Meningitis-inflamation of the meningeal

1. MENINGITIS
Moderator:
SIR GANESH PATIDAR
Lecturer
MSN
Mr. Manish Gauswami
Ms.Fanat Trupti
B.Sc. Nursing
2st year

2. INTRODUCTION
• It can occur as a complication of other disease and
50% is an opportunistic infection.
• In 2013 - 303,000 deaths
• In 2010 - 420, 000 deaths
• Although meningitis is a notifiable disease,
the exact incidence rate is unknown.

3. DEFINITION
Meningitis is an acute inflammation of the meningeal tissues surrounding the brain and
the spinal cord (meninges).

4. TYPES
Viral meningitis
Bacterial meningitis
Fungal meningitis
Parasitic meningitis

5. RISK FACTORS
Skipping vaccinations
Age-Viral meningitis occur in children younger than age 5. Bacterial
meningitis is common in those under age 20.
Living in a community setting
Pregnancy.
Compromised immune system. AIDS, alcoholism, diabetes, use of
immunosuppressant drugs etc.

6. ETIOLOGY
Primary- Neisseria meningitidis
Secondary- E. coli
Haemophilus influenzae
Streptococcus pneumoniae

7. PATHOPHYSIOLOGY
Invasion of microorganisms- usually upper respiratory tract infection
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Bacterial invasion leads to a rapidly increased blood supply to the meninges with
massive neutrophil migration.
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The neutrophils then engulf the bacteria and disintegrate. Exudate from tissue
destruction contributes to purulent material.
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The purulent material causes the meninges to become inflamed and increases ICP.
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Excessive release of ADH. ADH acts by inhibiting urination. This in turn leads to
water retention, oliguria , hypervolemia ,hyponatremia and further increase in ICP.

8. CLINICAL MANIFESTATION
Fever
Neck stiffness- Nuchal rigidity
Thigh flexion upon flexion of the neck (Brudzinski’s sign)
Resistance to the passive extension of the knee with the hip flexed
(Kernig’s sign)
Vomiting, photophobia may be seen
Petechial rashes
Acute confusion
Seizures and cranial nerve palsy
Coma in severe cases

9. DIAGNOSTIC EVALUATION
History Collection
Physical Examination
Blood culture
A nalysis of CSF
CBC, electrolyte levels, RBS
CT scan, MRI, PET scan
Skull x-ray
X- rays of the skull may demonstrate infected sinuses.

10. COMPLICATIONS
Hearing loss
Memory difficulty
Learning disabilities
Brain damage
Gait problems
Seizures
Kidney failure
Shock
Death

11. MANAGEMENT
I. MEDICAL MANAGEMENT
A. PHARMACOLOGICAL MANAGEMENT
Antibiotics- ampicillin, penicillin, amoxycillin
Antiviral- tenofovir
Antifungal- fluconazole
Corticosteroid- dexamethasone
IV mannitol for diuresis
IV phenytoin
Antipyretics- Acetaminophen

12. B. NON PHARMACOLOGICAL MANAGEMENT
M aintenance of fluid-electrolyte balance by IV fluid therapy
Nasogastric tube feeding
Vitamin supplementation
Head end elevation 30- 45 degree
Emotional support and necessary information for continuation of care at
home, follow-up and rehabilitation.

13. SURGICAL MANAGEMENT
Cochlear implantation rehabilitation due to deafness

14. NURSING MANAGEMENT
ASSESSMENT
Obtain a history of recent infections such as upper respiratory infection,
and exposure to causative agents.
Assess neurologic status and vital signs.
Evaluate for signs of meningeal irritation.
Assess sensorineural hearing loss (vision and hearing), cranial nerve
damage (eg, facial nerve palsy), and diminished cognitive function.

15. DIAGNOSIS
Ineffective Tissue Perfusion (cerebral) related to infectious process and
cerebral edema
Hyperthermia related to the infectious process and cerebral edema
Risk for Imbalanced Fluid Volume related to fever and decreased intake
Acute Pain related to meningeal irritation
Impaired Physical Mobility related to prolonged bed rest

16. INTERVENTIONS
Enhancing Cerebral Perfusion
Assess LOC, vital signs, and neurologic parameters frequentl
for signs and symptoms of ICP (e.g. decreased LOC, dilated pupils,
widening pulse pressure).
Maintain a quiet, calm environment to prevent agitation, which may cause
an increased ICP.
Prepare patient for a lumbar puncture for CSF evaluation, and repeat
spinal tap, if indicated. Lumbar puncture typically precedes neuroimaging
Notify the health care provider of signs of deterioration: increasing
temperature, decreasing LOC, seizure activity, or altered respirations.
I/V mannitol is administered.

17. Reducing Fever
Administer antimicrobial agents on time to maintain optimal blood levels.
Monitor temperature frequently or continuously.
Institute other cooling measures, such as a hypothermia blanket, as
indicated.
Administer antipyretics as ordered like paracetamol.

18. Maintaining Fluid Balance
Prevent I.V. fluid overload, which may worsen cerebral edema.
Monitor intake and output closely.
Monitor CVP frequently.
Administration of osmotic diuretic- mannitol

19. Reducing Pain
Assess level, intensity, duration & location of pain.
Darken the room if photophobia is present.
Assist with position of comfort for neck stiffness, and turn patient slowly and
carefully with head and neck in alignment.
Elevate the head of the bed to decrease ICP and reduce pain.
Administer analgesics as ordered; monitor for response and adverse reactions.
Avoid opioids, which may mask a decreasing LOC.
Promoting Return to Optimal Level of Functioning
Implement rehabilitation interventions after admission (eg, turning, positioning).
Progress from passive to active exercises based on the patient's neurologic status.

20. EXPECTED OUTCOMES
Enhanced Cerebral Tissue Perfusion
Fluid Balance Maintained
Reduced Fever
Reduced Pain
Return to Optimal Level of Functioning

21. HEALTH EDUCATION
Advise close contacts of the patient with meningitis that prophylactic
treatment may be indicated; they should check with their health care
providers or the local public health department.
Encourage the patient to follow medication regimen as directed to fully
eradicate the infectious agent.
Encourage follow-up and prompt attention to infections in future.

22. SUMMARY
We have discussed about meningitis, its cause, risk factor, pathophysiology,
clinical manifestation, diagnostic evaluation & management

23. CONCLUSION
Meningitis is an inflammation of the meninges. The meninges are the three
membranes that cover the brain and spinal cord. Meningitis can occur when
fluid surrounding the meninges becomes infected.