FOR NURSING STUDENTS

1. By
Sarika M L
Tutor
Sum Nursing College
Siksha O Anusandhan DTU
Bhubaneswar

2. “Meningitis is an inflammation of the lining around
the brain and spinal cord caused by bacteria or
viruses”- Iggulden 2006

3. CLASSIFICATION

4. Acute bacterial meningitis
This form of meningitis should be seen as a medical
emergency as the disease can quickly progress and a
devastating chain of events may occur that may lead
to death or disability.

5. Chronic meningitis
When signs and symptoms of meningeal
inflammation have been present for a month or
more then the condition can be defined as chronic.

6. Meningococcal disease
It has two main clinical presentation.-
meningitis and septicaemia- that often occur
together. Patients with meningococcal
septicaemia have a higher mortality rate than
patients with meningococcal meningitis.

7. CAUSATIVE ORGANISMS
 BACTERIAL MENINGITIS
 Pneumococcal meningitis :
 Streptococcus pneumonia( gram positive)
 H. influenza meningitides :
 Haemophilus influenza (gram negative)
 Meningococcal meningitides :
 Neisseria meningitides
 Others :
 Staphylococcus aureus, streptococcus group A and B, E.coli, Klebsiella, proteus,
pseudomonas, mycobacterium tuberculosis etc.
 VIRAL MENIGITIS
 Mumps, enterovirus, (echo, coxsackie, poliomyrlitis), herpes simplex virus type 2,
Epsein-Barr virus, arbo virus.

8. INCIDENCE
The bacteria Streptococcus pneumonia and Neisseria
meningitides are responsible for 80% of cases of meningitis in
adults.
 Haemophilus influenza was once a common cause of
meningitis in children.
 Out breaks of N. meningitides infection are most likely to occur
in dense community groups, such as college campuses and
military installations. Peak incidence is in winter and early
spring.

9. RISK FACTORS
 Tobacco use
 Viral upper respiratory tract infection
 Otitis media
 Mastoiditis
 immune system deficient people

10. PATHOPHYSIOLOGY
Meningeal infections generally originate in one of two
ways:
1. Through blood stream as a complication of other
infections
2. Direct spread; occur after traumatic injury to the
facial bones or secondary invasive procedures.

11. PATHOPHYSIOLOGY (Cont.…)
once the causative organism enters the blood stream
↓
crosses blood brain barrier
↓
proliferates in the CSF
↓
stimulate immune response in host
↓
release of cell wall fragments and lipopolysaccharides

12. PATHOPHYSIOLOGY (cont.…)
↓
Inflammation of subarachnoid and pia mater facilitated-
Increased ICP
↓
CSF circulates through the subarachnoid space, where
inflammatory cellular materials from the affected meningeal
tissue enter and accumulate.

13. PROGNOSIS
 Depends on the causative organism, the severity of infection
and the time of treatment.
 Acute fulfillment presentation may include adrenal damage,
circulatory collapse and wide spread
hemorrhage.(Waterhouse Friderichsen syndrome). This
syndrome is the result of endothelial damage and vascular
necrosis caused by bacteria.

14. COMPLICATIONS
 Visual impairment
 Deafness
 Seizure
 Paralysis
 Hydrocephalus
 Septic shock

15. CLINICAL FEATURES

16. Clinical Manifestation
Initial symptoms
Head ache
Fever

17. Clinical Manifestation
Other well recognized signs (Classical Sign)
Neck rigidity
Positive Kerning's sign
Brudzinski’s sign
Photophobia

18. Neck Rigidity

19. Clinical Manifestation
 Positive Kerning's sign

20. Clinical Manifestation
 Brudzinski’s sign

21. Clinical Manifestation
Photophobia

22. Other Signs And Symptoms
In Neisseria meningitides infection
 Rashes
 Skin lesions:- ranging from a petechial rash with purpuric
lesions to large areas of ecchymosis.

23. Other Signs And Symptoms
Disorientation and memory impairment
Behavioural manifestations:- Lethargy,
unresponsiveness, coma
Seizure
Initial signs of increased ICP secondary to diffuse brain
swelling or hydrocephalus
Brain herniation

24. Other Signs And Symptoms
Meningococcal meningitis:
 Septicaemia
 high fever
 extensive purpeuric lesions
 shock and signs of DIC
 Death may be occurring within a few hours of infection.

25. Development of signs and symptoms of meningococcal disease
SEPTICEAMIA
 rash anywhere in the body
 tachycardia
 tachypnoea
 cyanosis
 poor capillary refill
 rigors
 oliguria
 arthralgia
MENINGITIS
 severe headache
 neck stiffness
 photophobia
 drowsiness
 abnormal responses
 impaired consciousness
 death from central nervous system failure

26. Development of signs and symptoms of meningococcal disease
(cont.….)
SEPTICEAMIA(cont.…)
 myalgia
 abdominal pain
 diarrhoea
 impaired consciousness
 hypotension
 Death from Cardiovascular
failure

27. Development of signs and symptoms of meningococcal
disease (cont.….)
Viral meningitis
 Head ache
 Low grade fever
 Neck stiffness
 Signs and symptoms of upper respiratory tract infection

28. Diagnosis
•history, physical examination, laboratory data. A history of
recent infections, such as those involving the ears, sinuses or
respiratory tract, is of particular interest.
•Examination of CSF is the gold standard for the diagnosis of
bacterial meningitis.

29. Comparison of CSF culture:
CSF
characteristics
Acute bacterial meningitis Acute aseptic(viral)
meningitis
Appearance Turbid, cloudy Clear,; sometimes
turbid
Cells Increased WBC, mostly
polymorph nuclear neutrophils
Increased WBC; mostly
mononuclear
Protein level Increased(100-500 mg/ dL) Normal or slightly
increased

30. Comparison of CSF culture:
CSF characteristics Acute bacterial meningitis Acute aseptic(viral)
meningitis
Glucose level Decreased (<40mg/dL or 40% of
blood glucose level)
Normal
Smear and culture Bacterial presence on gram stain
and culture
Virus may demonstrated by special
techniques, and no bacteria
Pressure on LP Elevated(>180mm of water Variable

31. Newer laboratory techniques
 Counter immunoelectrophoresis(CIE)
 Radioimmunoassay(RIA)
 Latex particle agglutination(LPA)
 Enzyme linked immunosorbent assay(ELISA)
 Polymerase chain reaction(PCR)

32. Prevention
Anti microbial chemoprophylaxis
Rifampicin
Ciprofloxacin hydrochloride
Ceftriaxone sodium
Vaccination

33. Medical Management

34. Medical Management

37. Dexamethasone as adjunct therapy for the tratement
of acute bacterial meningitis and pneumococcal
meningitis.
It is administered 15-20 minutes before 1st dose of
antibiotics and then every 6hrs for 4days.

38. Nursing Management

39. Assessment
 VITAL SIGNS :-TPR, BP
 ICP: bradycardia and raised systolic BP
 GCS
 LOC: restless, lethargy, stupor, coma
 Signs and symptoms of meningeal irritation
 Seizure
 Intake/output
 Electrolyte level: hyponatremia
 Dehydration : profuse sweating, oliguria and dry skin(IV fluid
replacement)
 Respiratory parameters: auscultate chest, observe chest movement

40. Basic Supportive Care
 MAINTAIN AIRWAY
 POSITION: for drainage
 SUCTION
 TEMPERATURE CONTROL MEASURES
 OXYGEN THERAPY
 BASIC HYGIENIC CARE: mouth care every 2hr
 PROTECTION FROM INJURY: side rails, observe frequently, protecting
IV lines and any tubing, keeping the bed low when patient is alone.
 Assess for dyspnoea and cyanosis
 Monitor blood gases

41. Basic supportive care
 Elevated temperature: antipyretic-aminophen 650mg,remove excess
cloths, cool room temperature, tepid bath, hypothermia blanket
 Control pain and head ache: elevate head end 30degree, ice cap, quite
dark room
 Medications
Antibiotics
Analgesics
Antipyretics

42. Prevention of Complication
 PREVENTING BEDSORE
 SKIN CARE:
 linen change
 care over bony prominences
 2 HOURLY POSITION CHANGE
 ELASTIC HOSE: if patient is on bed rest
 OBSERVE FOR ADRENAL INSUFFICIENCY (hypotension, respiratory
collapse, petechial lesion )

43. REFERENCES
 Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Text book of medical
surgical nursing. 12th edition. New Delhi: Lippincott; 2011. 1950-52
 Chintamani. Medical surgical nursing. Haryana: Elsevier; 2011. 1457-59
 Hickey JV. The clinical practice of neurological and neurosurgical nursing.
Jalandhar: S Vikas and company;2014. 339-40