Nursing Management of Neurologic Patients

Nursing Management

• Continuous assessment of neurologic status and vital signs (every 2-4 hours).
• Evaluate oxygenation using arterial blood gas values and pulse oximetry.
• Monitor blood pressure as it may indicate impending cardiac/respiratory failure.
• Rapid IV fluid replacement may be necessary, but avoid overhydration to reduce cerebral edema risk.
• Control high fever to lessen oxygen demand on heart and brain.
• Protect patients from injury due to seizures or altered level of consciousness (LOC).
• Regular monitoring of body weight, serum electrolytes, and urine metrics, especially if SIADH is suspected.
• Minimize complications related to immobility, including pressure ulcers and pneumonia.
• Implement infection control measures for 24 hours after antibiotic therapy starts.
• Communicate updates about the patient’s condition to family and facilitate visitations appropriately.

Nursing Diagnosis

• Ineffective Tissue Perfusion (cerebral) due to infection and cerebral edema.
• Hyperthermia linked to infectious processes and cerebral edema.
• Risk for Fluid Volume Imbalance from fever and reduced intake.
• Acute Pain associated with meningeal irritation.
• Impaired Physical Mobility from extended bed rest.

Enhancing Cerebral Perfusion

• Frequent assessment of LOC, vital signs, and neurologic parameters.
• Check for signs of increased intracranial pressure (ICP) like decreased LOC and pupil dilation.
• Maintain a calm environment to prevent agitation, which can raise ICP.
• Prepare for lumbar puncture to evaluate cerebrospinal fluid (CSF), which may be followed by neuroimaging.
• Report any signs of deterioration, such as rising temperature or altered respirations.
• Administer IV mannitol as needed.

Reducing Fever

• Timely administration of antimicrobial agents is crucial to keep optimal blood levels.
• Frequent or continuous temperature monitoring.
• Use cooling measures like hypothermia blankets if required.
• Give antipyretics such as paracetamol as ordered.

Maintaining Fluid Balance

• Prevent IV fluid overload to avoid worsening cerebral edema.
• Closely monitor intake and output, and frequently check central venous pressure (CVP).

Diagnostics

• Use CT or MRI scans to assess shifts in brain contents prior to a lumbar puncture.
• Key diagnostic tests include bacterial culture and Gram staining of CSF and blood.
• White blood cell (WBC) count may reach 30,000/mm³ with elevated neutrophils.

Pharmacological Management

• Administer antibiotics like Vancomycin with cephalosporins or IV penicillins.
• Use corticosteroids like Dexamethasone.
• Manage dehydration and shock with fluid volume expanders.
• Control seizures with phenytoin (Dilantin).
• Treat increased ICP with mannitol and other relevant medications.

Clinical Manifestations

• Common signs include photophobia, muscular rigidity, disorientation, and potential behavioral changes.
• Severe cases may show symptoms of septicemia, including high fever and purpuric lesions.
• Complications can result in hearing loss, kidney failure, seizures, and potential death.

Risks and Pathophysiology

• Risk factors for meningitis include age (young children and teens), community living, pregnancy, and compromised immune status.
• Meningitis often originates from bloodstream infections or direct extension from facial injuries.
• Disease process includes inflammatory response in meninges leading to increased ICP and excessive ADH release, causing fluid retention and hyponatremia.

Clinical Signs of Meningitis

• Headache and fever are initial symptoms; headaches are typically severe due to meningeal irritation.
• Notable signs include nuchal rigidity, positive Kernig's and Brudzinski's signs.
• As infection progresses: lethargy and seizures may occur, along with signs of increased ICP.

Types of Meningitis

• Meningitis can be classified into viral, bacterial, fungal, and parasitic varieties.
• Bacterial meningitis is often caused by pathogens like Streptococcus pneumoniae and Neisseria meningitidis.

This quiz focuses on the essential nursing management practices for patients with neurologic concerns, including monitoring vital signs, oxygenation, and preventing complications. It also addresses key nursing diagnoses such as ineffective tissue perfusion. Test your knowledge on optimal care strategies and patient communication techniques in neurologic nursing.