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) before procedure -

Explain the procedure to patients , the purpose of it ,how and where it is done and by whom it is done

Advice the patient that fasting is not necessary

Take informed consent

Inform patient to empty the bladder and bowel before procedure

Check vital signs and neurological assessments

Ask the patient to be in lateral decubitus postion near the side of the bed with the neck ,hip , knees drawn up to the chest

Ask patient to remain in the same position throughout the procedure

B) During procedure - support the patient postion throughout the procedure and it requires sterile conditions as it a aseptic procedure

After procedure -

apply brief pressure to the punture site to prevent bleeding and it is covered by dressing or band aid

Place the patient on bed

Monitor vital signs , neurological checks intake and output  

Monitor punture site for Signs of leakage ,and drainage of blood

Encourage fluid intake

Label and number the specimen tube correctly

Adminster the analgesia as ordered

C) kernig sign - patient is positioned in supine position with hip and knee flexed to 90 degrees

Knees extended slowly by the examiner , resistance or pain in extension of knee beyond 30 degrees indicates positive kernig sign

Brudzinski sign - gently gasp the patient head from back and place other hand on chest

Gently flex the neck and try to bring the chin to chest region

Postive sign is involuntary flexion of hip and knee

4 . Photophobia - discomfort caused by light in eye , sunlight, flourescent light ,incandasent light all can cause Discomfort and need to close your eyes

Neuchal rigidity - sensation of soreness or discomfort in the neck when trying to move it

As the meningitis effect the brain and the spinal membrane it will effect the neurological process which results in photophobia

Neuchal rigidity is a sign of meningitis it due to inability of neck to move due to inflammation of meninges

5 ) to tell the difference between viral and bacterial meningitis CSF diagnosis is necessary

Bacterial meningitis CSF as more white blood cells , protien and low glucose than viral meningitis

Bacterial meningitis is more concerned than viral as viral is not fatal