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Management For Meningitis
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Management For Meningitis

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Management For Meningitis

Management For Meningitis


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  • 1. Management for Meningitis
    Reynel Dan L. Galicinao
  • 2. Ideal Medical Management
    Diagnostic Evaluation
    Complete blood count (CBC) with differential - detect an elevated leukocyte count in bacterial and viral meningitis
    Lumbar puncture - (elevated CSF pressure, cloudy or milky white CSF, high protein level, positive Gram stain and culture that usually identifies the infecting organism unless it's a virus, and depressed CSF glucose concentration)
    CSF evaluation for pressure, leukocytes, protein, glucose
  • 3. MRI/CT scan - with and without contrast rules out cerebral hematoma, hemorrhage, or tumor
    CT scan with contrast - to detect abscesses. Low CD4+ counts indicate immunosuppression in HIV-positive patients and other patients with immunosuppressive disorders.
    Latex agglutination may be positive for antigens in meningitis.
    Chest X-rays - may reveal pneumonitis or lung abscess, tubercular lesions, or granulomas secondary to fungal infection
  • 4. Treatment
    team effort with nursing, infectious diseases specialists, neurology, internal medicine, and otolaryngology specialists, and laboratory and diagnostic staff
    Antibiotic therapy and vigorous supportive care
    Usually, I.V. antibiotics are given for at least 2 weeks, followed by oral antibiotics
    ampicillin, cefotaxime, ceftriaxone, and nafcillin
    Dexamethasone (Decadron) - as adjunctive therapy
    Mannitol - to decrease cerebral edema
    Anticonvulsant (usually given I.V.) or a sedative - to reduce restlessness
    Aspirin or acetaminophen - to relieve headache and fever
  • 5. Supportive measures consist of bed rest, hypothermia, and fluid therapy to prevent dehydration
    Isolation - if nasal cultures are positive
    Therapy for any coexisting conditions, such as endocarditis or pneumonia
    Temozolomide (Temodar) - neoplastic meningitis
    Cochlear implantation rehabilitation - deafness caused by meningitis
    therapy for S. aureus and gram-negative bacilli - If meningitis is suspected after neurosurgical procedures, potential I.V. line bacteremia, CSF leak, or immunosuppression
    Antifungal agents - for cryptococcal meningitis
    Empiric antituberculosis drugs must be initiated if infection by Mycobacterium tuberculosis is suspected
  • 6. Actual Medical Managemnet
    Diagnostic Evaluation
    Hematology
    Chest X-ray (APL)
    IVF
    D5 0.3 NaCl 500cc @ 30cc/hr
    D5 IMB 500cc @ 20cc/hr
    Nasogastric tube – for feeding
    O2 inhalation 2-3 L/min via cannula
  • 7. Madications
    Ranitidine 6 mg IVTT q 8h
    Ceftriaxone (Medzef) 600 mg IVTT q 24h ANST (-)
    Dexamethasone 0.75 mg IVTT q 6h
    Phenobarbital 60mg IVTT now
    Pen G 300,000 IU IVTT q 6h ANST (-)
    Furosemide 6 mg IV now
  • 8. Ideal Nursing Management
    Nursing Assessment
    Obtain a history of recent infections such as upper respiratory infection, and exposure to causative agents
    Assess neurologic status and vital signs
    Evaluate for signs of meningeal irritation
    Assess sensorineural hearing loss (vision and hearing), cranial nerve damage (eg, facial nerve palsy), and diminished cognitive function.
  • 9. Ideal Nursing Diagnoses
    Acute pain related to meningeal irritation
    Anxiety
    Hyperthermia related to the infectious process and cerebral edema
    Impaired gas exchange
    Impaired Physical Mobility related to prolonged bed rest
    Ineffective Tissue Perfusion (cerebral) related to infectious process and cerebral edema
    Risk for deficient fluid volume related to fever and decreased intake
    Risk for impaired skin integrity
  • 10. Key outcomes
    The patient will
    express feelings of comfort and relief of pain
    identify strategies to reduce anxiety
    exhibit temperature within normal range
    maintain adequate ventilation and oxygenation
    maintain fluid volume within normal range
    Have skin integrity remain intact
  • 11. Ideal Nursing Interventions
    Reducing Fever
    Administer antimicrobial agents on time to maintain optimal blood levels.
    Monitor temperature frequently or continuously, and administer antipyretics as ordered.
    Institute other cooling measures, such as a hypothermia blanket, as indicated.
    Maintaining Fluid Balance
    Prevent I.V. fluid overload, which may worsen cerebral edema.
    Monitor intake and output closely.
    Monitor CVP frequently.
  • 12. Enhancing Cerebral Perfusion
    Assess LOC, vital signs, and neurologic parameters frequently. Observe for signs and symptoms of ICP (eg, decreased LOC, dilated pupils, widening pulse pressure).
    Maintain a quiet, calm environment to prevent agitation, which may cause an increased ICP.
    Prepare patient for a lumbar puncture for CSF evaluation, and repeat spinal tap, if indicated. Lumbar puncture typically precedes neuroimaging
    Notify the health care provider of signs of deterioration: increasing temperature, decreasing LOC, seizure activity, or altered respirations.
    Reducing Pain
    Administer analgesics as ordered; monitor for response and adverse reactions. Avoid opioids, which may mask a decreasing LOC.
    Darken the room if photophobia is present.
    Assist with position of comfort for neck stiffness, and turn patient slowly and carefully with head and neck in alignment.
    Elevate the head of the bed to decrease ICP and reduce pain.
  • 13. Promoting Return to Optimal Level of Functioning
    Implement rehabilitation interventions after admission (eg, turning, positioning).
    Progress from passive to active exercises based on the patient's neurologic status.
  • 14. Community and Home Care Considerations
    Prevent bacterial meningitis by eliminating colonization and infection with the offending organism.
    Administer vaccines against H. influenzae type B for children; N. meningitidis serogroups A, C, Y, and W135 for patients at high risk (especially college students, those without spleens, immunodeficient); and S. pneumoniae for patients with chronic illnesses and the elderly.
    Administer vaccines for travelers to countries with a high incidence of meningococcal disease and household contacts of someone who has had meningitis.
    Chemoprophylaxis for meningococcal disease, most commonly with rifampin, may be necessary for health care workers, household contacts in the community, day care centers, and other highly susceptible populations.
    If maintenance antifungal prophylaxis is initiated for patients with low CD4+ counts, as seen in some patients with AIDS, the patient must understand the importance of long-term pharmacologic therapy.
  • 15. Patient Education and Health Maintenance
    Advice close contacts of the patient with meningitis that prophylactic treatment may be indicated; they should check with their health care providers or the local public health department.
    To help prevent the development of meningitis, teach patients with chronic sinusitis or other chronic infections the importance of proper medical treatment.
    Encourage the patient to follow medication regimen as directed to fully eradicate the infectious agent.
    Encourage follow-up and prompt attention to infections in future.
    Inform patients who have children about the importance of vaccination with measles, mumps, rubella vaccine, H. influenzae type B vaccine, and pneumococcal vaccine as a preventive measure. Vaccination is recommended for children younger than school age.
  • 16. Evaluation: Expected Outcomes
    Afebrile
    Adequate urine output; CVP in normal range
    Alert LOC; normal vital signs
    Pain controlled
    Optimal level of functioning after resolution
  • 17. Ideal Nursing Management
    Nursing Diagnoses
  • 18. Nursing Interventions
    Monitored TPR q 4h
    Monitored I & O q shift
    Inserted IV line
    Regulated IVF to prescribed rate
    NGT feeding done
    Initiated seizure precautions
    Regulated O2 to prescribed rate
    TSB done for fever
    Encouraged rest periods
    Instructed SO on hand washing
    Given health teachings
    Medications given