Unit vii

Unit vii

• 1.
  DISEASES AFFECTING THE NERVOUS SYSTEM
• 2.
  MENINGITIS – CEREBROSPINALFEVER  Is the inflammation of the meninges of the brain and spinal cord as a result of bacterial infection.
• 3.
  ETIOLOGIC AGENT  Pneumococcus,Staphylococcus,Streptococcus and tubercle bacillus.  Neisseria meningitides (Meningococcus)  Incubation period:  1-10 days  Mode of transmission:  Respiratory Droplet
• 4.
  ETIOLOGIC AGENT  Diagnostic test:  Lumbar puncture  X ray of spinal cord  Gram staining  Smear and blood culture  Smear from petichiae  Urine culture
• 5.
  CLASSIFICATIONS 1. Acute meningococcemia  Invade the blood stream without involving the meninges  Nasopaharyngitis  Petichial purpuric or ecchymotic hemorrhages scatter over the entire body  Adrenal lesions  Adrenal medullary haemorrhage Water house- Friderichsen syndrome  Fulminnt type
• 6.
  CLASSIFICATIONS 2. Aseptic Menigitis 3. A. syndrome characterized by headache,fever,vomiting and meningeal symptoms 4. Fever 40 oC
• 7.
  CLASSIFICATIONS 5. Signs of meningeal irritation  Stiff neck or nuchal rigidity  Opisthotonus  + Brudzinki sign  + kernig’s sign  Exaggerated and symmetrical deep tendon reflexes
• 8.
  CLASSIFICATIONS 6. Sinus arrhythmia, irritability, photophobia, diplopia and other visual problems 7. Delirium, deep stupor and coma 8. Signs of intracranial pressure  bulging fontanels in infants  nausea and vomiting (projectile)  blurring of vision  alteration in sensorium
• 9.
  COMPLICATIONS MENINGITIS 1. Subdural effusion 2. Hydrocephalus 3. Deaf-mutism 4. Blindness of either one or both eyes 5. Otitis media and mastoiditis 6. Pneumonia or bronchitis 7. Subdural effusion 8. Hydrocephalus 9. Deaf-mutism 10. Blindness of either one or both eyes 11. Otitis media and mastoiditis 12. Pneumonia or bronchitis
• 10.
  MODALITIES OF TREATMENT 1. If meningitis is left untreated it has a mortality rate of 70-100% 2. Treatment includes appropriate antibiotic theraphy and vigorous supportive care 3. IV antibiotics are usually given for two weeks and are followed by oral antibiotics such as  ampicillin  cephalosporins (ceftriaxone)  aminoglycosides
• 11.
  MODALITIES OF TREATMENT 4. Digitals glycoside (digoxin) is administered to control arrhythmias 5. Mannitol is given to decrease cerebral edema 6. An anticonvulsant or sedative is needed to reduce restlessness and convulsions 7. Acetaminophen us helpful in relieving headache and fever
• 12.
  NURSING MANAGEMENT 1. Assess neurologic signs often. Observe the patient’s level of consciousness and check for increased intracranial pressure (ICP) (signs include plucking at bedcovers, vomiting, seizures and changes in motor functions and vital signs). 2. Watch out for the deterioration of the patient’s condition, which may signal an impending crisis. 3. Monitor fluid balance. Maintain adequate fluid intake to avoid dehydration, but avoids fluid overload because of the danger of cerebral edema. Measure central venous pressure and intake and output.
• 13.
  NURSING MANAGEMENT 4. Watch out for anyh adverse reaction to the antibiotics and/or other drugs. Avoid infiltration and phlebitis 5. Position the patient carefully to prevent joins stiffness and neck pain. Turn the patient often avoid pressure sores and respiratory complications. Assist with ROM. 6. Maintain adequate nutrition and elimination 7. Ensure the patient’s comfort
• 14.
  NURSING MANAGEMENT 8. Provide reassurance and support to the patient and the family 9. Follow strict aseptic technique when treating patients with head wounds or skull fractures 10. Isolation is necessary, especially if nasal culture is positive
• 15.
  PREVENTATION 1. Several caccines are available to protect against ceratin types of meningitis 2. Teach client with chronic sinusitis or other chronic infections the importance of proper and prompt medical treatment 3. Give rifampicin as prophylaxis , as ordered by the physician 4. Implement the universal precaution
• 16.
  RABIES  Hydrophobia/Lyssa  aspecific acute viral infection; communicated to man by the saliva of an infected animal
• 17.
  RABIES  Causative Agent  Rhabdovirus  Incubation Period  1 week to seven –and –a half in dogs  Ten days to fifteen years in human  Incubation depends on the following factors  Distance of the bite to the brain  Extensiveness of the bite  Species of the animal  Richness of the nerve supply in the area of the bite  Resistance of the host
• 18.
  RABIES  Period of Communicability  5 days before the onset off symptoms  Mode of Transmission:  Bite of a rabid animal  Break on the skin
• 19.
  CLINICAL MANIFESTATIONS 1. Prodromal /Invasive phase  A. fever,anorexia=,malaisesorethroat,copious salivation,lacrimation,irritability,hyperexcitability  Apprehensiveness,restlessness  There is pain at the original site of bite  Sensitive to light  Pain and aches in different parts of the body  Anesthesia, numbness and tingling burning and cold sensations may be felt  Mild to difficulty in swallowing.
• 20.
  CLINICAL MANIFESTATIONS 2. Excitement or neurological phase  Marked excitation and apprehension  Delirium associated with nuchal rigidity  Maniacal behaviour  Severe painful spasm of the muscles of the mouth  Aerophobia  Profuse drooling  Tonic contractions of the muscles  Death may occur
• 21.
  CLINICAL MANIFESTATIONS 3. Terminal /paralytic phase  Quiet and unconscious  Bowel and urinary control  Sapsms cease and there is progressive paralysis  Tachycardia and labored irregular respiration  Death occurs due to paralysis, circulatory collapse
• 22.
  DIAGNOSTIC PROCEDURES  Fluorescentrabies antibody  [presence of negri bodies in the dogs brain
• 23.
  MODALITIES OF TREATMENT 1. Wash the wounds from the bite and scratches with soap and running water for at least three minutes 2. Check the patient immunization status . 3. Tetanus antiserum infiltrated around the wound or IM after neg. skin test 4. Give anti-rabies vaccines both passive and active depending on the site and size of the bite.
• 24.
  NURSING MANAGEMENT 1. Isolate the patient 2. Give emotional and spiritual support 3. Provide optimum comfort 4. Darken the room and provide a quiet environment 5. Should not bathed and there should not be running water in the room or within the hearing distance of the patient 6. If IV fluid has to be given , it should be wrapped. 7. Concurrent and terminal disinfection should be carried out.
• 25.
  PREVENTION AND CONTROL 1. Vaccination of all dogs 2. Enforcement of regulation for the pick-up and destruction of stray dogs 3. Ten-to fourteen day confinement of any dog that has bitten a person 4. Availability of laboratory facilities for observation and diagnosis 5. Providing public education especially to children on the avoidance and reporting of all animals that appear sick.
• 26.
  POLIOMYELITIS  INFANTILE PARALYSIS/HEINE –MEDIN Disease  Is an acute infectious diseases characterized by changes in the CNS which may result in pathologic reflexes, muscle spasms, and paresis or paralysis.
• 27.
  POLIOMYELITIS  Causative Agent  Brunhilde  Lansing  Leon  Incubation period  7-21 days for paralytic cases  Period of Communicability  3days 3 months of illness
• 28.
  POLIOMYELITIS  Mode of Transmission:  Person to person  Direct contact with infected oropharyngeal secretions and feces  Indirectly through flies,contaminated water,food untensils and other articles.  Predisposing causes of Poliomyelitis  Age 60% are under 10 years of age  Sex. Males are more prone to the disease  Heredity not hereditary  Environmental and hygienic condition
• 29.
  POLIOMYELITIS  Types of Poliomyelitis 1. The abortive  Not invade the CNS  Headache and sorethroat  Slight and moderate fever  Occasional vomiting  Low lumbar pain  The patient usually recovers within 72 hours  Accounts of 4-8%
• 30.
  POLIOMYELITIS 2. Non paralytic  A. all the signs of the abortive type are observed  Types of spasm of thew muscles of the hamstring  Changes in deep and superficial reflexes  Pain in the neck back arms leghs and abdomen  Inability to place the head in between the knees  Positive pandy’s test  Transient paresis may occur  Meningeal irritation persisting for about 2 weeks
• 31.
  POLIOMYELITIS 3. Paralytic  Positive Hoynes sign  Paralysis occurs  Less tendon reflexes  Positive kernig’s sign  Weakness of the muscles  Hypersensitivity to touch
• 32.
  PARALYTIC  Spinal paralytic  Paralysis occurs in muscles innervated by the motor neurons of the spinal cord  Bulbar  Bulbospinal
• 33.
  TETANUS  Tetanus is an infectious disease caused by Clostridium tetani, which produces a potent exotoxin with prominent systematic neuromuscular effects such as generalized spas modic contarctions of the skeletal musculator
• 34.
  TETANUS  INCUBATION PERIOD  three days to three weeks in adults and three to thirty days in the new born  CAUSATIVE AGENT  Clostridium tetani  Sources of infection :  Animal and human feces  Soil dust  Plaster of paris unsterile sutures pins and scissors and rusty materials
• 35.
  TETANUS  Mode of transmission  Rugged , traumatic wounds and burns  Umbilical stump  Babies delivered to mothers without tetanus toxoid immunization  Dental extraction circumsion and ear piercings  Unrecognized wounds
• 36.
  CLINICAL MANIFESTATIONS 1. Neonate  Feeding and difficulties and sucking difficulties  Cry excessively cry is short and voiceless  Suck results in spasms and cyanosis  Fever due to infection and dehaydartion  Jaw becomed so stiff that the babay cannot suck or swallow  Tonic or rigid muscular contractions, spasms or convulsions are provoked by stimuli  Cyanosis and pallor develop  Severe cases may end in flaccidity exhaustion and finally death
• 37.
  CLINICAL MANIFESTATIONS 2. Older children and adult a) Tetanus remains localized signs of onset are spasm and increased muscle tone near the wound b) If it becomes systemic or generalized signs include  If hypertonicity , hypereactive deep tendon reflexes tachycardia , profuse sweating, low grade fever and painful involuntary muscle contractions  Neck and fatal muscle rigidity ( trismus)  Grinning expressions ( risus sardonicus) – pathognomonic sign of the disease  Board like abdomen/abdominal rigidity
• 38.
  OPISTHOTONUS  Intermittent tonicconvulsions lasting from several minutes which may result in cyanosis and sudden death.  In severe cases Laryngospasm is followed by the accumulation of secretions in the airways.  Fracture of the vertebrae may occur during spasms.
• 39.
  OPISTHOTONUS  COMPLICATIONS :  Laryngospasm:  Hypostatic Pneumonia  Hypoxia due to laryngospasm and decreased oxygen  Atelectasis and pneumothorax  Traumatic glositis and mecroglossia
• 40.
  MODALITIES OF TREATMENT 1. Specific  Within 72 hours after punctured wound, the patient should receive ATS,TAT or TIG especially if the patient not have previous immunization  Tetanus Toxoid .5 cc IM  PEN G Na.  Muscle relaxant 2. Non specific  Oxygen inhalation  NGT Feeding  Tracheostomy  Adequate fluid , electrolyte and caloric intake
• 41.
  GOOD NURSING CARE Maintain an adequate airway  Provide cardiac monitoring  Maintain an IV line for medication and emergency care if necessary  Carry out efficient wound care  Avoid stimulation : warn visitors not to upset or overl;y stimulate the patient  Prevent contractures and pressure sore  Watch out for urinary retention  Closely monitor vital signs and muscle tone  Provide optimum comfort measures.
• 42.
  PREVENTION  Active Immunization DPT for babies and children