A patient admitted to the medical ward has a fever of 103˚ F, nuchal rigidity, pain on extension of the legs, and opisthotonos. Based on these findings, prioritize these nursing diagnoses:
1. Altered comfort: pain
2. Altered cerebral perfusion
4. High risk for injury
• In meningitis, there is
• It is important to provide nursing care for increased ICP, seizures, and hyperthermia to improve cerebral perfusion.
• Opisthotonos is an ominous sign associated with meningitis in which the patient has a rigid body spasm with his/her head and heels bent back and a fully-arched back.
• Pain, the fifth vital sign, occurs in patients with meningitis, but this is not the most important nursing diagnosis in this situation.