00:01
Now, we're going to move to
the management of meningitis.
00:03
Now, we've had the lumbar puncture,
we talked about where it is,
and where the needles inserted,
and what your role is
when you're sitting
in this procedure.
00:11
So, now we're trying to find
the exact cause of the meningitis.
00:16
So, once we know that
we can decide how we're what we
need to do to treat the cause.
00:22
So, for example,
if it's a bacterial meningitis,
they're going to have
to have antibiotics.
00:28
Once CSF analysis is done, we can
kind of tweak which antibiotics
that might be best
to kill that infection.
00:36
But if it's bacterial,
we can treat it with antibiotics.
00:40
Now, remember,
if it is a viral meningitis,
you don't need to treat
the cause but the symptoms.
00:46
So, we don't have an antiviral
that can treat this.
00:49
So, we need to make sure
that we treat the symptoms
as much as possible.
00:53
We only give antibiotics in the
case of a bacterial meningitis.
00:57
And so that's why
a lumbar puncture is so important.
01:00
So, we know for sure which
type we're dealing with.
01:03
Now, of course,
the antibiotics are IV
because we want to get those
into the bloodstream right away.
01:08
But something else
I want you to keep in mind,
you'll notice this is a red slide.
01:12
And we did that for you in this
presentation to help you remember,
this is really important.
01:17
Patients with meningitis
will most often receive IV fluids.
01:21
Now, our goal there
is we're putting volume
right into their
intravascular space,
right into their veins.
01:28
So likely,
whether it's viral or bacterial,
the patient may receive
IV fluids to help
keep that intravascular volume up,
because we want to maintain
a safe blood pressure.
01:40
Now these patients are also
at risk to become septic.
01:43
And whenever a patient is septic,
they can risk septic shock.
01:47
We definitely want to
avoid that at all costs.
01:50
Now, some other medications
that we might consider.
01:52
Remember, meningitis is involving
that brain and they have a headache.
01:57
And remember, they had a fever,
and he was sweating, which is why
the physician or
the nurse practitioner
may consider an anticonvulsant.
02:05
That's a group of medication
that's prevents seizures.
02:09
Remember, you got all
this inflammation going on
in the layers that
surround the brain
that puts them at risk
to have seizures.
02:16
So, anticonvulsants
may be considered.
02:18
Analgesics for the headache,
they might also give antipyretics
which are for the fever.
02:25
So, really, what I want to encourage
you is don't memorize lists.
02:29
I want you to be thinking through.
02:31
Okay, look, she's got
three drug groups up there.
02:34
I'm just going
to memorize their AAA.
02:36
That's one way you could do it.
02:38
But think about
what you know this patient
is going through and say, why
would they give an anticonvulsant?
Why would they give an analgesic?
Why would they give an antipyretic?
That's going to help your brain
latch on to those concepts
and be able to recall them
when you need them.
02:53
Like let's say on a test
or an actual patient care.
02:59
Now, when it comes to nursing care,
these are some things
that you need to keep in mind.
03:03
Remember, this patient has
a headache and things are a pain,
they might be photophobic.
03:08
So what type of environment
would they need?
Well, they need an
environment that's quiet.
03:15
We want low light,
You also want to elevate
the head of the bed.
03:21
Now, when you elevate the head
of a patient's bed,
what that does is help reduce
the pressure inside their head.
03:27
I already have inflamed meninges,
anything you can do to reduce
the pressure in my head,
that's a fantastic thing.
03:35
Because it's going to promote
venous drainage from the head.
03:39
And when you promote
venous drainage,
you're going to reduce the
cerebral congestion and edema.
03:45
So, that's a lot of words.
But let me go back through that
I have the head
of the bed elevated,
because I want to promote
good drainage from the head.
03:56
So we lower the risk of the
patient having cerebral edema,
and an intracranial pressure
that's elevated to the point
that could cause damage
or harm to the brain.
04:07
Now, let's take a look
at their neurological status.
04:09
I love that picture that
image of the brain there,
you see we've got a
magnifying scope on that,
because we're thinking about what
is going on with this patient.
04:18
Now, when I have cared for
a patient who had meningitis,
the family was the first one to
pick up that they were not right.
04:26
Something was not going on right.
04:28
They could answer
the right questions for me,
but the family who knew
that client knew their personality,
they were the first ones to
know something is not right.
04:37
You'll also do the traditional
things like are you oriented?
Who is the President?
Can you squeeze my hands?
But keep in mind, oftentimes,
the first sign of a problem
is more of a personality change
than an obvious neuro status change.
04:52
Another red sign I want you
to be on the lookout for.
04:55
If you see the patient's
systolic blood pressure go up,
and you see their diastolic
blood pressure go down,
this is a bad sign.
05:04
That means we've got some
pretty significant increase
in the intracranial pressure.
05:08
So, be on the lookout for that
simple change in vital signs.
05:12
Thanks for hanging in with me
throughout this whole video
on meningitis.
05:16
We've looked at the causes, whether
they're infectious or noninfectious.
05:20
We've looked at the
ways we can diagnose it,
where you can even do some
super cool assessments,
and we do some more serious things
like a lumbar puncture, or CBC.
05:28
We gave you the options
for treatment.
05:30
Antibiotics, if it's bacterial.
05:31
Otherwise,
we're just treating the symptoms.
05:34
Watch out for things
like seizures or pain.
05:36
Now, the signs and
symptoms of meningitis,
you're going to need to
go back and review those.
05:41
Now, this is when it's going to
pay off for you big on exams.
05:45
And what I care about most
is on patient care.
05:48
So, I'm going to use the model
from what you take on the NCLEX.
05:52
Now, see, you're supposed
to be able to recognize cues
and you'll see those
in exam questions.
05:56
So think about what
the cues are for meningitis.
06:01
Well, those are all the things
the patient might report to you,
Or they might say to you,
or you might observe.
06:06
Next, step is analyzing.
06:09
Remember, we talked about all
the symptoms of meningitis?
Will you put those together
to make a big picture
overview of what's going
on with your patient.
06:18
Now, there's some weird ones, right?
Like the nuchal rigidity, and the
headache with the light sensitivity.
06:24
And those are things
that start to make you think
that this patient
could have meningitis.
06:28
Once we put all those together,
you're going to prioritize
your hypothesis.
06:32
What do you think is going on?
Now, well,
you're not the person that will,
as an RN, prescribe antibiotics
or do the lumbar puncture,
you as the RN are the one who sees
the patient first, most often.
06:46
And the quicker you can
put these cues together,
you're going to have a better
outcome for your patient.
06:51
Because once you figure out,
this is what I think is going on,
you're going to
generate a solution.
06:56
What should we do next?
you're going to take that step,
and then evaluate what you've done.
07:01
Now, if you're saying,
I'm not ever going
to have to do this,
I plan on doing
blank kind of nursing.
07:06
This is how great nurses think.
07:09
They know the cues,
they recognize them,
they analyze them,
they put together,
they have an idea
of what is not normal
about this patient's experience.
07:18
They figure out what the next
important step should be.
07:21
They take it along with
the healthcare team,
and they make sure
the patient is progressing
and moving towards health.
07:27
You are completely capable
of doing that.
07:30
So, spend some time,
go back in the videos.
07:32
Think through this framework
of what you would do
in an actual setting with a patient
who you find with meningitis.