2.5 Infectious Nervous System Disorders

Infectious neurological diseases usually render the patient acutely ill. Caring for a patient with an infectious neurological condition provides a challenge for the health care team in terms of bedside clinical skills and intensive planning for discharge and rehabilitation.

2-29.  MENINGITIS

Meningitis is inflammation of the meninges. The severity of the disease is dependent upon the specific microorganism involved, the presence of other neurological disorders, the general health of the patient, the speed of diagnosis, and the initiation of treatment.

Meningitis is caused by contaminated head injury, infected shunt, contaminated lumbar puncture, and the travel of infectious microorganisms to the meninges via the bloodstream or through direct extension from an infected area (such as the middle ear or paranasal sinuses). Common microorganisms include:

Meningococcus.
Streptococcus.
Staphylococcus.
Pneumococcus.

Diagnostic evaluation techniques include lumbar puncture to identify the causative organism in the cerebrospinal fluid, blood cultures, and physical examination.

The signs and symptoms include:

  • Elevated temperature
  • Chills
  • Headache (often severe)
  • Nausea, vomiting
  • Nuchal rigidity (stiffness of the neck)
  • Photophobia
  • Opisthotonos (extreme hyperextension of the head and arching of the back due to irritation of the meninges)
  • Altered level of consciousness
  • Multiple petechiae on the body

Nursing Management.

Administer intravenous fluids and medications, as ordered by the physician.

 Antibiotics should be started immediately.

Corticostertoids may be used for the critically ill patient.

Drug therapy may be continued after the acute phase of the illness is over to prevent recurrence.

Record intake and output carefully and observe patient closely for signs of dehydration due to insensible fluid loss.

Monitor patient's vital signs and neurological status and record. Assess level of consciousness, using GCS for accuracy and consistency. Monitor rectal temperature at least every 4 hours and, if elevated, provide for cooling measures such as a cooling mattress, cooling sponge baths, and administration of ordered antipyretics.

If isolation measures are required, inform family members and ensure staff compliance of isolation procedures in accordance with (IAW) standard operating procedures (SOP).

Provide basic patient care needs. The patient's level of consciousness will dictate whether the patient requires only assistance with activities of daily living or total care. If patient is not fully conscious, follow the guidelines for care of the unconscious patient. Also maintain dim lighting in the patient's room to reduce photophobic discomfort.

Provide discharge planning information to the patient and family. This would include follow-up appointments with the physician, discharge medication instruction, and possible follow-up with the community health nurse.

ENCEPHALITIS

Encephalitis is an infectious disease of the central nervous system characterized by pathological changes in the gray and white matter of the cord and brain. Pathophysiological changes associated with encephalitis include: severe, diffuse inflammation of the brain, intense lymphocytic infiltration, especially around cerebral blood vessels, and possible extensive nerve cell destruction.

Causes of encephalitis are microorganisms, chemical toxins (lead, arsenic, carbon monoxide), and a complication of infectious childhood diseases (measles, rubella, chicken pox).

The onset of symptoms is usually very sudden.

 

  • Fever
  • Severe headache
  • Nuchal rigidity
  • Vomiting
  •  Altered level of consciousness, lethargy
  • Seizures
  • Incoordination, muscular weakness
  • Visual disturbances (photophobia, diplopia)

Because no specific antiviral measure has yet been developed, medical treatment is symptomatic.      Specific supportive nursing measures which apply to the patient with meningitis should be followed.

 

2-31.  POLIOMYELITIS

Poliomyelitis is an acute, highly infectious viral disease characterized by fever, paralysis, and muscle atrophy. Infection is transmitted through oral and nasal secretions or through the oral-fecal route. The incidence of polio has been greatly reduced with childhood immunization using the Sabin and Salk polio vaccines.

Signs and symptoms of poliomyelitis include:

 

  • Headache.
  • Vomiting.
  • Fever.
  • Lethargy.
  • Anorexia.
  •  Muscle pain, stiffness.
  • Loss of deep tendon reflexes.
  • Muscle weakness.
  • Paralysis.

Medical and Nursing Management

Monitor patient's level of consciousness.

Utilize supportive nursing measures.

Consult infection control for recommendations regarding enteric precautions.

Involve physical therapy for a formal evaluation and instruction.

Determine the degree to which patient and family can participate in care.

Continually observe family interactions to determine long-term effect of polio on family resources and dynamics.

Seek assistance from Community Health Nurse for discharge planning and community assistance.

 

GUILLAIN-BARRE SYNDROME

Guillain-Barre Syndrome is a disorder of the nervous system that affects peripheral nerves and spinal nerve roots. It is also called infectious polyneuritis.

The exact cause of Guillain-Barre syndrome is unknown. Many patients give a history of a recent infection, especially of the upper respiratory tract. There is also evidence of a connection with the Swine flu vaccination. Diagnosis is made on the basis of the history and symptoms. Additionally, lumbar puncture will reveal increased protein in the CSF.

Signs and symptoms include:

 

  • Motor weakness, especially in the extremities, is often the first symptom.
  • Weakness usually progresses (ascends), over a period of several hours to one week, to the upper areas of the body, where muscles of respiration may be affected.
  • Sensory disturbances, numbness, and tingling.
  • Cranial nerve involvement resulting in difficulty chewing, talking, and swallowing.
  • Diminished or absent deep tendon reflexes.
  • Low grade fever.

Nursing Management

Treatment is nonspecific and symptomatic. The patient must be continuously observed for adequacy of respiratory effort and undergo continuous EKG monitoring.

Supportive nursing care measures indicated by the patient's degree of paralysis. In several weeks, paralysis will begin to disappear, usually starting from the head and moving downward. Residual effects are rare, but prolonged flaccid paralysis may lead to muscle atrophy requiring rehabilitation and physical therapy.