Question

Missy Saul, a 22-year-old female client, is experiencing a severe headache, photophobia, and has nuchal rigidity. The client has positive Kerning’s sign and Brudzinski’s s sign, which further supports the medical diagnosis of meningitis. The vital signs are T, 102°F; BP, 100/70 mm Hg; HR, 122 beats/minute; RR, 28 breaths/minute. The client is in droplet precautions because the nasal and oral secretions are infectious. The LPN/LVN needs to assist the neurologist during a lumbar puncture and send specimens to the lab to determine if the client has bacterial meningitis and to determine what antibiotics will be most effective to treat the infection.

a. What should the nurse explain to the client before the procedure?

b. Explain the nursing management needed during the procedure and after the procedure

c. What is Kerning's sign and what is Brudzinski's sign?

d. What are photophobia and nuchal rigidity? How does this relate to Meningitis?

3. Explain the difference between viral and bacterial meningitis. Which is more concerning?

Answer 1

A)1. Firstly nurse explain the proceure to the client

2. Explain the purpose of the proceure

3.Obtain informed consent

4.Instruct the client to empty the bladder prior to procedure

B) Nursing mnagement during the procedure.

1)Position the client in a lateral recumbent position and have the client draw the knees up to the abdomen and the chin onto chest

2)Assist with the collection of specimens

3)Maintain strict asepsis

Nursing management After procedure

1)Monitor vital signs and neurological signs to check the presence of csf leakage and also monitor for headache

2)Position the client flat as prescribed

3)Encourage fluid to replace csf obtained from the specimen collection

4) Monitor intake and output

C) Kernig's sign:

Loss of ability of a supine client to strengthen the leg completely when its flxed at the knee and hip ;indicates meningeal irritation

Brudzinsk's sign:

Involuntary flexion of hip and knee when the neck is passively flexed; indicates meningeal irritation

D) Photophobia:

It refers that intolerance to light.Due to meningitis meningeal irritation occur,which cause photophobia

Nuchal rigidity:

Loss of the ability to flex the neck forward due to the neck muscle rigidity.The inflammation of spinal meninges cause meningitis and the nerve fibres of dura matter got inflamed associated with neck pain and nuchal rigidity occur.

E)Bacterial meningitis:

Bacteial meningitis can be cause by various organisms ,most commonly haemophilus influenza typeb,streptococcus pneumonia or nessiera meningitidis;meningococcal meninigitis occurs in epidemic form and can be transmitted by droplets from nasopharyngeal secretions.When the bacteria invades into the blood stream and enter into the brain and spinnal cord cause bacterial meningits.

Viral meningitis:

It is associated with viruses such as mumps,paramyxovirus,herpesvirus and enterovirus.It is mostly infection of  brain and spinal cord.

When compared with both; bacterial mnenigitis is dangerous and it is life threatening infection and viral meningitis is less serious