Management For Meningitis


Published on

Management For Meningitis

  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Management For Meningitis

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