Bacterial Meningitis

HOLY NAME UNIVERSITY
THE PREMIER CATHOLIC UNIVERSITY IN THE PROVINCE OF BOHOL

College of Health Sciences – Nursing Department
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BACTERIAL MENINGITIS
§ Bacterial Meningitis is an infection

of the subarachnoid space and
brain usually due to any of a
variety of blood borne bacterial
pathogens.
§ Viruses probably account for most
cases of acute infection of the
meninges and is generally a
benign disease while blood-borne
bacterial meningitis usually
causes life-threatening meningitis.

BACTERIAL MENINGITIS
§ When the distinction between viral

and bacterial meningitis is
uncertain, empirical antibacterial
treatment is necessary
§ Empirical antimicrobial therapy is

used when antimicrobials are
given to a person before the
specific bacterium or fungus
causing an infection is known.

COMMON PATHOGENS
THAT CAUSE MENINGITIS
§ Streptococcus Pneumoniae
§ Neisseria Meningitidis
§ Streptococcus Agalactiae (a.k.a.
Group B Streptococcus, GBS)
§ Listeria Monocytogenes
§ Haemophilus Influenzae - was the
most common cause of Meningitis
in the past but now rarely seen due
to routine immunization (Hib & PCV
vaccines) against this organism.

HOW DOES MENINGITIS

SPREADS?
Pathologic organisms usually spread
to the meninges from any of the
following:
§ Upper respiratory tract infections
§ By direct introduction through a
Lumbar Puncture or skull fracture
Once bacteria enters the meningeal
space, they multiply rapidly and
spread throughout the CSF to invade
the brain tissues & the brain itself.
Please click the play button to watch the

YouTube video.

SIGNS & SYMPTOMS

§ Photophobia (pain or sensitivity to
light)
§ Headache
§ Nausea & Vomiting
§ Irritability
§ High-pitched cry
§ Poor feeding / suck
§ Fever & seizures
§ Nuchal rigidity – stiffness in the
neck
§ Bulging fontanelles – late sign in
infants (normally fontanelles are
soft & flat)
§ (+) Brudzinski’s sign – flexing the
patient’s neck causes involuntary
hip & knee flexion
§ (+) Kernig’s sign
ü Awake patient – pain is felt
when knee is extended; inability
to straighten the leg
ü Comatose patient – resistance
is felt when extending patient’s
knee
§ Petechiae - pinpoint, round spots
that appear on the skin
One of the physically demonstrable

symptoms of meningitis is Brudzinski's
sign. Severe neck stiffness causes a
patient's hips and knees to flex when the
neck is flexed.
Another physically demonstrable sign of

meningitis is Kernig's sign. Severe
stiffness of the hamstrings causes an
inability to straighten the leg when the hip
is flexed to 90 degrees.

HOW IS THE DIAGNOSIS OF

MENINGITIS BEING
CONFIRMED?
CSF Analysis obtained by Lumbar

puncture (Spinal Tap) confirms the
diagnosis.
CSF analysis in Bacterial meningitis
reveals:
§ CSF is cloudy
§ Elevated WBC count
§ Increased protein levels
§ Increased Intracranial Pressure
§ Glucose levels are decreased
(because bacteria have fed on
the glucose)
§ (+) Gram stain
CSF analysis in Viral meningitis

reveals:
§ CSF is clear
§ Slightly elevated WBC count
§ Normal protein levels
§ Normal glucose levels
§ (-) Gram stain
If the child has close contact with

someone with tuberculosis, a
Tuberculin Skin test is done to rule
out Tuberculosis meningitis.

IMPORTANT THINGS TO
REMEMBER IN A LUMBAR
PUNCTURE PROCEDURE
1. Verify that consent for the procedure

has been signed.
2. Confirm the patient’s identity
3. Empty the patient’s bladder prior to
the procedure.
4. Application of local anaesthetics
(Emla Cream) to numb the injection
site
5. Place the patient in side-lying position
with legs flexed at the knee and
pulled in towards their chest, and
upper thorax curved forward in an
almost fetal position. (side-lying
cannonball position)
6. Ensure that the patient remains in a
flat position after the procedure to
prevent CSF leakage
NURSING CARE FOR

PATIENTS WITH MENINGITIS
§ Implement droplet or respiratory
precaution right away if meningitis
is suspected
§ Maintain droplet precaution for at
least 24 hours after the start of
antibiotic therapy
§ Maintain patient on NPO status if
patient has decreased level of
consciousness (nothing by mouth
– No food or drinks because if
patient’s LOC is decreased, their
swallowing reflex may be impaired
& may be at risk for aspiration)
§ Provide a dark / quiet environment
to decrease stimulation because of
photophobia (sensitivity to light)
§ Administration of medications as
ordered (including IV antibiotics &
steroids)
§ Observe patient for signs of
increased ICP such as bulging
fontanelles, high-pitched cry,
increased head circumference,
irritability, bradycardia, headache,
seizures & respiratory changes.

THERAPEUTIC
MANAGEMENT
§ Antibiotic
therapy as
indicated by
sensitivity
studies is the
primary therapy.
§ Intrathecal injections (medication is
administered directly into the CSF)
may be necessary because the
blood-brain barrier may prevent the
chosen antibiotic from passing
freely into the CSF
§ A corticosteroid (dexamethasone)
or an osmotic diuretic (mannitol)
may be administered to reduce
ICP
§ Antibiotic therapy may be
prescribed prophylactically for the
child’s immediate family members
or playmates who have been in
close contact with the child

END OF PRESENTATION
Watch the YouTube video here:
https://www.youtube.com/watch
?v=OIEHGPX_Lqc&t=6s


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HOLY NAME UNIVERSITY

THE PREMIER CATHOLIC UNIVERSITY IN THE PROVINCE OF BOHOL

FAIR USE NOTICE AND

This PowerPoint presentation

Trailblazing Excellence in Educating Servant Leaders