Nursing Care

In the hospital, the nurse works most closely with the patients.  It is up to them to be the eyes and ears for the physicians and act accordingly when a patient’s condition changes.  Nurses learn how to make their own interpretations of a patient’s condition without thinking in terms of actual diagnosis.  They think in terms of the “Nursing diagnosis.” These diagnoses are developed based on what they observe during their assessments.  We will discuss more next week on how nursing diagnosis are developed.  However I feel that the plan of care is best understood if you know why the nurse if performing that care.  The nursing care is determined based on these diagnoses.  With meningococcal meningitis, the care for one patient may be different than what another patient needs.  Also, there may be different protocols for nursing care in different hospitals.  That is why as a nurse, it is important to know the condition of your patient, as well as requirements for care.  Below I have created a chart of nursing diagnoses and the perspective care that will be done in order to treat/manage the diagnoses. 

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Nursing Diagnosis	Care for condition/ Why nurses do this
·  Risk for infection transmission related to contagious nature of organism	·  Institute Infection control precautions until 24 hours after initiation of antibiotic therapy o   This limits the risk of transmission of infection to health care providers and possibly other hospital patients ·  Reduce high fever to decrease load on heart and bran for oxygen demands o   Patients with infection experience fever.  Fever affects other body systems that we need to perform correctly in order for the patient to properly heal
·  Acute Pain related to headache, fever, neck pain secondary to meningeal irritation	·  Deliver pain medications as ordered and as needed pain medication if pain is not well controlled o   It is proven that if patients are in pain, their body will not heal appropriately, or take longer to heal.  We want pain to be constantly monitored and under control
·  Acute pain related to nuchal rigidity, muscle aches, immobility and increased sensitivity to external stimuli secondary to infectious process	·  Deliver pain medications as ordered and as needed pain medication if pain is not well controlled o   It is proven that if patients are in pain, their body will not heal appropriately, or take longer to heal.  We want pain to be constantly monitored and under control
·  Impaired physical mobility related to IV infusion	·  Perform range of motion exercises o   Range of motion exercises prevent muscle and joint stiffening.  We want the patient to be able to be mobile once they are able ·  Place a indwelling catheter o   Putting a catheter in place allows for the patient to stay in bed rather than getting up to use the restroom.  With this however, there is a risk of infection so we only put in place if highly needed
·  Activity intolerance related to fatigue and malise secondary to infection	·  Perform activity as tolerated o   We do not want to push our patients to perform activities if their body needs to rest ·  Cluster nursing care in order to increase length of uninterrupted periods o   Limiting the amount of times a nurse enters the room allows for more time for the patient to rest, which is critical in the healing process
·  Risk for impaired skin integrity related to immobility, dehydration, and sweating	·  Prevent complications associated with immobility such as pressure ulcers and pneumonia o   Turning the patient will allow for pressure on the skin to be alleviated.  We can also teach out patients how to deep breathe or use devices such as the incentive spirometer in order to keep the lungs open and active.  This will prevent other infections such as pneumonia ·  Change bed linens often if sweating in order to prevent constant moisture on skin o   Moisture increases the risk for ulcer development
·  Risk for injury related to restlessness and disorientation secondary to meningeal irritation	·  Protect the patient from injury secondary to seizure activity or altered level of consciousness o   Patients may experience seizures or disorientation.  As nurses we can provide extra padding on the beds to prevent further seizure related injury.  Also if the patient is a risk for getting out of bed without a health care provider present, we can place bed alarms or restraints as needed. ·  Keep bed rails raised and bed in low position o   Raised bed rails prevent the patient from falling out of bed.  If a patient does happen to fall out, having the bed low will minimize risk for injury ·  Assess neurologic status and vital signs o   This will determine if a patient is ready to get up and walk.  We want to reduce the risk of falls ·  Determine their oxygenation status with blood gas values and pulse oximetry
·  Interrupted family process related to critical nature of situation and uncertain prognosis	·  Inform family about patient’s condition and permit family to see patient at appropriate intervals o   As previously stated, rest is crucial in the healing process.  We want the patient’s family involved at appropriate times ·  Provide emotional support and teaching o   Families will often be stressed due to the new condition of their loved one.  It is important to listen to the family’s concerns and teach the family about how to appropriately care for their loved one
·  Anxiety related to treatment and risk of death	·  Explain to patient each medical intervention that is occurring o   If the patient is conscious, it is always important to explain the care they you are providing.  This gives them knowledge about their condition and also teaches them about their care ·  Provide emotional support o   The patient will be anxious or scared about their changing condition.  It is important to listen to the patient as they express their concerns and provide appropriate feedback

Clearly, this is not a comprehensive list of care that needs to be performed.  However I have highlighted some of the essential care needs for a meningitis patient.  Finding specific information related to the nursing care of theses patients is difficult since nurses are trained through their programs with expensive comprehensive textbooks.  However, here are 2 websites that explain some of the information that I have included in the table.  http://nurseslabs.com/bacterial-meningitis/ and http://www.nursingcenter.com/lnc/CEArticle?an=00152193-200711000-00035&Journal_ID=54016&Issue_ID=751243. 

Here is another link for a case study on a patient with meningococcal meningitis. http://wps.prenhall.com/wps/media/objects/737/755395/bacterial_meningitis.pdf

BIBLIOGRAPHY

Nurse Labs. (2015). Bacterial Meningitis. Retrieved from http://nurseslabs.com/bacterial-men

ingitis/ 

Matthews, C. Miller, L. Mott, M. (November, 2007). Getting Ahead of Acute Meningitis and Encephalitis. Retrieved fromhttp://www.nursingcenter.com/lnc/CEArticle?an=00152193-200711000-00035&Journal_ID=54016&Issue_ID=751243