00:01
Now, let's take a look
at the symptoms.
00:04
You see that John has a
sweat droplets on his face.
00:07
That's because meningitis
often presents with a fever.
00:10
Now, because this is going
on inside their head,
it's not hard to remember that.
00:14
Yeah, they're going to have
some type of headache.
00:17
And some people experience
excruciating headaches.
00:21
Here's something
that's unusual though.
00:23
They have neck stiffness,
or we call that nuchal rigidity.
00:28
So not many patients
will come in and say,
"I am experiencing nuchal rigidity."
But they will tell you, "Man,
my neck is really sore and stiff."
That should get your
attention right away.
00:40
That's a classic sign that is kind
of limited or unique to meningitis.
00:45
Now on top of that, they're going
to have some nausea and vomiting,
and they just feel
all over miserable.
00:52
Take a look at this overall slide.
00:54
Here's something I want you to
understand about healthcare.
00:57
When you're
taking care of a patient,
they won't necessarily
have every single symptom,
and different patients
present differently.
01:04
So your job is to kind of take
a look at the whole picture.
01:07
Now in this one,
we put really big marks by headache,
and neck stiffness,
or nuchal rigidity.
01:14
Those are two things
when they are together
that really gets our attention.
01:18
Photophobia may or may not be there,
that light may be
too bright for them,
or they may not experience this.
01:25
The takeaway point
I want you to remember is
not everyone presents
like a textbook.
01:31
You have to put all
these clues together
to look at the big picture.
01:35
So, nausea and vomiting real general
confusion, altered mental status,
whoa, that means something is off.
But it could be lots of things.
01:42
But when you see these things
together in one picture,
this strongly points
towards meningitis.
01:50
Now, let's take a look
at a couple of assessments
that a healthcare
person could perform
to see if we've got more
clues to this mystery.
01:57
There's two signs:
Brudzinski sign is one,
Kernig sign is the other.
02:02
Now, take a look
at our graphic there.
02:04
You see the definition of
Brudzinski sign on your screen,
and you see that there's a hand
behind the head of the patient.
02:11
So, when you flex
the patient's neck,
you'll see a flexion of the
hips and knees in response.
02:18
So, when you flex
the patient's neck,
you're going to see the knees
and hips flex in response.
02:25
That's called the Brudzinski sign.
02:27
Now, the second one is easier to
pronounce. It's the Kernig sign.
02:32
So, you see the client
is laying on their back.
02:34
Now, we're going to do
this test on this client
because they have
some other symptoms.
02:37
We know they have that stiff
neck or that nuchal rigidity.
02:40
So, we're going to flex the hip
to a 90 degree angle.
02:44
So, see that. Think about you
and have to have their leg
up in the air like that.
That's why we have them laying down.
02:50
Now, their knees also bent
as we would say.
02:53
The idea is, you're going
to either ask the patient
or help the patient to
straighten out that leg.
03:00
If the patient has meningitis,
they will be resistant to that.
03:03
They're not going to want to do
that because it will cause pain.
03:06
So, that's another positive sign.
03:08
If you have the patient in this
position, you have their hip flex,
so their leg is up.
03:13
And you're trying to get them
to straighten out their leg
or to lower that leg.
So, it's straight again.
03:17
The patient will resist it because
it causes pain from the meningitis.
03:22
So, those are the two signs.
03:23
You've got Brudzinski,
where you flex the neck,
and you'll see the
knees and hips flex,
or you lay them flat,
you flex the hip.
03:31
You try to straighten out that leg
or ask the patient to
straighten out their leg,
and they're not going
to want to do it
because it causes pain.
03:38
You should have a mental picture
of the signs and symptoms
that are presented in
patients with meningitis.
03:44
Now, I want to talk
about the other ways
that we use to
diagnose this disease.
03:49
Right away, you can tell this
test is a little different.
03:52
You got the patient
laying on their side
with their spinal column exposed.
03:57
This is one of the tests
that we can perform
to really narrow in
on the diagnosis of meningitis.
04:02
It's called a lumbar puncture.
04:04
So, in this procedure,
a needle is actually inserted
between two lumbar
bones or vertebra.
04:11
Now, the location of this is usually
between L3 and L4, or L4 and L5.
04:17
Now, this is not something
that an RN would perform.
04:19
This has to be performed by
a advanced care provider,
nurse practitioner,
or a PA, or a physician.
04:27
So, this won't be something
that you will do as an RN,
but you will absolutely
have the opportunity
to assist in these
types of procedures.
04:34
Think about how uncomfortable
the patient is like this.
04:37
That's not a very
comfortable position.
04:39
They already don't feel good.
04:40
So, your role is to assist
as you get the sample
and also keep it
close eye on the patient
monitoring them for both
emotional and physical status.
04:52
They see where we've punctured.
04:53
They've taken that little spot,
and they've blown it up.
04:56
So they're showing you exactly
where that needle is going.
04:59
Because once you get
that needle inserted,
they remove a small sample
of cerebral spinal fluid.
05:04
Yeah, the same stuff that's
going on around your brain
to help cushion it. That's why
it's called cerebral spinal fluid.
05:12
So you're going to withdraw
just a small amount of that.
05:16
And here's a couple
easy tips for you.
05:18
When you see the sample,
if it's clear, and the patient
has meningitis,
it's likely a viral cause.
05:25
But if it's bacterial,
the sample will look like this
be kind of cloudy.
05:31
So, that's just a rule of thumb,
you would have to send it to lab
to get actual lab work.
05:36
But I want you to watch,
if you get to help
with a lumbar puncture
as a student,
and then your practice
you absolutely will.
05:42
But take a look at
what did that fluid look like.
05:45
Here's another red slide,
because I want you to remember,
the patient needs
to empty their bladder.
05:50
Now, this is our role that everyone
on the team needs to make sure
that the patient has
an empty bladder.
05:56
Now, we're sticking a needle in.
05:58
Can you imagine
why that would be important,
because a full bladder
can interfere with the procedure,
it can cause discomfort
or even complications.
06:07
So, your role if you're on the team
that is performing this procedure,
you want to make sure the patient
is being monitored closely
is in the right position,
and that they have
empty their bladder
to minimize any chance
of complications.
06:20
Now, there's some other ways
we can diagnose.
06:22
Look, we can do a CSF analysis,
we talked about that.
06:25
We can also look at
a complete blood count,
which that's lab work,
you draw blood from a vein
and run a complete blood count
of the cells and that fracture,
or you can do a blood culture.
06:36
And that's where you'll grow some
things, or see if things grow.