MENINGITIS

Question 1

An inflammation of the fluid and membranes (meninges) surrounding the brain and spinal cord.

Answer 1

Meningitis

Question 2

Inflammatory response to infection causes increase or decrease ICP?

Answer 2

increase ICP

Question 3

Causative Agents of Meningitis?
tip: SP, HI, NM

Answer 3

 Streptococcus Pneumoniae
 Hemophilus Influenzae
 Neisseria Meningitidis

Question 4

Causative Agents of Meningitis?

Answer 4

SP, HI, NM

Question 5

Causative Agents of Meningitis?

Answer 5

 Streptococcus Pneumoniae
 Hemophilus Influenzae
 Neisseria Meningitidis

Question 6

Meningitis 2 Modes of Transmission:

Answer 6

 Droplet
 Direct Contact

Question 7

Incubation Period:

Answer 7

2-10 days

Question 8

Average incubation period:

Answer 8

 Average: 6-7 days

Question 9

Diagnostic test to collect CSF

Answer 9

Lumbar Tap

Question 10

Definitive diagnostics of meningitis:

Answer 10

Lumbar Tap

Question 11

Lumbar Tap Position:

Answer 11

Fetal position

Question 12

Test done before aspirating CSF

Answer 12

Queckenstedt’s Test

Question 13

Test for arachnoid obstruction

Answer 13

Queckenstedt’s Test

Question 14

MENINGISTIS PATHOGNOMONIC Signs and Symptoms:

Answer 14

1. Nuchal Rigidity: Pain upon flexion of the neck
2. Kernig’s Sign: Pain upon straightening of the leg
3. Brudzinski’s Sign: Flexion of the knee upon flexion of the neck
4. Opisthotonos: Severe arching of the back
5. Decortication
6. Decerebration

Question 15

MENINGISTIS PATHOGNOMONIC Signs and Symptoms: Pain upon flexion of the neck

Answer 15

1. Nuchal Rigidity

Question 16

MENINGISTIS PATHOGNOMONIC Signs and Symptoms: Pain upon straightening of the leg

Answer 16

2. Kernig’s Sign

Question 17

MENINGISTIS PATHOGNOMONIC Signs and Symptoms: Flexion of the knee upon flexion of the neck

Answer 17

3. Brudzinski’s Sign

Question 18

MENINGISTIS PATHOGNOMONIC Signs and Symptoms: Severe arching of the back

Answer 18

4. Opisthotonos

Question 19

5th and 6th MENINGISTIS PATHOGNOMONIC Signs and Symptoms?
tip: D, D

Answer 19

5. Decortication
6. Decerebration

Question 20

Signs and Symptoms of ↑ ICP: Cushing’s Triad.
Name its 3 characteristics.

Answer 20

Hypertension. Bradycardia. Bradypnea.

HYPER-BRADY-BRADY

Question 21

Signs and Symptoms of ↑ ICP: ___ characterized by a difference in pupil sizes

Answer 21

Anisocoria

Question 22

Cranial nerve effected on Anisocoria

Answer 22

CN3

Question 23

Signs and Symptoms of ↑ ICP: ___ characterized by a double vision

Answer 23

Diplopia

Question 24

Cranial nerve effected on Diplopia

Answer 24

CN6 (Abducens)

Question 25

Deconjugate movement of the eye

Answer 25

Doll’s Eye Sign

Question 26

5 other Signs and Symptoms of ↑ ICP:

Answer 26

 High temperature  N/V  Photophobia  Seizures  Wide Pulse Pressure

Question 27

Increase ICP management. Position: Semi Fowler’s rationale

Answer 27

Semi Fowler’s to: Promote lung expansion Drain excess CSF

Question 28

Increase ICP management.  HOB Elevation:

Answer 28

HOB Elevation: 30-45˚ NOT 90˚ -it can cause Brain Herniation

Question 29

Increase ICP management.  Safety  Limit fluid intake: ___ CSF

Answer 29

to decrease CSF

Question 30

Increase ICP management. Rest:

Answer 30

Physical activity would be a stimulus for possible seizure

Question 31

Name factors to avoid that ↑ ICP:

Answer 31

Bending, Stooping, Valsalva maneuver, Cough, Sneezing

Question 33

4 Meningitis Pharmacologic Management O-C-A-A

Answer 33

1. Osmotic Diuretics 2. Corticosteroids 3. Anticonvulsants 4. Antacids

Question 34

DOC

Answer 34

Mannitol

Question 35

Mannitol acts to ↓ cerebral edema. WOF?

Answer 35

Hypotension and dizziness

Question 36

DOC of Corticosteroids:

Answer 36

Dexamethasone/ Decadron these drugs could cross BBB

Question 37

Anticonvulsants: DOC

Answer 37

Dilantin/Phenytoin

Question 38

Phenytoin, if given PO, administer with meals because?

Answer 38

Causes GI upset

Question 39

Phenytoin if given per IV, prepare 10ml NSS, why?

Answer 39

Crystalizes in veins

Question 40

Method to administer 5ml NSS, phenytoin, 5ml NSS.

Answer 40

Sandwich Method

Question 41

SIDE EFFECTS: Anticonvulsants: Dilantin/Phenytoin

Answer 41

 Causes GI upset  Nystagmus (uncontrolled eye movement)  Red urine  Overgrowth of gum tissues  Gingival Hyperplasia

Question 42

Gingival Hyperplasia Nursing Intervention:

Answer 42

Soft bristle toothbrush

Question 43

Meningitis Pharmacologic Management -Antacids: H2 Receptor Blockers to?

Answer 43

prevent GI upset (please validate this info)

Question 44

Phenytoin Therapy Side Effects

Answer 44

 Gastric Ulcers  Red Urine  Ataxia  Nystagmus  Bone Marrow Depression: Cause aplastic anemia

Question 45

Meningitis Collaborative Management: Bedrest: _____ and ________

Answer 45

 Bedrest: Dark room and cool over eyes

Question 46

Meningitis Collaborative Management: PenG

Answer 46

Antibiotics IV: Codeine (Opioids) – causes respiratory depression, dizziness, constipation

Question 47

Meningitis Collaborative Management:DOC for severe headache

Answer 47

Glucocorticoids: Dexamethasone

Question 48

Meningitis Collaborative Management: DOC for temperature above ↑ 38˚C;

Answer 48

Paracetamol

Question 49

Meningitis Collaborative Management: DOC to relieve cerebral edema:

Answer 49

Mannitol

Question 50

Meningitis Collaborative Management: -Assess BP -DOC to prevent seizures?

Answer 50

Phenytoin/Dilantin