Question

Case Study, Chapter 69, Management of Patients with Neurologic Infections, Autoimmune Disorders, and Neuropathies 1. Brian Jones, a 22-year-old college student, is admitted from the emergency departmert 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) To what room should the charge nurse assign the patient? a. What additional signs and symptoms could a patient diagnosed with bacterial meningitis exhibit? b. What diagnostic and lab tests are used to confirm the diagnosis of meningitis? c. What medical management should the nurse anticipate for the patient? d. What nursing care should be provided for the patient? e.

Answer 1

a The nurse should assign the patient to emergency department .Since it is a medical emergency,rapid diagnosis based on history and physical examination is crucial because the patient is in a critical state when health care is sought.it generally requires respiratory isolation until the cultures are negative.

b.Fever,severe headache,nausea,vomiting,nuchal rigidity are key signs of meningitis.A positive kerning sign,a positive Brudzinki s sign,photophobia,a decreased LOC,and signs of increased ICP may also be present..With meningitis,the headache becomes progressively worse and maybe accompanied by vomiting and irritability.

c.Diagnosis is usually verified by doing a lumbar puncture with analysis of the CSF for protein,glucose,WBC,gram stain and culture,CBC,Coagulation profile,electrolyte levels,glucose,platelet count,blood culture,CT scan,MRI,PET scan and Skull x-ray studies.

d When meningitis is suspected ,antibiotic therapy is instituted after the collection of specimens for culture ,even before the diagnosis is confirmed.The fundus of the eye should be examined via ophthalmoscope for papilledema before lumbar puncture for identification of possible increased ICP. Ampicillin, pencillin, Vancomycin, ceftriaxone, ceftizoxime are commonly prescribed drug of choice for treating bacterial meningitis.The corticosteroid dexamethasone may also be prescribed prior to or with the first dose of antibiotics .Although the data are limited,administration of dexamethasone appears to be associated with a lower mortality rate and a reduced incidence of hearing loss in patients with bacterial meningitis.

e

• Monitor neurologic status on an ongoing basis to determine extent of problem.
• Administer PRN medications for anxiety .
• Provide patient optimal pain relief with prescribed analgesics to relieve pain.
• Monitor for seizure activity.
• Monitor temperature as frequently as possible.
• Monitor blood pressure,pulse and respiration to evaluate effects of hyperthermia.