Chapter 69, Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies

Chapter69, Management of Patients With Neurologic Infections, AutoimmuneDisorders, and Neuropathies

  1. Brian Jones, a 22-year-old college student, is admitted from the emergency department to a medical-surgical unit with the diagnosis of acute bacterial meningitis. The patient presented with the following vital signs: temperature, 104°F blood pressure, 110/70 mm Hg heart rate, 100 bpm respiratory rate, 20 breaths/min. The patient presented with a severe, constant headache and nuchal rigidity. (Learning Objective 1)

  1. To what room should the charge nurse assign the patient?

TheICU, the intensive care unit. With bed rails erected.

  1. What additional signs and symptoms could a patient diagnosed with bacterial meningitis exhibit?

Someof the other clinical symptoms might be nuchal rigidity due toincreased neck muscle tone and stiffness, altered mental status (likelethargy, obtundation) as well as photophobia whereby there isintolerance to light and phonophobia (intolerance to loud noises).Some other signs may be Kernig’s sign or the Brudzinski sign as asign of meningism. Other visible signs may be signs of the foot andmouth disease as well as genital herpes.

  1. What diagnostic and lab tests are used to confirm the diagnosis of meningitis?

Whensuspected of having meningitis blood tests are performed for markersof inflammation (C-reactive protein, complete blood count) and evenblood cultures are done. In confirming meningitis the analysis of thecerebrospinal fluid through lumbar puncture, LP spinal tap is done. ACT or MRI scan can also be conducted in place of the lumbar puncture.Hereby, there may be DNA based PCR (polymerase chain reaction)amplification for better treatment or prognosis.

  1. What medical management should the nurse anticipate for the patient?

Widespectrum antibiotics after confirmation are conducted. There shouldbe benzyl-penicillin that should be administered before transfer tothe hospital. Intravenous fluids if there is a reported hypotensionor shock are present. Medical ventilation can also be done ifconsciousness is observed to be extremely low.

  1. What nursing care should be provided for the patient?

Assessmentof neurologic status and vital signs constantly, this may bedetermination of oxygenation from arterial gas values and pulseoximetry. Insertion of cuffed endotracheal tube or tracheostomy andposi-position the patient on medical ventilation. Rapid IV fluidreplacement but care should be taken not to overhydrate due to riskof cerebral edema. Monitoring of daily body weight, serumelectrolytes and urine volumes and osmolality and inform family aboutpatients conditions and permit family to see patient at appropriateintervals.

References

Glimåker,M., Johansson, B., Halldorsdottir, H., Wanecek, M., Elmi-Terander,A., Ghatan, P. H., &amp … Bellander, B. M. (2014). Neuro-IntensiveTreatment Targeting Intracranial Hypertension Improves Outcome inSevere Bacterial Meningitis: An Intervention-Control Study. PlosONE,9(3),1-9. doi:10.1371/journal.pone.0091976

InBautista, C., &amp Foster, J. (2013). Centralnervous system infections.

Li,Y., Zhang, G., Ma, R., Du, Y., Zhang, L., Li, F., &amp … Kang, X.(2015). The diagnostic value of cerebrospinal fluids procalcitoninand lactate for the differential diagnosis of post-neurosurgicalbacterial meningitis and aseptic meningitis. ClinicalBiochemistry,48(1/2),50-54. doi:10.1016/j.clinbiochem.2014.10.007