Page 174 - Critical Care Notes

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NEURO
■ Administer antihypertensive or vasopressors to maintain BP within normal
limits. Consider IV fluid resuscitation as indicated.
■ Monitor for and provide preventive care for infections caused by complica-
tions: pneumonia, UTIs, septicemia.
■ Insert indwelling Foley catheter if incontinent.
■ Provide enteral feedings and nutritional support.
■ Active and passive range of motion and physical or occupational therapy
are provided.
■ Corticosteroids such as prednisone may be tried but generally are not
effective.
■ Administer IVIG at 400 mg/kg for 5 consecutive days.
■ Plasmapheresis (therapeutic plasma exchange): two sessions for patients
with mild disease, 4 exchanges for moderate disease, up to 6 exchanges
for severe disease. Side effects increase with number of exchanges.
■ Provide DVT and stress ulcer prophylaxis.
■ Institute safety precautions if changes in mental status occur.
■ Provide short- and long-term rehabilitation, physical therapy, and occupa-
tional therapy consultations.
■ Complications include:
■ Loss of bowel and bladder control
■ Pressure ulcers, contractures and muscle wasting
■ Thrombophlebitis
■ Respiratory tract infections, respiratory failure and sepsis
Bacterial Meningitis
Bacterial meningitis is an inflammation that involves the arachnoid and pia
mater of the brain, the subarachnoid space, and the CSF.
Pathophysiology
■ Bacteria enter the CNS through the bloodstream and cross the blood-brain
barrier or directly enter the bloodstream via penetrating trauma, invasive
procedures, cancer, certain drugs, or ruptured cerebral abscess. An upper
respiratory infection → bacteria in nasopharynx → bloodstream → CSF
subarachnoid space and pia-arachnoid membrane → meninges.
■ Purulent exudate → clings to meningeal layers → clogs CSF → tissue
and vascular congestion and obstruction → cranial nerve dysfunction,
hyperemia of meningeal blood vessels, brain tissue edema, ↑ CSF, ↑ ICP,
↑ WBC in subarachnoid space → acute hydrocephalus and seizures.
■ Abnormal stimulation of hypothalamic area → inappropriate ADH produc-
tion → water retention.
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