Meningitis is an inflammation of the meninges, the lining of the brain and the spinal cord. It is usually caused by a primary viral or bacterial infection, but it can also develop from a fungal infection. – Viral meningitis, more common, is less severe and self-limiting. Treatment focuses on symptoms. About 90% of viral meningitis are caused by enter viruses, which also cause stomach flu. – Bacterial meningitis, although rare, can be rapidly fatal. It develops when bacteria invade the meninges directly or when bacteria travel through the bloodstream to the brain from another site of infection.
The leading cause of bacterial meningitis is S. pneumoniae and N. meningitides. – Pneumococcal meningitis, caused by S. pneumoniae is the most common and most serious form of bacterial meningitis. Many patients who’ve had pneumococcal meningitis suffer neurologic damage ranging from deafness to severe brain damage. – Meningococcal meningitis, caused by N. meningitis is spread by contact with infectious secretions from the respiratory tract and throat. The very old and very young are especially vulnerable.
Signs and symptoms Signs and symptoms of meningitis are similar regardless of whether it’s viral or bacterial in origin, although symptoms of viral meningitis may be milder. Inflammation of the meninges causes neck stiffness and headache, nausea, vomiting, fever, photophobia, confusion, sleepiness, seizures. These signs and symptoms develop over several hours or up to 2 days, and often are mistaken for a severe cold or flulike illness. DIAGNOSTIC If you’re assessing a patient with suspicious signs and symptoms, start by taking a history, focusing on possible mosquito exposure. Perform a physical assessment, focusing on the neurologic system. You can perform two tests to determine if the patient has meningeal inflammation.
Both are done with the patient lying supine on the bed. – Kernig’s sign: flex one of patient’s legs at both his hip and knee, and then straighten his knee. Pain and increase resistance to knee extension are a positive Kernig’s sign and suggest meningeal irritation. – Brudzinski’s sign first make sure the patient has no injury to the cervical spine. Then place your hand behind his head and flex his neck forward until MENINGITIS his chin touches his neck. Normally, they remain relaxed and motionless. Involuntary flexion of the hips and knees is a positive Brudzinski’s sign, suggesting meningitis irritation.
Meningitis usually causes a low glucose count and elevated white blood cell count. In bacterial meningitis, the CSF protein concentration is elevated. The patient may have a CT or MRI of his head and sinuses to detect inflammation and certain viral infections and to rule out other other possible causes of his signs and symptoms. TREATING MENINGITIS The severity of the patient’s signs and symptoms determines whether he’ll need hospitalization. Because meningitis is contagious, maintain isolation precautions as appropriate. For bacterial meningitis, patient will be started on an I. V. antibiotic, such as vancomycin or ampicillin.
When a bacterial pathogen is identified, the patient will receive the appropriate antibiotic. Adjunctive dexamethasone, to control edema, should be considered for patients with suspected or proven bacterial meningitis. If the meningitis turns out to be viral in origin, the health care provider will discontinue the antibiotics and may order an antiviral drug such as acyclovir. For both types of meningitis, supportive treatment may include: – I. V. fluids to replace losses from diaphoresis and vomiting. – Acetaminophen to manage fever and pain associated with headache or neck stiffness. – antileptics if patient has seizures.
– Mannitol to reduce intracranial hypertension. – antiemetics to treat nausea and vomiting. PLANNING ROUTINE NURSING CARE 1. Perform frequent vital signs and neurologic assessments. 2. Asses mental status, muscle strength, headache severity, pupillary reaction. 3. Maintain a patent airway, suction the patient as needed. 4. Monitor his oxygenation and administer supplemental oxygen as needed. 5. Keep patient’s room quiet and darkened to make him more comfortable and reduce his agitation. 6. Depending on his level of consciousness, he may need an indwelling urinary catheter for accurate intake and output monitoring.
7. Provide meticulous skin care to prevent skin breakdown. 8. Take safety precautions, such as raising the side rails and keeping the MENINGITIS bed in low position. 9. Provide emotional support and education for the patient and his family and facilitate communication between them and the health care team. PREVENTATIVE STEPS Vaccines are available against pneumonia, pneumococcal meningitis, and other bacteria that can lead to meningococcal meningitis. There are no vaccines available for encephalitis. The CDC recommends that adolescents age 11-18 receive the MCV4 vaccine against meningococcal meningitis.
The pneumococcal polysaccharide vaccine, which protects against pneumococcal meningitis, is recommended for all adults over age 65 and children over age 2 that have certain chronic medical conditions. The pneumococcal conjugate vaccine is recommended for all children over age 2 and appears to be effective in infants. Anyone who’s been in close contact with a patient who has meningococcal meningitis should receive post exposure prophylaxis with antibiotic therapy. Meticulous hand hygiene also can reduce risk: teach patients to wash their hands before and after exposure to someone who may be infected with meningitis or encephalitis.
Community mosquito control programs also can help prevent meningitis and encephalitis. Teach patients to use insect repellent when outdoors. QUIZ YOURSELF 22) Which of the following assessment data indicated nuchal rigidity? 1. Positive Kernig’s sign 2. Negative Brudzinski’s sign 3. Positive homan’s sign 4. Negative Kernig’s sign A positive Kernig’s sign indicated nuchal rigidity, caused by an irritative lesion of the subarachnoid space.
Brudzinski’s sign is also indicative of the condition. 23) Meningitis occurs as an extension of a variety of bacterial infections due to which of the following conditions? 1. Congenital anatomic abnormality of the meninges MENINGITIS 2. Lack of acquired resistance to the various etiologic organisms 3. Occlusion or narrowing of the CSF pathway 4. Natural affinity of the CNS to certain pathogens 2. Extension of a variety of bacterial infections is a major causative factor of meningitis and occurs as a result of a lack of acquired resistance to the etiologic organisms. Preexisting CNS anomalies are factors that contribute to susceptibility. 24) Which of the following pathologic processes is often associated withasept ic meningitis?
1. Ischemic infarction of cerebral tissue 2. Childhood diseases of viral causation such as mumps 3. Brain abscesses caused by a variety of pyogenic organisms 4. Cerebral ventricular irritation from a traumatic brain injury. 2. Aseptic meningitis is caused principally by viruses and is often associated with other diseases such as measles, mumps, herpes, and leukemia. Incidences of brain abscess are high in bacterial meningitis, and ischemic infarction of cerebral tissue can occur with tubercular meningitis. Traumatic brain injury could lead to bacterial (not viral) meningitis.