7 Meningitis Nursing Care Plans

7 Meningitis Nursing Care Plans
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Meningitis is the inflammation of the meninges of the brain and spinal cord as a result of either bacteria, viral or fungal infection. Bacterial infections may be caused by Haemophilus influenzae type b, Neisseria meningitidis(meningococcal meningitis), and Streptococcuspneumoniae (pneumococcal meningitis). Those at greatest risk for this disease are infants between 6 and 12 months of age with most cases occurring between 1 month and 5 years of age. The most common route of infection is vascular dissemination from an infection in the nasopharynx or sinuses, or one implanted as a result of wounds, skull fracture, lumbar puncture, or surgical procedure. Viral (aseptic) meningitis is caused by a variety of viral agents and usually associated with measles, mumps, herpes, or enteritis. This form of meningitis is self-limiting and treated symptomatically for 3 to 10 days.
Treatment includes hospitalization to differentiate between the two types of meningitis, isolation and management of symptoms, and prevention of complications.
Nursing Care Plans
Nursing care plan goals for a child with meningitis include attain adequate cerebral tissue perfusion through reduction in ICP, maintain normal body temperature, protection against injury, enhance coping measures, accurate perception of environmental stimuli, restoring normal cognitive functions and prevention of complications.
Here are seven (7) nursing care plans (NCP) for meningitis:
1. Ineffective Tissue Perfusion (Cerebral)
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Ineffective Tissue Perfusion: Decreased in the oxygen resulting in the failure to nourish the tissues at the capillary level
May be related to
• - Increased intracranial pressure
• - Cerebral edema
Possibly evidenced by
• - Delirium, hallucinations
• - Drowsiness
• - Hypercapnia
Desired Outcomes
• - Child will have vital signs return to normal; child is alerted and oriented: motor, cognitive, and sensory function are within acceptable parameters for the child’s age; normal specific urine gravity.
Nursing Interventions	Rationale
Monitor vital signs and neurological status.	Increasing systolic blood pressure accompanied by decreasing diastolic blood pressure is an ominous sign of increased ICP.
Observe for any signs of increased intracranial pressure.	Signs and symptoms that indicate an increase in ICP include headache, drowsiness, decreased alertness, vomiting, bulging fontanelle (infants).
Assess for nuchal rigidity, twitching, increased restlessness, and irritability.	These are signs of meningeal irritation, which may happen because of infection.
Observe for increasing restlessness, moaning, and guarding behaviors.	These nonverbal cues may indicate increasing ICP or pain. Unrelieved pain can potentiate increased ICP.
Monitor arterial blood gases (ABGs) and oxygen saturation.	Determines presence of hypoxia and indicates therapy needs.
Maintain head or neck in midline position, provide small pillow for support.	Turning head to one side compresses the jugular veins and inhibits venous drainage, thereby increasing ICP.
During reposition, avoid bending of the knee and pushing heels against the mattress.	These activities increase intra-thoracic and intrabdominal pressures, thereby increasing ICP.
Provide comfort measures and Decrease external stimuli such as quiet environment, soft voice, and gentle touch.	Produces relaxing effect which decreases adverse physiologic response and promotes rest to maintain or lower ICP.
Elevate the head of the bed 30°, and avoid neck flexion and hip flexion.	Promotes venous drainage from head, thereby reducing cerebral congestion and edema and risk of increased ICP.
Administer oxygen as needed.	Reduces hypoxia which can increase blood volume, promotes cerebral vasodilation and elevate ICP.
Administer medications as indicated:
Osmotic diuretic: Mannitol (Osmitrol)	Used to treat cerebral edema by promoting cerebral blood flow
Anticonvulsants: Diazepam (Valium) or phenytoin (Dilantin)	Used to control seizures related to increased intracranial pressure.
2. Hyperthermia
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Hyperthermia: Body temperature elevated above normal range.
May be related to
• - Infection
• - Abnormal temperature regulation
Possibly evidenced by
• - Body temperature above the normal range
• - Hot, flushed skin
• - Increased heart rate
• - Increased respiratory rate
• - Seizures
Desired Outcomes
• - Child will regain and maintain body temperature within a normal range.
Nursing Interventions	Rationale
Assess the child’s vital signs closely.	A history of aseptic viral meningitis usually begins with an onset of fever up to 104°F. As hyperthermia progresses, HR and BP increase also.
Assess for signs of dehydration such as dry mouth, sunken eyes, sunken fontanelle, low concentrated urine output.	Elevated body temperature increases the metabolic rate, hence increases the insensible fluid loss.
Gradually decrease temperature.	Shivering can happen from rapid reduction of temperature which can result to rebound effect and increase the temperature instead lower the temperature.
Perform tepid sponge.	Decreases temperature by liberating heat by conduction and convection.
Maintain adequate fluid intake as tolerated.	Prevents dehydration; Avoid fluid overload because of the risk of cerebral edema.
Administer antibiotics as indicated.	Antibiotics are given to treat the underlying causes of inflammation and thus prevent the occurrence of seizure activity.
Administer antipyretics as indicated.	Antipyretics decrease fever and lessen brain oxygen demand as fever increases cerebral metabolic demand.
3. Acute Pain
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Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.
May be related to
• - Increased intracranial pressure
• - Meningeal irritation
Possibly evidenced by
• - Neck stiffness
• - Headache
• - Irritability
• - Nuchal rigidity
Desired Outcomes
• - Child will express feelings of comfort and relief of pain.
Nursing Interventions	Rationale
Assess for headache and photophobia.	When the meninges of the brain become infected, it can lead to inflammation that triggers severe headaches; Meningitis also causes hypersensitivity to bright lights.
Assess for Kernig’s sign (pain and resistance on passive knee extension with hips fully flexed) and Brudzinski’s sign (hips flex on bending the head forward).	These are used to assess for any sign of meningeal irritation.
Maintain a quiet environment and keep child’s room darkened.	Darkening the room may decrease photophobia.
Prevent stimulation and restrict visitors.	Stimulation can increase intracranial pressure, hence intensifying the pain.
Control environment to encourage rest.	Environmental changes such as increased noise and glaring light cause sensory overload that promotes cerebral irritation leading to convulsions.
Turn the client often and position the client carefully.	Promotes comfort and reduce irritation and agitation.
Assist ROM exercises.	Prevent joint stiffness and neck pain.
Administer antibiotic and corticosteroid as prescribed.	Antibiotic and corticosteroid therapy are used to reduce the inflammation and therefore decrease pain.
Administer analgesics such as acetaminophen or NSAIDs as prescribed.	NSAIDs are given to relieve pain.
4. Disturbed Sensory Perception
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Disturbed Sensory Perception: Change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli
May be related to
• - Decreased LOC
• - Cerebral edema
• - Increased ICP
• - Hydrocephalus
Possibly evidenced by
• - Altered sensorium
Desired Outcomes
• - Child will maintain normal LOC.
Nursing Interventions	Rationale
Assess level of consciousness using pediatric Glasgow coma scale.	Glasgow coma scale is a reliable and objective way of measuring the motor, verbal and sensory cues related to LOC. Neurological assessment aids in determining the extent of damage in meningitis.
Observe and notify physician for persistent deterioration in LOC.	Additional or changes in the treatment may be required once the LOC furtherly decreases. Change in mentation, seizures, increased blood pressure (BP), bradycardia, or respiratory abnormalities may indicate increasing ICP with decreased cerebral perfusion pressure.
Assess for signs of cerebral edema such as dizziness, headache, irregular breathing, neck pain, nausea or vomiting.	Anoxia, vasodilation, or vascular stasis can lead to cerebral edema due to the increased intracellular and extracellular fluid in the brain as the symptoms progress.
Assess ability to follow simple or complex commands.	Impaired cognitive function occurs with cerebral hemisphere involvement.
Evaluate presence or absence of protective reflexes: swallow, gag, blink, cough.	Absence of reflexes is a late sign indicative of increasing ICP.
Assess for signs of meningeal irritation such as headache, photobia, nuchal rigidity, opisthotonic position, Kernig’s sign, Brudzinki’s sign.	Meningeal signs are a result of meningeal and spinal root inflammation, and/or pooling of infectious exudates and are cardinal features of meningeal irritation.
Elevate head of bed up to 30° to 45° with the client’s head in neutral position.	Promotes venous outflow from the brain and help decrease ICP.
Reorient the client to the environment, as needed.	Frequent reality orientation is important to promote cognitive function.
Assist with diagnostic testing: - Electroencephalogram - Lumbar puncture for CSF - Magnetic resonance imaging (MRI), computed tomography (CT), or ventriculogram	The following diagnostic exam are done to evaluate cerebral pressure and identify the presence of infectious organisms.
Initiate seizure precautions: observe and provide care during seizure.	Providing appropriate and precise care during a seizure prevents complication and further brain damage.
Maintain a quiet environment and keep the lights dim.	Prevents stimulation that can cause or precipitate an episode of convulsion.
Assess pupil size every 3 hours during the first 24 hours and consequently every 6 hours.	Increased intracranial pressure (ICP) will result in uneven pupil sizes, fixed dilated pupil.
Observe and document pattern and frequency of seizure. Notify physician of seizure activity.	Changes in seizure pattern signify the need for additional neurological evaluation, anticonvulsant medications, and reevaluation of treatment. Seizure usually happens prior an increase in intracranial pressure (ICP). Adequate treatment of infection will mitigate further deterioration and maintain intracranial pressure within normal limits.
Allow parents to participate in the child’s care.	Support better coping and decrease anxiety.
Administer and monitor anticonvulsants drug levels.	Anticonvlsants are both used as prophylaxis and treatment. Therapy involves keeping therapeutic blood levels to avoid the occurrence of seizures.
5. Anxiety
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Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.
May be related to
• - Threat to or change in health status of child
• - Threat to or change in environment [hospitalization of child]
Possibly evidenced by
• - Increased apprehension that condition of child might worsen
• - Expressed concern and worry about actual hospitalization of child and seriousness of illness
Dlevels tocomes
• - Parents will experience decreased anxiety
Nursing Interventions	Rationale
Assess sources and level of anxiety, how anxiety is manifested, and need for information and support.	Provides information about the need for interventions to relieve anxiety and concern; sources may include fear and uncertainty about treatment and recovery, guilt for presence of illness, possible loss of the parental role, and loss of responsibility when hospitalization necessary.
Assess parental feelings of guilt from not suspecting the seriousness of the illness sooner; encourage them to openly discuss feelings.	Prevents or minimizes feelings of blame or guilt.
Encourage to express concerns and ask to express concerns and ask questions regarding the condition of ill child.	Provides an opportunity to vent feelings, secure information needed to reduce anxiety.
Encourage the parent to stay with the child or visit when able and call when concerned if hospitalized; assist in care (hold, feed, bathe, clothe and diaper), and provide information about child’s daily routines.	Allows parent to care for and support child instead of increasing anxiety if not with child.
Encourage to be involved in care and decision-making regarding needs.	Promotes constant monitoring of child’s child’s condition for improvements or worsening of symptoms.
Teach about disease process and behaviors, physical effects and symptoms of disease.	Relieves anxiety of parents.
Explain the reason for procedures or type of therapy, effects of any diagnostic tests (specify).	Reduces fear of the unknown which increases anxiety.
Teach parents about isolation precautions for at least 24 hours or until diagnosis is made and antibiotic therapy begins to take effect.	Provides opportunity to validate type of meningitis and to take measures to prevent transmission to others in contact with child.
Clarify any misinformation and answer questions in lay terms when parents able to listen, give same explanation as other staff and/or physician gave regarding disease process and transmission.	Prevents unnecessary anxiety resulting from inaccurate knowledge or beliefs or inconsistencies in information.
6. Deficient Knowledge
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Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
May be related to
• - Lack of exposure to information.
Possibly evidenced by
• - Request for information about medications, signs and symptoms and behaviors to report
• - General care during convalescence of infant/child
Desired Outcomes
• - Parents verbalize understanding of cause and treatment plan.
Nursing Interventions	Rationale
Assess knowledge of disease and method to control and resolve disease; willingness and interest of parents to implement care.	Promotes plan of instruction that is realistic to ensure compliance with medical regimen; prevents a repetition of information.
Provide information and explanations in clear language that is understandable; use pictures, pamphlets, video tapes, model in teaching about disease.	Ensures understanding based on readiness and ability to learn; visual aids reinforce learning.
Teach about administration of medications including (specify: action of drugs, dosages times frequency, side effects, expected results, methods to give medications); provide written instructions and schedule to follow and inform to administer full course of antibiotic to child.	Provides information for compliance in medication therapy to prevent or treat infection and seizure activity resulting from the disease; bacterial meningitis is treated with antibiotics, and viral meningitis may be treated with antibiotics until diagnosis is established.
Assist to plan feedings and/or develop menus to include nourishing fluids, caloric and basic four groups for age group.	Promotes optimal nutrition in a progressive manner as tolerable.
Reinforce to parents follow up to assess for potential hearing impairment.	Promotes identification of hearing loss (injury to 8th cranial nerve caused by meningitis).
Inform parents as to the benefits of routine immunizations with H. influenzae (type B) vaccine, beginning at 2 months of age for a total of 3 doses.	May prevent the disease; data suggests the incidence of this form of meningitis has decreased since the vaccine was introduced; may decrease the spread of infection to unvaccinated infants.
Teach to promote adequate rest and activities that provide age-appropriate play and stimulation (specify).	Rest important for convalescence and stimulating activities needed for continued development or to promote stimulation if developmental lag is present.
Teach to isolate other children in the family for 24 hours if respiratory infection present or until the culture is negative.	Prevents transmission of bacteria to others in the family.
Teach to report elevated temperature, poor feeding or anorexia, irritability or other changes in behavior or level of consciousness, decrease in hearing acuity.	Reveals signs and symptoms of presence of or spread of infection.
Administer antibiotics as prescribed (specify) as soon as ordered based on analysis of CSF, throat cultures.	Manages existing infection and prevents further spread of infection (action of drug).
Provide stool softeners or mild laxative, avoid use of restraints and prevent or reduce crying episodes.	Prevents constipation and lessen the risk of increased ICP due to straining from defecation.
7. Risk for Injury
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Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.
May be related to
• - Internal factor of altered neurologic regulatory function.
Possibly evidenced by
• [not applicable]
Desired Outcomes
• - Child will not experience injury
Nursing Interventions	Rationale
Assess neurologic status to include VS pattern, changes in consciousness, behavior patterns and pupillary/ocular responses appropriate for age (measure head circumference in infant) (specify when).	Provides information that offers clues to possible change in intracranial pressure caused by inflammation of the brain and associated edema.
Attach cardiac and respiratory monitor to assess for bradycardia and hypoxia.	Increased intracranial pressure will decrease pulse and respirations, widen the pulse pressure with pulse becoming irregular and respirations rapid and shallow as ICP progresses and the body attempts to decrease blood flow to brain.
Note any seizure activity including onset, frequency, duration and type of movements before, during, or after seizure; pad bed and remove objects/toys from bed and administer any ordered anticonvulsants.	Prevents injury during seizure which is a complication of meningitis.
Provide a quiet environment free from bright lighting, minimize gentle handling and care of infant/child, allow for rest periods between care or procedures, restrict visiting if irritable.	Promotes comfort and rest and reduces irritability.
Stay with infant/child and sit near and speak in a low voice.	Provides limited stimulation to infant/child during acute stage of disease.
Position with head elevated up to 30 degrees and maintain head alignment with sandbag.	Decreases intracranial pressure by allowing blood flow from brain by gravity or any obstruction of jugular drainage.
Reposition q 2h, positioning child to optimize comfort with HOB slightly elevated, no pillow in bed, side-lying position if nuchal rigidity present; avoid sudden movements such as lifting the head; have oxygen and suctioning equipment on hand to be administered when needed.	Maintains airway patency and prevents obstruction by secretion which increases CO2 retention and ICP.
Explain causes of increased ICP and importance of preventing any further increases in ICP.	Allows for understanding of increased ICP and life-threatening nature of such a complication.
Inform parents of changes in condition, reasons for physical and mental changes and effects of the disease.	Promotes knowledge about possible manifestations of the disease and causes.
Inform of reason for seizure activity and other signs and symptoms of the disease and treatment necessitated by them.	Provides knowledge of seizure complications and actions and responsibility in prevention and/ or treatment of this activity.
Inform parents of risk for complications and need for monitoring for increased ICP; review signs and symptoms of increased ICP.	Allows for ongoing care and responsibility in preventing change in neurologic status.
Administer antibiotics as prescribed (specify) as soon as ordered based on analysis of CSF, throat cultures.	Manages existing infection and prevents further spread of infection (action of drug).
Administer stool softeners, avoid use of restraints and prevent or reduce crying episodes.	Prevents Valsalva’s maneuver that will increase ICP.
References and Sources : nurse labes