Medical Surgical Meningitis #1

Question

In planning for discharge for a client with bacterial meningitis, the nurse will be sure to include which instruction?

Answers

  1. Keep all family and visitors from visiting your room for protective isolation.
    • Rationale:

      This answer is not correct because bacterial meningitis is droplet precautions until the client has finished 24 hours of antibiotics. Protective isolation is not required with bacterial meningitis.

  2. Make sure you eat high protein diet with plenty of fluids
    • Rationale:

      This answer is not correct because although it is important for clients to eat a good diet, it is not more important than taking antibiotics The most important instruction for the client is to be sure to take prescribed antibiotics until completed.

  3. Take all of the antibiotics until gone.
    • Rationale:

      This answer is correct because failure to complete antibiotics may lead to re-infection and may spread, causing endocarditis and other infections in the body, especially if the bacteria were from streptococci. Clients must be instructed to take all oral ABT until finished. Cephalosporins is the most common drug of choice for bacterial meningitis; however, a culture of CSF will be used to determine resistance or susceptibility to specific antibiotics. It is to be noted that cephalosporins should be used with caution in clients with allergies to penicillin. Cephalosporins come with a black box warning for drug resistance. For bacterial meningitis, the initial antibiotic therapy is intravenous.

  4. Incorporate regular exercise with active range of motion.
    • Rationale:

      This answer is not correct because while returning to exercise is important, gradual increase should be performed. The answer selection for exercise was not as important as prescribed antibiotics.

Overview

Meningitis is a bacterial or viral infection of the meninges that can be fatal in a short time frame. Antibiotics are necessary to treat bacterial meningitis and should be taken until gone.

Explanation

Learning Outcomes

Bacterial meningitis can lead to death quickly. Most important is to treat the cause of the meningitis and start IV therapy as soon as indicated. While the client may be in isolation while in the hospital before the initial 24 hours of antibiotic therapy, the family may not need to quarantine the client when at home. Droplet precautions are to be initiated since transmission is direct contact and respiratory droplets. Interventions include contact tracing of family members who may require prophylactic treatment, ordered according to the bacterial strain and health provider recommendations, monitoring vital signs and neurological status, watch for increasing ICP, and monitoring for meningeal irritation. Monitoring for meningeal irritation includes assessing for Kernig’s sign, nuchal rigidity and Brudzinski’s sign.

Test Taking Tip

Notice the phrase “discharge planning”. For bacterial meningitis, antibiotic treatment is induced rapidly, which would be intravenously. The client will take p.o. ABT when home. Time matters, watch for hints like that when answering questions.

Video Rationale