Nuccal rigidity (stiff neck)

Fever

Arching of back and extended head

Headache

Decreased LOC

Nystagmus (eye movement/pupillary response)

Photophobia- sensitivity to light

Phonophobia- sensitivity of sound

Tachycardia

Vaccine: 11-12 years old, booster at 16yrs old or 8wks after initial

Droplet precautions for bacterial

Private room

Maintain 3ft

Treat the microorganism

Viral- most common and temporary

Bacterial- EMERGENT

Possible causes: Intracerebral (ICH)

• Severe Hypertension

• cocaine use

The patient may complain of a severe headache.

Changes in the arterial wall can cause arteries to rupture, leading to bleeding that may result in edema, distortion, and displacement.

Subarachnoid (SAH):

• Bleeding may be from a traumatic injury or aneurysm.

Treatments:

Endovascular interventions

• Embolize vessels

• Clips and coils

• at risk for hemorrhagic stroke 1 week after discharge

• cause: atherosclerosis

• treatment: fibrinolytic therapy, TPA (alteplase); antiplatelets (heparine, warfarin)

• s/s: usually no headache, weakness, vision loss, speech difficulty

• diagnostic test: CT scan

Lumbar puncture- CSF analysis

CT

Gram Stain

Culture

Blood

CBC

XR

Cranial nerves 3, 4, 6, 7, 8

-Eye movement: 3, 4, 6

-facial: 7 (Bell’s palsy)

- acoustic (hearing)- 8

Cues:

Brudzinski’s sign: when neck is flexed, hips and knees flex

Kernig’s sign: leg extension at knee, causing pain

• IICP

Epidural Hematoma: arterial bleed- FAST

• neurosurgical emergency

• acute increased IICP

• Environment Control: Close the blinds, Dim Lights, patient door is closed

• Keep patient away from Nurse’s Station

• Suctioning: PRN, no more than 10 seconds (Hyperoxygenate prior and after suctioning the client)

• Patient needs to refrain from sneezing, no Q-tips

• Keep HOB elevated at 30 degrees

• Supratentorial: HOB elevated 30 degrees

• Infratentorial: HOB elevated 10 degrees

• Keep patient from hip flexion and neck flexion

• Drug Intervention: Osmotic Diuretic; Mannitol 

• Turn the patient TV off, keep it low

• Assess LOC, Glasgow Coma Scale

• Pupillary Response (Cranial Nerves: Oculomotor, Abducens, Optic,)

• visual, spatial awareness/perception

• disoriented to time/place

• personality changes, impulsivity

• poor impulse control, poor judgement

Left-sided:

• Center for Speech

• Language

• Mathematic skills

• Analytical thinking

Mannitol- Mannitol is an osmotic diuretic. It works by pulling water out of the brain cells and putting it into circulation. This will result in the brain taking up "less space" and decrease ICP. Important complications include: fluid and electrolyte imbalance, heart failure etc.

Antihypertensives: Labetalol and CCB.

Labetalol: combined alpha/beta blocker- it reduces blood pressure slowly which is perfect for the balance that needs to be maintained between hypo and hypertension in these patients. Main side effects of labetalol include: bradycardia, hypotension.

Nimodipine: causes peripheral vasodilation and causes fall in blood pressure. Major side effects include: flushing, peripheral edema and hypotension.

Sedatives/analgesics: Fentanyl, cistacuronium: these are used for pain management and sedation in patients who may need airway protection (eg GCS less than 8).

- No tPA!

- Manage BP (avoid rapid lowering)

- Manage ICP (HOB ↑30°, avoid straining)

HOB elevated to 30degrees

Neuro checks

• q4h

Monitor for IICP