Meningitis 1 Meningitis Katie, Elizabeth, Alison LVN #11

Meningitis 2 Meningitis Meningitis is an infection of the protective membrane that surrounds the brain and spinal cord (also known as the meninges). While this disease can be fatal, the severity of illness differs depending on the cause. Pathophysiology Meningitis is best managed when the nurse has at least a basic understanding of the pathophysiology of this disease. The pathophysiology of meningitis is one where an infectious agent (bacteria, virus or fungus) enters the central nervous system usually via the respiratory tract or blood stream and replicates uncontrollably resulting in the inflammation of the meninges. Clinical Manifestations Common clinical manifestations for meningitis in adults include a severe headache, a rigid neck and a sudden high fever. Other signs associated with meningitis include photophobia, phonophobia, altered level of consciousness, irritability, leg pain and abnormal skin color. Patients may exhibit a positive Kernig's or Brudzinski's sign. Kernig's sign is assessed by having the patient lie supine with knees flexed to chest. The sign is positive if pain limits the extension of the knee. Brudzinski's sign is assessed by flexing the neck, if this movement causes involuntary flexion of the knee and hip (fetal position) the sign is considered positive. Diagnostic Tests Some diagnostic tests for meningitis include blood cultures (reveals microorganism growth), X-rays or CT scans of the head chest or sinuses (reveal swelling or inflammation), and

Meningitis 3 lumbar puncture. A lumbar puncture, or spinal tap, is used to make a definitive diagnosis of meningitis. A sample of cerebrospinal fluid is collected and analyzed. Patients with meningitis exhibit a low glucose level, an increased white blood cell count, and increased protein. Short Term Goals/ Nursing Interventions With bacterial meningitis IV antibiotics need to be implemented as soon as possible to prevent the patient from succumbing to septicemia. The doctor may also recommend treatment for dehydration or shock. Once patient is stable, surgical draining of infected fluid may be necessary. Pain management during this time is paramount. Antibiotics can not cure viral meningitis and most cases improve on their own. Treatment usually includes bed rest, fluids and OTC medications to reduce fluids and body aches. Long Term Goals/ Nursing Interventions Close monitoring for the development of complications is required. Seizure precautions are indicated along with proper isolation precautions. Monitor patient for cytopenia, or liver dysfunctions, as these are potential adverse effects of medications. Drug-level monitoring may be needed for some antibiotics, such as vancomycin and the amino glycosides. Patient Education/ Prevention The best way to prevent meningitis is to wash your hands, stay healthy, and cover your mouth. These three things help deter the spread of germs that could potentially harm you. Some forms of bacterial meningitis are preventable if the proper vaccine is administered.

Meningitis 4 References http://www.medindia.net/patients/patientinfo/meningitis_pathphysiology.htm http://www.ocbmedia.com/meningitis/pathophysiology.php http://www.mayoclinic.com/health/meningitis/DS00118 http://www.cdc.gov/meningitis/index.html