Nursing Care Plan (NCP) for Meningitis

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Outline

Pathophysiology

The meninges surround both the brain and the spinal cord to provide cushion and protection as well as create cerebrospinal fluid.  In meningitis, these meninges get infected and inflamed, causing symptoms that range from altered level of consciousness (due to inflammation in the brain) to nuchal rigidity or numbness & tingling (because of the effect on the spinal cord).

Etiology

Meningitis can be caused by bacteria or viruses, which can be introduced via the bloodstream as well as through invasive procedures or fractures of the skull.  Transmission is via droplets and usually occurs in areas of population density or crowded living spaces such as college dorms, prisons, and homeless shelters.

Desired Outcome

Treat the underlying infection, decrease inflammation and swelling in the brain, and prevent long-term neurological deficits.

Meningitis Nursing Care Plan

Subjective Data:

  • Confusion
  • Lethargy
  • Photophobia
  • Headache

Objective Data:

  • Fever
  • Increased ICP
  • Seizures
  • Nuchal rigidity

Nursing Interventions and Rationales

  • Place the patient in droplet isolation
  Meningitis is spread via droplets; therefore a mask, gown, and gloves should be worn at all times and all surfaces should be cleaned thoroughly
  • Administer analgesics and/or anti-inflammatories
  To alleviate a headache or nuchal rigidity caused by inflammation.
  • Administer antimicrobials
  Many antibiotics cannot cross the blood-brain barrier but will be given to treat any bloodstream infection. Antivirals can be given as well.
  • Assess LOC and neuro status q2-4 hours
  Inflammation of the meninges can cause irritation of the brain tissue and swelling, which can cause decreased LOC.
  • Monitor ICP and CPP if available
  If there is enough hydrocephalus or edema, providers may place an EVD for ICP monitoring. If so, monitor ICP and CPP hourly and manage EVD.
  • Initiate seizure precautions
  Inflammation of the meninges can irritate the nerves and brain tissue, leading to the development of seizures.
  • Educate patient and family on infection control measures and s/s to report to the provider
  Handwashing is imperative, considering droplet transmission. Family members should also wash their hands on the way in and out of the room. Patients should report any s/s infection

Writing a Nursing Care Plan (NCP) for Meningitis

A Nursing Care Plan (NCP) for Meningitis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Let’s create a care plan for meningitis. In meningitis, the meningiomas that surround the brain and spinal cord to provide cushion and protection, as well as to create cerebral spinal fluid, become inflamed and infected. They have symptoms that range from altered mental status level of consciousness to nuchal rigidity, which is the stiffness of the neck or numbness and tingling. Because of the effect on the spinal cord with this condition we want to consider managing the infectious disease process. Meningitis is very infectious. So we want to place these patients on droplet precautions. We want to promote comfort. We want to take care of the pain, optimize cognitive ability. We want to prevent injury as well as perform frequent neuro checks. The desired outcome for a treatment of meningitis is to treat the underlying infection. We want to decrease inflammation and swelling in the brain, as well as prevent long-term neurological deficits.

Some subjective data. So when a patient comes in, oftentimes they will come in with some confusion. They’ll be complaining of lethargy or they’ll be tired. Alright. They will also complain of headache and photophobia when it comes to some things that we will observe, meningitis patients will have a high temperature. They’ll have a fever, they’ll have increased intracranial pressure as well as there may be some seizures that are witnessed as well as nuchal rigidity or the stiffness of the neck. So what are some things that we can do as nurses? Well, we can place the patient on droplet isolation. It’s very important for this patient to be in isolation because meningitis is very infectious. So we can wear a mask gown and gloves should be worn at all times. And the surfaces in the patient’s room should be cleaned thoroughly. We want to assess their level of consciousness, and we want to just get a good idea of their neuro status every two to four hours is good for neuro checks. Inflammation of the meninges can cause irritation of the brain and cause tissue swelling, which can decrease the level of consciousness in these patients. We want to initiate seizure precautions because of that inflammation in the meninges, the nerves and brain tissues will become irritated and it can lead to the development of seizures. So what are some things that we do with seizure precautions? We want to pad the railings on the bed. We want to make sure the bed is low. We want to keep the bed at its lowest position. We want to keep eyes on the patient. So frequent monitoring. We want to keep good eyes on this patient because this patient is at high risk for seizures. We want to administer any analgesics or any anti-inflammatories we want that will help alleviate the headaches associated with meningitis or the nuchal rigidity caused by the inflammation. We want to monitor the ICP and the cerebral pressure as well. If there’s enough hydrocephalus or edema in the brain, the doctors may want to place a EVD or an external ventricular device for monitoring. If so, the ICP will be done hourly to manage it. Remember, the EVD is the external ventricular drain that drains the fluid out for the brain. 

Here are some things that we want to focus on and hone in on with our key points. Remember that in meningitis, the meninges that are around both the brain and the spinal cord become infected and inflamed. Some subjective data that the patient may present with: confusion, lethargy, photophobia, and headaches. Some things that we may observe are fever, increased intracranial pressure, and seizures. Initiate some seizure precautions. That’s number one, we want to protect the patient. We want to keep this patient safe. They are at high risk for seizures. So we want to make sure that the appropriate precautions to ensure patient safety are placed. We also want to monitor for frequent neuro checks. We want to do frequent neuro checks because we want to monitor for level of consciousness changes, subdue changes and level of consciousness can be caught early with frequent checks. We love you guys; go out and be your best self today, and, as always, happy nursing.

 

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