1.Admit to:
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.
7. Diet: NPO
8. IV Fluids: D5 ½ 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 gm IV q12h in place of ampicillin if drug-resistant
pneumococcus is suspected.
10. Symptomatic Medications:
-Heparin 5000 U SC q12h or pneumatic compression stockings.
-Famotidine (Pepcid) 20 mg IV/PO q12h.
-Acetaminophen (Tylenol) 650 mg PO/PR q4-6h prn temp >39/C.
-Docusate sodium 100-200 mg PO qhs.
11. Extras: CXR, ECG, PPD, CT scan.
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 2: Glucose, protein (1-2 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 Bstrep, VDRL,
cryptococcal antigen, toxoplasma titers. India ink, fungal cultures, AFB (8-10 mL).
