Meningitis is an inflammation of the meninges that surround the brain and spinal cord. It can be caused by viruses, bacteria, fungi or parasites. Common symptoms include fever, neck stiffness, vomiting and photophobia. Diagnosis involves examining cerebrospinal fluid through lumbar puncture. Treatment focuses on antibiotics, antivirals or antifungals as well as managing symptoms. Nursing care aims to enhance cerebral perfusion, reduce fever and pain, maintain fluid balance, and help the patient return to normal functioning.

1. CHIRAYU COLLEGE OF NURSING, BHOPAL
SUBJECT- MEDICAL SURGICAL NURSING
TOPIC- MENINGITIS
PREPARED BY
MR. MIGRON RUBIN
LECTURER

2. OBJECTIVES
 To introduce & define the topic
 To enlist risk factors & etiology
 To explain clinical manifestation & diagnostic evaluation
 To explain management & health education of meningitis

3. INTRODUCTION
 Meningitis involves meninges

4. TYPES
 Viral meningitis
 Bacterial meningitis
 Fungal meningitis
 Parasitic meningitis

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

6. 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.

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

8. 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.

9. 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

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

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

12. 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

13.  B. NON PHARMACOLOGICAL MANAGEMENT
 Maintenance 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.

14.  SURGICAL MANAGEMENT
 Cochlear implantation rehabilitation due to deafness

15.  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.

16. 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

17. GOAL
 To Enhanced Cerebral Tissue Perfusion
 To Reduce Fever
 To Maintain Fluid Balance
 To Reduce Pain
 To Return to Optimal Level of Functioning/ mobility

18. INTERVENTIONS
 Enhancing Cerebral Perfusion
 Assess LOC, vital signs, and neurologic parameters frequently. Observe
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.

19.  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.

20.  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

21.  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.

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

23. 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.

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

25. 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.

26. REFERENCES
 Boyer Jo Mary(2004), Textbook Of Medical Surgical Nursing, Philadelphia, Lippincott
William & Wilkins.
 Lewis Mantik Sharon et. Al. (2000), Medical Surgical Nursing, Assessment &
Management Of Clinical Problems, St. Louis, Missouri, Mosby Publishers.
 Lippincott (2001), Manual of Nursing Practice, J.P. Brothers, Philadelphia.