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Bacterial Meningitis
The patients being seen in our Emergency Departments, Urgent Cares and Primary Care offices are no longer local, nor do they come from a homogeneous background. Bacterial meningitis is a global health concern which results in significant morbidity and mortality. Fifty per cent of cases can be fatal if left untreated. Even with early diagnosis and treatment, 8–15% of patients die, often within 48 hours of symptom onset and 10–20% of survivors develop permanent sequelae including brain damage, hearing loss, and learning disabilities.1
The age groups afflicted by bacterial meningitis vary with the causative bacteria and geographical location of the patient. Knowing some of these facts including travel or home of origin, typical bacteria, typical age of onset and the signs and symptoms of disease progression are key for the early diagnosis and treatment of these patients, many of whom may also have language or age limitations complicating their ability to communicate clearly.
Teaching students and newer nurses to recognize the subtle signs within given populations is key to successful identification and treatment of these patients. Thoughtful and timely communication is also key to a successful treatment plan.
History: Consider the following for group or classroom discussions: What questions should be a priority? Who are the best historians? What is (are) the patient’s chief complaints? What was the time of onset? Does the patient appear or behave differently according to those familiar with them? What are key V.S. changes or assessment findings that may assist in a differential diagnosis? What lab work or other diagnostic tests may be helpful in determining the cause or severity of this patient’s illness? Are there infectious disease considerations that may impact family, friends or acquaintances? When is infectious disease reporting required?
Treatment: What orders should the nurse expect and prepare for? How does the nurse determine treatment priorities? What assessment changes should the nurse look for to assist in determining treatment effectiveness? How does the nurse determine if and when the physician should be contacted? What changes should trigger a Rapid Response/SWAT Team deployment within the facility? What is the facility or local protocol for reporting communicable diseases?
Conclusion: An experienced nurse who is curious and determined is the patients best advocate. Teaching and mentoring students to develop critical thinking skills will prepare them to connect-the-dots, identify trends and assure positive patient outcomes.
Resources1: Global etiology of bacterial meningitis: A systematic review and meta-analysis (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995389/; Journal ListPLoS Onev.13(6); 2018PMC5995389)
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