Meningitis: Management and Care (Nursing)

00:01 Now, we're going to move to the management of meningitis.

00:03 Now, we've had the lumbar puncture, we talked about where it is, and where the needles inserted, and what your role is when you're sitting in this procedure.

00:11 So, now we're trying to find the exact cause of the meningitis.

00:16 So, once we know that we can decide how we're what we need to do to treat the cause.

00:22 So, for example, if it's a bacterial meningitis, they're going to have to have antibiotics.

00:28 Once CSF analysis is done, we can kind of tweak which antibiotics that might be best to kill that infection.

00:36 But if it's bacterial, we can treat it with antibiotics.

00:40 Now, remember, if it is a viral meningitis, you don't need to treat the cause but the symptoms.

00:46 So, we don't have an antiviral that can treat this.

00:49 So, we need to make sure that we treat the symptoms as much as possible.

00:53 We only give antibiotics in the case of a bacterial meningitis.

00:57 And so that's why a lumbar puncture is so important.

01:00 So, we know for sure which type we're dealing with.

01:03 Now, of course, the antibiotics are IV because we want to get those into the bloodstream right away.

01:08 But something else I want you to keep in mind, you'll notice this is a red slide.

01:12 And we did that for you in this presentation to help you remember, this is really important.

01:17 Patients with meningitis will most often receive IV fluids.

01:21 Now, our goal there is we're putting volume right into their intravascular space, right into their veins.

01:28 So likely, whether it's viral or bacterial, the patient may receive IV fluids to help keep that intravascular volume up, because we want to maintain a safe blood pressure.

01:40 Now these patients are also at risk to become septic.

01:43 And whenever a patient is septic, they can risk septic shock.

01:47 We definitely want to avoid that at all costs.

01:50 Now, some other medications that we might consider.

01:52 Remember, meningitis is involving that brain and they have a headache.

01:57 And remember, they had a fever, and he was sweating, which is why the physician or the nurse practitioner may consider an anticonvulsant.

02:05 That's a group of medication that's prevents seizures.

02:09 Remember, you got all this inflammation going on in the layers that surround the brain that puts them at risk to have seizures.

02:16 So, anticonvulsants may be considered.

02:18 Analgesics for the headache, they might also give antipyretics which are for the fever.

02:25 So, really, what I want to encourage you is don't memorize lists.

02:29 I want you to be thinking through.

02:31 Okay, look, she's got three drug groups up there.

02:34 I'm just going to memorize their AAA.

02:36 That's one way you could do it.

02:38 But think about what you know this patient is going through and say, why would they give an anticonvulsant? Why would they give an analgesic? Why would they give an antipyretic? That's going to help your brain latch on to those concepts and be able to recall them when you need them.

02:53 Like let's say on a test or an actual patient care.

02:59 Now, when it comes to nursing care, these are some things that you need to keep in mind.

03:03 Remember, this patient has a headache and things are a pain, they might be photophobic.

03:08 So what type of environment would they need? Well, they need an environment that's quiet.

03:15 We want low light, You also want to elevate the head of the bed.

03:21 Now, when you elevate the head of a patient's bed, what that does is help reduce the pressure inside their head.

03:27 I already have inflamed meninges, anything you can do to reduce the pressure in my head, that's a fantastic thing.

03:35 Because it's going to promote venous drainage from the head.

03:39 And when you promote venous drainage, you're going to reduce the cerebral congestion and edema.

03:45 So, that's a lot of words. But let me go back through that I have the head of the bed elevated, because I want to promote good drainage from the head.

03:56 So we lower the risk of the patient having cerebral edema, and an intracranial pressure that's elevated to the point that could cause damage or harm to the brain.

04:07 Now, let's take a look at their neurological status.

04:09 I love that picture that image of the brain there, you see we've got a magnifying scope on that, because we're thinking about what is going on with this patient.

04:18 Now, when I have cared for a patient who had meningitis, the family was the first one to pick up that they were not right.

04:26 Something was not going on right.

04:28 They could answer the right questions for me, but the family who knew that client knew their personality, they were the first ones to know something is not right.

04:37 You'll also do the traditional things like are you oriented? Who is the President? Can you squeeze my hands? But keep in mind, oftentimes, the first sign of a problem is more of a personality change than an obvious neuro status change.

04:52 Another red sign I want you to be on the lookout for.

04:55 If you see the patient's systolic blood pressure go up, and you see their diastolic blood pressure go down, this is a bad sign.

05:04 That means we've got some pretty significant increase in the intracranial pressure.

05:08 So, be on the lookout for that simple change in vital signs.

05:12 Thanks for hanging in with me throughout this whole video on meningitis.

05:16 We've looked at the causes, whether they're infectious or noninfectious.

05:20 We've looked at the ways we can diagnose it, where you can even do some super cool assessments, and we do some more serious things like a lumbar puncture, or CBC.

05:28 We gave you the options for treatment.

05:30 Antibiotics, if it's bacterial.

05:31 Otherwise, we're just treating the symptoms.

05:34 Watch out for things like seizures or pain.

05:36 Now, the signs and symptoms of meningitis, you're going to need to go back and review those.

05:41 Now, this is when it's going to pay off for you big on exams.

05:45 And what I care about most is on patient care.

05:48 So, I'm going to use the model from what you take on the NCLEX.

05:52 Now, see, you're supposed to be able to recognize cues and you'll see those in exam questions.

05:56 So think about what the cues are for meningitis.

06:01 Well, those are all the things the patient might report to you, Or they might say to you, or you might observe.

06:06 Next, step is analyzing.

06:09 Remember, we talked about all the symptoms of meningitis? Will you put those together to make a big picture overview of what's going on with your patient.

06:18 Now, there's some weird ones, right? Like the nuchal rigidity, and the headache with the light sensitivity.

06:24 And those are things that start to make you think that this patient could have meningitis.

06:28 Once we put all those together, you're going to prioritize your hypothesis.

06:32 What do you think is going on? Now, well, you're not the person that will, as an RN, prescribe antibiotics or do the lumbar puncture, you as the RN are the one who sees the patient first, most often.

06:46 And the quicker you can put these cues together, you're going to have a better outcome for your patient.

06:51 Because once you figure out, this is what I think is going on, you're going to generate a solution.

06:56 What should we do next? you're going to take that step, and then evaluate what you've done.

07:01 Now, if you're saying, I'm not ever going to have to do this, I plan on doing blank kind of nursing.

07:06 This is how great nurses think.

07:09 They know the cues, they recognize them, they analyze them, they put together, they have an idea of what is not normal about this patient's experience.

07:18 They figure out what the next important step should be.

07:21 They take it along with the healthcare team, and they make sure the patient is progressing and moving towards health.

07:27 You are completely capable of doing that.

07:30 So, spend some time, go back in the videos.

07:32 Think through this framework of what you would do in an actual setting with a patient who you find with meningitis.