Clinical Care - Part 1

The patient shows symptoms like vomiting, nausea, dizziness, and severe headache. According to Leroux et al. (2018), migraine occurs with a strong headache with other associated issues like sensitivity to light, vomiting, and nausea. Migraine is found to occur in different individuals with different stages and symptoms like in prodrome the patient suffers from the symptoms for hours or days (Liu et al., 2019). In this case, the patient is also found to be photophobic, this shows that he has migraine-related issues. Moreover, he also got an injection of Morphine 10mg for a migraine headache and injection of Metoclopramide 10 mg. According to (Leroux et al., 2018), metoclopramide is recommended for sores in the esophagus, speeding up the issues of ulcers, and heartburn issues. Metoclopramide medication is also used in preventing nausea or vomiting issues as well. The temperature of the patient is 39 degrees and it is a high value. The normal temperature of the elderly patient is found to be 37 degrees (Arngrim et al., 2017). According to Yang & Wang (2017), vomiting is also a sign of infection like meningitis or other. So, it is found that infection is also associated with symptoms like vomiting, nausea, high temperature, or irritability. In this case, the patient has a provisional diagnosis is bacterial meningitis indicating that he might have this problem or related issue again.

 According to Liu et al. (2018), lumbar puncture is a medical treatment that is used to diagnose disorders of the central nervous system or Meningitis. The complications with meningitis are the formation of blood clots in the brain blood vessels with reduced blood supply to the brain because there is a toxic effect of the bacteria. Moreover, computerized tomography (CT) scans and magnetic resonance imaging (MRI) is generally used for the internal body structure detailed study. A computerized tomography scan or X-ray and magnetic resonance imaging can be very helpful in detecting the areas associated with meningitis. According to Arngrim et al. (2017), the respiratory rate for a normal adult is 12-16 breaths per minute but in this case, the rate is very high with a value of 28 breaths per minute. It is found that with meningitis the patient suffers from a high breathing rate as they feel respiratory issues. It is also observed that a postural tachycardia syndrome (POTS) is a health disorder that causes fainting, lightheadedness, and a rapid heart rate. All these symptoms are found to be very common in a migraine patient. The patient is also found to have a high blood pressure of 170/90 mmHg. The patient’s blood glucose level is 3.5 mmol/L. The normal value for normal blood pressure in the case of an adult is 120/80 mmHg and blood glucose levels are 3.9-7.1 mmol/L (Kwit et al., 2018). This indicated that the patient had high blood pressure but low blood glucose level.

According to Pomar et al. (2020), hemodynamic change due to low blood glucose levels or hypoglycemia can lead to other health issues like an increase in systolic blood pressure, elevated heart rate, changes in cardiac output, and many others. Moreover, in admission to the hospital, the patient was diagnosed with nuchal rigidity that means stiffness in the neck. According to van Veen et al. (2017), a patient who is suffering from meningitis develops nuchal rigidity as well along with many other associated health complications. The medication treatment of paracetamol is used for controlling the high fever and high body temperature whereas dexamethasone is used for treating vomiting, nausea, breathing issues, immune system disorders, and certain cancers. The patient is also recommended to get an anti-biotic therapy, dexamethasone, paracetamol, and mannitol. According to Jarrin et al. (2016), a pupil reaction assessment is done in case of neurological assessments as this test provides information about brain damage. A dilated pupil shows that the patient might have certain migraine-related issues. PEARL is a pupil assessment test that is conducted to check the functioning of the pupils. In this case, the patient shows a pupil response that is slow and PEARL, this indicates that he has some brain damage or brain-related issues. All these symptoms mostly indicate that the patient might be having migraine-related or migraine issues. However, few signs and symptoms also indicate that the patient might also be suffering from meningitis as he already had a provisional diagnosis of bacterial meningitis. According to Giffin et al. (2016), blood tests and computerized tomography scans and MRI are used to detect migraine and all are also recommended in this case. If such a patient does not take care of his tobacco, caffeine, physical activities, and other factors then it can trigger migraine issues. For managing the migraine and meningitis issues the patient is recommended with certain medications that adjust his blood pressure back to normal to prevent the severity of the situation but this also impacts other levels in the body. Furthermore, it is found that the medications for lowering blood pressure can also lower blood glucose levels.

Clinical Care - Part 2

The nurse plays a key role in providing the patient with a high quality of care. In their professional practice, they face many ethical challenges; therefore a nurse is required to be friendly with the concept of ethical decision making and ethical codes of conduct. An effective care plan can have a positive impact on the health of the patient. The 2 nursing diagnoses are the diagnosis for meningitis and diagnosis for meningitis by using CT scan and MRI. According to Elf et al. (2019), for migraine diagnosis, the nurse should as the patient for his/her medical history and related symptoms. This is because migraine is also associated with other health complications like stroke, persistent aura without infarction, migrainous infarction, migralepsy, and many others. so, if it is left untreated then it can deteriorate the health of the patient to a great extent and might be fatal for the patient as well. Similarly, in the case of meningitis if the patient does not get immediate treatments as per his/her diagnosed conditions then it can lead to brain damage, kidney failure, memory difficulty seizures, and many others. So, these two are the priorities for the nurse to diagnose to start the immediate treatment of the patient and provide him with safe and quality care services.

The nursing care goals in case of migraine diagnosis are: at first the nurse should conduct the imaging tests like a CT scan and MRI of the patient and blood tests can also be performed to get more insights. The nurse should ensure that the headache-related pain is reduced, the physiological and emotional state of the patient should be maintained so that he does not get anxiety and depression issues. The goal is to provide effective pharmacological treatments and proper care plan as per his diet and treatment to ensure that he is cured and does not get the disorder again, ensuring that a long term goal is achieved. In the case of meningitis, the goal is to first perform the limber puncture, maintain the body temperature of the patient, prevent the complication to impact the health of the patient. Another goal is to prevent the vomiting issues that might impact the fluid balance of the body. The treatment should be provided immediately to the patient so that the situation does not get worse. The patient should be taught about his health issues and provided with a care plan as well so that in the long term he is in a healthy state. The interventions for migraine are: 1. the patient should be provided with pain relievers like ibuprofen, aspirin, or others (Moura et al., 2020) and 2. Nausea medications like Gravol, Kytril, Zofran, decadron, and others should be provided. 3. Neuromodulation devices should be used to relieve the pain from migraines and to prevent migraines. The migraine patients suffer from varying intensities of pain, nausea, and headache so medications are recommended to control the conditions (van den Berg et al., 2016). 4. The patient should be provided with proper supplements so that the nutrients and minerals are in adequate quantity in the patient’s body. A balance of omega fatty acids is beneficial for migraine patients so the diet should be maintained (Veenstra et al., 2016). 5. The patient’s vital signs like blood pressure, temperature, and other feedback should be taken from the patient to deliver effective care.

The nursing interventions for meningitis are 1. monitoring the vitals of the patient. The monitoring and evaluation of the vital signs can provide useful information about the progress report of the patient as well as about the other associated health issues in every disease or disorder (Leroux et al., 2018). 2. The neck of the patient should be maintained at a proper angle so that he is comfortable and the neck rigidity issues are resolved. The repositioning should be properly performed so that there is no risk of increased intrabdominal and intra-thoracic pressures that ultimately result in increased intracranial pressure (ICP) .3. The monitoring and evaluation of osmotic levels of the patient and administration of medications accordingly. The use of mannitol and other osmotic diuretics helps in promoting cerebral blood flow by treating cerebral edema (Ling et al., 2017). 4. His oxygen levels should be maintained and provided as per the needs. 5. The urine and stool precautions should be maintained as it is a case of infection. The urine and stools of the infected patient might have the disease-causing bacteria in his/her urine or stool that might infect the nursing staff pr other healthcare providers of the patient so proper management of urine and stools is preferred (Purwandari et al., 2020). According to Moura et al. (2020), proper nursing interventions in meningitis can reduce the chances of occurrence of conditions like hypoxia, repositioning induces relaxing impacts and the non-verbal cues can elevate the intracranial pressure. Therefore, all the observations should be properly documented and effectively resolved.

The 5 expected outcomes are – the patient might be suffering from severe migraine, bacterial meningitis, postural tachycardia syndrome (POTS), fluid-electrolyte imbalance of the body, and brain lesions. According to Pomar et al. (2020), the clinical data that shows that a patient is having migraine show following features: the patient who suffers from severe headache, vomiting, nausea, and photophobic issues are likely to develop a migraine. In migraine, a very commonly associated health issue is postural tachycardia syndrome (POTS), in this, the patient faints and show high heart rate with nausea. As a few of these symptoms are found in the patient so it is expected that he might also have postural tachycardia syndrome (POTS). Moreover, a patient with symptoms like nausea and vomiting are very common in bacterial meningitis. According to Jarrin et al. (2016), if the patient has pain in neck or stiffness in the neck, headache for more than hours and days, increased sensitivity to sound, smell and light, a headache that increases with activity, droopy eyes, stuffy nose, and others. These clinical symptoms indicate that the patient has a migraine. Excessive vomiting disturbs the levels of calcium, magnesium, chloride, and bicarbonates inside the body, leading to an imbalance of fluid-electrolyte in the patient (Leroux et al., 2018). The symptoms of fluid-electrolyte imbalance are fatigue, lethargy, irregular heart rate, nausea, vomiting, or seizures (Leroux et al., 2018). According to Jarrin et al. (2016), a patient with migraine is at a very high risk to develop brain lesions, a condition in which he/she will have impaired movements as the motor skills are affected, nausea, vomiting, and headache as a first symptom.

Clinical Care - Part 3

I learned a lot through this assignment as earlier I had no idea that migraine is also associated with other health complications like postural tachycardia syndrome (POTS) or brain lesions. I explored much clinical information related to migraine and bacterial meningitis. The meningitis disease exposes an infection risk to the associated health professionals because of the bacteria present in the urine and stool of the patient. If the patient is having migraine or meningitis then he/she should be immediately provided with medications and assessments for the vital signs. The patient should be maintained with proper osmotic diuretics to ensure fluid-electrolyte balance and proper neck repositioning ensures he/she is relaxed. The patient should also be assessed after medication administration and should be explained about his/her health treatment and disease so that a long term health care is provided to him/her with effective care plans. Such patients with high blood pressure, low blood glucose levels, migraine issues, and meningitis issues should be immediately operated to prevent the associated health complications like high breathing rate with respiratory issues and impacts on brain cells (Moura et al., 2020).

References for Nursing Interventions with Clinical Reasoning

Arngrim, N., Hougaard, A., Ahmadi, K., Vestergaard, M. B., Schytz, H. W., Amin, F. M., & Ashina, M. (2017). Heterogenous migraine aura symptoms correlate with visual cortex functional magnetic resonance imaging responses. Annals of Neurology82(6), 925-939.

Elf, K., Carlsson, T., Rivas, L. S., Widnersson, E., & Nyholm, L. (2019). Electroencephalographic patterns during common nursing interventions in neurointensive care: A descriptive pilot study. Journal of Neuroscience Nursing51(1), 10-15.

Giffin, N. J., Lipton, R. B., Silberstein, S. D., Olesen, J., & Goadsby, P. J. (2016). The migraine postdrome: An electronic diary study. Neurology87(3), 309-313.

Jarrin, I., Sellier, P., Lopes, A., Morgand, M., Makovec, T., Delcey, V., & Bergmann, J. F. (2016). Etiologies and management of aseptic meningitis in patients admitted to an internal medicine department. Medicine95(2).

Kwit, N. A., Nelson, C. A., Max, R., & Mead, P. S. (2018, January). Risk factors for clinician-diagnosed Lyme arthritis, facial palsy, carditis, and meningitis in patients from high-incidence states. Open Forum Infectious Diseases, 5(1).

Leroux, E., Beaudet, L., Boudreau, G., Eghtesadi, M., Marchand, L., Pim, H., & Chagnon, M. (2018). A nursing intervention increases quality of life and self‐efficacy in migraine: A 1‐year prospective controlled trial. Headache: The Journal of Head and Face Pain58(2), 260-274.

Ling, L., Guo, L., Wang, J., Zhang, L., Zhu, J., & Huang, Z. (2017). Nursing management of lumbar drainage in cryptococcal meningitis: A case report. Journal of Neuroscience Nursing49(4), 198-202.

Liu, Y., Li, S., Wang, R., Han, X., Su, M., Cao, X., & Yu, S. (2018). A new perspective of migraine symptoms in patients with congenital heart defect. Headache: The Journal of Head and Face Pain58(10), 1601-1611.

Moura, R. G., Fernandes, C. D. S., Brandão, M. G., Neto, N. M. G., Caetano, J. Á., & Barros, L. M. (2020). Experience of the nursing team concerning the care of patients with meningitis attended in emergency. Journal of Nursing Education and Practice10(9).

Pomar, V., de Benito, N., Mauri, A., Coll, P., Gurguí, M., & Domingo, P. (2020). Characteristics and outcome of spontaneous bacterial meningitis in patients with diabetes mellitus. BMC Infectious Diseases20, 1-9.

Purwandari, G. M., & Yona, S. (2020). Classical therapy as the intervention to relieve headache in a meningitis patient. UI Proceedings on Health and Medicine4(1), 102-104.

van den Berg, J. S., Steiner, T. J., Veenstra, P. J., & Kollen, B. J. (2017). Migraine nurses in primary care: Costs and benefits. Headache: The Journal of Head and Face Pain57(8), 1252-1260.

van Veen, K. E., Brouwer, M. C., van der Ende, A., & van de Beek, D. (2017). Bacterial meningitis in patients using immunosuppressive medication: A population-based prospective nationwide study. Journal of Neuroimmune Pharmacology12(2), 213-218.

Veenstra, P., Kollen, B. J., de Jong, G., Baarveld, F., & van den Berg, J. P. (2016). Nurses improve migraine management in primary care. Cephalalgia36(8), 772-778.

Yang, C. P., & Wang, S. J. (2017). Sleep in patients with chronic migraine. Current Pain and Headache Reports21(9), 39.

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