1. Diagnostic tests for meningitis include lumbar puncture, CBC, chest x-ray, and MRI/CT scan to identify the infecting organism and rule out other causes. 2. Treatment involves IV antibiotics for 2+ weeks along with dexamethasone, mannitol, anticonvulsants, and supportive care like hydration and fever control. 3. Nursing management focuses on monitoring for increased ICP, maintaining fluid balance, reducing fever and pain, and educating on prevention and follow up care.

1. Management for MeningitisReynel Dan L. Galicinao

2. Ideal Medical ManagementDiagnostic EvaluationComplete blood count (CBC) with differential - detect an elevated leukocyte count in bacterial and viral meningitisLumbar 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. Treatmentteam effort with nursing, infectious diseases specialists, neurology, internal medicine, and otolaryngology specialists, and laboratory and diagnostic staffAntibiotic therapy and vigorous supportive careUsually, I.V. antibiotics are given for at least 2 weeks, followed by oral antibioticsampicillin, cefotaxime, ceftriaxone, and nafcillinDexamethasone (Decadron) - as adjunctive therapy Mannitol - to decrease cerebral edemaAnticonvulsant (usually given I.V.) or a sedative - to reduce restlessnessAspirin or acetaminophen - to relieve headache and fever

5. Supportive measures consist of bed rest, hypothermia, and fluid therapy to prevent dehydrationIsolation - if nasal cultures are positiveTherapy for any coexisting conditions, such as endocarditis or pneumoniaTemozolomide (Temodar) - neoplastic meningitisCochlear 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 immunosuppressionAntifungal agents - for cryptococcal meningitisEmpiric antituberculosis drugs must be initiated if infection by Mycobacterium tuberculosis is suspected

6. Actual Medical ManagemnetDiagnostic EvaluationHematologyChest X-ray (APL)IVFD5 0.3 NaCl 500cc @ 30cc/hrD5 IMB 500cc @ 20cc/hrNasogastric tube – for feedingO2 inhalation 2-3 L/min via cannula

7. MadicationsRanitidine 6 mg IVTT q 8hCeftriaxone (Medzef) 600 mg IVTT q 24h ANST (-)Dexamethasone 0.75 mg IVTT q 6hPhenobarbital 60mg IVTT nowPen G 300,000 IU IVTT q 6h ANST (-)Furosemide 6 mg IV now

8. Ideal Nursing ManagementNursing AssessmentObtain a history of recent infections such as upper respiratory infection, and exposure to causative agentsAssess neurologic status and vital signsEvaluate for signs of meningeal irritationAssess sensorineural hearing loss (vision and hearing), cranial nerve damage (eg, facial nerve palsy), and diminished cognitive function.

9. Ideal Nursing DiagnosesAcute pain related to meningeal irritationAnxietyHyperthermia related to the infectious process and cerebral edemaImpaired gas exchange Impaired Physical Mobility related to prolonged bed restIneffective Tissue Perfusion (cerebral) related to infectious process and cerebral edemaRisk for deficient fluid volume related to fever and decreased intakeRisk for impaired skin integrity

10. Key outcomesThe patient will express feelings of comfort and relief of painidentify strategies to reduce anxietyexhibit temperature within normal rangemaintain adequate ventilation and oxygenationmaintain fluid volume within normal rangeHave skin integrity remain intact

11. Ideal Nursing InterventionsReducing FeverAdminister 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 BalancePrevent I.V. fluid overload, which may worsen cerebral edema.Monitor intake and output closely.Monitor CVP frequently.

12. Enhancing Cerebral PerfusionAssess 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 neuroimagingNotify the health care provider of signs of deterioration: increasing temperature, decreasing LOC, seizure activity, or altered respirations.Reducing PainAdminister 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 FunctioningImplement 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 ConsiderationsPrevent 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 MaintenanceAdvice 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 OutcomesAfebrileAdequate urine output; CVP in normal rangeAlert LOC; normal vital signsPain controlledOptimal level of functioning after resolution

17. Ideal Nursing ManagementNursing Diagnoses

18. Nursing InterventionsMonitored TPR q 4hMonitored I & O q shiftInserted IV lineRegulated IVF to prescribed rateNGT feeding doneInitiated seizure precautionsRegulated O2 to prescribed rateTSB done for feverEncouraged rest periodsInstructed SO on hand washingGiven health teachingsMedications given