2. Diagnosis: Meningitis.

3. Condition:

4. Vital signs: q1h. Call physician if BP systolic >160/90, <90/60; P >120, <50; R>25, <10; T >39°C or less than 36°C

5. Activity: Bed rest with bedside commode.

6. Nursing: Respiratory isolation, inputs and outputs, lumbar puncture tray at bedside.

8. IV Fluids: D5 / NS at 125 cc/h with KCL 20 mEq/L.

9. Special Medications: Empiric Therapy 15-50 years old:

-Vancomycin 1 gm IV q12h AND EITHER -Ceftriaxone (Rocephin) 2 gm IV q12h (max 4 gm/d) OR Cefotaxime (Claforan) 2 gm IV q4h. Empiric Therapy >50 years old, Alcoholic, Corticosteroids or Hematologic Malignancy or other Debilitating Condition: -Ampicillin 2 gm IV q4h AND EITHER -Cefotaxime (Claforan) 2 gm IV q6h OR Ceftriaxone (Rocephin) 2 gm IV q12h OR Ceftazidime (Fortaz) 2 gm IV q8h.

-Use Vancomycin 1 mg IV q12h in place of ampicillin if drug-resistant pneumococcus is suspected.

10. Symptomatic Medications:

-Acetaminophen (Tylenol) 650 mg PO/PR q4-6h prn temp >39°C.

12. Labs: CBC, SMA 7&12. Blood C&S x 2. UA with micro, urine C&S. Antibiotic levels peak and trough after 3rd dose, VDRL.

Lumbar Puncture:

CSF Tube 1: Gram stain, C&S for bacteria (1-4 mL).

CSF Tube 3: Cell count and differential (1-2 mL).

CSF Tube 4: Latex agglutination or counterimmunoelectrophoresis antigen tests for S. pneumoniae, H. influenzae (type B), N. meningitides, E. coli, group B strep, VDRL, cryptococcal antigen, toxoplasma titers. India ink, fungal cultures, cryptococcal antigen, AFB (8-10 mL).

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