ATI, CH5: Meningitis – Flashcards

- what is known as an inflammation of the meninges, which are the membranes that protect the brain & spinal cord?? - viral or aseptic, is the most common form & commonly resolves w/o txt. - Bacterial/Septic is a contagious infection w/ a high mortality rate. The prognosis depends on how quickly care is initiated. - a vaccine is available for high-risk populations, such as residential students.

- ensure infants receive "Haemophilus Influenzae Type B (HIB)" vaccine on schedule. - Pneumococcal Polysaccharide Vaccine (PPSV) - vaccinate adults who are immunocompromised, who have a chronic disease, who smoke cigs, or who live in a long term care facility. Give one dose to adults 65 or older who have not previously been vaccinated nor have history of disease. - Ensure that adolescents receive the "Meningococcal" vaccine (MCV4) (Neisseria meningitidis) on schedule prior to living in a residential setting in college. Individuals in other communal living conditions (military) should also be immunized.

- risk factors for what type of meningitis includes diseases such as Mumps, Measles, Herpes, Arbovirus (west Nile)

- risk factors for what type of meningitis includes infections such as Otitis Media, Pneumonia, or Sinusitis in which the infectious microorganism is "Neisseria Meningitidis, Streptococcus Pneumoniae, or Haemohilus Influenzae".

- risk factors include: *viral invasion *Bacterial Infection *Immunosuppression *Invasive procedures, skull fracture, or penetrating head wound (direct access to CSF). *Overcrowded or communal living conditions.

- Subjective Data: *Excruciating, constant headache *Nuchal Rigidity (stiff neck) *Photophobia

- Physical Assessment: *Fever & Chills *N&V *Altered LOC *Positive Kernigs sign (resistance and pain w/ extension of the pts leg from a flexed position. *Positive Brudzinski sign (flexion of extremities occurring w/ deliberate flexion of the pts neck). *Hpyeractive DTR *Tachycardia *Seizures *Red Macular Rash (Meningococcal meningitis) *Restlessness, irritability - Laboratory Tests: *Urine, throat, nose, & blood culture & sensitivity. *CBC - elevated WBC count - Diagnostic Procedures: *CSF analysis - the most definitive diagnostic procedure. collected via Lumbar puncture. Results indicative of Meningitis: #Appearance of CSF - cloudy (bacterial) or clear (Viral). #Elevated WBC #Elevated Protein #Decreased Glucose (bacterial) #Elevated CSF pressure

- Nursing Care: *Isolate the Pt as soon as meningitis is suspected. *Maintain Isolation precautions per hospital policy. *Droplet Precautions which requires private room or a room w/ cohorts, wearing of a surgical mask when w/in 3 ft of the pt, appropriate hand hygiene, & use of designated equipment, such as BP cuff & thermometer. *Implement fever reduction measures (cooling blanket). *Report Meningococcal infections to the Public Health Dpt *Decrease Environmental Stimuli: - provide quiet environment - minimize exposure to bright light *Bed rest, w/ HOB elevated 30 degrees. *Seizure precautions *Replace fluids & electrolytes as indicated by lab values. *Older adult clients are at an increased risk for secondary complications, such as pneumonia.

- Rx's for Meningitis: *Ceftriaxone (Rocephin) or Cefotaxime (Claforan). - Antibiotics given until culture & sensitivity results are available. effective for bacterial. *Phenytoin (Dilantin) - Anticonvulsants given if ICP increases or pt experiences seizure. *Acetaminophen (Tylenol), Ibuprofin (Motrin): - analgesics for headache &/or fever - non-opioid to avoid masking changes in the level of consciousness. *Ciprofloxacin (Cipro), Rifampin (Rifadin): - prophylactic antibiotics given to individuals in close contact w/ the pt

- Complication 1: *Meningitis can cause ICP to increase. - NURSING ACTIONS: *monitor for signs/sxs of increasing ICP (decreased LOC, pupillary changes, & widening pulse pressure). *Provide interventions to reduce ICP (positioning & avoidance of coughing & straining). *Mannitol can be administered IV. - Complication 2: *SIADH - NURSING ACTIONS: *monitor for signs/sxs (dilute blood, concentrated urine). *provide Interventions, such as the administration of Demeclocycline (Declomycin) & restriction of fluid. - Complication 3: *Septic Emboli (leading to disseminated Intravascular coagulation or cardiovascular accident). - can form during meningitis & travel to other parts of the body, particularly the hands. - development of 'Gangrene' will necessitate amputation. - NURSING ACTIONS - *monitor Circulatory status of extremities & coagulation studies. *Report any alteration immediately to the provider.