COLLEGE OF ST.

JOHN - ROXAS Member: Association of

LASSAI- Accredited Superschools (ALAS) Atila Balgos St.

Banica, Roxas City

NCM 116

Care Of The Clients With Problems In Nutrition, And Gastro-internal,

Metabolism  And Endocrine, Perception And Coordination, Acute And Chronic

CASE STUDY IN MANAGEMENT OF PATIENTS WITH MANAGEMENT OF PATIENTS

WITH NEUROLOGIC INFECTIONS,  AUTOIMMUNE DISORDERS, AND NEUROPATHIES

Crisha Ann Bacuta BSN-3

College of St. John – Roxas

11/05/21
 COLLEGE OF ST. JOHN - ROXAS 
Member: Association of LASSAI-
Accredited Superschools (ALAS)  Atila
Balgos St. Banica, Roxas City 

NCM 116 
Care of Clients With Problems in Nutrition, and Gastro-internal, Metabolism and 
Endocrine, Perception and Coordination, Acute and Chronic 

CASE STUDY 

Management of Patients With Neurologic Infections,  

Autoimmune Disorders, and Neuropathies 

1. Brian Jones, a 22-year-old college student, is admitted from the emergency  department to a
medical-surgical unit with the diagnosis of acute bacterial  meningitis. The patient
presented with the following vital signs: temperature,  104°F; blood pressure, 110/70 mm
Hg; heart rate, 100 bpm; and respiratory rate,  20 breaths/min. The patient presented with
a severe, constant headache and  nuchal rigidity.  

a. To what room should the charge nurse assign the patient? 

The nurse should assign the patient to emergency department .Since it is a medical
emergency,rapid diagnosis based on history and physical examination is crucial because the
patient is in a critical state when health care is sought.it generally requires respiratory isolation
until the cultures are negative.

• The patient needs to be admitted to droplet precautions in an

isolation room, which consists of a private room in which health care
professionals and visitors wear a face mask when entering the room.

• The patient will need to continue in isolation until the patient has
completed 24 hours of antibiotic therapy.

b. What additional signs and symptoms could a patient diagnosed with  bacterial
meningitis exhibit? 

Fever,severe headache,nausea,vomiting,nuchal rigidity are key signs of meningitis.A

positive kerning sign,a positive Brudzinki s sign,photophobia,a decreased LOC,and signs
of increased ICP may also be present..With meningitis,the headache becomes
progressively worse and maybe accompanied by vomiting and irritability.

• The patient could have photophobia, a positive Kernig sign, and a positive Brudzinski
sign.
• The Brudzinski sign is a more sensitive indicator of meningeal irritation.
• The patient may have signs and symptoms of increased intracranial pressure, and
the early symptom is change in the level of consciousness or confusion.
• The patient may also develop a rash that consists of a petechial rash with areas of
purpuric lesions to large areas of ecchymosis.
• The rash may appear on the face and extremities.

c. What diagnostic and lab tests are used to confirm the diagnosis of meningitis?

Diagnosis is usually verified by doing a lumbar puncture with analysis of the CSF for
protein,glucose,WBC,gram stain and culture,CBC,Coagulation profile,electrolyte
levels,glucose,platelet count,blood culture,CT scan,MRI,PET scan and Skull x-ray studies.

• CT or MRI of the head to confirm that no hemorrhage or brain

herniation is present before a spinal tap is performed
• Spinal tap to obtain cerebrospinal fluid sent for culture and gram
stain; a patient with bacterial meningitis will have an elevated white
blood count and the presence of polysaccharide antigens to the
bacteria causing the meningitis
• Blood cultures to determine if the patient is septic

d. What medical management should the nurse anticipate for the patient?

When meningitis is suspected ,antibiotic therapy is instituted after the collection of specimens

for culture ,even before the diagnosis is confirmed.The fundus of the eye should be examined

via ophthalmoscope for papilledema before lumbar puncture for identification of possible

increased ICP. Ampicillin, pencillin, Vancomycin, ceftriaxone, ceftizoxime are commonly

prescribed drug of choice for treating bacterial meningitis.The corticosteroid dexamethasone

may also be prescribed prior to or with the first dose of antibiotics .Although the data are

limited,administration of dexamethasone appears to be associated with a lower mortality rate

and a reduced incidence of hearing loss in patients with bacterial meningitis.

e. What nursing care should be provided for the patient?

 Monitor neurologic status on an ongoing basis to determine extent of problem.

 Administer PRN medications for anxiety .
 Provide patient optimal pain relief with prescribed analgesics to relieve pain.
 Monitor for seizure activity.
 Monitor temperature as frequently as possible.
 Monitor blood pressure,pulse and respiration to evaluate effects of hyperthermia.

1 
COLLEGE OF ST. JOHN - ROXAS  Member: Association of
LASSAI- Accredited Superschools (ALAS)  Atila Balgos St. Banica,
Roxas City 

Management of Patients With Oncologic   

or Degenerative Neurologic Disorders 

1. The clinical nurse specialist working on the neurologic units is asked by the staff  to
develop a list of supportive resources for patients and their families who are  affected by
oncologic or degenerative neurologic disorders. The clinical nurse  specialist provides both
national and local services available on this list that staff  may use when caring for patients
and their families. (Learning Objective 5) 

a. What national support services are available for patients/families diagnosed  with
neurologic oncology problems? (Provide a brief description of the  services provided.) 
 b. What local support services and online support groups are available for 
patients/families diagnosed with neurologic oncology problems? 

c. What national support services are available for patients/families diagnosed  with
degenerative neurologic problems? (Provide a brief description of the  services
provided.) 

d. What local support services and online support groups are available for 
patients/families diagnosed with degenerative neurologic problems?