Elevate head of patient (approximately 15-30 degrees) to prevent a negative gradient between intracranial and paranasal sinus cavities that would allow an ascending path for the bacteria intracranially. This angle of inclination is sufficient to reduce the CSF pressure at the basal cisterns.
Put patient on bed rest (7-10 day trial of bed rest)
Apply strict CSF rhinorrhea precautions.
Avoid:
nose blowing,
Valsalva maneuvers,
the use of straws,
the use of an incentive spirometer
sneezing
heavy lifting
Stool softeners should be used (as prescribed) to decrease the strain and increased ICP associated with bowel movements.
Monitor patient’s vital signs and report for fever or other signs of meningitis.Others may develop bacterial meningitis within days of the onset of the rhinorrhea because in both situations an open communication exists between the brain cavity and the non-sterile nose.
Monitor the patient’s level of consciousness (LOC).
A lumbar drain may be needed and placed by a surgeon to seal the leak if bed rest, head elevation, and strict CSF rhinorrhea precautions fail. Approximately 5-10 mL of CSF will be drained per hour.
