Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph
Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

NAME:Bea Flor Rapisura-Pegad YR&SEC: BSN IVDATE: 4-07-2021

Critical Thinking Exercise No. 12

Nursing Management of the client with
MENINGITIS
SITUATION: A 21-year old college student was taken to the Emergency Department after her
roommate found her lying with her right thigh flexed up toward her abdomen and complaining
of a severe headache and stiff neck. Initial assessment by the nurse revealed a positive Kernig’s
sign and positive Brudzinski sign. Bacterial meningitis is suspected.

Answer the following comprehensively.

1. What is the significance of the positive Kernig and Brudzinski signs?
A Positive Brudzinski's sign includes involuntary flexion of the hip and knee
when the neck is bent forward. A positive Kernig's sign is an inability to extend
the leg while the hip is flexed to 90 degrees. Both signs have low sensitivity but
high specificity for meningitis.
2. What other signs should the nurse assess for in order to confirm the presence of
bacterial meningitis?
In a patient suspected for bacterial meningitis, the nurse must assess for signs
and symptoms which includes; fever, severe unrelenting headache, confusion,
vomiting ,stiff neck, and photophobia

3. What actions will the nurse take after assessing the client?
Monitor patient closely, and refer to physician immediately after the
assessment.

4. How does the clinical presentation of septic meningitis differ from aseptic meningitis?

Septic meningitis is also called as bacterial while aseptic is the other term for
viral meningitis.
 In septic meningitis(bacterial) it is acquired in the environment and can also be
found in the nose and respiratory system. There is a 10 percent death rate from
bacterial meningitis, but if diagnosed and treated early enough, most people
recover. While the aseptic meningitis is acquired thru viruses such as chicken
pox, HIV, Herpes, mumps, measles, and rabies. Aseptic meningitis is often a
mild condition, and you may recover without medication or treatment. Many
of the symptoms are similar to those of the common cold or flu so you may
never know you had aseptic meningitis. This makes aseptic meningitis different
from bacterial meningitis, which causes severe symptoms and may be life-
threatening.

5. List down nursing responsibilities in assisting Lumbar puncture.

The following are the nursing interventions prior to a lumbar puncture:

 Explain the procedure to the patient.  Explain to the patient the purpose of lumbar
puncture, how and where it’s done, and who will perform the procedure.

 Obtain informed consent.  Make sure the patient has signed a consent form if
required by the institution.

 Reinforce diet.  Advise the patient that fasting is not required.

 Promote comfort.  Instruct the patient to empty the bladder and bowel  before the
procedure.

 Establish a baseline assessment data.  Do vital signs monitoring and neurologic

assessment of the legs by assessing the patient’s movement, strength, and sensation.

 Place the client in a lateral decubitus position.  Assist the client to assume a lateral
decubitus (fetal) position, near the side of the bed with the neck, hips, and knees
drawn up to the chest. An alternative position is to have the patient sit on the edge of
the bed while leaning over a bedside table.

 Instruct to remain still.  Explain that he or she must lie very still throughout the
procedure. Any unnecessary movement may cause traumatic injury.

The nurse should note of the following nursing interventions post-lumbar puncture:
 Apply brief pressure to the puncture site.  Pressure will be applied to avoid
bleeding, and the site is covered by a  small occlusive dressing or band-aid.

 Place the patient flat on bed.  The patient remains flat on bed for 4 to 6 hours
depending on the physician. He or she may turn from side to side as long as the head
is not elevated.

 Monitor vital signs, neurologic status, and intake and output.  Take vital signs,
measure intake and output, and assess neurologic status at least every 4 hours for 24
hours to allow further evaluation of the patient’s condition.

 Monitor the puncture site for signs of CSF leakage and drainage of blood.  Signs
of CSF leakage includes positional headaches, nausea and vomiting, neck stiffness,
photophobia (sensitivity to light), sense of imbalance, tinnitus (ringing in the ear), and
phonophobia (sensitivity to sound).

 Encourage increased fluid intake.  An increased amount of fluid intake (up to 3,000
ml in 24 hours) will replace CSF removed during the lumbar puncture.

 Label and number the specimen tube correctly.  Ensure all samples are properly
labeled and sent to the laboratory immediately for further evaluations.

 Administer analgesia as ordered.  Headaches after the procedure can last for a few
hours or days and is usually treated with analgesics.