meningitis

1. MENINGITIS
LINDA H. WARREN EDD RN CCRN

2. MENINGITIS:
SEPTIC: caused by bacteria
• Streptococcus pneumoniae
• N. Meningitidis:
- Transmitted by secretions or
aerosol contamination.
- Droplet precautions.
- Infection is most likely in dense
community groups (such as
college campuses).
- Usually require a meningitis
vaccine before attending school.
• More severe than viral.
ASEPTIC: caused by viral infection:
• Lymphoma
• Leukemia
• Brain abscess
• Enteroviruses
• Most common type.
• Less severe than bacterial.
Inflammation of the membranes & CSF surrounding the brain and spinal cord.

4. MANIFESTATIONS:
• HA
• Fever
• Changes in LOC
• Behavioral changes
• Nuchal rigidity (stiff neck)
• Positive Kernig's sign
• Positive Brudzinski’s sign
• Photophobia (light sensitivity)

5. ASSESSMENT:
• Fever
• HA
• N/V
• Nuchal rigidity  meningeal irritation
• Photophobia
• Decreased LOC
• Petechial rash if meningococcal organism
MENINGITIS:

7. Kernig’s Sign
Pain in the lower back and resistance to straightening the leg at the knee.
Pain increases as leg is lifted & flexed.

8. Brudzinski’s Sign
Involuntary flexion of the hip and knees when the head is flexed.
Laying supine, head is forward, knees will rise to relieve discomfort.

9. PETECHIAL RASH
Early Rash Advance Stage Rash

10. BACTERIAL MENINGITIS
COMPLICATIONS:
• Increased ICP
• SIADH
• Septic emboli (leading to DIC or stroke)
• Vegetative bacteria breaks off and is
lodged into smaller capillaries.

12. DIAGNOSTICS:
• Urine, throat, nose, and blood cultures (viral or bacterial?)
• Lumbar puncture
• May do CT scan before LP
CSF tested for:
• Elevated WBC count
• Decreased glucose (bacterial)
• Elevated protein
• CSF may be cloudy (bacterial) OR clear (viral)
BACTERIAL MENINGITIS

13. • ISOLATION– DROPLET PRECAUTIONS (wear mask)
until 24 hours of ABX given.
• Abx started early!!
• Need to use ABX that cross BBB:
- Ceftriaxone (rocephin) or cefotaxime (claforan)
in combo. with vancocin (vancomycin)
• Decadron (dexamethasone)  anti-inflammatory
• Phenytoin (dilantin) for seizures
• Mannitol (osmitrol) for diuresis
- Decreases cerebral edema
NURSING CARE OF BACTERIAL MENINGITIS
• Bedrest
• IV fluids
• Pain management
• Fever management
• Monitor for increased ICP…
- Assess for Cushings triad,
changes in LOC.
- HOURLY NEURO CHECKS.
- Would NOT insert ICP
monitor in meningitis.

14. • Frequent or continual neuro. assessment
• HOB up 30 degrees (lowers ICP)
• Report to the public health dept  highly
communicable / DROPLETS
• Infection control precautions (isolation,
droplet precautions)
NURSING CARE OF BACTERIAL MENINGITIS
• Monitor for increased ICP
• Safety – bed rails up and padded (seizures)
• Decrease environmental stimuli (dim lights)
• Serum electrolytes, fluid balance
• Regular diet if no decreased LOC
• If decreased LOC, NPO
• Measures to facilitate coping of patient / family.

15. MEDICAL MANAGEMENT
PREVENTION: vaccination for all children and at-risk adults against…
• haemophilus influenzae
• S. Pneumoniae
• Meningococcal
• Early administration: high doses of appropriate IV ABX.
• Dexamethasone (anti-inflammatory)
• TX of dehydration, shock, and seizures.
Unfavorable outcomes: tachycardia, elderly, decreased GCS