Question

in Case Study, Chapter 69, Management of Patients with Neurologic Infections, Autoimmune Disorders, and Neuropathies Dsorders and Nel 1. Brian Jones, a 22-year-old college student, is admitted from the emergency department to a medical-surgical unit with the diagnosis of acute bacterial meningitis. The patient presented with the following vital signs: temperature, 104°F blood pressure, 110/70 mm Hg, heart rate, 100 bpm; respiratory rate, 20 breaths/min. The patient presented with a severe, constant headache and nuchal rigidity. (Learning Objective 1)

Answer 1

The patient with bacterial meningitis is usually acutely ill.The fever is high and head pain is severe.irritation of the cerebral cortex may result in seizures.The changes in mental status and LOC depends on the degree of increased ICP .Assessment of vital signs ,neurologic evaluation ,fluid intake and output ,and evaluation of lung fields and skin should be performed at regular intervals based on the patients condition and record carefully.Head pain and neck pain secondary to movement require attention.Codeine provides some pain relief without undue sedation for most patients.The patient should be assisted to a position of comfort,often curled up with the head slightly extended.The head of the bed should be slightly elevated ,when permitted after lumbar puncture.A darkened room and a cool cloth over the eyes re;ieve the discomfort of photophobia.All patients suffer some degree of mental distortion and hypersensitivity and maybe frightened and misinterpret the environment.Every attempt should be maintained to reduce environmental stimuli.Fever must be vigorously managed because it increases cerebral edema and the frequency of seizures. Acetaminophen or aspirin maybe used to reduce fever..However if the fever is resistant to aspirin more vigorous measures are necessary ,such as automatic cooling blanket.Replacement fluids should be calculated as 800ml/day for respiratory losses and 100ml for each degree of temperature above 100.4 degree .Supplemental feeding to maintain adequate nutritional intake via tube or or oral feedings may be necessary.