BSN Notes: Neurology- Brain Abscess

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Brain Abscess

·                  A brain abscess is a collection of infectious material within the tissue of the brain. It accounts for less than 2%
·                  Brain abscesses are rare in immunocompetent people; they are more frequently diagnosed in people who are immunosuppressed as a result of an underlying disease or use of immunosuppressive medications.
Pathophysiology
·                  Predisposing conditions (otitis media and rhino sinusitis, intracranial surgery, penetrating head injury, or tongue piercing)
·                  Organisms causing brain abscess may reach the brain by hematologic spread from the lungs,  gums, tongue, or heart, or from a wound or intra-abdominal infection
·                  Bacteria are the most common causative organisms.    
·                  Prevention: To prevent brain abscess, otitis media, mastoiditis, rhino sinusitis, dental infections, and systemic infections should be treated promptly.
Clinical Manifestations
·                  The clinical manifestations of a brain abscess result from alterations in intracranial dynamics (edema, brain shift), infection, or the location of the abscess.
·                  Headache, usually worse in the morning, is the most prevailing symptom.
·                  Fever, vomiting, and focal neurologic deficits occur as well.
·                  Focal deficits such as weakness and decreasing vision reflect the area of brain that is involved.
·                  As the abscess expands, symptoms of increased ICP such as decreasing LOC and seizures are observed.
Assessment and Diagnostic Findings
·                  Neuroimaging studies such as MRI or CT scanning identify the size and location of the abscess.
·                  The MRI or CT scans reveal a ring around a hypodense area.
·                  Aspiration of the abscess, guided by CT or MRI, is the best method to culture and identify the infectious organism.
·                  Blood cultures are obtained if the abscess is believed to arise from a distant source. Chest x-ray is performed to rule out predisposing lung infections and an electroencephalogram (EEG) may help localize the lesion.
Medical Management
·                  Treatment is aimed at controlling increased ICP, draining the abscess, and providing antimicrobial therapy directed at the abscess and the primary source of infection.
·                  Large IV doses of antibiotics are administered to penetrate the blood—brain barrier and reach the abscess.
·                  The choice of the specific antibiotic medication is based on culture and sensitivity testing and directed at the causative organism.
·                  A stereotactic CT-guided aspiration may be used to drain the abscess and identify the causative organism.
·                  Corticosteroids may be prescribed to help reduce the inflammatory cerebral edema i the patient shows evidence of an increasing neurologic deficit. Antiseizure medications (phenytoin, Phenobarbital) may be prescribed to prevent or treat seizures.
Nursing Management

                 Nursing care focuses on continuing to assess the neurologic status, administering medications, assessing the response to treatment, and providing supportive care.
                 Ongoing neurologic assessment alerts the nurse to changes in ICP, which may indicate a need for more aggressive intervention.
                 The nurse also assesses and documents the responses to medications. Blood laboratory test results, specifically blood glucose and serum potassium levels, need to be closely monitored when corticosteroids are prescribed.
                 Administration of insulin or electrolyte replacement may be required to return these values to normal or acceptable levels.
                 Patient safety is another key nursing responsibility. Injury may result from decreased LOC or falls related to motor weakness or seizures.
·         The patient with a brain abscess is very ill, and neurologic deficits, such as hemi paresis, seizures, visual deficits, and cranial nerve palsies, may remain after treatment.
                 Seizures are common sequel. The nurse must assess the family's ability to express distress at the patient's condition, cope with the patient's illness and deficits, and obtain support.

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notes.nursium.com: BSN Notes: Neurology- Brain Abscess
BSN Notes: Neurology- Brain Abscess
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