{
  "name": "Meningitis",
  "slug": "meningitis",
  "url": "https://nursingplex.com/care-plans/meningitis",
  "category": "Neurological",
  "summary": "CNS infection; isolation, neuro monitoring, quiet environment and antibiotics.",
  "nursing_diagnoses": [
    "Hyperthermia",
    "Acute pain",
    "Risk for injury",
    "Ineffective cerebral tissue perfusion"
  ],
  "overview": [
    "Meningitis is inflammation of the meninges surrounding the brain and spinal cord. Bacterial meningitis, most often from Neisseria meningitidis or Streptococcus pneumoniae, is a medical emergency with rapid deterioration; viral meningitis is generally self-limiting and treated supportively.",
    "The classic triad is fever, severe headache and nuchal rigidity, often with photophobia, vomiting and altered mental status. Positive Kernig and Brudzinski signs support the diagnosis, and a petechial or purpuric rash suggests meningococcal disease with impending septic shock.",
    "Care is time-critical: obtain cultures and start antibiotics without delay, place droplet precautions for suspected meningococcal disease, monitor for increased intracranial pressure and seizures, and provide a dark, quiet environment. Prophylaxis for close contacts is a nursing responsibility often missed."
  ],
  "key_facts": [
    {
      "label": "Do not delay antibiotics",
      "text": "Give the first dose immediately after cultures — and even before lumbar puncture if it must be delayed for imaging."
    },
    {
      "label": "Isolation",
      "text": "Droplet precautions for suspected bacterial meningitis, maintained for 24 hours of effective antibiotic therapy."
    },
    {
      "label": "CSF in bacterial disease",
      "text": "Cloudy fluid, high protein, low glucose, high neutrophils and high opening pressure."
    },
    {
      "label": "Rising ICP signs",
      "text": "Widening pulse pressure, bradycardia and irregular respirations (Cushing triad), plus declining consciousness."
    },
    {
      "label": "Meningococcal rash",
      "text": "Petechiae or purpura that does not blanch signals sepsis and possible DIC."
    },
    {
      "label": "Prophylaxis",
      "text": "Close contacts of meningococcal cases need rifampin, ciprofloxacin or ceftriaxone."
    }
  ],
  "nursing_priorities": [
    "Start antimicrobial therapy immediately and control the infection.",
    "Prevent transmission with correct isolation.",
    "Monitor and manage increased intracranial pressure and seizures.",
    "Relieve pain and photophobia.",
    "Maintain fluid, electrolyte and hemodynamic stability.",
    "Ensure contact prophylaxis and vaccination follow-up."
  ],
  "assessment": {
    "subjective": [
      "Severe headache, neck pain and stiffness",
      "Photophobia, nausea and vomiting",
      "Fever, chills and profound malaise",
      "Recent upper respiratory infection, sinusitis, otitis, head trauma or neurosurgery",
      "Vaccination history and close-contact exposure"
    ],
    "objective": [
      "Temperature, vital signs and trends toward Cushing triad",
      "Level of consciousness, Glasgow Coma Scale, orientation and irritability",
      "Nuchal rigidity, positive Kernig and Brudzinski signs, opisthotonos in severe cases",
      "Petechial or purpuric rash and perfusion status",
      "Pupil size and reactivity, cranial nerve function and seizure activity",
      "CSF results, blood cultures, WBC and coagulation studies",
      "In infants: bulging fontanel, high-pitched cry, poor feeding and paradoxical irritability"
    ],
    "related_factors": [
      "Bacterial or viral invasion of the meninges",
      "Contiguous spread from sinus, ear or skull fracture",
      "Hematogenous spread and immunocompromise",
      "Crowded living such as dormitories and military barracks",
      "Missing meningococcal or pneumococcal vaccination"
    ]
  },
  "goals": [
    "The client will receive antibiotics within one hour of suspicion and become afebrile.",
    "The client will maintain a stable or improving level of consciousness with no signs of increased ICP.",
    "The client will remain free of seizures and injury.",
    "The client will report headache at or below 3/10.",
    "Close contacts will receive prophylaxis and the client will receive vaccination teaching."
  ],
  "interventions": [
    {
      "title": "Infection control and treatment",
      "points": [
        "Institute droplet precautions immediately for suspected bacterial meningitis and maintain for 24 hours of therapy.",
        "Draw blood cultures, assist with lumbar puncture, and give the first antibiotic dose without waiting for results.",
        "Administer dexamethasone before or with the first antibiotic dose when ordered for pneumococcal disease.",
        "Identify close contacts and coordinate prophylaxis with infection control and public health."
      ]
    },
    {
      "title": "Neurologic monitoring",
      "points": [
        "Perform neurologic checks hourly during the acute phase and report any decline promptly.",
        "Keep the head of bed elevated 30 degrees with the head midline and avoid neck flexion or hip flexion.",
        "Cluster care and avoid Valsalva, coughing and straining, which raise intracranial pressure.",
        "Maintain seizure precautions with padded rails, suction at the bedside and prescribed anticonvulsants."
      ]
    },
    {
      "title": "Comfort and supportive care",
      "points": [
        "Darken the room, minimize noise and limit visitors to reduce photophobia and stimulation.",
        "Give analgesia and antipyretics; use cooling measures for high fever.",
        "Position for comfort with the neck supported; do not force flexion.",
        "Monitor fluid balance carefully — avoid overhydration, which worsens cerebral edema, and watch for SIADH."
      ]
    },
    {
      "title": "Complication surveillance",
      "points": [
        "Monitor perfusion, urine output, lactate and coagulation for septic shock and DIC.",
        "Assess hearing before discharge; sensorineural hearing loss is a common sequela, especially in children.",
        "Watch for hydrocephalus, cranial nerve deficits and focal neurologic changes.",
        "Support nutrition and mobility as consciousness improves."
      ]
    }
  ],
  "patient_teaching": [
    "Explain the reason for isolation and how long it lasts.",
    "Teach household and close contacts to seek prophylaxis promptly.",
    "Recommend meningococcal and pneumococcal vaccination for the patient and eligible contacts, including college students.",
    "Report persistent headache, hearing change, poor school performance or seizures after discharge.",
    "Complete the entire antibiotic course and attend follow-up including hearing evaluation.",
    "Explain that recovery fatigue and concentration problems can last weeks."
  ]
}