Exam 2 - Neuro - Meningitis

Meningitis Definition

o   Inflammation of the brain and the spinal cord

Types of Meningitis

bacterial

viral

bacterial meningitis precautions

ICP precautions

Droplet precautions

who is more at risk for meningitis?

college students

\-administer meningococcal booster before going to college

viral meningitis

§ treat the s/s

§  Usually self-limiting

§  Full recovery expected

Long term complications of meningitis

o   Hearing loss

o   Vision loss

o   Temporary paralysis

Dysphagia

S/S of meningitis

o   Nuchal rigidity (neck stiffness)

o   __Positive Kernig’s sign__

o   __Positive Brudzinski’s sign__

o   Tachycardia

o   Fever (Due to infection)

o   N/V

o   Severe headache

o   Photophobia (Sensitivity to light)

o   Decreased LOC (confusion)

o   Increased ICP

o   Seizures

what is Positive Kernig’s sign?

§  __resistance and pain with extension of the client’s leg from a flexed position__

\
THINK “K” for knee

what is Positive Brudzinski’s sign?

§  __flexion of the knees and hips occurring with deliberate flexion of the client’s neck__

\
THINK “B” for brain

Meningitis dx

o   CT Scan - To rule out obstruction of the foramen magnum to prevent fluid shift resulting in herniation

o   Lumbar puncture with CSF fluid analysis

what position should the pt be in for a lumbar puncture?

o   Lying position on their side

o   Sitting position tilting head forward

Meningitis: Lumbar Puncture – Nursing Care

o   Informed consent

o   Position patient

§  Bent over and sitting – to open vertebra

§  Side lying in fetal position – to open vertebra

o   Send CSF to the lab

o   Keep pt flat (If the pt sits up, they will complain of a headache)

§  Monitor pt’s for 1-4 hours

o   Pt may complain of headache (Can give fluids and pain meds)

§  Do not report a headache to the PCP (It is expected)

o   Check gauze (COCA – color, odor, consistency, and amount)

§  There are no stitches

§  Gauze and band aid only

what are the complications of a lumbar puncture?

§  CSK leak

§  Bleeding

§  Infection

§  Notify PCP

Meningitis Priority Nursing Care - For Increased ICP

§  Elevate HOB slightly

§  Report decreased LOC

§  Assess GCS/Neuro

§  Administer anti-seizure meds

§  Initiate seizure precautions

§  Administer mannitol

Meningitis Priority Nursing Care - For delirium and comfort

§  Dim lights

§  Administer analgesic for headache (Must be NON-OPIOID)

§  Decrease hallucinations by having family members around (familiar faces)

Meningitis Priority Nursing Care - For fever

high temp increase risk of seizures

·      Initiate seizure precautions

·      Administer anti-seizure meds (Phenytoin (Dilantin))

·      Administer aspirin or acetaminophen (Must treat fever ASAP)

·      Provide cooling blanket if the fever is severe

·      Strict I/O’s (Fever = fluid loss)

Meningitis Priority Nursing Care - For infection

·      Administer widespread ABX first

·      Discharge ABX for viral meningitis

·      Droplet precautions

Meningitis: Bacterial Complications

§  Increased ICP

§  SIADH

§  Septic embolism

Meningitis: Bacterial Complications - nursing actions

§  Isolation

§  Monitor vitals

·      Treat fever to decrease risk for seizure (Administer Tylenol or aspirin)

§  Neuro assessment

§  Strict I/O’s

§  Initiate seizure precautions

Meningitis Meds - ABX

§  Vancomycin with a cephalosporin

·      Cephalosporin could be cefuroxime, cefotaxime, ceftriaxone, ceftizoxime, ceftazidime

Meningitis Meds - pain meds

§  For stiff neck

·      NSAID

Meningitis Meds - anti-seizure meds

§  Phenytoin (Dilantin)

§  Levetiracetam