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

3. Anxiety

4. High risk for injury

2, 1, 3, 4

Explanation

• In meningitis, there is inflammation of the meninges of the brain and spinal cord. Patients have altered cerebral perfusion related to an increased intracranial pressure (ICP) and inflammatory process.

• 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. 

Risk for injury must be considered in patients with meningitis, but as long as cerebral perfusion is improved, the chance for injury is lowered. Decreasing pain and minimizing anxiety will also help lower the risk for injury.

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