Question

Make a nursing education plan and brochure for a patient with Bacterial meningitis

Answer 1

MENINGITIS

Meningitis is an inflammation of the lining around the brain and spinal cord caused by bacteria or viruses.

• Bacterial meningitis is caused by bacteria.
• Meningitis can be the primary reason a patient is hospitalized or can develop during hospitalization.
• Meningeal infections generally originate in one of two ways: through the bloodstream or by direct spread.
• N. meningitidis concentrates in the nasopharynx and is transmitted by secretion or aerosol contamination.
• One of the causative organism enters the bloodstream, it crosses the blood brain barrier and proliferates in the cerebrospinal fluid.
• The host immune system stimulates the release of cell wall fragments and lipopolysaccharides, facilitating inflammation of the subarachnoid and pia mater.

CAUSES OF B.MENINGITIS

• Factors that may cause bacterial meningitis include:

• Tobacco use. Tobacco use predisposes the patient to meningitis.
• Viral upper respiratory infection. Viral upper respiratory infection increase the amount of droplet production.
• Otitis media. Otitis media increase the risk of bacterial meningitis because the bacteria can cross the epithelial membrane and enter the subarachnoid space.
• Immune system deficiency. People with immune system deficiencies are also at greater risk for development of bacterial meningitis.
• Bacteria. The bacteria Streptococcus pneumoniae and Neisseria meningitides are responsible for 80% of cases of meningitis in adults, as well as Haemophilus influenzae in children.

NURSING ASSESSMENTS

Assessment of the patient with bacterial meningitis include.

• Neurologic status. Neurologic status and vital signs are continually assessed.
• Pulse oximetry and arterial blood gas values. These values are used to quickly identify the need for respiratory support.

NURSING DIAGNOSIS

Based on the assessment data, major nursing diagnoses include:

• Risk for Infection related to contagious nature of organism.
• Acute Pain related to headache, fever, neck pain secondary to meningeal irritation.
• Impaired Physical Mobility related to intravenous infusion, nuchal rigidity and restraining devices.
• Activity Intolerance related to fatigue and malaise secondary to infection.
• Risk for Impaired Skin Integrity related to immobility, dehydration, and diaphoresis.
• Risk for Injury related to restlessness and disorientation secondary to meningeal irritation.
• Interrupted Family Process related to critical nature of situation and uncertain prognosis.
• Anxiety related to treatment and risk of death.
• Risk for Ineffective Therapeutic Regimen Management

NURSING CARE PLANNING AND GOALS

Goals for a patient with bacterial meningitis include:

• Protection against injury.
• Prevention of infection.
• Restoring normal cognitive functions.
• Prevention of complications

NURSING INTERVENTIONSI

Important components of nursing care include the following measures:

• Assess neurologic status and vital signs constantly. Determine oxygenation from arterial blood gas values and pulse oximetry.
• Insert cuffed endotracheal tube (or tracheostomy), and position patient on mechanical ventilation as prescribed.
• Assess blood pressure.  (usually monitored using an arterial line) for incipient shock, which precedes cardiac or respiratory failure.
• Rapid IV fluid replacement may be prescribed, but take care not to overhydrate patient because of risk of cerebral edema.
• Reduce high fever to decrease load on heart and brain from oxygen demands.
• Protect the patient from injury secondary to seizure activity or altered level of consciousness (LOC).
• Monitor daily body weight; serum electrolytes; and urine volume, specific gravity, and osmolality, especially if syndrome of inappropriate antidiuretic hormone (SIADH) is suspected.
• Prevent complications associated with immobility, such as pressure and pneumonia.
• Institute infection control precautions until 24 hours after initiation of antibiotic therapy (oral and nasal discharge is considered infectious).
• Inform family about patient’s condition and permit family to see patient at appropriate intervals.

DISCHARGE AND HOME CARE GUIDELINES

After hospitalization, the patient at home should:

• Activities. Alternate rest and activity to conserve energy.
• Diet. Consume safe, clean, and healthy foods.
• Asepsis. Promote simple infection control procedures at home.
• Infectious process. Identify signs and symptoms of an infectious process and report to the physician promptly.