Chap 39 Continued

Front 1

What is a brain abscess...?

Back 1

A brain abscess is a collection of purulent material in the brain If untreatedk, it can be FATAL..

Front 2

Patho and ETIO BRAIN ABSCESS

Back 2

a Brain abscess occurs from an infection in nearby structures such as the middle ear, sinuses, or teeth, or from an infection in OTHER ORGANS.

A brain abscess can develop after intracranial surgery or head trauma.

It can be secondary to D/O i.e. endocarditis, bacteremia, and PULIMINARY OR ABDONINAL INFECTIONS.

Front 3

IICP can develop ....?

Back 3

Because it occupies space in the cranium; the abscess occupies space in the cranium which increases ICP.

Front 4

Complications include:

Back 4

Paralysis, mental deterioration, seizure disorder and visual disturbances.

Front 5

Assessment findings for brain absesses?

Back 5

IICP, fever, headache, and neurologic changes such as paralysis, seizures, muscle weakness and lethargy.

Front 6

Lab tests show...?

Back 6

1) Elevated WBC.
2) CSF confirms DX (but can cause HERNIATION OF BRAIN STEM)

Front 7

Medical and surgical management

Back 7

1) Antimicrobrial Therapy
2) A craniotomy to drain the abscess
3) Cerebrial edema and seizures are treated with drug therapy. Additional treatment includes CONTROL OF FEVER, mechanical ventilation, IV fluids, and nutritional support.

Front 8

NURSING MANAGEMENT (Brain Abscess) is:

Back 8

1) ALOC
2) Changes in sensory and motor functions.
3) SIGNS OF IICP
4) Monitor vital signs frequently
5) Measure fluid intake and output BECAUSE OVER HYDRATION CAN LEAD TO CEREBRAL EDEMA.

Front 9

Multiple Sclerosis is:

Back 9

A chronic progressive disease of the CNS. Onset is in young adulthood and early middleage. The highest incidense is between 20 and 40. It affects men and women approimately equally.

Front 10

Patho and ETIO

Back 10

The cause is unknown, but MS is considered autoimmune and characterized as a demyelinating disease. Loss of Myelin and subsequent degeneration and atrophy of nerve axons interrupts transmission of impulses along these fibers.

Front 11

What areas are most affected?

Back 11

1) optic nerves
2) cerebrum
3) brain stem
4) cerebellum
5) and the spinal cord

Front 12

As the disease progresses, there are many complications such as:

Back 12

As the disease progresses many complications such as pressure ulcers, cachexia, deformities and contractures develop. Pneumonia brought about by inactivity, shallow breathing and general debility, often is the immediate cause of death.

Front 13

Cachexia;

Back 13

ca·chex·i·a (k-kks-)
n.
Weight loss, wasting of muscle, loss of appetite, and general debility that can occur during a chronic disease

Front 14

Assessment findings of MS:

Back 14

Vision problems (double vision, diplopia, nystagmum, weakness, clumsiness, numbness and tingling of an arm or leg, an intntion tremor, and slurred hesitant speech (scanning speech) mood swings (emotional lability) are common. Weakness of an arm or a leg progresses to ataxia.

Front 15

What is ataxia:

Back 15

It is motor incoordination.

Front 16

(MS continued)
or paraplegia

Back 16

paralysis of both legs

Front 17

(assessment and findings Ms)

Back 17

Occasional bowel and bladder incontinence leads to total incontinence.
Slight visual disturbances lead to blindness.
The illness impairs intellectual functioning LATE in its course.
Loss of memory, difficulty concentrating and impaired judgment occur.

Front 18

Early DX is difficult because:

Back 18

Symptoms are vague, and in some cases temporary.
A lumbar puncture and CSF analysis reveal an increased WBC.

Front 19

Electrophoresis of the CSF

Back 19

is a technique for ELECTRICALLY SEPARATING PROTEINS demonstrates abnormal immunoglobulin G bands, described as oligoclonal bands. The bands appear separated rather than homogenous, which is the normal finding. A CT or MRI may or may not disclose leisions in the brain's white matter.

Front 20

Medical Management of MS

Is there a cure for MS?

Back 20

No, nor is their any single treatment that relieves all symptoms.

Front 21

What do we do for a client with MS?

Back 21

Keep the client functional for as long as possible.

Front 22

Drugs used to treat MS.

Back 22

Baclofen (Lioresal) and Dantrolene (Dantrium) for muscle spasticity and rigidity. ATB's for infx, and tranquilizers to alleviate mood swings, Oxybutynin (Ditropan) is used to treat urinary incontinence and Bethanechol (Urecholine) to relieve urinary retention. The anti-inflamatory action of corticosteroids relieves SX and hastens remission. Interferon beta-LA (Avonex) is used to treat relapsing forms of MS. Interfuron Beta B-1 also decreases ecerbations and disability. Both are administered SubQ. Copaxone blocks damage to the myelin and significantly reduces relapses of MS. Also adminsitered SubQ.

Front 23

NURSING PROCESS
The client with a neuro-muscular disorder:

Back 23

1)Perform a thorough neurological assessment.
2)Evaluate pulmonary functions including RR, depth and lung sounds, to determine the client's ability to ventilate.
3)Take client's temp regurlarly (to detect early signs of infection)
$)Note the client's ability to chew and swallow effectively and observe for drooling, choking when swallowing liquids and regurgitating fluids.
5)Measure INO's
6)Assess muscle strengtg and coordination
7)and client's response to physical activity

Front 24

DIAGNOSIS, PLANNING AND INTERVENTIONS

Risk for ineffective breathing pattern?

Back 24

It is related to weakening of muscles for respiration.

Front 25

Myesthenia Gravis

Back 25

Is a neuromuscular D/O characterized by severe weakness of one or more GROUPS of skeletal muscles.

Front 26

PATHO AND ETIO of MG

Back 26

Cause is unknown.

Believed to be autoimmune and to develop when blood cells and thymus gland antibodys destroy nerve ending receptor sites of receptor muscles.

Front 27

MG
The symptoms develop because?

Back 27

Acetylcholine CANNOT STIMULATE RECEPTORS ON SKELETAL MUSCLES. The outcome is extreme muscle weakness.

Front 28

MG
Assessment findings?

Back 28

Muscleweakness varies depending on muscles affected.
The most common manifestations are PTOSS (drooping of the eyelids, difficulty chewing and swallowing, diplopia, voice weakness, mask-like facial epression and weakness of extremities.
The respiratory symptom also is affected.

Front 29

Diagnostic Confirmation is made by:

Back 29

IV administration of edrophonium (tensilon), which relieves Sx IN A FEW SECONDS.
Chest exrays may show a tumor of the thymus (thymoma).
Electromyography measures the electro potential of muscles.

Front 30

Tx MG Treatment

Back 30

Anticholinesterase drugs such as pyridostigmine bromide (mestinon), Mytelase. Other treatment include surgical removal of the Thymus gland.
Predinsone and plasmapheresis for clients who do not respond to other methods of therapy. If myasthenic crisis with severe respiratory stress occurs, the client requires intubation and mechanical ventilation.