Nursing care plan on meningitis

Posted on by Soumya Ranjan Parida
Comprehensive Nursing Care Plan on Meningitis: 13 Nursing Diagnoses with Complete Interventions

Comprehensive Nursing Care Plan on Meningitis

13 Essential Nursing Diagnoses with Complete Interventions

Osmosis Style Notes Nursing Students NANDA Diagnoses Visual Learning

About This Resource

Welcome to this comprehensive Osmosis-style nursing care plan for meningitis. This resource has been designed specifically for nursing students and includes 15 essential nursing diagnoses with detailed interventions, rationales, and expected outcomes. We’ve incorporated visual learning aids, mnemonics, and flowcharts to enhance your understanding and retention.

The care plan on meningitis provided here is evidence-based and follows the latest nursing practice guidelines. It will help you understand the complex nursing care required for patients with meningitis and prepare you for clinical rotations and exams.

Table of Contents

Introduction to Meningitis

Meningitis is the inflammation of the meninges – the protective membranes covering the brain and spinal cord. This condition can be life-threatening and requires prompt medical intervention and skilled nursing care. The care plan on meningitis must address the multifaceted nature of this condition and its potential complications.

Types of Meningitis

  • Bacterial Meningitis: Caused by bacteria such as Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Most severe form that requires immediate treatment.
  • Viral Meningitis: Caused by viruses such as enteroviruses, herpes simplex virus, and others. Generally less severe than bacterial meningitis.
  • Fungal Meningitis: Caused by fungi like Cryptococcus and Candida. More common in immunocompromised individuals.
  • Parasitic Meningitis: Rare form caused by parasites such as Angiostrongylus cantonensis.
  • Non-infectious Meningitis: Caused by conditions such as cancer, lupus, certain medications, or head injuries.

Key Statistics

  • Bacterial meningitis affects approximately 1.2 million people worldwide annually
  • Highest incidence in the “meningitis belt” of sub-Saharan Africa
  • In the United States, about 4,100 cases of bacterial meningitis occur each year
  • Mortality rate for untreated bacterial meningitis approaches 100%
  • With treatment, mortality rate ranges from 5-40% depending on pathogen and age
  • 10-20% of survivors experience long-term neurological sequelae
  • Most common in children under 5 years and adults over 60 years of age

Clinical Significance

Meningitis is a medical emergency requiring immediate recognition and treatment. The nursing care plan on meningitis focuses on early detection, preventing complications, and supporting recovery. Nurses play a crucial role in recognizing symptoms, administering treatments, monitoring for complications, and providing patient and family education.

Pathophysiology of Meningitis

Disease Process

  1. Microbial Invasion: Pathogens enter the body through respiratory mucosa, colonize the nasopharynx, and may enter the bloodstream.
  2. Blood-Brain Barrier Penetration: Microorganisms cross the blood-brain barrier (BBB) and enter the cerebrospinal fluid (CSF).
  3. Bacterial Multiplication: Once in the CSF, bacteria multiply rapidly due to lack of immune defenses in this area.
  4. Inflammatory Response: The body initiates an inflammatory response, releasing cytokines, chemokines, and other inflammatory mediators.
  5. Meningeal Irritation: Inflammation of the meninges results in classic symptoms such as headache, neck stiffness, and photophobia.
  6. Increased Intracranial Pressure: Inflammation leads to cerebral edema and increased intracranial pressure.
  7. Neurological Damage: Without prompt treatment, ongoing inflammation and increased pressure can lead to permanent neurological damage or death.

Mnemonic: “MENINGES”

M – Microbes enter through respiratory tract/blood

E – Enter CSF by crossing blood-brain barrier

N – Numerous bacteria multiply rapidly in CSF

I – Inflammatory response triggered

N – Neurologic symptoms develop

G – Greater intracranial pressure results

E – Edema of brain tissue occurs

S – Sequelae may be permanent without treatment

Pathophysiology Flowchart

Pathogen Colonization

Nasopharynx or sinuses

Hematogenous Spread

Bacteria enter bloodstream

Blood-Brain Barrier Penetration

Pathogens cross into CSF

Bacterial Replication

Rapid multiplication in CSF

Inflammatory Response

Release of cytokines & inflammatory mediators

Meningeal Inflammation

Irritation of meninges

Clinical Manifestations

Headache, fever, neck stiffness, altered mental status

Complications

↑ ICP, seizures, neurological deficits, shock

Key Pathophysiological Findings

  • CSF in bacterial meningitis typically shows:
    • Increased white blood cells (predominantly neutrophils)
    • Decreased glucose levels
    • Increased protein levels
  • Blood-brain barrier disruption allows proteins and immune cells to enter the CSF
  • Cerebral edema results from increased capillary permeability
  • Vasculitis can lead to cerebral ischemia and infarction

Nursing Assessment for Meningitis

Subjective Data

  • Headache: Severe, persistent, may be frontal or generalized
  • Photophobia: Sensitivity to light
  • Phonophobia: Sensitivity to sound
  • Nausea: With or without vomiting
  • Fatigue and malaise: General feeling of unwellness
  • Myalgia: Muscle pain and body aches
  • Altered mental status: Confusion, irritability, or decreased level of consciousness
  • History of recent infection: Recent upper respiratory infection, otitis media, or sinusitis
  • History of immunocompromise: HIV, chemotherapy, transplant recipients
  • Vaccination status: Particularly for H. influenzae type B, pneumococcal, and meningococcal vaccines

Mnemonic: “HEADACHE”

H – Headache (severe, persistent)

E – Eyes sensitive to light (photophobia)

A – Altered mental status

D – Drowsiness or confusion

A – Anorexia and nausea

C – Cranial nerve abnormalities

H – High fever

E – Extreme neck stiffness (nuchal rigidity)

Objective Data

  • Vital Signs:
    • Fever (often high-grade, >39°C/102.2°F)
    • Tachycardia
    • Tachypnea
    • Elevated or decreased blood pressure (depending on disease progression)
  • Neurological Signs:
    • Altered level of consciousness (Glasgow Coma Scale)
    • Nuchal rigidity (neck stiffness)
    • Positive Kernig’s sign (pain and resistance on passive knee extension with hip flexed)
    • Positive Brudzinski’s sign (involuntary hip and knee flexion when neck is flexed)
    • Cranial nerve deficits
    • Focal neurological deficits
    • Seizure activity
    • Papilledema on fundoscopic exam (late sign)
  • Skin Findings:
    • Petechial or purpuric rash (particularly with meningococcal meningitis)
    • Skin mottling
  • Other Signs:
    • Bulging fontanelle (in infants)
    • Poor feeding (in infants)
    • Irritability or high-pitched cry (in infants)
    • Signs of increased intracranial pressure
    • Signs of dehydration

Meningeal Signs Assessment

Kernig’s Sign:

  1. Position patient supine
  2. Flex the hip and knee to 90°
  3. Attempt to extend the knee
  4. Positive sign: Pain and resistance to extension

Brudzinski’s Sign:

  1. Position patient supine
  2. Passively flex the neck forward
  3. Positive sign: Involuntary flexion of hips and knees

Critical Assessment Findings

The following findings warrant immediate medical attention and should be reported promptly:

  • Decreased level of consciousness
  • Focal neurological deficits
  • Seizure activity
  • Signs of increased intracranial pressure (Cushing’s triad: hypertension, bradycardia, irregular respiration)
  • Purpuric rash (suspect meningococcemia)
  • Hypotension or signs of shock
  • Respiratory distress
  • Bulging fontanelle in infants

15 Nursing Diagnoses for Meningitis

Using the Nursing Diagnoses

Each nursing diagnosis in this care plan on meningitis includes:

  • NANDA-approved diagnostic statement
  • Related factors and defining characteristics
  • Expected outcomes
  • Nursing interventions with detailed rationales
  • Evaluation criteria

Use these care plans as a guide for developing individualized patient care. Remember to adapt interventions based on the patient’s specific condition, age, and available resources.

1. Risk for Infection Transmission

NANDA-I

Diagnostic Statement

Risk for Infection Transmission related to exposure to pathogenic organisms, as evidenced by presence of infectious agent (bacterial or viral) causing meningitis.

Risk Factors

  • Presence of infectious agent in the cerebrospinal fluid
  • Exposure to respiratory secretions from infected individuals
  • Direct contact with infectious agents
  • Crowded living conditions
  • Inadequate vaccination

Expected Outcomes

  • Patient will not transmit infection to others as evidenced by absence of secondary cases.
  • Healthcare providers will maintain appropriate infection control measures.
  • Close contacts will receive prophylactic treatment as appropriate.
  • Patient will demonstrate understanding of transmission prevention measures.

Nursing Interventions

Interventions Rationales
Implement appropriate isolation precautions based on the type of meningitis (droplet precautions for bacterial meningitis, particularly meningococcal). Bacterial meningitis, especially meningococcal, can be transmitted through respiratory droplets. Appropriate isolation prevents transmission to healthcare workers and visitors.
Maintain isolation for at least 24 hours after initiation of effective antimicrobial therapy for bacterial meningitis. The risk of transmission significantly decreases after 24 hours of effective antibiotic therapy as the organism is cleared from the nasopharynx.
Ensure proper hand hygiene before and after patient contact. Hand hygiene is the most effective measure to prevent healthcare-associated infections and cross-contamination.
Use personal protective equipment (PPE) as appropriate (masks, gloves, gowns). PPE provides a barrier against infectious agents and reduces the risk of transmission.
Identify close contacts of patients with bacterial meningitis for prophylactic treatment. Close contacts of patients with meningococcal or Haemophilus influenzae type B meningitis are at increased risk and may require chemoprophylaxis.
Educate the patient and family about transmission prevention measures. Understanding transmission routes and prevention measures enhances compliance and reduces transmission risk.
Administer antibiotics promptly as prescribed. Early antibiotic administration reduces bacterial load and decreases the risk of transmission.
Ensure proper handling and disposal of respiratory secretions and contaminated materials. Proper waste management prevents environmental contamination and reduces transmission risk.

Evaluation

  • No evidence of secondary cases among contacts
  • Healthcare providers consistently implement appropriate infection control measures
  • Close contacts receive prophylactic treatment as indicated
  • Patient and family verbalize understanding of transmission prevention measures

Care Plan Notes

The type of isolation required depends on the causative organism. For meningococcal meningitis, droplet precautions are essential until 24 hours after starting effective antibiotics. For viral meningitis, standard precautions are usually sufficient.

2. Risk for Increased Intracranial Pressure

NANDA-I

Diagnostic Statement

Risk for Increased Intracranial Pressure related to inflammatory process of the meninges, cerebral edema, and possible obstruction of CSF flow, as evidenced by signs of increased intracranial pressure.

Risk Factors

  • Inflammatory process in the subarachnoid space
  • Cerebral edema secondary to inflammation
  • Possible obstruction of CSF flow
  • Inappropriate antidiuretic hormone secretion
  • Increased blood volume in the brain due to fever

Expected Outcomes

  • Patient will maintain normal intracranial pressure as evidenced by normal neurological assessment findings.
  • Patient will not demonstrate signs and symptoms of increased intracranial pressure.
  • If signs of increased ICP develop, they will be recognized and treated promptly.

Nursing Interventions

Interventions Rationales
Perform neurological assessments at regular intervals (e.g., every 1-2 hours initially, then as appropriate). Regular neurological assessments allow for early detection of changes that may indicate increased ICP.
Monitor for signs of increased ICP: decreased level of consciousness, headache, vomiting, altered pupillary reactions, abnormal posturing, Cushing’s triad (hypertension, bradycardia, irregular respirations). Early recognition of signs and symptoms allows for prompt intervention to prevent neurological compromise.
Position patient with head of bed elevated 30-45 degrees with head in neutral alignment. This position promotes venous drainage from the head and reduces ICP. Neutral head alignment prevents compression of jugular veins.
Maintain normovolemia and avoid fluid overload. Fluid overload can exacerbate cerebral edema and increase ICP.
Administer prescribed medications to reduce ICP (e.g., mannitol, hypertonic saline, corticosteroids) as ordered. These medications help reduce cerebral edema and ICP through various mechanisms.
Minimize activities that increase ICP: limit suctioning, avoid Valsalva maneuver, manage pain and agitation. Certain activities can transiently increase ICP and should be minimized to prevent neurological deterioration.
Maintain normothermia: administer antipyretics and implement cooling measures as needed. Fever increases cerebral metabolism and blood flow, potentially exacerbating increased ICP.
Maintain a quiet, calm environment with minimal stimulation. Excessive environmental stimulation can increase agitation and ICP.
Prepare for and assist with intracranial pressure monitoring if indicated. Direct ICP monitoring provides objective data on pressure trends and response to interventions.

Evaluation

  • Patient maintains stable neurological status
  • No signs or symptoms of increased ICP
  • If ICP is monitored directly, measurements remain within normal range (5-15 mmHg)
  • Prompt recognition and management of any signs of increased ICP

Critical Consideration

Increased intracranial pressure is a life-threatening complication of meningitis that requires immediate intervention. Changes in neurological status should be reported promptly to the healthcare provider. The nursing care plan on meningitis must prioritize monitoring for and responding to signs of increasing ICP.

3. Hyperthermia

NANDA-I

Diagnostic Statement

Hyperthermia related to infectious process and inflammatory response, as evidenced by elevated body temperature, warm skin, tachycardia, and tachypnea.

Defining Characteristics

  • Body temperature above normal range (often >39°C/102.2°F)
  • Flushed, warm skin
  • Tachycardia
  • Tachypnea
  • Increased metabolic rate
  • Increased oxygen consumption
  • Diaphoresis

Expected Outcomes

  • Patient will maintain normothermia (body temperature between 36.5-37.5°C or 97.7-99.5°F).
  • Patient will not experience complications related to hyperthermia.
  • Patient will report increased comfort as temperature normalizes.

Nursing Interventions

Interventions Rationales
Monitor body temperature at regular intervals (every 2-4 hours or more frequently if indicated). Regular monitoring allows for evaluation of temperature trends and effectiveness of interventions.
Administer antipyretic medications as prescribed (e.g., acetaminophen, ibuprofen). Antipyretics help reduce fever by inhibiting prostaglandin synthesis in the hypothalamus.
Apply external cooling measures as appropriate: tepid sponging, cooling blankets, ice packs to axilla and groin. External cooling helps reduce body temperature through conduction and convection. Gradual cooling prevents shivering, which can increase metabolic rate and heat production.
Ensure adequate hydration through oral or intravenous fluids as appropriate. Fever increases fluid loss through diaphoresis and increased respiration. Adequate hydration helps maintain hemodynamic stability and supports temperature regulation.
Remove excess clothing and blankets; maintain a cool environment. Reducing external heat and facilitating heat dissipation helps lower body temperature.
Monitor for complications of hyperthermia: dehydration, altered mental status, seizures. Hyperthermia can lead to various complications that require prompt recognition and management.
Monitor vital signs, especially heart rate and respiratory rate. Tachycardia and tachypnea often accompany fever and can lead to increased oxygen demand and consumption.
Avoid rapid cooling measures that may induce shivering. Shivering increases metabolic rate and heat production, potentially worsening hyperthermia.

Evaluation

  • Body temperature returns to normal range
  • Heart rate and respiratory rate return to normal limits
  • Patient reports improved comfort
  • No complications related to hyperthermia are observed
  • Antipyretic measures are effective in controlling fever

Clinical Tip

When implementing cooling measures, monitor for shivering which can increase metabolic rate and heat production. If shivering occurs, adjust cooling measures to achieve a more gradual temperature reduction. In meningitis, fever control is particularly important as elevated temperature increases cerebral metabolism and can worsen neurological outcomes.

4. Acute Pain

NANDA-I

Diagnostic Statement

Acute Pain related to inflammation of the meninges, increased intracranial pressure, and systemic inflammatory response, as evidenced by verbal reports of headache, neck pain, photophobia, and physiological indicators of pain.

Defining Characteristics

  • Verbal reports of severe headache
  • Neck pain and stiffness (nuchal rigidity)
  • Photophobia and phonophobia
  • Irritability and restlessness
  • Facial grimacing or guarding behavior
  • Changes in vital signs in response to pain
  • Altered muscle tone (neck rigidity)

Expected Outcomes

  • Patient will report decreased pain intensity as measured on a pain scale.
  • Patient will demonstrate increased comfort through decreased distress behaviors.
  • Patient will be able to participate in necessary care activities with minimal pain-related limitations.

Nursing Interventions

Interventions Rationales
Assess pain characteristics: location, intensity (using age-appropriate pain scale), quality, onset, duration, aggravating and relieving factors. Comprehensive pain assessment guides appropriate interventions and establishes a baseline for evaluating the effectiveness of pain management strategies.
Administer prescribed analgesics on schedule or as needed. (Note: NSAIDs are often preferred as they have both analgesic and anti-inflammatory effects.) Pharmacological pain management is essential for severe pain. NSAIDs can address both pain and the underlying inflammatory process.
Create a quiet, darkened environment with minimal stimulation. Photophobia and phonophobia are common in meningitis. Reducing environmental stimuli can decrease pain and discomfort.
Assist with positioning: maintain head and neck in neutral alignment, avoiding extreme flexion or extension. Proper positioning can reduce meningeal irritation and associated pain. Neutral alignment minimizes stress on inflamed meninges.
Apply cool compresses to forehead if headache is present. Cool compresses can provide local comfort and may help reduce pain through gate control mechanisms.
Implement non-pharmacological pain management strategies: relaxation techniques, distraction, guided imagery. Non-pharmacological strategies can complement medication management and provide additional pain relief without adverse effects.
Schedule activities and procedures to allow for periods of uninterrupted rest. Rest periods can reduce pain exacerbation and promote comfort. Clustering care activities minimizes disruption.
Evaluate the effectiveness of pain management interventions and adjust as needed. Ongoing evaluation ensures that pain management strategies are effective and allows for timely adjustments if needed.

Evaluation

  • Patient reports decreased pain intensity on pain scale
  • Decreased distress behaviors related to pain
  • Vital signs within normal limits or stable
  • Patient able to rest comfortably
  • Patient able to participate in necessary care activities

Clinical Note

In patients with meningitis, pain management should be approached judiciously. While adequate pain control is essential, opioid analgesics should be used cautiously as they can mask signs of neurological deterioration and potentially depress respiration. NSAIDs and acetaminophen are often preferred for their efficacy in managing headache and fever without significantly affecting neurological assessment.

5. Risk for Seizure Activity

NANDA-I

Diagnostic Statement

Risk for Seizure Activity related to CNS infection, cerebral irritation, metabolic abnormalities, fever, and increased intracranial pressure associated with meningitis.

Risk Factors

  • Central nervous system infection (meningitis)
  • Cerebral irritation from inflammatory process
  • High fever
  • Electrolyte imbalances
  • Increased intracranial pressure
  • Hypoxia secondary to respiratory compromise
  • Age (young children are at higher risk)

Expected Outcomes

  • Patient will remain free from seizure activity.
  • If seizures occur, patient will not experience injury during seizure activity.
  • Patient will maintain patent airway and adequate oxygenation during and after any seizure activity.

Nursing Interventions

Interventions Rationales
Monitor for signs of impending seizure: aura, change in mental status, focal twitching, changes in vital signs. Early recognition of prodromal signs may allow for preventive measures and preparation for seizure management.
Implement seizure precautions: padded side rails, bed in low position, suction equipment and oxygen readily available. Seizure precautions reduce the risk of injury if a seizure occurs and ensure that necessary equipment is available for prompt intervention.
Administer prophylactic anticonvulsant medications as prescribed. Anticonvulsant medications may be prescribed prophylactically in high-risk patients to prevent seizure activity.
Maintain a quiet, non-stimulating environment. Excessive stimulation can lower the seizure threshold in susceptible individuals.
Manage fever aggressively with antipyretics and cooling measures as ordered. High fever can lower the seizure threshold, particularly in children, and should be managed proactively.
Monitor electrolyte levels and correct imbalances as prescribed. Electrolyte abnormalities, particularly hyponatremia which can occur with SIADH in meningitis, can increase seizure risk.
If seizure occurs, ensure patient safety:
  • Position patient to side if possible
  • Do not restrain movements
  • Protect head
  • Do not force anything into mouth
  • Loosen restrictive clothing
 These measures protect the patient from injury during a seizure, maintain airway patency, and prevent aspiration.
Document seizure characteristics if they occur: onset, duration, type of movement, level of consciousness, post-ictal state. Detailed documentation provides important clinical information for diagnosis and treatment decisions.
Have emergency medications readily available (e.g., lorazepam, diazepam). Prompt administration of emergency medications can terminate prolonged seizures and prevent status epilepticus.

Evaluation

  • Patient remains free from seizure activity
  • If seizures occur, patient does not sustain injury
  • Airway remains patent during and after any seizure activity
  • Seizure precautions are consistently implemented
  • Staff responds appropriately to any seizure activity

Mnemonic: “SEIZURES”

S – Safety measures implemented

E – Environment modified to reduce stimulation

I – Identify and document seizure characteristics

Z – Zero restraint during seizure activity

U – Understand triggering factors (fever, lights)

R – Respiratory support as needed

E – Emergency medications available

S – Side-lying position during post-ictal state

6. Ineffective Cerebral Tissue Perfusion

NANDA-I

Diagnostic Statement

Ineffective Cerebral Tissue Perfusion related to cerebral inflammation, increased intracranial pressure, possible vasculitis, and cerebral edema, as evidenced by altered level of consciousness, cognitive deficits, and focal neurological signs.

Defining Characteristics

  • Altered level of consciousness
  • Restlessness, irritability
  • Behavioral changes
  • Memory deficits
  • Cognitive impairment
  • Focal neurological deficits
  • Changes in pupillary response
  • Changes in vital signs (Cushing’s triad in late stages)

Expected Outcomes

  • Patient will maintain adequate cerebral perfusion as evidenced by improved or stable neurological status.
  • Patient will demonstrate improved level of consciousness and cognitive functioning.
  • Patient will not develop new or worsening neurological deficits.

Nursing Interventions

Interventions Rationales
Perform comprehensive neurological assessments at regular intervals (every 1-2 hours initially, then as appropriate): level of consciousness, pupillary response, motor strength, sensory function, cranial nerve function. Regular neurological assessments allow for early detection of changes in cerebral perfusion and function. Deterioration in neurological status may indicate worsening cerebral perfusion.
Monitor vital signs: blood pressure, heart rate, respiratory rate, oxygen saturation. Changes in vital signs may reflect alterations in cerebral perfusion pressure. Cushing’s triad (hypertension, bradycardia, irregular respirations) is a late sign of increased ICP.
Maintain head of bed elevation at 30-45 degrees with head in neutral alignment. This position promotes venous drainage and helps optimize cerebral perfusion pressure while minimizing increases in ICP.
Maintain adequate oxygenation: monitor oxygen saturation, administer oxygen as needed, position for optimal respiratory function. Adequate oxygenation is essential for cerebral cellular metabolism. Hypoxemia can worsen cerebral ischemia and neurological deficits.
Maintain normothermia: administer antipyretics and implement cooling measures as needed. Fever increases cerebral metabolic demand, potentially worsening the mismatch between oxygen supply and demand.
Administer prescribed medications to optimize cerebral perfusion: vasopressors for hypotension, antihypertensives for hypertension, osmotic agents for cerebral edema. Pharmacological interventions may be necessary to maintain cerebral perfusion pressure within an optimal range.
Avoid activities that increase ICP: limit suctioning, prevent Valsalva maneuver, manage coughing, minimize unnecessary stimulation. Increases in ICP can further compromise cerebral perfusion by reducing cerebral perfusion pressure.
Monitor intake and output, maintain normovolemia. Hypovolemia can decrease cerebral perfusion, while hypervolemia can worsen cerebral edema. Fluid management should be carefully balanced.
Monitor for signs of SIADH (inappropriate ADH secretion): hyponatremia, fluid retention, concentrated urine. SIADH is a potential complication of meningitis that can lead to hyponatremia and worsen cerebral edema.

Evaluation

  • Stable or improved neurological status
  • Improved level of consciousness
  • Absence of new neurological deficits
  • Vital signs within acceptable parameters
  • Intracranial pressure within normal range if monitored
  • Adequate cerebral perfusion pressure maintained

Cerebral Perfusion Management in Meningitis

Optimize Cerebral Perfusion Pressure (CPP)

CPP = MAP – ICP

Maintain Adequate MAP

  • Ensure normovolemia
  • Treat hypotension
  • Vasopressors if needed

Reduce ICP

  • Elevate head 30-45°
  • Osmotic agents
  • Minimize triggers

Optimize Oxygenation and Ventilation

Prevent hypoxemia and hypercapnia

Control Metabolic Demands

Manage fever, seizures, and agitation

7. Anxiety

NANDA-I

Diagnostic Statement

Anxiety related to acute illness, hospitalization, uncertain prognosis, and fear of potential complications, as evidenced by expressed concerns, restlessness, and increased tension.

Defining Characteristics

  • Verbalized anxiety and worry
  • Increased tension and restlessness
  • Expressed concerns about treatment and prognosis
  • Increased heart rate and respiratory rate
  • Difficulty sleeping
  • Focused on self
  • Facial tension and vigilance

Expected Outcomes

  • Patient will report decreased anxiety levels.
  • Patient will demonstrate reduced physical symptoms of anxiety.
  • Patient will utilize effective coping strategies to manage anxiety.
  • Patient will verbalize understanding of the illness, treatment plan, and prognosis.

Nursing Interventions

Interventions Rationales
Establish a therapeutic relationship with the patient and family: introduce yourself, explain your role, demonstrate empathy and availability. A therapeutic relationship provides emotional support and builds trust, helping to alleviate anxiety. The patient’s perception of having supportive caregivers can reduce feelings of isolation and fear.
Assess anxiety level using appropriate assessment tools and through observation of behavioral and physiological indicators. Systematic assessment of anxiety provides a baseline for evaluating the effectiveness of interventions and guides selection of appropriate strategies.
Provide clear, concise information about the illness, treatment plan, procedures, and expected outcomes in simple language. Repeat information as needed. Knowledge and understanding can reduce fear of the unknown, which is a common source of anxiety. Information should be provided at the patient’s level of understanding and repeated as necessary due to possible cognitive effects of the illness.
Create a calm, quiet environment with minimal stimulation. Environmental factors can significantly impact anxiety levels. A quiet environment reduces sensory overload, which is particularly important for patients with meningitis who may have heightened sensitivity to stimuli.
Encourage expression of fears and concerns; validate feelings. Verbalization of fears and concerns can help reduce anxiety. Validation acknowledges the legitimacy of the patient’s emotions and reinforces that anxiety is a normal response to serious illness.
Teach and encourage the use of relaxation techniques: deep breathing, progressive muscle relaxation, guided imagery. Relaxation techniques can activate the parasympathetic nervous system, counteracting the physiological stress response associated with anxiety.
Involve family members in care as appropriate; provide information and support to family members. Family involvement can provide comfort to the patient and help reduce anxiety. Supporting family members allows them to be more effective in supporting the patient.
Administer anxiolytic medications as prescribed, monitoring for effectiveness and side effects. Pharmacological management may be necessary for severe anxiety. However, in meningitis, medications that affect neurological assessment should be used judiciously.
Maintain consistency in care providers and routines when possible. Predictability and consistency can help reduce anxiety by providing a sense of stability in an otherwise uncertain situation.

Evaluation

  • Patient reports decreased anxiety levels
  • Patient demonstrates reduced physiological and behavioral manifestations of anxiety
  • Patient successfully utilizes relaxation techniques or other coping strategies
  • Patient verbalizes accurate understanding of the illness, treatment plan, and prognosis
  • Family members demonstrate reduced anxiety and increased ability to support the patient

Clinical Tip

For patients with meningitis, anxiety may be exacerbated by physical discomfort, sensory sensitivity, and cognitive changes. A comprehensive approach to anxiety management should address both psychological and physiological factors. Effective pain management, fever control, and symptom relief can significantly reduce anxiety by addressing physical discomfort. When implementing relaxation techniques, consider the patient’s cognitive status and tailor approaches accordingly.

8. Deficient Fluid Volume

NANDA-I

Diagnostic Statement

Deficient Fluid Volume related to increased insensible losses secondary to fever, inadequate oral intake, and vomiting, as evidenced by dry mucous membranes, poor skin turgor, concentrated urine, and elevated hematocrit.

Defining Characteristics

  • Dry mucous membranes
  • Decreased skin turgor
  • Thirst
  • Decreased urine output with increased concentration
  • Elevated hematocrit
  • Tachycardia
  • Hypotension (more severe deficits)
  • Weakness
  • Sunken eyes or fontanelles (in infants)

Expected Outcomes

  • Patient will maintain adequate hydration status as evidenced by normal skin turgor, moist mucous membranes, and adequate urine output.
  • Patient will maintain electrolyte balance within normal range.
  • Patient will demonstrate hemodynamic stability with normal vital signs for age.

Nursing Interventions

Interventions Rationales
Assess hydration status: skin turgor, mucous membranes, fontanelles (in infants), urine output and concentration, vital signs. Regular assessment of hydration status allows for early identification of fluid deficits and evaluation of the effectiveness of interventions.
Monitor intake and output accurately; calculate fluid balance every 8-12 hours. Precise monitoring of fluid balance helps guide fluid replacement therapy and detect trends in fluid status.
Weigh patient daily at the same time, using the same scale and similar clothing. Body weight is a sensitive indicator of fluid status; rapid weight changes often reflect fluid balance alterations.
Administer IV fluids as prescribed, monitoring rate and patient response. IV fluid therapy is essential for replacing fluid losses and maintaining hydration when oral intake is inadequate. However, in meningitis, fluid management must be carefully balanced to avoid cerebral edema.
Monitor laboratory values: electrolytes, BUN, creatinine, hematocrit. Laboratory values provide objective data about fluid and electrolyte status and renal function.
Encourage oral fluids if the patient is alert and able to swallow safely; offer small, frequent amounts. Oral hydration is preferred when feasible as it is more physiological and carries less risk than IV therapy. Small, frequent amounts may be better tolerated in patients with nausea.
Administer antiemetics as prescribed for nausea and vomiting. Controlling nausea and vomiting can improve oral intake and prevent further fluid losses.
Implement measures to reduce fever: antipyretics, cooling measures. Fever increases insensible fluid losses through diaphoresis and increased respiratory rate. Fever reduction can help decrease fluid requirements.
Monitor for signs of fluid overload: increased respiratory rate, crackles on auscultation, edema, increasing blood pressure. Fluid resuscitation in meningitis requires careful balance to avoid causing or worsening cerebral edema. Signs of fluid overload should prompt immediate reassessment of the fluid management plan.

Evaluation

  • Normal or improved skin turgor and moist mucous membranes
  • Urine output >0.5-1 mL/kg/hr with normal specific gravity
  • Stable vital signs within normal range for age
  • Electrolyte levels within normal range
  • Absence of signs of dehydration
  • Stable or return to baseline body weight

Important Consideration

Fluid management in meningitis requires a delicate balance. Patients are at risk for dehydration due to fever, decreased intake, and vomiting. However, aggressive fluid resuscitation may worsen cerebral edema. Additionally, patients with meningitis may develop syndrome of inappropriate antidiuretic hormone secretion (SIADH), leading to fluid retention and hyponatremia. Close monitoring of fluid status, neurological signs, and serum sodium levels is essential. Consult with the healthcare team to establish appropriate fluid goals based on the individual patient’s condition.

9. Risk for Injury

NANDA-I

Diagnostic Statement

Risk for Injury related to altered consciousness, confusion, disorientation, seizure activity, and impaired mobility associated with meningitis.

Risk Factors

  • Altered level of consciousness
  • Confusion and disorientation
  • Potential for seizure activity
  • Impaired physical mobility
  • Sensory-perceptual alterations
  • Dizziness or vertigo
  • Weakness and fatigue
  • Medication side effects

Expected Outcomes

  • Patient will remain free from injury during hospitalization.
  • Patient will maintain a safe environment.
  • Patient/family will demonstrate understanding of safety measures.

Nursing Interventions

Interventions Rationales
Conduct a fall risk assessment on admission and regularly thereafter. Systematic assessment of fall risk allows for implementation of appropriate preventive measures based on identified risk factors.
Implement fall prevention measures: bed in low position, side rails up (if appropriate), call bell within reach, non-slip footwear, clear pathways. Environmental modifications can significantly reduce the risk of falls and injuries, especially in patients with altered cognition or mobility.
Maintain seizure precautions: padded side rails, suction equipment available, bed in lowest position. Patients with meningitis are at risk for seizures due to cerebral irritation and inflammation. Seizure precautions reduce the risk of injury if seizures occur.
Provide frequent orientation to time, place, and person for confused patients. Reorientation helps reduce confusion and may improve patient cooperation with safety measures.
Ensure adequate lighting while being mindful of photophobia; consider nightlights for nighttime. Appropriate lighting helps prevent falls while accommodating the photophobia that is common in meningitis.
Assist with ambulation; use assistive devices as needed. Physical assistance and appropriate assistive devices can prevent falls in patients with weakness, dizziness, or impaired coordination.
Consider the use of bed alarm or patient sitter for high-risk patients. Additional monitoring may be necessary for patients with significant cognitive impairment or those at high risk for falls or self-harm.
Ensure that personal items, call light, and frequently used items are within easy reach. Easy access to necessary items reduces the need for the patient to stretch or get up unassisted, which could lead to falls.
Maintain a consistent schedule for toileting to reduce urgent attempts to get to the bathroom. Scheduled toileting can prevent urgent situations that may lead to falls when patients attempt to get to the bathroom quickly without assistance.
Educate the patient and family about safety measures and the importance of calling for assistance. Patient and family education enhances cooperation with safety measures and enables them to participate actively in preventing injuries.

Evaluation

  • Patient remains free from falls and injuries
  • Safety measures are consistently implemented
  • Patient and family demonstrate understanding of and cooperation with safety measures
  • Environment is maintained in a safe manner
Bed Safety

Low position, rails up when appropriate, wheels locked

Call System

Call light within reach, respond promptly

Mobility

Assist with ambulation, use appropriate devices

Environment

Clear pathways, adequate lighting, minimize clutter

10. Disturbed Sensory Perception

NANDA-I

Diagnostic Statement

Disturbed Sensory Perception related to neurological irritation, inflammation of cranial nerves, and altered cerebral function, as evidenced by photophobia, phonophobia, altered response to stimuli, and sensory deficits.

Defining Characteristics

  • Photophobia (sensitivity to light)
  • Phonophobia (sensitivity to sound)
  • Altered response to visual, auditory, or tactile stimuli
  • Reported or observed change in sensory acuity
  • Irritability in response to normal stimuli
  • Disorientation
  • Potential cranial nerve deficits (vision, hearing, facial sensation)

Expected Outcomes

  • Patient will experience reduced discomfort from sensory stimuli.
  • Patient will maintain optimal sensory function.
  • Patient will verbalize improved comfort in relation to sensory perception.
  • Patient will demonstrate appropriate responses to environmental stimuli.

Nursing Interventions

Interventions Rationales
Assess sensory perception: visual acuity, auditory function, response to touch, pain perception, cranial nerve function. Comprehensive assessment of sensory function establishes a baseline and guides appropriate interventions. Changes in sensory function may indicate disease progression or complications.
Modify the environment to reduce sensory stimuli: dim lighting, reduce noise, limit unnecessary tactile stimulation. Environmental modifications can significantly reduce discomfort in patients with photophobia and phonophobia, which are common in meningitis due to meningeal irritation.
Provide sunglasses or eye shields for patients with photophobia. Eye protection can reduce discomfort from light sensitivity while allowing necessary visual function.
Use a soft voice and reduce environmental noise for patients with phonophobia. Modulating auditory stimuli can reduce discomfort and irritability in patients with sound sensitivity.
Approach and touch the patient gently; explain actions before initiating contact. Patients with altered sensory perception may be startled or distressed by unexpected touch. Clear communication and gentle approach can reduce adverse reactions.
Provide reorientation to time, place, and person as needed. Sensory alterations can contribute to disorientation. Regular reorientation helps maintain cognitive function and reduces confusion.
Schedule care activities to allow for periods of uninterrupted rest. Rest periods without sensory stimulation can reduce fatigue and sensory overload, potentially improving tolerance to necessary stimuli.
Monitor for changes in cranial nerve function: vision, hearing, facial sensation and movement, swallowing. Cranial nerve deficits may occur in meningitis due to direct nerve involvement or increased intracranial pressure. Early detection allows for prompt intervention.
Administer prescribed analgesics and other medications to reduce discomfort. Pain management can improve tolerance to sensory stimuli and reduce overall distress.

Evaluation

  • Patient reports decreased discomfort from sensory stimuli
  • Patient demonstrates improved tolerance to necessary environmental stimuli
  • Patient maintains or improves baseline sensory function
  • Patient responds appropriately to environmental stimuli
  • Cranial nerve function remains intact or improves

Clinical Note

Disturbed sensory perception in meningitis often results from irritation of the meninges and potential cranial nerve involvement. Photophobia and phonophobia are particularly common and can cause significant distress. In children, irritability and inconsolability may be manifestations of sensory disturbances. Long-term sequelae of meningitis may include permanent sensory deficits, particularly hearing loss due to cranial nerve VIII involvement. Early auditory testing should be considered for patients recovering from bacterial meningitis.

11. Risk for Impaired Skin Integrity

NANDA-I

Diagnostic Statement

Risk for Impaired Skin Integrity related to immobility, altered mental status, fever, diaphoresis, and potential poor nutritional status secondary to meningitis.

Risk Factors

  • Decreased mobility or bed rest
  • Altered mental status limiting ability to change position
  • Hyperthermia and diaphoresis
  • Potential fluid and nutritional deficits
  • Mechanical factors (pressure, shear, friction)
  • Moisture from fever and diaphoresis
  • Potential incontinence due to altered mental status

Expected Outcomes

  • Patient will maintain intact skin throughout hospitalization.
  • Patient will not develop pressure injuries or skin breakdown.
  • If skin integrity is compromised, prompt healing will occur without complications.

Nursing Interventions

Interventions Rationales
Conduct a comprehensive skin assessment on admission and at least once per shift, with particular attention to pressure points. Regular skin assessment allows for early identification of skin changes and prompt intervention to prevent progression to more severe skin breakdown.
Use a validated pressure injury risk assessment tool (e.g., Braden Scale) to identify level of risk. Standardized assessment tools help quantify risk and guide appropriate preventive measures based on identified risk factors.
Reposition the patient at least every 2 hours, or more frequently if indicated. Regular repositioning relieves pressure on vulnerable areas and promotes blood flow to tissues, reducing the risk of pressure injuries.
Use appropriate pressure-redistributing surfaces (mattress, cushions) based on risk assessment. Specialty surfaces can help distribute pressure more evenly, reducing the risk of pressure injuries in high-risk patients.
Keep skin clean and dry; use pH-balanced cleansers and moisturizers. Proper skin hygiene maintains skin integrity while avoiding excessive dryness or moisture that can predispose to breakdown. pH-balanced products help maintain the skin’s acid mantle.
Change bed linens and clothing when damp from diaphoresis. Prolonged moisture exposure can macerate skin and increase susceptibility to breakdown. Keeping the patient dry helps maintain skin integrity.
Minimize shear and friction during repositioning: use lift sheets, adequate assistance, and proper positioning techniques. Shear and friction forces can damage skin and underlying tissues. Proper transfer and positioning techniques reduce these forces.
Provide adequate nutrition and hydration to support skin integrity. Proper nutrition, including adequate protein, vitamins, and minerals, is essential for maintaining healthy skin and preventing breakdown.
Implement incontinence management strategies as needed; clean skin promptly after any episodes of incontinence. Urine and feces can be irritating to skin and increase the risk of breakdown. Prompt cleaning and appropriate barrier products protect skin from moisture and irritants.
Document skin condition, preventive measures, and any skin changes. Documentation ensures continuity of care and allows for evaluation of the effectiveness of preventive measures.

Evaluation

  • Skin remains intact without signs of breakdown
  • No development of pressure injuries
  • If skin compromise occurs, prompt healing is observed
  • Skin remains clean, dry, and well-hydrated
  • Risk assessment scores improve or remain stable

Mnemonic: “SKIN CARE”

S – Surface selection (appropriate mattress, cushions)

K – Keep turning (regular repositioning)

I – Incontinence management

N – Nutrition support

C – Cleanse gently

A – Assess skin regularly

R – Reduce pressure, shear, and friction

E – Educate patient and family

12. Fatigue

NANDA-I

Diagnostic Statement

Fatigue related to inflammatory process, infectious state, increased metabolic demands, altered nutritional intake, and sleep disruption, as evidenced by verbalized lack of energy, increased need for rest, and decreased performance capacity.

Defining Characteristics

  • Verbalized or observed lack of energy
  • Increased rest requirements
  • Decreased performance capacity
  • Lethargy or listlessness
  • Disinterest in surroundings
  • Inability to maintain usual routines
  • Increased physical complaints

Expected Outcomes

  • Patient will report decreased fatigue and increased energy levels.
  • Patient will participate in activities at a level appropriate to their condition.
  • Patient will demonstrate energy conservation techniques.
  • Patient will achieve adequate rest and sleep.

Nursing Interventions

Interventions Rationales
Assess level of fatigue using a standardized scale (e.g., Fatigue Severity Scale) and identify contributing factors. Systematic assessment of fatigue provides a baseline for evaluating the effectiveness of interventions and helps identify specific factors that may be addressed.
Plan care activities to allow for uninterrupted rest periods; cluster care when possible. Scheduled rest periods help conserve energy. Clustering care minimizes disruptions and allows for longer periods of uninterrupted rest.
Assist with activities of daily living as needed, encouraging self-care within energy limitations. Assistance with ADLs conserves energy while promoting independence appropriate to the patient’s condition.
Create and maintain a restful environment: control noise, lighting, temperature; minimize interruptions. Environmental factors can significantly impact rest and energy conservation. A quiet, comfortable environment promotes rest and reduces unnecessary energy expenditure.
Implement measures to improve sleep: maintain day-night cycle, minimize nighttime disruptions, comfort measures. Quality sleep is essential for energy restoration. Sleep promotion measures can help improve sleep quality and reduce fatigue.
Ensure adequate nutrition and hydration; consult with dietitian as needed. Proper nutrition provides essential nutrients for energy production. Inadequate intake can worsen fatigue.
Treat underlying contributors to fatigue: manage pain, treat infection, address anemia if present. Addressing medical factors contributing to fatigue is essential for effective management. Pain, infection, and anemia are common contributors to fatigue.
Teach energy conservation techniques: prioritizing activities, pacing, using assistive devices, planning rest periods. Energy conservation techniques help patients manage limited energy resources effectively and accomplish necessary activities with less fatigue.
Gradually increase activity as tolerated during recovery phase; avoid excessive exertion. Progressive activity helps rebuild stamina without causing excessive fatigue. Gradual progression prevents setbacks due to overexertion.

Evaluation

  • Patient reports decreased fatigue and increased energy levels
  • Patient participates in activities at an appropriate level without excessive fatigue
  • Patient demonstrates use of energy conservation techniques
  • Patient achieves adequate rest and sleep
  • Contributing factors to fatigue are effectively managed

Patient Education Tip

Inform patients and families that fatigue is a common symptom during both the acute phase of meningitis and the recovery period. Post-infectious fatigue may persist for weeks to months after the acute illness has resolved. Encourage a gradual return to normal activities with planned rest periods. Explain that pushing through excessive fatigue can delay recovery and may contribute to a prolonged convalescence period.

13. Sleep Pattern Disturbance

NANDA-I

Diagnostic Statement

Sleep Pattern Disturbance related to pain, discomfort, hospitalization, environmental factors, neurological irritation, and frequent assessments/interventions, as evidenced by difficulty falling or staying asleep, early awakening, or verbalized dissatisfaction with sleep.

Defining Characteristics

  • Difficulty falling asleep
  • Frequent awakenings
  • Early morning awakening
  • Verbalized dissatisfaction with sleep
  • Observed restlessness during sleep
  • Increased irritability related to lack of sleep
  • Fatigue not relieved by sleep
  • Dark circles under eyes

Expected Outcomes

  • Patient will report improved sleep quality and quantity.
  • Patient will demonstrate fewer signs of sleep deprivation.
  • Patient will identify factors that promote sleep.
  • Patient will establish a beneficial sleep routine.

Nursing Interventions

Interventions Rationales
Assess sleep patterns: bedtime routine, usual sleep hours, factors that promote or inhibit sleep, changes since illness onset. Comprehensive assessment of sleep patterns helps identify specific issues and guide appropriate interventions based on individual needs and preferences.
Minimize environmental disruptions: control noise, adjust lighting to promote day-night cycles, maintain comfortable room temperature. Environmental factors significantly impact sleep quality.

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