1. Bacterial meningitis.

  2. Encephalitis (also includes aseptic meningitis): inflammation of the brain and its coverings due to direct viral invasion, which usually results in a lengthy coma.
    1. Pathophysiology: brain tissue injury- release of enzymes that increase vascular dilation, capillary permeability-edema formation-increased intracranial pressure-depression of CNS function.
    2. Risk factors:
      1. Arboviruses.
      2. Enteroviruses (poliovirus, echovirus).
      3. Herpesvirus.
      4. Varicella-zoster (chickenpox).
      5. Postinfection complication (measles, mumps, smallpox).
    3. Assessment:
      1. Subjective data:
        1. Headache-severe.
        2. Fever-sudden.
        3. Nausea, vomiting.
        4. Sensitivity to light (photophobia).
        5. Difficulty concentrating.
      2. Objective data:
        1. Altered level of consciousness.
        2. Nuchal rigidity.
        3. Tremors; facial weakness.
        4. Nystagmus.
        5. Elevated temperature.
        6. Diagnostic test: lumbar puncture-fluid cloudy; increased neutrophils, protein.
        7. Lab data: blood-slight to moderate leukocytosis (about 14,000).
    4. Analysis/nursing diagnosis:
      1. Self-care deficit related to altered level of consciousness.
      2. Risk for injury related to coma.
      3. Sensory/perceptual alteration related to brain tissue injury.
      4. Altered thought processes related to increased intracranial pressure.
    5. Nursing care plan/implementation:
      1. Goal: support physical and emotional relaxation.
        1. Vital signs; neurological signs as ordered.
        2. Seizure precautions.
        3. Position: to maintain patent airway; prevent contractures; ROM.
        4. Medications as ordered:
          1. Analgesics for headache and neck pain.
          2. Antipyretics for fever.
          3. Antivirals.
          4. Anticonvulsants for seizures.
          5. Antibiotics for infection in aseptic meningitis.
          6. Osmotic diuretics to reduce cerebral edema.
          7. Corticosteroids for inflammation.
        5. No isolation.
      2. Goal: health teaching: self-care activities with residual motor and speech deficits; physical therapy.
    6. Evaluation/outcome criteria:
      1. Regains consciousness; is alert, oriented.
      2. Performs self-care activities with minimal assistance.