A 19-year-old college student is admitted from the ED with fever 39.5 °C, severe headache, photophobia, neck stiffness, and a petechial rash. Bacterial meningitis is suspected. Which immediate interventions should the nurse implement? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Bacterial meningitis is a medical emergency. (1) Droplet precautions on admission until 24 hours of effective antibiotics — the most likely organisms (Neisseria meningitidis, Streptococcus pneumoniae) spread by respiratory droplets. (2) Empiric ceftriaxone + vancomycin (covers Strep pneumo, Neisseria, and resistant Strep pneumo) with adjunctive dexamethasone before or with the first dose to reduce neurologic complications, especially in pneumococcal disease. (3) Blood cultures, then lumbar puncture, but do NOT delay antibiotics for LP — every hour of delay raises mortality. (5) Public health follow-up — meningococcal disease requires post-exposure prophylaxis for close contacts (rifampin, ciprofloxacin, or ceftriaxone). Choice 2 is incorrect — bacterial meningitis is droplet, NOT airborne; airborne precautions are reserved for tuberculosis, measles, and varicella.
Bacterial meningitis is a clinical and microbiologic emergency. The most likely community-acquired organisms in this age group are Neisseria meningitidis (often presenting with petechial rash) and Streptococcus pneumoniae. Standard inpatient management combines droplet precautions until 24 hours of effective antibiotics, empiric IV ceftriaxone plus vancomycin to cover S. pneumoniae and Neisseria, and adjunctive dexamethasone given just before or with the first antibiotic dose to reduce neurologic complications (especially in pneumococcal disease). Diagnostic workup includes blood cultures and lumbar puncture, but antibiotics must not be delayed for LP — every hour of delay increases mortality. Public health steps include identifying close contacts (roommates, intimate contacts) for post-exposure chemoprophylaxis with rifampin, ciprofloxacin, or ceftriaxone. Bacterial meningitis is transmitted by droplet, not airborne, so a negative-pressure airborne room with N95 is not the standard precaution.
A 19-year-old college student is admitted with fever 39.5 °C, severe headache, photophobia, neck stiffness, and a petechial rash. Bacterial meningitis is suspected. The nurse plans immediate interventions.
Bacterial Meningitis Likely Pathogens — Adolescents and young adults: Neisseria meningitidis (often with petechial rash) and Streptococcus pneumoniae. Older adults and immunocompromised: add Listeria monocytogenes (covered with ampicillin). Empiric therapy is broad until cultures and Gram stain return.
Empiric Therapy — IV ceftriaxone plus vancomycin to cover Streptococcus pneumoniae (including resistant strains) and Neisseria meningitidis. Add ampicillin if Listeria is a concern (older adults, immunocompromised, neonates). Adjunctive dexamethasone reduces neurologic complications, given just before or with the first dose.
Public Health and Prophylaxis — Meningococcal disease is reportable. Close contacts (household, kissing, eating utensils, sleeping together) need post-exposure prophylaxis with rifampin, ciprofloxacin, or ceftriaxone. Transmission-based precautions: droplet, until 24 hours of effective antibiotics.