Meningitis: Assessment and Diagnosis (Nursing)

by Rhonda Lawes, PhD, RN

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    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.

    About the Lecture

    The lecture Meningitis: Assessment and Diagnosis (Nursing) by Rhonda Lawes, PhD, RN is from the course Acute Neurologic Disorders (Nursing) (release in progress).

    Included Quiz Questions

    1. Neck stiffness
    2. Unequal pupils
    3. Fever with headache
    4. Photophobia
    1. Flexing of the hips and knees when the neck is flexed
    2. Inability to extend the leg when the hip is flexed
    3. Involuntary movement of the toe when the sole of the foot is stroked
    4. Inability to stand up straight when the eyes are closed
    1. Ensuring that the client has emptied their bladder before the procedure
    2. Ensuring that an intubation tray is ready at the bedside
    3. Making sure that the client’s neck and upper spine are cleansed with chlorhexidine
    4. Assisting the client to lay on their stomach with their head tilted to the left

    Author of lecture Meningitis: Assessment and Diagnosis (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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