NSG 430 EXAM 9 (Complete And Verified Study material) (17pages) LEARNEXAMS

1. Meningitis: Answer Inflammation of the meninges - Bacterial most often caused by streptococcus pneumoniae (ear infection, sinusinfection, head trauma, dental therapy, etc) S/S: Sudden onset headache, Kernig's sign (90 degree hip flexion followed by straighten of leg causes pain), Brudzinski's sign (flexion of the neck causes flexionof the hips and knees), fever, confusion, irritability, skin rashes Diagnostics: CBC, CRP, blood cultures, lumbar puncture (cloudy CSF abnormal, WBC and protein may be elevated, decreased glucose in bacterial meningitis) Management: Droplet precautions at least for 24 hours, supportive care for viral infections, anti-seizure medications, seizure precautions, steroids, monitor/decreaseICP 2. Lumbar puncture: Answer - Requires informed consent - Ask patient to empty bladder (must lay flat for 1 hour after) - Positioning: Lateral recumbent preferred (can measure CSF pressure) - Tripod or orthopneic position if LR contraindicated (higher risk of disc herniation, cannot measure CSF pressure) - Strict sterile technique - Contraindicated in increased ICP if space-occupying lesionsPost-op care: - Occlusive dressing (do not remove) - Monitor for bleeding or CSF leakage - Supine x 1 hour - Push fluids to prevent headache - Monitor I&O - Alert provider immediately if leakage (may use blood patch) Nursing considerations: Bedrest as ordered, monitor VS, quiet and nonstimulating environment, antipyretics, antibiotics, analgesics, seizure precautions, monitor for increased ICP, isolation precautions, elevate HOB 30 degrees and avoid neck flexionand extreme hip flexion Prevention:Vaccine, prophylactic abx for close exposure - EBP recommends checking a head CT before a lumbar puncture to rule out space occupying lesion