Which actions can the nurse take to decrease environmental stimuli for a patient with bacterial meningitis?
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Assessment sabado 1.A home health nurse is providing teaching about post seizure management to the parents of a school age child who has epilepsy and experiences tonic-clonic seizures. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) "Hyperextend your child's head for 5 minutes following a seizure." "Immediately following a seizure, give your child 6 ounces of water." "Following a seizure, record the length and characteristics of your child's seizure." "Administer rectal diazepam to your child following a seizure." "Call for emergency medical services if the size of your child's pupils are unequal after a seizure." 2.A nurse in a pediatric clinic is discussing the pathophysiology of Reye syndrome with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicate an understanding of the disorder? "Reye syndrome causes fatty changes in the liver." "Reye syndrome leads to venous thrombus formation." "Reye syndrome is associated with misuse of acetaminophen." "Reye syndrome is linked to decreased serum ammonia levels 3.A nurse is teaching the parents of a toddler about strategies to manage temper tantrums. Which of the following instructions should the nurse include in the teaching? "Honor the child's request if she holds her breath." "Establish a structured daily routine for the child." "Place the child in her room alone until the temper tantrum ends." "Comfort the child during the temper tantrum." 4.A nurse is completing an assessment following suctioning of a child who has a tracheostomy. Which of the following findings should the nurse identify as an indication that the procedure has been effective? Increased respiratory rate Meningitis Nursing Care Plans Diagnosis and InterventionsMeningitis NCLEX Review and Nursing Care Plans Meningitis is a disease that involves the inflammation of the membranes that surround the brain and spinal cord, known as meninges. The inflammation may be due to viral, bacterial, fungal or parasitic infections, but most cases in the U.S. are due to viruses. Meningitis may develop as a complication of spinal lumbar surgery, although this is very rare. Meningitis affect both newborn babies and older people. Meningitis may lead to serious complications if left untreated. Signs and Symptoms of MeningitisChildren age 2 and above, as well as adults may have the following:
Below age 2, infants and newborns may experience:
Causes and Risk Factors of MeningitisBacterial meningitis is caused by the spread of bacteria into the bloodstream until they reach the central nervous system. It may also happen when the bacterial pathogens directly infect the meninges, such as in skull fracture, sinus or ear infection. Streptococcus pneumoniae or pneumococcus bacteria are the most common cause of bacterial meningitis in the U.S. Meningococcus that originate from an upper respiratory tract infection into the bloodstream may travel to the brain and cause meningococcal meningitis. Tuberculous meningitis may occur if Mycobacterium tuberculosis travels usually from the lungs via the blood stream and invades the meninges. Bacterial meningitis is contagious via respiratory route. On the other hand, enteroviruses are the most common cause of viral meningitis. HIV and herpes simplex virus may also cause this. Chronic meningitis, which develops over 2 weeks or more, is rare and is usually caused by fungi. One of the risk factors that contribute to the development of meningitis includes the failure to complete vaccinations that protect against preventable meningitis, such as meningitis caused by the Hemophilus influenzae bacteria. Age is also a factor, as children below 5 years old are more susceptible to viral meningitis, while bacterial meningitis is more common in young children and teens age 20 and below. Pregnancy, weakened immune systems, and living in crowded places increase the risk of having meningitis. Complications of MeningitisThe complications of meningitis may be life-threatening, especially that of bacterial meningitis. These are usually associated with neurological functioning. Some of the complications of meningitis include seizures, brain damage, kidney failure, hearing loss, learning disabilities, gait problems, memory difficulty, shock, or death.
Treatment for Meningitis
Nursing Diagnosis for MeningitisMeningitis Nursing Care Plan 1Nursing Diagnosis: Ineffective Tissue Perfusion (Cerebral) related to cerebral edema and increased intracranial pressure (ICP) secondary to meningitis as evidenced by drowsiness, hallucinations, and hypercapnia Desired Outcome: The patient will maintain cerebral tissue perfusion as evidenced by increased level of consciousness (i.e. awake and alert) and will have an oriented with persons, places, and things.
Meningitis Nursing Care Plan 2Nursing Diagnosis: Hyperthermia related to infective process of bacterial meningitis as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse. Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
Meningitis Nursing Care Plan 3Acute Pain Nursing Diagnosis: Acute Pain related to meningeal inflammation and elevated intracranial pressure secondary to meningitis as evidenced by stiffness in the neck, migraine, anxiety, and nuchal tightness. Desired Outcomes:
Meningitis Nursing Care Plan 4Disturbed Sensory Perception Nursing Diagnosis: Disturbed Sensory Perception related to reduced level of consciousness, elevated intracranial pressure, cerebral inflammation, and hydrocephalus secondary to meningitis as evidenced by the altered sensorium or nerve system. Desired Outcomes:
Meningitis Nursing Care Plan 5Risk for Injury Nursing Diagnosis: Risk for Injury related to modified neurological regulatory function, disorientation, and restlessness secondary to meningitis. As a risk nursing diagnosis, Risk for injury is not correlated with any signs and symptoms because it has not yet developed in the patient, and safety precautions will be undertaken instead. Desired Outcome: The patient will be knowledgeable enough on avoiding injury and how to manage it if it occurs unexpectedly.
More Nursing Diagnoses for Meningitis:
Nursing ReferencesAckley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon Disclaimer: Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. What is the priority nursing action for bacterial meningitis?A major priority of nursing care for a child suspected of having meningitis is to administer the prescribed antibiotic as soon as it is ordered. The child is also placed on respiratory isolation for at least 24 hours while culture results are obtained and the antibiotic is having an effect.
What are the nursing interventions for meningitis?Ineffective Tissue Perfusion (Cerebral). What precautions are taken with clients with bacterial meningitis?What infection control precautions are required? Meningococcal meningitis patients should be placed on droplet precautions (private room, mask for all entering the room) until they have completed 24 hours of appropriate antibiotic therapy. Negative pressure ventilation is not required.
What steps can be taken to help reduce the risk of contracting and spreading meningitis?Prevention. Wash your hands. Careful hand-washing helps prevent the spread of germs. ... . Practice good hygiene. Don't share drinks, foods, straws, eating utensils, lip balms or toothbrushes with anyone else. ... . Stay healthy. ... . Cover your mouth. ... . If you're pregnant, take care with food.. |