Case Study, Chapter 69, Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies

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.

a. To what room should the charge nurse assign the patient?

b. What additional signs and symptoms could a patient diagnosed with bacterial meningitis exhibit?

c. What diagnostic and lab tests are used to confirm the diagnosis of meningitis?

 

Answer:

a) The patient should be admitted to the isolation room or pivate room for droplets precaution for atleast 24 hours after the administration of antibiotic.

b) A patient with bacterial meningitis may have the following signs and symptoms:

• photophobia
• projectile vomiting
• cutaneous rash
• purpura
• myalgia
• painful eye movement
• positive Kernig's sign and Brudzinski's sign
• irratibility
• clouding of consciousness
• cerebral hernia
• seizures

c)

lab test used for confirmation of

• Cerebro spinal fluid examination (CSF)
• Specific bacterial antigen test- Immunoflorescent test, latex agglutination and countercurrent immuno- electrophoresis
• blood cultivation
• fim preparation of skin petechiae and purpura

diagnostic test

• complete patient history evaluation
• evaluation of signs and symptoms
• evaluation of changes in vital signs
• MRI
• CT or X-rays  of chest or sinuses

medical management

• Antimicrobial therapy should be started without delay when the patient is suspected of bacterial meningitis. third generation cephalosporin lsuch as cefotaxim or ceftriaxone is the first line of trratment with and addition of ampicillin and vancomycin with or without rifampicin incase of serious risk of infection.
• corticosteroids to reduce brain swelling is sometime prescribed
• sedaives for irritability or restessness
• anticonvulsions to prevent or treat seizures
• analgesic for headaches
• CSF shunt

Nursing care

• obtain history of recent infections and exposure to the causative agent
• Assess the neurological status and vital signs
• administer antimicrobial medication on time
• check the body temperature
• hypothermia blanket when indicated
• maintain intake output chart
• check for fluid overload
• monitor CVP
• Assess Level of consciousness
• maintain a calm and quiet environment with less stimuli
• prepare patient for Lumbar puncture when needed
• Assist with positioning of the patient , turn and move patient cautiously with head and neck in alignment
• elevate the head of the bed to decrease ICP
• Implement rehabilitation interventions after admission.