Meningitis: NCLEX Priorities

Bacterial meningitis is an infectious and neurologic emergency in one patient. Precautions and CSF findings are the test points.

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Recognize it

Fever, severe headache, nuchal rigidity (stiff neck), photophobia, nausea, and declining level of consciousness. Track LOC with the Glasgow Coma Scale. Kernig's sign: hip flexed to 90, pain and resistance on straightening the knee. Brudzinski's sign: flexing the neck makes the hips and knees flex involuntarily. A rapidly spreading petechial or purpuric rash suggests meningococcemia: emergency.

Bacterial vs viral CSF

Bacterial: cloudy CSF, high protein, LOW glucose (bacteria consume it), very high WBCs, mostly neutrophils. Life-threatening; IV antibiotics immediately. Viral (aseptic): clear CSF, normal glucose, mildly elevated protein, lymphocytes. Usually self-limiting with supportive care. Cultures are drawn before antibiotics when possible, but antibiotics are never delayed for imaging or LP logistics in suspected bacterial meningitis.

Droplet precautions and timing

Bacterial meningitis (meningococcal, H. influenzae): droplet precautions until 24 hours of effective antibiotics have run. Private room, mask within 3 feet, mask on the patient for transport. Close contacts of meningococcal cases get prophylactic antibiotics. After that 24-hour mark, standard precautions. Viral meningitis: standard precautions.

LP care and the nursing environment

Before the lumbar puncture: have the patient void; position side-lying, knees to chest (or sitting, leaning forward). After: lie flat per protocol, encourage fluids, monitor the site for leak and the patient for worsening headache. On the unit: quiet, dim room (photophobia), seizure precautions, HOB slightly elevated, minimize stimulation, neuro checks. Watch for rising ICP: decreasing LOC, pupil changes, Cushing's triad.

Frequently asked

New admission with suspected bacterial meningitis. First nursing action?

Institute droplet precautions on arrival, then support rapid cultures and immediate antibiotics.

Why is low CSF glucose the bacterial clue?

Bacteria metabolize glucose in the CSF. Viruses do not, so viral CSF glucose stays normal.

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