Meningitis

Ch. 42
Meningitis

 Inflammation of the meninges of the

brain and spinal cord
 Types
 Viral [most common]
 Bacterial [Streptococcus pneumoniae
(pneumococcal disease) and Neisseria
meningitidis. N. meningitidis meningitis
is also known as meningococcal
meningitis
 Fungal [Crytococcus neoformans]
Meningitis

 Blood
 Direct route ---CNS
 Trauma [Penetrating]
 Surgical procedures
 Ruptured brain abscess
 Basilar fx---CSF ---
Otorrhea o Rhinorrhea
 Viral Meningitis

 Aka aseptic
 No organisms are isolatedfrom
c/s ok CSF
 Viral illnesses (mumps, measles,
herpes, arboviruses [West Nile])
 There is no vaccine against viral
meningitis
 Tx: adm of antivirals
Fungal Meningitis

 Fulminant fungal-based infection of

the sinuses are from the organism
Cryptococcus neoformans
 Fulminant invasive fungal sinusitis
 Tx: symptomatic; IV antifungals
 Bacterial Meningitis

 Infectious micro-organism is
Neisseria meningitidis,
Streptococcus pneumoniae, or
Haemophilus influenzae
 Meningococcal meningitis- medical
emergency
 Contagious, high mortality
 Manifestations

 SUBJECTIVE DATA
 Excruciating, constant headache
 Nuchal rigidity (stiff neck)
 Photophobia (sensitivity to light)
 Manifestations

 OBJECTIVE DATA: Physical Assessment Findings  Positive Brudzinski’s sign (flexion

 Fever and chills of the knees and hips
 occurring with deliberate flexion of
 Nausea and vomiting
the client’s neck)
 Altered level of consciousness (confusion,
 Hyperactive deep tendon reflexes
disorientation,
 Tachycardia
 lethargy, difficulty arousing, coma)
 Seizures
 Positive Kernig’s sign (resistance and pain with
 Red macular rash (meningococcal
extension of the client’s leg from a flexed position)
meningitis)
 Restlessness, irritability
 Nursing Alert

 For the patient with meningitis, assess his or her neurologic status
and vital signs at least every 4 hours or more often if clinically
indicated.
 The priority for care is to monitor for early neurologic changes that
may indicate increased ICP, such as decreased level of
consciousness (LOC).
 The patient is also at risk for seizure activity.
Laboratory Diagnostic
 Cerebrospinal fluid (CSF) analysis
 most definitive diagnostic procedure.
 Urine, throat, nose, and blood culture
and sensitivity  CSF is collected during a lumbar puncture
 CBC: WBC: Elevated performed by the provider.
 Results indicative of meningitis
 Appearance of CSF: cloudy (bacterial) or
clear (viral)
 Elevated WBC
 Elevated protein
 Decreased glucose (bacterial)
 Elevated CSF pressure
 Complications

 Increased IICP
 SIADH
 Septic emboli
Drug Therapy

 Ceftriaxone or cefotaxime
 vancomycin: Phenytoin
 Acetaminophen, ibuprofen
 Ciprofloxacin, rifampin, or ceftriaxone
 Nursing Alert

 Place the patient with bacterial meningitis that is transmitted by droplets on

Droplet Precautions in addition to Standard Precautions.
 When possible, place the patient in a private room.
 Stay at least 3 feet from the patient unless wearing a mask.
 Patients who are transported outside of the room should wear a mask (see
Chapter 23).
 Teach visitors about the need for these precautions and how to follow them.
Nursing

 ● Implement fever-reduction measures, such as a cooling blanket, if necessary.

 ● Report meningococcal infections to the public health department.
 ● Decrease environmental stimuli.
 ● Provide a quiet environment.
 ● Minimize exposure to bright light (natural and electric)
 ● Maintain bed rest with the head of the bed elevated to 30°.
 ● Monitor for increased ICP.
 ● Tell the client to avoid coughing and sneezing, which increase ICP
Nursing

 ● Maintain bed rest with the head of the bed elevated to

30°.
 ● Monitor for increased ICP.
 ● Tell the client to avoid coughing and sneezing, which
 increase ICP