Buy a Nursing essay from nursingessays.us

Left your Nursing Assignment to the last minute? Let a qualified expert do your Nursing essay for you and deliver it before your deadline!

9.8
Buy Nursing essay Papers
Calculate your paper price
Pages (550 words)
Approximate price: -

Meningitis


Grace, a 5-year old, has been ill with fever for three days already, and it just grows worse as days passed despite the medications. She has started feeling stiffness on her neck, and has been lethargic for most hours of the day. Her mother brought her to the Emergency Department, and after assessment and diagnostic tests, Grace was diagnosed with Meningitis.

Description


Infections of the central nervous system (CNS) can be divided into two broad categories: those primarily involving the meninges (meningitis; see the image below) and those primarily confined to the parenchyma (encephalitis).

Meningitis is a clinical syndrome characterized by inflammation of the meninges, the three layers of membranes that enclose the brain and spinal cord. These layers consist of the following:

  • Dura – A tough outer membrane.
  • Arachnoid – A lacy, weblike middle membrane.
  • Subarachnoid space – A delicate, fibrous inner layer that contains many of the blood vessels that feed the brain and spinal cord.

Anatomically, meningitis can be divided into inflammation of the dura (sometimes referred to as pachymeningitis), which is less common, and leptomeningitis, which is more common and is defined as inflammation of the arachnoid tissue and subarachnoid space.

Pathophysiology


Most cases of meningitis are caused by an infectious agent that has colonized or established a localized infection elsewhere in the host.

  • The organism invades the submucosa at these sites by circumventing host defenses (eg, physical barriers, local immunity, and phagocytes or macrophages).
  • Invasion of the bloodstream and subsequent seeding is the most common mode of spread for most agents.
  • Meningeal seeding may also occur with a direct bacterial inoculate during trauma, neurosurgery, or instrumentation.
  • The blood-brain barrier can become disrupted; once bacteria or other organisms have found their way to the brain, they are somewhat isolated from the immune system and can spread.
  • When the body tries to fight the infection, the problem can worsen; blood vessels become leaky and allow fluid, WBCs, and other infection-fighting particles to enter the meninges and brain;this process, in turn, causes brain swelling and can eventually result in decreasing blood flow to parts of the brain, worsening the symptoms of infection.
  • Replicating bacteria, increasing numbers of inflammatory cells, cytokine-induced disruptions in membrane transport, and increased vascular and membrane permeability perpetuate the infectious process in bacterial meningitis.

Statistics and Incidences


The incidence of meningitis varies according to the specific etiologic agent, as well as in conjunction with a nation’s medical resources.

  • With almost 4100 cases and 500 deaths occurring annually in the United States, bacterial meningitis continues to be a significant source of morbidity and mortality; the annual incidence in the United States is 1.33 cases per 100,000 population.
  • The incidence of neonatal bacterial meningitis is 0.25-1 case per 1000 live births.
  • In addition, the incidence is 0.15 case per 1000 full-term births and 2.5 cases per 1000 premature births.
  • N meningitidis causes approximately 4 cases per 100,000 children aged 1-23 months.
  • The risk of secondary meningitis is 1% for family contacts and 0.1% for daycare contacts.
  • The rate of meningitis caused by S pneumoniae is 6.5 cases per 100,000 children aged 1-23 months.
  • Newborns are at highest risk for acute bacterial meningitis.
  • After the first month of life, the peak incidence is in infants aged 3-8 months.

Causes


Causes of meningitis include bacteria, viruses, fungi, parasites, and drugs (eg, NSAIDs, metronidazole, and IV immunoglobulin [IVIg]).

  • Bacteria. S pneumoniae, a gram-positive coccus, is the most common bacterial cause of meningitis.
  • Viruses. Enteroviruses account for of the majority of cases of aseptic meningitis in children; the nonpolio enteroviruses (NPEVs) account for approximately 90% of cases of viral meningitis in which a specific pathogen can be identified; the mumps virus is the most common cause of aseptic meningitis in unimmunized populations, occurring in 30% of all patients with mumps.
  • Fungi. Cryptococcus neoformans is an encapsulated, yeastlike fungus that is ubiquitous; Coccidioides immitis is a soil-based, dimorphic fungus that exists in mycelial and yeast (spherule) forms; lastomyces dermatitidis is a dimorphic fungus that has been reported to be endemic in North America (eg, in the Mississippi and Ohio River basins).
  • Parasite. Angiostrongylus cantonensis, the rat lungworm, can cause eosinophilic meningitis (pleocytosis with more than 10% eosinophils) in humans; Gnathostoma spinigerum, a GI parasite of wild and domestic dogs and cats, may cause eosinophilic meningoencephalitis; Gnathostoma spinigerum, a GI parasite of wild and domestic dogs and cats, may cause eosinophilic meningoencephalitis.

Clinical Manifestations


Only about 44% of adults with bacterial meningitis exhibit the classic triad of fever, headache, and neck stiffness.

  • Fever. The patient presents with fever at first, which ultimately grow worse.
  • Seizures. As bacterial meningitis progresses, patients of any age may have seizures (30% of adults and children; 40% of newborns and infants).
  • Neck stiffness. The patient feels stiffness of the neck as part of the triad of symptoms.
  • Positive Kernig’s sign. When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended.
  • Positive Brudzinski’s sign. When the patient’s neck is flexed, flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity.
  • Neurologic symptoms. Patients with subacute bacterial meningitis and most patients with viral meningitis present with neurologic symptoms developing over 1-7 days.
  • High-pitched cry. Infants may present with high-pitched crying.
  • Lethargy. An infant may appear only to be slow or inactive, or be irritable.
  • Photalgia (photophobia). Discomfort when the patient looks into bright lights.

Assessment and Diagnostic Findings


The diagnostic tests in patients with clinical findings of meningitis are as follows:

  • Lumbar puncture. In general, whenever the diagnosis of meningitis is strongly considered, a lumbar puncture should be promptly performed; examination of the cerebrospinal fluid (CSF) is the cornerstone of the diagnosis.
  • CT scan. A screening computed tomography (CT) scan of the head may be performed before LP to determine the risk of herniation.
  • Blood studies. In patients with bacterial meningitis, a complete blood count (CBC) with differential will demonstrate polymorphonuclear leukocytosis with a left shift.
  • Chest radiography. As many as 50% of patients with pneumococcal meningitis also have evidence of pneumonia on initial chest radiography.
  • Cultures and bacterial antigen testing. The utility of cultures is most evident when LP is delayed until head imaging can rule out the risk of brain herniation, in which cases antimicrobial therapy is rightfully initiated before CSF samples can be obtained.
  • Serum procalcitonin testing. increasing data suggest that serum procalcitonin (PCT) levels can be used as a guide to distinguish between bacterial and aseptic meningitis in children.

Medical Management


Management of the patient includes:

  • Crystalloid infusion. If the patient is in shock or hypotensive, crystalloid should be infused until euvolemia is achieved.
  • Seizure precautions. If the patient’s mental status is altered, seizure precautions should be considered, seizures should be treated according to the usual protocol, and airway protection should be considered.
  • IVT and oxygen administration. If the patient is alert and in stable condition with normal vital signs, oxygen should be administered, intravenous (IV) access established, and rapid transport to the emergency department (ED) initiated.

Pharmacologic Management

Begin empiric antibiotic coverage according to age and presence of overriding physical conditions.

  • Sulfonamides. Trimethoprim and sulfamethoxazole work together to inhibit bacterial synthesis of tetrahydrofolic acid.
  • Tetracyclines. Tetracyclines inhibit protein synthesis and, therefore, bacterial growth by binding with 30S and possibly 50S ribosomal subunits of susceptible bacteria.
  • Carbapenems. Carbapenems inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins; carbapenems, including meropenem, can be used for the treatment of meningitis.
  • Fluoroquinolones. Fluoroquinolones inhibit bacterial DNA synthesis and, consequently, growth by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material.
  • Glycopeptides. Vancomycin inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization; it is indicated for many infections caused by gram-positive bacteria.
  • Aminoglycosides. Aminoglycosides primarily act by binding to 16S ribosomal RNA within the 30S ribosomal subunit; they have mainly bactericidal activity against susceptible aerobic gram-negative bacilli.
  • Cephalosporins, 3rd generation. Third-generation cephalosporins are less active against gram-positive organisms than first-generation cephalosporins are; they are highly active against Enterobacteriaceae, Neisseria, and H influenzae.
  • Antivirals. Antiviral agents interfere with viral replication; they weaken or abolish viral activity; they can be used in viral meningitis.
  • Systematic antifungals. Antifungal agents are used in the management of infectious diseases caused by fungi.
  • Vaccines, inactivated. Inactivated bacterial vaccines are used to induce active immunity against pathogens responsible for meningitis.
  • Corticosteroids. The use of steroids has been shown to improve overall outcome for patients with certain types of bacterial meningitis, such as H influenzae, tuberculous, and pneumococcal meningitis.
  • Osmotic diuretics. Mannitol may reduce subarachnoid-space pressure by creating an osmotic gradient between CSF in the arachnoid space and plasma.
  • Loop diuretics. Furosemide is a loop diuretic that increases the excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule.
  • Anticonvulsants. Anticonvulsants are used to help aggressively control seizures (if present) in acute meningitis, because seizure activity increases ICP.

Nursing Management


Nursing management of the patient with meningitis include the following:

Nursing Assessment

Assessment of the patient with bacterial meningitis include.

  • Neurologic status. Neurologic status and vital signs are continually assessed.
  • Pulse oximetry and arterial blood gas values. These values are used to quickly identify the need for respiratory support.

Nursing Diagnosis

Based on the assessment data, major nursing diagnoses include:

Nursing Care Planning & Goals

Main Article: 7 Meningitis Nursing Care Plans

Goals for a patient with bacterial meningitis include:

  • Protection against injury.
  • Prevention of infection.
  • Restoring normal cognitive functions.
  • Prevention of complications.

Nursing Interventions

Important components of nursing care include the following measures:

  • Assess neurologic status and vital signs constantly. Determine oxygenation from arterial blood gas values and pulse oximetry.
  • Insert cuffed endotracheal tube (or tracheostomy), and position patient on mechanical ventilation as prescribed.
  • Assess blood pressure (usually monitored using an arterial line) for incipient shock, which precedes cardiac or respiratory failure.
  • Rapid IV fluid replacement may be prescribed, but take care not to overhydrate patient because of risk of cerebral edema.
  • Reduce high fever to decrease load on heart and brain from oxygen demands.
  • Protect the patient from injury secondary to seizure activity or altered level of consciousness (LOC).
  • Monitor daily body weight; serum electrolytes; and urine volume, specific gravity, and osmolality, especially if syndrome of inappropriate antidiuretic hormone (SIADH) is suspected.
  • Prevent complications associated with immobility, such as pressure and pneumonia.
  • Institute infection control precautions until 24 hours after initiation of antibiotic therapy (oral and nasal discharge is considered infectious).
  • Inform family about patient’s condition and permit family to see patient at appropriate intervals.

Evaluation

Expected patient outcomes include:

  • Avoidance of injury.
  • Avoidance of infection.
  • Restoration of normal cognitive functions.
  • Prevention of complications.

Discharge and Home Care Guidelines

After hospitalization, the patient at home should:

  • Activities. Alternate rest and activity to conserve energy.
  • Diet. Consume safe, clean, and healthy foods.
  • Asepsis. Promote simple infection control procedures at home.
  • Infectious process. Identify signs and symptoms of an infectious process and report to the physician promptly.

Documentation Guidelines

The focus of documentation in patients with bacterial meningitis are:

  • Client’s description of response to pain.
  • Acceptable level of pain.
  • Prior medication use.
  • Current physical findings.
  • Client’s understanding of individual risks and safety concerns.
  • Availability and use of resources.
  • Current and previous level of function.
  • Effect on independence and lifestyle.
  • Results of laboratory and diagnostic tests.
  • Mental status pr cognitive evaluation results.
  • Plan of care.
  • Teaching plan.
  • Response to interventions, teaching, and actions performed.
  • Attainment or progress towards desired outcomes.
  • Modifications to plan of care.

Practice Quiz: Meningitis


Here’s a 5 item quiz about Meningitis. If you need more, visit our NCLEX page.

Exam Mode

In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz.

Practice Quiz: Meningitis

Start
Congratulations - you have completed Practice Quiz: Meningitis. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.

Practice Mode

Practice Mode: This is an interactive version of the Text Mode. All questions are given on a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.

Practice Quiz: Meningitis

Start
Congratulations - you have completed Practice Quiz: Meningitis. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.

Text Mode

Text Mode: All questions and answers are given on a single page for reading and answering at your own pace. Be sure to grab a pen and paper to write down your answers.

1. Tiffany is diagnosed with increased intracranial pressure (ICP); which of the following if stated by her parents would indicate a need for Nurse Charlie to reexplain the purpose for elevating the head of the bed at a 10 to 20-degree angle?

A. Help alleviate headache
B. Increase intrathoracic pressure
C. Maintain neutral position
D. Reduce intra-abdominal pressure.

1. Answer: B. Increase intrathoracic pressure

  • B: Head elevation decreases, not increases, intrathoracic pressure.
  • A, C, and D: Elevating the head of the bed in a child with increased ICP helps to alleviate headache, maintain neutral position, and reduce intra-abdominal pressure, which may contribute to increased ICP.

2. During assessment, the nurse knows that well-recognized signs common to all types of meningitis include:

A. Positive Kernig’s sign
B. Positive Brudzinski’s sign
C. Photophobia
D. Negative Kernig’s sign

2. Answer: D. Negative Kernig’s sign.

  • D: A patient with meningitis exhibits a positive and not a negative Kernig’s sign.
  • A, B, and C: These are symptoms of bacterial meningitis.

3. The most severe form of meningitis is considered to be:

A. Bacterial
B. Aseptic
C. Septic
D. Viral

3. Answer: A. Bacterial.

  • A: Bacterial meningitis is the most severe form of meningitis.

4. Meningitis alters intracranial physiology, causing:

A. Cerebral edema
B. Increased permeability of the blood-brain barrier
C. Raised intracranial pressure
D. All of the above changes

4. Answer: D. All of the above changes.

  • D: All of the options listed above are caused by meningitis.
  • A: Cerebral edema is caused by bacterial meningitis.
  • B: Increased permeability of the blood-brain barrier is caused by meningitis.
  • C: Raised intracranial pressure is caused by meningitis.

5. In diagnosing seizure, which of the following is the most beneficial?

A. Skull radiographs
B. EEG
C. Brain scan
D. Lumbar puncture

5. Answer: B. EEG

  • B: The EEG recognizes abnormal electrical activity in the brain. The pattern of multiple spikes can assist in the diagnosis of particular seizure disorders.
  • A: Skull radiographs can distinguish fractures and structural abnormalities.
  • C: Brain scans confirm space-occupying lesions.
  • D: Lumbar puncture confirms problems related to cerebrospinal fluid infection or trauma.

See Also


Related topics to this study guide:

Further Reading


Recommended resources and books for pediatric nursing:
  1. PedsNotes: Nurse's Clinical Pocket Guide (Nurse's Clinical Pocket Guides)
  2. Pediatric Nursing Made Incredibly Easy
  3. Wong's Essentials of Pediatric Nursing
  4. Pediatric Nursing: The Critical Components of Nursing Care

Questions?

Ask our team

Want to contact us directly? No problem. We are always here for you.

Frequently Asked Buy a Nursing essay Questions

See all
Is your service confidential?

When you place an order with our company, we ask you to provide us with such personal information as your name, phone number, and email address. We need this data to keep you updated on the important things related to your order or account, and never share it with any third parties. We also don’t use your contact details for spamming you.

Please note that our support team may contact you using only the phone number(s) stated on our website, such +1 (248) 599-2414 and/+44 (151) 528-2636. In order to secure our mutual cooperation, please do not communicate with those who introduce themselves as essaypapers support staff and reach you from different phone numbers.

Also, remember that we never ask you to provide your credit card information via phone conversations. You should enter this information only on PayPal or Gate2Shop billing forms when making an online payment on our website. The essaypapers support administrator will send a confirmation letter to your personal order page when your payment is received.

We also use a secure encrypted connection and do not store your private data if we do not need it anymore. For more details about how we ensure your confidentiality, check our Privacy Policy, which completely complies with the GDPR.

We offer original model papers that can be used legally in a number of ways if properly referenced:

  • As a source of arguments or ideas for your own research
  • As a source of additional understanding of the subject
  • Direct citing

Nonetheless, check your college’s/university’s policies, including their definition of plagiarism and paraphrasing before using our services. Make conscious decisions in regards to your education.

How do I order a paper from essaypapers?

We take care not only of your academic success, but also of your experience with us. That’s why we have made the process of placing your order as easy and fast as possible—usually, it takes no more than 2-3 minutes.

Let’s have a closer look at the simple steps you need to go through for submitting your order:

Fill in the order form.

Be sure to include specific instructions regarding your paper and to upload any of the required materials. If you have any questions while specifying your paper’s information, just click on the info sign at the end of every field name and you will see a detailed tip on what exact information is required.

Proceed with the payment.

After you are through with the order form, you will need to make a payment via a preferable system. Right after that, you will be automatically provided with your personal order page where you can track your order’s progress, provide additional requirements, and send messages to your writer or support manager.

A personal writer is assigned to your order.

Our qualified staff will choose the most suitable writer whose skills and experience match your field of study and paper’s details. In case the writer must have any particular software or literature in order to get the Nursing Assignment done, please do not forget to mention this in your initial instructions.

Your paper is completed and delivered to your personal order page.

When the writer finishes your paper, it is delivered to your personal order page as a PDF document, available for preview only. You will be able to download an editable MS Word version of the order right after you click the “Approve” button in the “Files” tab of your personal order page. If any changes are to be applied to the paper, you are always welcome to request a free revision with a new deadline for the writer (be sure to check more information about this in our revision policy).

You can check how easy the process is by going to the order page and submitting your paper details right now.

Is there a money-back guarantee? If yes, how can I receive a refund?

You can get more details about possible types and terms of refunds on our official money-back guarantee page.

How will I receive a completed paper?

You will get the first version of your paper in a non-editable PDF format within the deadline. You are welcome to check it and inform us if any changes are needed. If everything is okay, and no amendments are necessary, you can approve the order and download the .doc file. If there are any issues you want to change, you can apply for a free revision and the writer will amend the paper according to your instructions.

If there happen to be any problems with downloading your paper, please contact our support team.

What if I’m not satisfied with my order?

If your paper needs some changes, you can apply for a free revision that is available for 7 days after your paper is approved. To use this option, you have a “Revision” button on your personal page.

After the 7-day period, you cannot apply for a free revision, though you still can use a paid revision option. The price of such a revision will differ depending on the number of amendments needed to be done. Please contact our support team to find out how we can help you with the amendments to your paper.

If you think our writer didn’t manage to follow your instructions, and as a result, your paper is of poor quality, please contact us and we will do our best to solve the problem.

If the revisions didn’t give the desired result, you can apply for a refund. Our dispute department will process your inquiry to find out what kind of refund we can give you. To find out more, please visit our money-back guarantee page.

How do I request a refund?

You can’t apply for a refund on certain stages of your order, like when the order is not finished by the writer yet.

When the paper is delivered, the “Refund” button on your personal order page becomes clickable.

On the relevant tab of your personal order page, you will also be able to choose the type of refund you’re demanding and the reason why you applying for it. As soon as you do that, our dispute department will start working on your inquiry. All kinds of refunds concerning the quality or the lateness of your paper should be requested within 14 days from the time the paper was delivered, as in 14 days your paper, will be automatically approved.

Your inquiry should be submitted by clicking the “Refund” button on your personal order page only.

Order your essay today and save 15% with the discount code NURSINGHELP