NURSING CARE PLAN FOR

PATIIENTS WITH
MENINGITIS

By Diane Kathryn S. Nierva, RN.

GOOD AFTERNOON!!!!!!! GUYS!!

• ARE YOU STILL THERE???

Objective:
• RR: 50
• O2 saturation: 89%
• GCS= 11
• Pale and weak in
appearance
• Use of accessory muscles
• With nasal flaring
• With chest retractions
INEFFECTIVE BREATHING
PATTERN RELATED TO
DECREASED LEVEL OF
CONSCIOUSNESS AND
RESPIRATORY FATIGUE AS
EVIDENCED BY ALTERED
RESPIRATORY RATE
 Plan of Action

• At the end of nursing intervention the

patients respiration will be reestablished
and it’s rate return to normal range.
Nursing Interventions:
• Assess the condition of patient. Check for the
level of consciousness.
• Identify if there is an impending respiratory
failure by monitoring respiration changes. Note
respiratory rate, depth, rhythm, symmetry of
chest movement and use of accessory muscles.
• Assess Arterial blood gas level and oxygen
saturation.
• Provide oxygen therapy .
• Notify the attending physician of the patient’s
current condition.
• Assist with the implementation of ventilatory
support as indicated. Check ventilator alarms
if functioning. Look if oxygen line is connected
to the proper outlet.
• Administer medications as ordered. Check
patients response to the medication.
• SUBJECTIVE: • Objective:
• “ Masakit ang ulo ko” as • Pain scale: 9/10
verbalized by patient • With facial grimace
• Irritable
• Restless
• With high pitched cry
• BP: 120/70 mmHg
ALTERATION IN COMFORT,
PAIN RELATED TO
MENINGEAL IRRITATION
SECONDARY TO DISEASE
CONDITION.
Plan of action

• At the end of nursing intervention, pain

level experienced will be decreased or
alleviated.
Nursing Interventions
• Assess patients pain scale.
• Place child on a comfortable position. Be
careful not to flex the childs neck when
turning or positioning her. Allow the child to
assume a comfortable position. (mostly
opisthotonic position wherein the neck and
head is hyperextended to relieve discomfort.)
• Provide rest periods to facilitate comfort,
sleep, and relaxation.
• Keep the lights dim and maintain quiet
environment.
• Provide pain medication as ordered and
check effectiveness of medication given.
• OBJECTIVE:
• Restlessness
• Irritable
• GCS= 12
• High pitched cry
• Tensed bulging anterior fontanelle upon palpation
• Pulse rate 70 bpm
• RR= 18
• With unequal pupil size L= 4, R= 2
ALTERED CEREBRAL TISSUE
PERFUSION RELATED
DECREASED BLOOD FLOW TO
THE BRAIN DUE TO
CEREBRAL EDEMA/
INCREASED ICP SECONDARY
TO DISEASE CONDITION.
Plan of Action

• At the end of nursing intervention,

optimal tissue perfusion will be
improved in the brain as evidenced
by increase in the level of
consciousness.
Nursing Interventions:
• Assess patients condition. Check for signs of increased ICP like
restlessness and irritability, high pitched cry, vomiting, and
headache.
• Check for the Level of consciousness.
• Monitor vital signs. Get the temperature, Respiratory rate,
Heart Rate and Blood Pressure. Note: Increased Blood
pressure, bradycardia and Wide pulse pressure are indicators
of increased ICP.
• Measure child’s head circumference.
• Weigh him or her daily.
• Give oxygen inhalation via nasal cannula.
• Place child head positioned on midline to encourage
jugular venous drainage and the head of the bed is
elevated to 15[degrees] to 30[degrees]. The child's
head should be maintained midline to prevent
impairment in drainage from the external jugular
veins and the head of bed should be maintained at
30[degrees] with alterations based on the child's
response. The child must be euvolemic prior to
placing in this position to avoid orthostatic
hypotension.
• Regulate IV fluids properly at the rate ordered.
• Provide medication as prescribed like mannitol.
Subjective
• “Parang mainit ang katawan
nya” as verbalized by
mother
Objective:
• With flushed face
• Skin warm to touch
• Pale and weak in
appearance
• temperature= 39 C
• RR= 46 breaths/min
• HR= 96
Alteration in Body temperature;
hyperthermia; related to presence
of pyogenic microorganisms in the
thermoregulating center of the
brain.
Plan of Action

• At the end of nursing intervention,

temperature will decrease or return
to normal range.
Nursing Interventions:

• Assess for the possible contributing factors.

• Monitor vital signs
• Render continuous tepid spongebath and teach
significant others on proper provision.
• Provide adequate ventilation. Remove overly
constricting or thick clothing.
• Maintain a quiet and restful environment.
• Regulate IV fluids properly.
• Administer antipyretics as ordered.
• Subjective: • Objective:
• “Nurse nanginginig • With Upward rolling of
yung anak ko at the eye
tumatarak ang mata”
• With tonic clonic
seizure of 2 minutes
duration
• Pale in appearance
• With drooling noted
• with cyanotic lips noted
• With cyanotic nailbeds
Risk for injury related to
seizure episodes
secondary to disease
condition
Plan of Action

• At the end of nursing

intervention, significant others
will understand and
demonstrate ways on how to
manage patient when seizure
occurs
Nursing Interventions:
• Monitor Childs vital signs.
• Remove unnecessary articles on patients’ bed.
• Provide oxygen to patient.
• Place child on side lying position to avoid aspiration.
• Do not put anything on child's mouth when there is a
seizure attack. Do not restrain child.
• Provide a quiet non stimulating environment and dim
the lights.
• Teach parents on management of patient with seizure.
Subjective objective
“Nasasamid siya pag • GCS= 11
pinapadede ko, hidi • With poor sucking
sya masyadong and swallowing
makalunok” as reflex noted
verbalized by • With increased
mother. accumulation of
saliva in the mouth.
RISK FOR ASPIRATION
RELATED TO DECREASE
LEVEL OF CONSCIOUSNESS
AND POOR SECRETION
CONTROL.
Plan of Action

• At the end of nursing

intervention, the risk for
aspiration will be
minimized as exhibited by
proper feeding of mother.
Nursing Interventions:
• Assess patient’s level of consciousness. Assess
patient’s ability to swallow and strength of gag and
cough reflex.
• Instruct significant other not to feed patient on lying
position.
• Maintain operational suction equipment at bedside.
• Suction oral cavity and nose as needed.
• Place patient’s head of bed at 30 degrees elevation.
• Teach significant others on proper feeding
with head slightly elevated and propped on
right side after feeding.
• Provide oral care after meals.
• Notify the physician or other health care
provider immediately of noted decrease in
cough and/or gag reflexes or difficulty in
swallowing
• When feeding per orem is not possible:
• Assist in insertion of nasogastric tube as ordered.
Prepare the necessary materials needed.
• Check for patency of NGT prior to tube feeding.
• Check for any residual in the tube
• Flush NGT with 20-30 cc of water
• Feed patient with head part of bed elevated.
For Family and Other Persons
safety
Risk for Infection related to
presence of pathogenic
microorganism in the cerebrospinal
fluid as evidenced by lab result.
Plan of Action

• At the end of Nursing Intervention,

Significant others will demonstrate
ways and means to prevent spread
of infection.
Nursing Interventions:
• Assess family’s level of understanding of child’s
current condition.
• Demonstrate proper hand washing technique to
relatives and stress out its importance.
• Instruct significant others to wear protective gears
such as face mask.
• Isolate patient as quickly as possible.
• Minimize room visits as much as possible.
• Discard any articles or body secretions from the
patient in the proper waste disposal bin.
• Acquire prophylaxis by taking prescribed medications
or vaccination.