Chapter 64
Management of Patients with
Neurologic Infections,
Autoimmune Disorders, and
Neuropathies
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Infectious Neurologic Disorders
Meningitis
Brain abscesses
Various types of encephalitis
Creutzfeldt–Jakob disease (CJD)
Variant Creutzfeldt–Jakob disease (vCJD)
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Meningitis
Inflammation of the meninges, which cover and protect the
brain and spinal cord
Two main types: bacterial and viral
Classified:
o Septic caused by bacteria (Streptococcus pneumoniae,
Neisseria meningitidis)
o Aseptic caused by viral infection secondary to cancer or a
weak immune system
N. meningitidis is transmitted by secretions or aerosol
contamination, and infection is most likely in dense community
groups such as college campuses
Manifestations include headache, fever, changes in LOC,
behavioral changes, nuchal rigidity (stiff neck), positive Kernig
sign, positive Brudzinski sign, and photophobia
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Kernig Sign
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Brudzinski Sign
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Medical Management of Meningitis
Prevention by meningococcal vaccine to youth 11 to
12 years of age; booster at 16. First-year college
students and members of the military
Early administration of high doses of appropriate IV
antibiotics for bacterial meningitis
Dexamethasone
Treatment for dehydration, shock, and seizures
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Nursing Management of Meningitis
Frequent or continual assessment, including VS and LOC
Pain and fever management
Protect patient from injury related to seizure activity or altered
LOC
Monitor daily weight, serum electrolytes, urine volume, specific
gravity, and osmolality
Prevent complications associated with immobility
Infection control precautions
Supportive care
Measures to facilitate coping of patient and family
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Guillain–Barré Syndrome #1
Autoimmune disorder with acute attack of peripheral
nerve myelin
Rapid demyelination may produce respiratory failure
and autonomic nervous system dysfunction with CV
instability
Most often follows a viral infection
Manifestations are variable and may include
weakness, paralysis, paresthesia, pain, and
diminished or absent reflexes, starting with the
lower extremities and progressing upward; bulbar
weakness; cranial nerve symptoms; tachycardia;
bradycardia; hypertension; or hypotension
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Guillain–Barré Syndrome #2
Medical management
o Medical emergency
o Requires intensive care management with
continuous monitoring and respiratory support
o Therapeutic plasma exchange and IVIG are used
to reduce circulating antibodies
Recovery rates vary, but most patients recover
completely
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Assessment of the Patient with Guillain–
Barré Syndrome
Ongoing assessment with emphasis on early
detection of life-threatening complications of
respiratory failure, cardiac dysrhythmias, and deep
vein thrombosis (DVT)
Monitor for changes in vital capacity and negative
inspiratory force
Assess VS frequently or continuously, including
continuous monitoring of ECG
Patient and family coping
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Collaborative Problems and Potential
Complications of the Patient with Guillain–
Barré Syndrome
Respiratory failure
Autonomic dysfunction
DVT
Pulmonary embolism
Urinary retention
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Planning and Goals for the Patient with
Guillain–Barré Syndrome
Major goals include:
o Improved respiratory function
o Increased mobility
o Improved nutritional status
o Effective communication
o Decreased fear and anxiety
o Effective patient and family coping
o Absence of complications
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Nursing Interventions for the Patient with
Guillain–Barré Syndrome #1
Enhancing physical mobility and prevention of DVT
o Support limbs in functional position
o Passive ROM at least twice daily
o Frequent position changes at least every 2 hours
o Elastic compression hose or sequential
compression boots
o Adequate hydration
Administer IV and parenteral nutrition as prescribed
Carefully assess swallowing and gag reflex and take
measures to prevent aspiration
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Nursing Interventions for the Patient with
Guillain–Barré Syndrome #2
Develop a plan for communication individualized to
patient needs
Decreasing fear and anxiety
o Provide information and support
o Referral to support group
o Relaxation measures
o Maintain positive attitude and atmosphere to
promote a sense of well-being
o Diversional activities
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