Meningitis Mia — Bacterial Meningitis: Stiff Neck, Droplet Precautions & Rapid Antibiotics
A college dorm, a fever, and a neck too stiff to touch her chin to her chest
Mia, a 19-year-old dorm resident, spikes a fever of 103F with a pounding headache. She cannot bend her chin to her chest, the lights hurt, and she is becoming confused.
Mia's meninges are inflamed by bacterial invasion, and the pressure and irritation produce the classic triad: fever, severe headache and nuchal rigidity. Photophobia, vomiting and altered mental status follow. Kernig's and Brudzinski's signs are positive because stretching inflamed meninges hurts. Bacterial meningitis kills quickly, so care is time-driven: droplet precautions immediately, blood cultures and lumbar puncture, then antibiotics without delay. A purpuric rash suggests meningococcal disease, which is highly contagious and requires prophylaxis of close contacts.
Read Meningitis Mia's full story →The story arc
The setup
Mia lives in a crowded college dorm and skipped her meningococcal vaccine.
The turn
She develops a fever of 103F, a severe headache, photophobia and a neck so stiff she cannot flex it.
The crisis
Mia becomes confused and a purple non-blanching rash spreads across her trunk.
The save
Droplet precautions are started on arrival, cultures and lumbar puncture are obtained, and IV antibiotics are given immediately. Close contacts get prophylaxis.
NCLEX study section — Bacterial Meningitis: Stiff Neck, Droplet Precautions & Rapid Antibiotics
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Neurological
Take this chapter into practice questions on the same topic.