Case Study: Acute Bacterial Meningitis.
The purpose of the case study is to have you expand upon the pathophysiological disease process by searching for evidence-based practice treatment and advanced practice nursing role implications related to the disease.Case Study: Acute Bacterial Meningitis.
Case Study Topic:
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Select either a type of pain syndrome or a neurologic disease process (headache, CVA, acute bacterial meningitis, Alzheimer’s, anxiety, depression, chronic pain syndrome) and discuss the pathophysiologic process involved. Case Study: Acute Bacterial Meningitis.
Identify current evidence-based treatment modalities for the selected cancer and discuss how the treatment impacts the disease process.
Conduct an evidence-based literature search to identify the most recent standards of care/treatment modalities from peer reviewed articles and professional association guidelines (www.guideline.gov). These articles and guidelines can be referenced, but not directly copied into the clinical case presentation. Cite a minimum of three resources.
Include the following in your clinical case presentation:
A discussion the pathophysiology of the disease, including signs and symptoms
An explanation of diagnostic testing and rationales for each
A review of different evidence-based treatment modalities for the disorder obtained from guideline.gov or a professional organization such as thyroid (Thyroid society), OB-GYN (ACOG), urology (AUA), etc.
Next, address the following questions:
How does the information in this case inform the practice of a master’s prepared nurse?
How would the master’s prepared nurse use this information to design a patient education session for someone with this condition?
What was the most important information presented in this case?
What was the most confusing or challenging information presented in this case?Case Study: Acute Bacterial Meningitis.
Discuss a patient safety issue that can be addressed for a patient with the condition presented in this case.
The use of medical terminology and appropriate graduate level writing is expected.
Your paper should be 3–4 pages, excluding cover page and reference page.
Your resources must include research articles as well as reference to non-research evidence-based guidelines.
Use APA format to style your paper and to cite your sources. Your source(s) should be integrated into the paragraphs. Use internal citations pointing to evidence in the literature and supporting your ideas. You will need to include a reference page listing those sources. Cite a minimum of three resources.
Acute bacterial meningitis occurs when the meninges are inflamed after inflammatory cells within the cerebrospinal fluids are activated and mediate inflammation of the meninges (Bijlsma et al, 2016). The patient presented symptoms such as fever, neck stiffness, loss of consciousness, headache, confusion, and nuchal rigidity. The patient’s temperature was 39°C, pulse rate 110 beats /minute and respiratory rate 15/minute.
Pathophysiology of Acute Bacterial Meningitis
The infectious agent (bacteria) colonizes the host in sites such as skin, respiratory tract, GI or the genitourinary tract. The bacteria then reach the meninges and subarachnoid space by invading the bloodstream or via direct spread. After the bacteria reach the CNS, multiplication of bacteria occurs without causing infection because white blood cells and immunoglobulins are normally absent from scarce (Saux, 2014). The bacteria then release teichoic acid, endotoxins, as well as substances that generate an inflammatory response. This leads to protein increase and since bacteria ingest glucose and since the CSF has low levels of CSF, the levels of glucose reduce (Oordt et al, 2018).
The subarachnoid space then becomes inflamed, accompanied by cortical encephalitis. In addition, during meningitis, the blood-brain barrier is disrupted and therefore other microorganisms can access the brain. In case the body attempts to fight the infection, the blood vessels start leaking and as a result the fluid, white blood cells, as well as other particles fighting infection get in the brain and meninges (Saux, 2014). This causes the brain to swell and results in reduced blood flow into the brain parts, which worsens the symptoms.Case Study: Acute Bacterial Meningitis. Complications of acute bacterial meningitis include brain herniation, septic shock, deafness, arterial or venous infarcts, subdural empyema, and high intracranial space (Bijlsma et al, 2016). The most common symptoms of meningitis include fever, headache, vomiting, nausea, change in mental status, sleepiness, stiff neck, sepsis,low blood pressure, photophobia, and even meningococcal septicemia (Oordt et al, 2018).
Diagnostic Testing for Acute Bacterial Meningitis
Imaging: CT or MRI scan of the head was done to indicate the inflammation or swelling of the meninges. The rationale for this is because meningitis causes swelling of the brain meninges and hence a scan will reveal any swelling or inflammation (Ling et al, 2017). The imaging revealed inflammation of the meninges.
Lumbar puncture: This was done to obtain CSF for analysis. This is because bacterial meningitis is indicated by increased pressure, the turbidity of the fluid, high WBC count, increased proteins, and low CSF; blood glucose ratio (Saux, 2014).Case Study: Acute Bacterial Meningitis.
Blood Culture: This was done to identify the exact causative pathogen. Blood culture of the blood samples obtained from the patient revealed small colonies of Streptococcus pneumonia. In addition, antibiotic susceptibility was conducted for the organism. The organism was susceptible to cefotaxime (Griffiths & McGill, 2018).
Evidence-Based Treatment Modalities
Antibiotics: Antibiotics are the mainstay therapy in acute meningitis. When bacterial meningitis is established through CSF analysis, antibiotic therapy should be initiated. The basis of the targeted antibiotic therapy is on presumptive microorganism identified through CFS Gram Stain (Ling et al, 2017). Basically, a specific antibiotic in bacterial meningitis is administered depending on the identified causative microorganism, susceptibility testing, and the age of the patient (Ling et al, 2017).For this patient the therapy was cefotaxime.
Corticosteroids: Adjunctive dexamethasone 10 mg IV was administered to the patient. The rationale administering dexamethasone is because evidence shows that the subarachnoid space inflammatory response is a key contributing element to death in bacterial meningitis (Ling et al, 2017). Therefore, dexamethasone can reduce the inflammatory response and hence reduce numerous pathophysiologic effects like cerebral edema, elevated intracranial pressure, neuronal injury, as well as changed cerebral blood flow (Saux, 2014).Case Study: Acute Bacterial Meningitis.
The Significance of the Information to a Nurse Practitioner
The information from the case informs an NP of the importance of differentiating between viral meningitis and bacterial meningitis. Guidelines recommend differentiation between bacterial, viral and other organisms in meningitis in order to avoid avoidable antibiotic therapies and hospitalizations (Ling et al, 2017). Additionally, the information from the case study provides the rationale of identifying the exact causative agent for meningitis in order to administer the specific antibiotic that the pathogen is susceptible to.Case Study: Acute Bacterial Meningitis.
However, in this case,Streptococcus pneumonia was the microorganism that caused meningitis for the patient. The confusing aspect is that the pathogen was susceptible to cefotaxime yet the recommended therapy for Streptococcus pneumonia includes third-generation cephalosporins and vancomycin. Accordingly, from the case study, it is evident that ceftriaxone or cefotaxime are the medications of choice for pneumococcal meningitis (Tewabe et al, 2018). Evidence has shown treatment failure when antibiotics such asthird-generation cephalosporins, and vancomycin, and penicillin are used (Gudina et al, 2018). Therefore, it is important to evaluate the susceptibility of antibiotics according to the NCCLs’ guidelines.
The nurse practitioner can use the case study information to educate the patient on the importance of predisposing risk factors to meningitis such as sharing items like toothbrush, sharing eating utensils or even kissing. In addition, the patient will be educated on the importance of adhering to the treatment regimen (Griffiths & McGill, 2018).
It is important to address the aspect of fever and loss of consciousness for the patient. This is because impairment of the consciousness level and prolonged fever after the start of antimicrobial therapy are associated with poor health outcomes for patients with meningitisTewabe et al, 2018). Therefore, the patient requires close monitoring.Case Study: Acute Bacterial Meningitis.