Brain Abscess
- accumulation of pus within the brain tissue from local/systemic infection
- Causes:
- EENT infections
- brain trauma/surgery
- bacterial endocarditis
- pulmonary infection
- causes of brain abscess from sites far away from the brain are caused by bacteria traveling through the circulatory system via the carotid artery and into the cerebral arteries
- Common bacterial causes:
- Streptococci
- Staphylococci
- Signs and Symptoms
- Affected Area: Frontal Lobe
- hemiparesis
- aphasia - impairment of language
- seizure
- frontal headache
- Affected Area: Temporal Lobe
- aphasia
- vision changes
- facial weakness
- localized headache
- Affected Area: Cerebellum
- ataxia - lack of coordinated muscle movements
- nystagmus
- occipital headache
- Diagnostic Tests
- CT & MRI
- Treatment
- antibiotics - helps kill bacteria
- corticosteroids - reduces inflammation
- surgical drainage of abscess via craniotomy (hole made into skull) or craniectomy (part of skull is temporarily removed then placed back)
- Nursing Management
- paper and pen communication
- non-stimulating environment
- complete bed rest
- assess neurologic vital signs
Viral Encephalitis
- Types
- Epidemic
- caused by Arboviruses (ARthropod-BOrne Viruses; e.g. ticks, mosquitoes)
- headache, fever, nausea and vomiting, nuchal rigidity, coma
- Non-epidemic
- dormant viruses in the nerves reawaken and attack the brain
- herpes simplex, mumps, measles, varicella
- fever, seizures, headache, nausea and vomiting
- may lead to brain herniation, brain swelling, coma, death
- Treatment and Management
- ACYCLOVIR
- provide safety
- assess neurologic vital signs
- avoid increasing ICP
- elevate head of bed
- anticonvulsants
- steroids
Meningitis
- primarily affect the subarachnoid space
- Mode of Transmission: head injury, droplet transmission, bloodstream
- Types
- Aseptic - no bacteria, meninges may be irritated by lymphoma, leukemia, or brain abscess
- Septic - Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae
- Tuberculous - Mycobacterium tuberculosis
- Signs and Symptoms
- headache
- fever
- nuchal rigidity
- photophobia
- seizures
- increased ICP
- neurologic impairment
- Kernig's sign - thigh and hip flexion, leg can't be extended
- Brudzinski's sign - flex the neck, knees and hips flex too
- Diagnostic Test
- increased WBC count
- CSF analysis - increased protein, decreased glucose
- Treatment
- RIFAMPICIN
- phenytoin - for seizures
- cephalosporin - to augment rifampicin's anti-infective capabilities
- mannitol - to decrease ICP
- dexamethasone - for inflammation
- codeine - for pain and coughing
- pyritinol - for altered levels of consciousness
- Management
- non-stimulating environment
- respiratory isolation
- raise side rails
- small frequent feedings
- assess neurologic vital signs
- complete bed rest
- increase protein and caloric intake
- elevate head of bed
- seizure precautions
Viral Meningitis
- Causative Agent:
- Mumps virus
- Human Immunodeficiency Virus
- Herpes Simplex Virus
- Cytomegalovirus
- Epstein-Barr Virus
- Signs and Symptoms: same as bacterial meningitis
- Diagnostic Test
- decreased WBC count
- CSF analysis
- polymerase chain reaction test
- Treatment
- antivirals - stops proliferation of virus but doesn't treat disease
- anticonvulsants
- complete bed rest
- symptomatic management
Cryptococcosis / Torulosis
- Causative Agent: Cryptococcus neoformans
- Signs and Symptoms:
- chest pain
- fatigue
- confusion
- fever
- headache
- Diagnostic Test: CSF analysis
- Treatment: AMPHOTERICIN B
Mucormycosis / Phycomycosis
- Causative Agent: Mucorales and Phycomycetes spores
- Signs and Symptoms
- one-sided headache
- facial pain
- black nasal discharges
- sinusitis
- Diagnostic Test: CSF analysis
- Treatment: AMPHOTERICIN B
Diphtheria / Kleb-Loeffler's Disease
- Causative Agent: Corynebacterium diphtheriae
- Affects respiratory tract, larynx, and pharynx
- Reservoir: humans
- Mode of Transmission: direct contact, droplet
- Incubation Period: 2-5 days
- Types:
- Respiratory
- bull neck appearance
- serosanguinous secretions
- pseudomembranes - thick patchy grayish-green membranes over larynx, pharynx, and tonsils
- Cutaneous
- small ulcers often seen on the legs
- Diagnostic Test
- Schick Testing - tests susceptibility to diphtheria
- throat culture
- Treatment
- ERYTHROMYCIN
- Nursing Management
- soft diet
- strict isolation
- complete bed rest
- small frequent feedings
- Complications
- Diphtheritic Neuropathy - the toxin of C. diphtheria causes chronic demyelination of nerves damaging the autonomic nervous system
Tetanus
- Causative Agent: Clostridium tetani
- C. tetani toxins block the neurotransmitter acetylcholine rendering muscles unable to properly function
- Reservoir: soil and animal feces
- Mode of Transmission: dental infections, open fractures, animal bites, open wounds
- Incubation Period: 3-21 days
- Signs and Symptoms
- RISUS SARDONICUS
- trismus
- opisthotonus
- respiratory spasm (late)
- Diagnostic Test: clinical only (based on observation of symptoms)
- Treatment
- TIg - tetanus immunoglobulin to provide passive immunity
- TT - tetanus toxoid to provide active immunity
- Management
- maintain patent airway
- do not restrain
- soft diet
- avoid unnecessary stimulation
Botulism
- Causative Agent: Clostridium botulinum
- Reservoir: soil, contaminated food
- Mode of Transmission: ingestion of toxins or spores
- Incubation Period: 18-36 hours
- Types
- Infant - colonization of GI tract through ingestion of spores
- Wound - contamination of wound by the bacteria
- Foodborne - ingestion of toxins from contaminated food
- Signs and Symptoms
- nausea and vomiting
- diarrhea
- dysphagia - difficulty swallowing
- dystonia - sustained twitching and repetitive movements
- dry mouth
- ptosis - drooping of eyelids
- diplopia - double vision
- dysarthria - motor speech disorder; poor articulation; ("bolol-bolol")
- descending paralysis
- Diagnostic Test: serum analysis and gastric lavage
- Treatment
- BOTULINUM ANTITOXIN
- GASTRIC LAVAGE of wound
- DEBRIDEMENT
- mechanical ventilation if descending paralysis has set in
- AVOID
- cracked jars
- dented/inflated cans
- forcefully expelled food from cans (foods oozing out or explode upon opening)
- "off" odor in foods
- loose/dented lids
Syphilis and Neurosyphilis
- Causative Agent: Treponema pallidum
- Reservoir: humans
- Mode of Transmission: sexual contact, contact with infected lesions, sharing of needles
- Incubation Period: 10-90 days
- Stages
- Primary - appearance of painless chancres (ulcerations) at site of infection
- Secondary - chancres appear at trunk and extremities, transmission can occur, lymphadenopathy, meningitis, hair loss, weight loss, fever, malaise
- Latency - no signs and symptoms
- Tertiary - appearance of gummas (soft, tumor-like balls of inflammation)
- Neurosyphilis
- Neurosyphilis Types
- Asymptomatic - present in CSF upon test but no signs and symptoms
- Meningovascular
- affects CNS and damages blood vessels
- presents with cranial nerve palsies
- may present as STROKE SYNDROME, damage and subsequent occlusion of the middle cerebral artery
- Parenchymatous / General Paresis
- present with dementia
- Argyll-Robertson pupil - unreactive to light
- Tabes Dorsalis
- areflexia - absence of deep tendon reflexes
- loss of proprioception of feet (doesn't know where foot is placed)
- irregular intense stabbing pain
- Diagnostic Test:
- FTA-Abs (Fluorescent Treponema Antibody Absorption)
- TPHA (Treponema Pallidum Particle Hemagglutination)
- Treatment: PENICILLIN
- Jarisch-Herxheimer Reaction - reaction caused by sudden death of millions of bacteria; manifested by fever, muscle pains, headache
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