Streptococcus pneumoniae Bacterial Meningitis

Resources

Nursing Diagnosis 4

Nursing Diagnosis 3

Brouwer, M. C., Tunkel, A. R., & van de Beek, D. (2010). Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis. Clinical Microbiology Reviews, 23(3), 467–492.

Caple, C., & Schub, T. (2015). Meningitis, Bacterial. Quick Lesson, 1-2.

Center for Disease Control (2014, April 1). Bacterial Meningitis. Retrieved from http://www.cdc.gov/meningitis/bacterial.html

Donovan, C., & Blewitt, J. (2010). Signs, symptoms and management of bacterial meningitis. Paediatric Nursing, 22(9), 30-36.

Edmond, K., Clark, A., Korczak, V.S., Sanderson, C., Griffiths, U.K., & Rudan, I. (2010). Global

and regional risk of disabling sequelae from bacterial meningitis: A systematic review and meta-analysis. The Lancet Infectious Diseases, 10(5), 317–328.

Immunization Action Coalition Pneumococcus: Questions and Answers Information about the disease and vaccines. (2014, October 1). Retrieved from http://www.immunize.org/catg.d/p4213.pdf

Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2011). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. (8th ed., p. 1452). St. Louis, MO: Elsevier/Mosby.

Statistics and Disease Facts - NMA. (n.d.). Retrieved September 11, 2015, from http://www.nmaus.org/disease-prevention-information/statistics-and-disease-facts/

Swearingen, P. (2012). All-in-One Care Planning Resource: Medical-surgical, Pediatric, Maternity, & Psychiatric Nursing Care Plans (3rd ed.). St. Louis, MO: Elsevier/Mosby.

Thigpen, M., Whitney, C., Messonnier, N., Zell, E., Lynfield, R., Hadler, J., & Schuchat, A.

(2011). Bacterial meningitis in the united states, 1998-2007. The New England Journal of

Medicine, 364(21), 2016-25.

Tortora, G., Funke, B., & Case, C., (2013). Microbiology: An Introduction (8th ed.). Boston, MA: Pearson.

Woehrl, B., Klein, M., Grandgirard, D., Koedel, U., & Leib, S. (2011). Bacterial meningitis: Current therapy and possible future treatment options. Expert Review of Anti-infective Therapy, 1053-1065.

Self-care deficit related to impaired mental status as evidence by disheveled appearance (Swearington, 2012).

Deficient knowledge related to unfamiliarity with rationale and procedure for droplet precaution as evidenced by client not wearing facemask in presence of visitors (Swearingen, 2012).

Goals

Interventions

Goals

Interventions

Patient is able to perform self-care activities.

• ST: Within 12 hours of admittance, patient will verbalize understanding of self care goals; self bathing, oral hygiene, planned use of assistive devices to complete ADLs.
• Within 24 hours of discharge, patient performs self care activities and demonstrates ability to use adaptive devices for successful completion of ADLs.

• Assess patient to perform ADLs.
• Demonstrate the use of adaptive devices such as long handed combs, brushes, eating utensils, electric toothbrushes, and razors to complete ADLs.

• Assess patient knowledge based and explain the method of disease transmission via respiratory droplets generated by the patient. Explain that coughing, sneezing, talking, performance of cough inducing procedures, and contact with oral secretions present risk of transmission and require droplet precaution.
• Instruct patient on proper droplet precaution behavior; hand hygiene, cover mouth when coughing, sneezing or talking, adorn appropriate face mask upon leaving room or within close proximity of unaffected persons.

Before visitation patient and family verbalize knowledge about the rationale for transition based precaution droplet and prescribed restrictions and precautionary measures.

• ST: Patient and family verbalize knowledge of required personal protective equipment required for entrance into patient's room
• LT: All visitors adorn appropriate precautionary personal protective equipment prior to entering patient room.

Holly Hamilton

Justine Kinzel-Eckman

Brier Roukema

Alyssa Vasquez

Nursing Diagnosis 2

Deficient knowledge related to unfamiliarity with side effects and precautions for prescribed antibiotics as evidence by initial diagnosis (Swearingen, 2012).

Case Study

Goals

Interventions

Disease Process

Before beginning medication regimen patient and family verbalize knowledge about potential side effects and precautions for antibiotics prescribed.

• ST: Patient verbalizes understanding of prescribed medication side effects prior to medication administration.
• LT: Patient reports compliance with prescribed medication regimen and reports any adverse effects experienced.

• Assess patient and family health care literacy, culture, culturally specific information needs.
• Teach patient about prescribed antibiotic and medication therapy.

Purulent Exudate on Brain Matter

• Jack Andrews, 36, white male, 86 kg
• Has Stage II testicular cancer, undergoing chemotherapy treatment
• 9th grade school teacher
• Fast onset of symptoms (stiff neck, SOB, photophobia, etc.)

• Organism gains entry to the CNS through upper

respiratory tract or bloodstream

• May also enter by direct extension from penetrating wounds

of the skull or through fractured sinuses in basal skull

fractures

• Inflammation leads to increased pressure within the skull
• Flow of blood to the brain becomes slowed or blocked, which subsequently results in diminished oxygen and nutrients reaching the brain
• Purulent secretions spread to other areas of the brain through the CSF and cover cranial nerves and other intracranial structures
• Ultimately, this disease has the potential to result in death

or permanent disability

• If bacterial meningitis is suspected, prompt diagnosis

and immediate medical treatment are necessary.

Nursing Diagnosis 1

Acute pain related to photophobia, headache, nuchal rigidity as evidence by patient subjective pain report of 9 on 1-10 pain scale (Swearingen, 2012).

Interventions

Goals

• Assess patient for pain and discomfort using appropriate pain scale.
• Provide quite environment, darkened room, eyewear, and restrict visitors as necessary.
• Support patient in a comfortable position while keeping neck aligned during position changes.
• Promote bed rest and assist patient with activities of daily living as needed.
• Provide gentile, passive range of motion exercises and movements. If patient is afebrile, apply moist heat to neck and back.

• ST: patient will report less than 5 on pain scale as result of pain managment intervention.
• LT: Patient will report less than 2 on pain scale by discharge.

Risk Factors

• Age
• Medical conditions
• Close contact
• Lack of vaccination status
• Compromised immune

Streptococcus pneumoniae Bacterial Meningitis

Diagnostic tests

• Head CAT scan with contrast or MRI image with gadolinium
• Lumbar puncture for CSF analysis
• Blood cultures

Signs & Symptoms

Introduction

Treatment

• Severe Headache
• Nausea
• Vomiting
• Diarrhea
• Nochal rigidity
• Photophobia
• Impaired mental status
• Neurologic dysfunction

Infection of Meninges

• Disease caused by inflammation of the protective meninges that cover the brain and spinal cord
• Infectious meningitis
• Noninfectious meningitis
• H. influenzae, S. pneumoniae, L. moncoctyogenes, or N. meningitidis

• Pneumococcal conjugate vaccine (PCV13) <5 years old or >65 years old
• Pneumococcal polysaccharide vaccine (PPSV23) adults >65 years old or those <65 years old with risk factors
• 2 g IV Rocephin (Ceftriaxone) q12 hours
• 2 g IV Vancocin (Vancomycin) q12 hours
• IV isotonic 0.9% normal saline
• 10 mg IV Decadron (dexamethasone) (initial dose) tapering to 4 mg IV q6 hours
• 500 mg capsule Dilantin (Phenoytoin) PO q4-6 hours