J.H. is diagnosed with Escherichia coli meningitis. His medical care plan will include 14 to 21 days of anti-biotic therapy. you are developing his nursing plan of care.

Question

Outline a plan of care for J.H., describing nursing interventions that would be appropriate for managing pain and infection, maintaining hydration, assisting with increased intracranial pressure (ICP), and teaching to review with his parents.

Answer 1

Pain
• Assess pain every 4 hours using the FLACC scale.
• Administer pain medication as ordered.
• Keep stimulation at a minimum with a quiet environment and dim lights.
Hydration
• Strict intake and output.
• Monitor perfusion: cap refill, BP, pulses, mottling, anterior fontanel.
• Daily weights.
• Patient will be NPO initially and diet advanced as tolerated with improved status.
• Maintain and monitor IV. Might need to advocate for peripherally inserted central catheter (PICC)
line for long-term antibiotic therapy.
• Monitor for complications such as syndrome of inappropriate antidiuretic hormone (SIADH).
Infection
• Maintain isolation precautions.
• Administer antibiotics as ordered.
• Monitor laboratory values and cultures.
Increased ICP
• Assess for signs and symptoms of increased ICP: increased irritability, change in level of
consciousness (LOC).
• FOC (frontal occipital circumference) every shift.
• Observe seizure precautions and monitor for seizure activity.
Parent education
• Explain disease process and treatment plan.
• Educate on need for isolation precautions.
• Assess support system and allow for questions.
• Encourage comfort measures, bonding, and participation in care.