This document provides information on the nursing management of patients with meningitis and encephalitis. It defines meningitis as an inflammation of the meninges covering the brain and spinal cord. Meningitis can be caused by bacteria or viruses. Encephalitis is an inflammation of the brain itself. The document outlines the signs and symptoms, causes, diagnostic process, potential complications, and treatment approaches for both conditions. It also provides detailed nursing assessments, interventions, and priorities of care for managing patients with meningitis or encephalitis, including monitoring for increased intracranial pressure, maintaining respiratory function, managing pain and anxiety, and supporting rehabilitation.

1. Management of Patient with
meningitis and encephalitis
By: Robina Yaqoob

2. Objectives:
• nursing management of patients with
inflammations and infections of CNS.

3. Meningitis
Meningitis
(from Greek meninx, "membrane”)
is an acute inflammation of the meninges.
Caused by either bacteria or virus.

4. Route of Entry
Route of Entry in CNS
• Skull or Back bone Fractures (trauma)
• Medical Procedures
• Along peripheral Nerves
• Blood or Lymphatic system

5. Etiology
The causes can be classified into:
• Bacterial Infections
•Viral Infections
• Fungal Infections
• Inflammatory diseases (SLE)
• Cancer
Trauma to head or spine

6. Pathophysiology
Bacteria enters blood stream/ trauma
Enters the mucosal surface/ cavity
Breakdown of normal barriers
Crosses the blood brain barrier Proliferates
in the CSF Inflammation of the meninges
Increase in ICP

7. Bacterial Meningitis
• Also known as septic meningitis.
• Extremely serious that requires immediate
care.
• Can lead to permanent damage of brain or
disability and death.
• Spreads by: -coughing or sneezing

8. Tubercular Meningitis
TB meningitis is caused by Mycobacterium
tuberculi.
Infection with this bacterium begins usually
in the lungs
1 – 2% of cases the bacteria travel via the
bloodstream.
Unlike other types of meningitis its
progresses very slowly and symptoms are
vague.

9. Viral Meningitis
• Also known as aseptic meningitis.
• More common than bacterial form and usually less
serious.
• Less likely to have permanent brain damage after
the infection resolves.
Treatment:
No specific treatment available.
Most patients recover completely on their own

10. Causative agents
• Enterovirus
• Adenovirus
• Arbovirus
• Measles virus
• Herpes simplex virus
• Varicella

11. Fungal Meningitis
• It is much less common than the other two infections.
It is rare in healthy people but it is more likely in persons
who have impaired immune system.
Risk factors
• Systemic infections
• Viral RTIs
• Tobacco use
• Impaired Immune system
• Over crowding
• Vaccinations
• Seasonal: Winter,Spring

12. Conti…
KERIG’S SIGN
Severe stiffness of the hamstrings causes
an inability to straighten the leg when the hip
is flexed to 90 degrees.
BRUDZINKI’SIGN
Severe neck stiffness causes a patient's
hips and knees to flex when the neck is
flexed.

13. Assessment and Diagnosis
• History taking
• Physical assessment
• CT and MRI
• Blood culture and sensitivity
• Lumbar Puncture
• CSF finding

14. Complications
• Sensory-neural hearing loss
• Epilepsy/ seizures
• Memory loss
• Paralysis
• Learning difficulty
• Behavioral difficulty
• Decreased intelligence
• Septicemia
• Death

15. Nursing Management
Nursing 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.

16. Nursing Diagnoses
• Acute pain related to meningeal irritation
• Hyperthermia related to the infectious process and
cerebral edema
• Impaired gas exchange
• Impaired Physical Mobility related to prolonged
bed rest
• Ineffective Tissue Perfusion (cerebral) related to
infectious process and cerebral edema
• Risk for deficient fluid volume related to fever and
decreased intake
• Risk for impaired skin integrity

17. outcomes
• The patient will <br />express feelings of
comfort and relief of pain<br />identify
strategies to reduce anxiety<br />exhibit
temperature within normal range<br
/>maintain adequate ventilation and
oxygenation<br />maintain fluid volume
within normal range<br />Have skin
integrity remain intact<br />

18. Nursing Interventions
• Reducing/manage Fever
• Maintain isolation precautions
• Administer antimicrobial agents on time to
maintain optimal blood levels
• Monitor temperature frequently or continuously,
and administer antipyretics as ordered.
• Institute other cooling measures, such as a
hypothermia blanket, as indicated.
• Maintaining Fluid Balance Prevent I.V. fluid
overload, which may worsen cerebral edema.
• Monitor intake and output closely.

19. Conti….
• Enhancing Cerebral Perfusion
• Assess LOC, vital signs, and neurologic parameters frequently.
• Observe for signs and symptoms of ICP (eg, 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.
• Reducing Pain
• Administer analgesics as ordered; monitor for response and adverse
reactions. Avoid opioids, which may mask a decreasing LOC.

20. Conti…
• Monitor CVP frequently.
• 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.
• Meningitis can be fatal. Nursing staff need to prioritise
antibiotic treatment, as delays are associated with poorer
outcomes.
• 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.

21. Encephalitis
Encephalitis (from Ancient Greek, enképhalos
“brain”) is an acute inflammation of the brain.
Encephalitis with meningitis is known as
meningo-encephalitis.
Etiology
Viral cause ,HSV encephalitis.
Arthropod borne virus encephalitis.
Bacterial cause, Fungal cause ,Auto immune
Herpes Simplex virus Encephalitis.
Caused by herpes Simplex virus;

22. Types:
Its of two types:
1. HSV-I typically affects children and adults
2. 2. HSV-II common in neonates
Treatment: Acyclovir or ganciclovir

23. Clinical manifestations
Younger children or infants:
Irritability • Poor appetite • Fever • Drowsy or
confused patient.
In Adults:
Acute onset of fever • Headache • Confusion •
Seizures. • Malaise
Cranial nerve dysfunction:
Hemi paresis • Dysphasia. • Change in LOC •
Increased ICP related to hydrocephalus.

24. Assessment and Diagnosis
• MRI (determine inflammation.)
• EEG • Lumbar puncture
• Blood test.
• Urine analysis.

25. Nursing Diagnosis
• Ineffective gas exchange r/t decreased tissue
perfusion
• Impaired physical mobility r/t paralysis, fatigue.
• Pain r/t disease condition.
• Altered nutrition less than body requirement r/t
dysphagia ( c. nerve dysfunction).
• High risk for injury r/t seizures episodes
• Impaired verbal function r/t cranial nerve dysfunction.
• Fear and anxiety r/t loss of control and paralysis.
• Potential for secondary complication (infections etc)

26. Complications
• Seizures
• Learning difficulty in children
• Behavioral difficulty
• Hemi paresis
• Death

27. Medical Management
• Treatment (which is based on supportive care)
are as follows:
Antiviral medications (if virus is cause)
Antibiotics, (if bacteria is cause)
Steroids
Sedatives for restlessness
Acetaminophen for fever
Physical therapy (if brain is affected post-
infection)

28. NURSING MANAGEMENT
• Ongoing assessment for disease progression is critical.
• The patient is monitored for life- threatening
complications e.g, respiratory failure.
• Maintain Respiratory function. Suctioning
• Assess respiratory rate and quality frequently.
• Monitor perfusion with pulse oximetry.
• Monitor the patient for respiratory insufficiency.

29. Conti…
• Ventilator support, oxygen therapy.
• Chest physiotherapy.
• Elevation of head of bed.
• Reducing effects of physical immobility.
• The paralyzed extremities are supported in functional
positions,
• ROM exercises every 2 hourly
• Use of comfort devices

30. Conti…
• Use of elastic stocking
• Hygiene maintenance
• Nutritional Support.
• Monitor intake and output
• Relieving fear and anxiety. Manage pain
with analgesic
• Diversion therapy

31. Brain abscess
A cerebral abscess is a pus-filled pocket of
infected material in your brain. It is sometimes
called a brain abscess. An abscess can cause
your brain to swell, putting harmful pressure on
brain tissue. An abscess can also keep blood
from flowing to parts of your brain.
OR
Brain abscess is defined as purulence and
inflammation in one or more localized regions
within the brain parenchyma.

32. Causes
Heart and lung infections are among the most
common causes of brain abscesses.
However, brain abscesses can also begin from an
ear or sinus infection, or even an abscessed tooth.
An abscess in the brain of an otherwise healthy person
is usually caused by bacterial infection.
Fungal brain abscesses tend to occur in people with
weakened immune systems.
Most abscesses are caused by an infection with
staphylococcal bacteria. • The infection may also be introduced
through a skull fracture following a head trauma or surgical procedures

33. What are the risk factors?
• a compromised immune system
• cancer and other chronic illnesses
• Congenital heart disease
• Head injury
• Meningitis
• Immunosuppressant drugs

34. Symptoms
usually develop slowly over several weeks, but they can also come
on suddenly.
• differences in mental processes, such as increased confusion,
decreased responsiveness, and irritability
• decreased speech
• decreased sensation
• decreased movement due to loss of muscle function
• changes in vision
• changes in personality or behavior
• Vomiting
• Fever/chills
• neck stiffness, especially when it occurs with fevers and chills
• sensitivity to light

35. Diagnosis
• any of these symptoms closely resemble other diseases or
health problems. Talk to your doctor immediately if you
develop any of the symptoms. You’ll likely need a neurological
exam. This exam can reveal any increased pressure within
the brain, which can occur from swelling. CT and MRI scans
can also be used to diagnose a brain abscess.
• In some cases, your doctor may need to perform a lumbar
puncture, or spinal tap. This involves the removal of a small
amount of cerebral spinal fluid to test for any problems other
than an infection. A lumbar puncture will not be performed if
any significant brain swelling is suspected, as it can
temporarily worsen the pressure inside the head. This is to
avoid the risk of brain hematoma, or a ruptured blood vessel
in the brain.

36. What’s the treatment for a brain abscess
A brain abscess is a serious medical
situation. A stay in the hospital will be
required. Pressure due to swelling in the
brain can lead to permanent brain damage.
• antibiotics
• Surgery (excision or drainage combined with prolonged
antibiotics (usually 4-8 wk) remains the treatment of choice.

37. Nursing Management & Interventions
• Nursing interventions should support the medical treatment
• Patients and families need to be advised of neurologic deficits
that may remain after treatment (hemiparesis, seizures, visual
deficits, and cranial nerve palsies).
• Frequently assess neurologic status, especially LOC, speech
and sensorimotor and cranial nerve functions.
• WOF signs of increased ICP: decreased LOC, vomiting,
abnormal pupil response and depressed respirations.
• The nurse assesses the family’s ability to express their
distress at the patient’s condition, cope with the patient’s
illness and deficits, and obtain support.
• Always provide safety measures.

38. References
• Smeltzer. Suzzanne C., et al; Textbook of Medical
Surgical Nursing; Vol. 2;1950- 1952, 1953-1955 12th
edition • Case, Christine.L; Microbiology An Introduction;
8Th edition • www.meningitisnow.org • www.who.int •
www.wikipedia.com