Question

Neurology Assignment 4

A previously well 16-year-old African-American young man presented to the Emergency Department (ED) with persistent vomiting, severe headaches, and decreased energy of 5 weeks duration. Five weeks earlier, the patient had presented to his pediatrician with headache and vomiting. He was treated with oral amoxicillin for presumed streptococcal pharyngitis, but the group A Streptococcus antigen test was negative. Three weeks later, he presented to a local ED with worsening nausea, vomiting, dizziness, poor oral intake, worsening headaches, neck stiffness and fever. He has a strange affect and belligerent behaviour he is also complaining of neck stiffness.

1. Outline the medical treatment of Meningitis
2. Briefly describe three (3) classes of medications used in the treatment of patients suffering from Meningitis
3. What are the nursing considerations/management
4. Develop a plan of care for this patient. Two (2) actual problems and One (1) potential problem.

Answer 1

ANSWERS:-

1) Outline the medical treatment of Meningitis-

* Antibiotics therapy- to control the multiplication of bacteria.

- Pencillins ( eg, ampicillin,piperacillin)

- Cephalospirins (eg, ceftriaxone, cefotaxime)

- Vancomycin

* Steroids - helps to reduce body's inflammatory response. Dexamethasone has been shown to be beneficial.

* Intravenous fluids to treat dehydration and shock.

* Mechanical ventilation in case of respiratory failure.

* Osmotic diuretic (mannitol) to treat increased Intra Cranial Pressure(ICP)

* Anticonvulsants (eg, phenytoin) to control seizures.

2) Briefly describe the three classes of medications used in the treatment of Meningitis-

a) Antibiotics - Broad spectrum antibiotics are given intravenously to control the multiplication of bacteria and to kill them.Antibiotics like pencillins,cephalosporins and vancomycin which is a tricyclic glycopeptide antibiotic; are used to control infection.

b) Steroids - Dexamethasone - it suppresses cell and tissue immune reactions and inflammatory process.

c) Anticonvulasants- meningeal irrigation due to infection can cause seuzures ,so anticonvulasants like phenytoin is given to control.

d) Osmotic diuretics- Increased ICP in Meningitis is treated with osmotic diuretics like mannitol.

3) Nursing considerations and management in Meningitis-

* Monitor vital signs and neurological status frequently to identify any variations immediately.

* measures to reduce fever .

* Administer IV fluids to treat dehydration and shock , maintain intake output chart.

* Monitor oxygen saturation ,patient may go to respiratory failure.

* Safety precautions to prevent injury due to seizures and irritability.

4) Plan of care-

a) Hyperthermia related to inflammation and impaired thermal regulation .

* Monitor vital signs closely.

* Provide tepid sponge to reduce temperature .

* Ensure adequate fluid intake and hydration.

* Provide adequate ventilation and remove extra clothing.

* Administer antipyretics and antibiotics as ordered.

b) Ineffective cerebral tissue perfusion related to inflammation and increased ICP ( evidenced by headache, neck rigidity).

* Monitor vital signs and neurological status.

* Observe for any changes in level of consciousness.

* Provide a calm and quiet environment free from bright light, sound etc.

* Provide 30degree head end elevation to reduce cerebral congestion and edema.

* Support the head and neck with pillows.

c) Imbalanced nutrition less than body requirement related to nausea and vomiting.

* Assess the nutritional status by checking weight

* Monitor frequency and amount of vomitus.

* Provide small and frequent feeds.

* Administer IV fluids.

* Keep NPO(Nil per oral) in case of severe nausea and vomiting.

*Monitor intake and output.

Potential problem-

a) Risk for injury related to altered neurological function

* Assess neurological functions and vital signs.

* Assess for seizure activities

* Always stay with the patient.

* Ensure safety precautions like keep bed rails , do not keep any sharp objects near the patient etc.

* Provide a calm and quiet environment.