ tigas”

c. Paralysis –major problem

5. Impaired cerebellar function

Triad Sx of MS aka (Charcot’s triad)

I – intentional tremors

N – nystagmus – abnormal rotation of eyes

A – Ataxia & Scanning speech

6. Urinary retention or incontinence

7. Constipation


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8. Decrease sexual ability

**Dx – MS

1. CSF analysis thru lumbar puncture

- Reveals increase CHON & IgG

2. MRI – reveals site & extent of demyelination

3. Lhermitte’s response is (+). Introduce electricity at the back. Theres spasm & paralysis at spinal cord.

Nsg Mgt MS

Supportive mgt1.) Meds

a. Acute exacerbation

ACTH – adenocorticotopic

Steroids – to reduce edema at the site of demyelination to prevent paralysis

2. Maintain siderails

3. Assist passive ROMexercises – promote proper body alignment

4. Prevent complications of immobility

5. Encourage fluid intake & increase fiber diet – to prevent constipation

6. Provide catheterization die urinary retention

7. Give diuretics

Urinary incontinence – give Prophantheline bromide (probanthene)

Antispasmodic anti cholinergic

8. Give stress reducing activity. Deep breathing exercises, biofeedback, yoga techniques.

9. Provide acid-ash diet – to acidify urine & prevent bacteria multiplication

Ex. Grape, Cranberry, Orange juice, Vit C

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MYASTHENIA GRAVIS (MG) disturbance in transmission of impulses from nerve to muscle cell at neuro muscular junction.

Common in Women, 20 – 40 yo, unknown cause or idiopathic

Autoimmune – release of cholenesterase – enzyme [REMEMBER! Lumabas sa boards yan.]

Cholinesterase destroys ACH (acetylcholine) = Decrease acetylcholine

Descending muscle weakness

Nsg priority:

o a/w o aspiration o immobility

S/ Sx:

Ptosis – drooping of upper lid of the eye ( initial sign)

Check Palpebral fissure – opening of upper & lower lids = to know if (+) of MG.

Diplopia – double vision

Mask like facial expression

Dysphagia – risk for aspiration!!!

Weakening of laryngeal muscles – hoarseness of voice

Resp muscle weakness – leads to respiratory arrest. [Prepare at bedside tracheostomy set]

Extreme muscle weakness during activity especially in the morning.

Dx test

Tensilon test (Edrophonium Hcl) – temporarily strengthens muscles for 5 – 10 mins. Short term- cholinergic. PNS effect.

o Remember ung aso sa video dati, ung biglang lumakas – meaning nun (+) sya for MG

Nsg Mgt

1. Maintain patent a/w & adequate vent by:

*Assist in mechanical vent – attach to ventilator

*Monitor pulmonary function test.

= kasi decreased vital lung capacity ung pt.

2. Monitor VS, I&O neuro check, muscle strength or motor

grading scale (4/5, 5/5, etc)

3. Siderails

4. Prevent complications of immobility.

Adult - every 2 hrs. // Elderly - every 1 hr.

5. NGT feeding


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4. Assess for movement & sensation of extremeties

Result

1. CSF analysis: a. increase CHON & WBC Content of CSF: CHON, WBC, Glucose

b. Decrease glucose

Confirms meningitis c. increase CSF opening pressure

N 50 – 160 mmHg

d. (+) Culture microorganism

2. Complete blood count CBC – reveals increase WBC

Management:

1. Adm meds

a.) Broad-spectrum antibiotic penicillin

**Side effects:

1.

GIT irritation – take with food

2. Hepatotoxicity, nephrotoxcicity

3. Allergic reaction

4.

Super infection – alteration in normal bacterial flora

Normal flora sa throat – streptococcus

Normal flora sa intestine – e coli

**Sign of superinfection of penicillin = diarrhea

b.) Antipyretic

c.) Mild analgesic

2. Strict respiratory isolation 24h after start of antibiotic therapy

**Side note:

A – Cushing’s synd – reverse isolation - due to increased corticosteroid in body.

B – Aplastic anemia – reverse isolation - due to bone marrow depression.

C – Cancer any type – reverse isolation – immunocompromised.

D – Post liver transplant – reverse isolation – takes steroids lifetime.

E – Prolonged use steroids – reverse isolation

F – Meningitis – strict respiratory isolation – safe after 24h of antibiotic therapy

G – Asthma – not to be isolated

3. Comfy & dark room – due to photophobia & seizure4. Prevent complications of immobility

5. Maintain F & E balance

6. Monitor vs, I&O, neuro check

7. Provide client health teaching & discharge plan

a. Nutrition – increase cal & CHO, CHON-for tissue repair. Small freq feeding

b. Prevent complication hydrocephalus, hearing loss or nerve deafness.

8. Prevent seizure.

Where to bring 2 y/o post meningitis

Audiologist - due to damage to hearing- post repair myelomeningocele

Urologist -Damage to sacral area – spina bifida – controls urination

9. Rehab for neurological deficit. [Can lead to mental retardation or a delay in psychomotor development.]

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CEREBRO VASCULAR ACCIDENT – stroke, brain attack or cerebral thrombosis, apoplexy Partial or complete disruption in the brains blood supply

2 largest & common artery in stroke

Middle cerebral artery

Internal carotid artery

Common to male – 2 – 3x high risk


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234652147 MS Nursing Reviewer

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