Meningitis is an inflammation of the protective membranes covering the brain and spinal cord known as the meninges. It can be caused by bacterial, viral, fungal or non-infectious etiologies. Bacterial meningitis requires urgent treatment to prevent high mortality. Common symptoms include fever, headache, neck stiffness, nausea and altered mental status. Diagnosis involves lumbar puncture and analysis of cerebrospinal fluid. Treatment involves intravenous antibiotics, steroids, anticonvulsants and supportive care like hydration and fever control. Nursing care focuses on monitoring for complications, maintaining fluid balance and facilitating recovery.

1. MENINGITIS
KIRAN NAYYAR

3. INTRODUCTION

4. DEFINITION
 Meningitis is
an acute inflammation of the
protective membranes covering
the brain and spinal cord, known
collectively as the meninges.
 Meningitis is the infection and
inflammation of the meninges
(covering of the brain and spinal
cord: dura mater, arachnoid, and pia
mater) and the cerebrospinal fluid.

5. Direct spread
Hematogeno
us spread
 Thoroughly
overlying skin
 Up through nose
 Anatomical defect
• Congenital- spina
bifida
• Acquired- skull
fracture
 Binding to
surface receptors
 Area of damage

6. Skull or Back bone
fracture (trauma)
Medical procedure
Along peripheral
nerves
Blood or lymphatic
system

7. ETIOLOGY
The causes can be
classified into:
• Bacterial meningitis
• Viral meningitis
• Fungal meningitis
• Non-infection meningitis
• Trauma to head or spine

10. Pathophysiology
Bacteria enters blood stream/ trauma
Enter the mucosal surface/ cavity
Breakdown of normal barriers

11. Crosses the blood brain barrier
Proliferates in the CSF
Inflammation of the meninges
Increase in ICP

12. BACTERIAL MENINGITIS

14. • Consider as a medical
emergency.
• Also known as septic
meningitis.
• Untreated bacterial meningitis
has a mortality approaching
100%.
• The organisms usually gain
entry to the CNS through the
upper respiratory tract or the
blood stream.
• But they may enter by direct
extension from penetrating
wounds of the skull.

15. CAUSATIVE AGENTS
Streptococcus pneumonia 30-80%
Neisseria meningitis 15-40%
Hemophilus influenza 2-7%

17. CLINICAL MANIFESTATION
 Fever
 Headache
 Neck stiffness
 Nausea/vomiting
 A positive Kernig’s sign
 A positive Brudzinski’s sign
 Photophobia
 Decreased LOC
 Sign of increased ICP may also be
present
 Change in mental status, such as
disorientation, restlessness and mental
confusion
 Headache.
 Blurred vision.
 Confusion.
 High blood pressure.
 Shallow breathing.
 Vomiting.
 Changes in the behaviour.
 Weakness or problems with moving or
talking.

20. DIAGNOSTIC EVALUATION
 Blood culture
 Lumber puncture with analysis of the CSF. Variation in the CSF
depends on the causative organism. Protein level in the CSF is usually
elevate and in higher in bacterial than viral meningitis. CSF glucose
concentration is commonly decreased in bacterial meningitis.
 Specimen of the CSF, sputum and nasopharyngeal secretion are
taken for culture before start of antibiotics therapy to identify the
causative organism
 A gram stain is done to detect the bacteria.
 X-ray of the skull may demonstrate infected sinuses.
 CT scan
 MRI

21. COLLABARATIVE CARE
 History
 Physical examination
 Bed rest
 IV fluids
 Antibiotics IV
 Cephalosporin (ceftriaxone)
 Codeine for headache
 Dexamethasone
 Acetaminophen or aspirin for temperature above 100.4oF
 Hypothermia
 Clear liquid as desired or tolerated
 Phenytoin IV
 Mannitol IV for diuresis

23. Viral meningitis usually begins with symptoms of a viral
infection such as fever, a general feeling of illness, headache,
and muscle aches.
Later, people develop a headache and a stiff neck that makes
lowering the chin to the chest difficult or impossible.
Doctors suspect viral meningitis based on symptoms and do a
spinal tap (lumbar puncture) to confirm the diagnosis. If people
appear very ill, they are treated for bacterial meningitis until
that diagnosis is ruled out. If the cause is human
immunodeficiency virus (HIV) or a herpesvirus, drugs
effective against those viruses are used.
 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.
 Most patients recover completely on their own.

24. CAUSATIVE AGENTS
• Enterovirus
• Adenovirus
• Arbovirus
• Measles virus
• Herpes simplex virus
• Varicella
DIAGNOSTIC EVALUATION
• Lumber puncture
• PCR (Polymerase chain reaction)
organism are not seen on gram stain
and acid-fast smears. Then PCR test
used to detect viral specific DNA or
RNA is a highly sensitive method for
diagnosing CNS viral infection.

26. FUNGAL MENINGITIs

27.  It is much less
common than the
infections.
 It is rare in healthy
people but is more
likely in person who
have impaired
immune system.

29. CAUSATIVE AGENTS
• Cryptococcus
• Histoplasma
• Blastomyces
• Coccidioides
• Candida.

30. TUBERCULAR
MENINGITIS

31. • Tuberculous Meningitis (TBM) is a form of meningitis characterized by
inflammation of the membranes (meninges) around the brain or spinal
cord and caused by a specific bacterium known as Mycobacterium
tuberculosis. In TBM, the disorder develops gradually.
 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 type of meningitis its progresses very slowly and symptoms
are vague.

32. CLINICAL MANIFESATION
 Fever
 Headache
 Irritability
 Drowsiness
 Malaise
 Seizures
 Positive kernig and Brudzinski signs

33. DIAGNOSTIC
EVALUATION
• Lumber puncture
• PCR
• Culture of other body fluids can help
confirm the diagnosis
• Radiographic studies

34. CSF FINDING

36. Complications
Hearing loss
Memory
difficulty
Learning
disabilities
Brain
damage
Gait problem Seizures
Kidney
failure
Shock death

37. Management
Pharmacological Nonpharmacological
Nursing
management

38. Medical management

40.  Third generation cephalosporins such as cefotaxime or ceftriaxone
 Vancomycin is added in the regime in case of resistance.
 Dexamethasone
 Dehydration and shock can be treated with fluid therapy.
 Phenytoin for seizure management.
Bacterial meningitis

41.  There is no specific treatment for viral meningitis.
 Most patients completely recover on their own within 7 to 10 days. It includes bed rest,
plenty of fluids, good nutrition and over the counter pain medications to help reduce
fever and relieve body ache.
 Seizure prophylaxis: Lorazepam or phenytoin or barbiturate.
 Increased ICP: injection Mannitol 1g/kg followed by 0.25-0.5g/kg.
 Adequate hydration is to be maintained.
 Antipyretics
 Antiemetics
Viral meningitis

42. Intravenous therapy with amphotericin B is the most common
treatment. It is often combined with an oral antifungal medicine called
5-flucytosine. Another oral drug, fluconazole, in high doses may also
be effective.
Fungal meningitis

45. NURSING MANAGEMENT
 Management resolves around prevention of dehydration, electrolyte
imbalance, edema and fever.
 Rapid I/V fluid replacement may be prescribed but care to be taken not to
over hydrate the patient because of risk for cerebral edema.
 Body weight, serum electrolyte and urine volume are closely monitored.
 Arterial pressure is monitored to assess cardiac or respiratory failure and risk
of shock.
 Oxygen may be needed to maintain arterial pressure of oxygen.
 Assess patient’s neurologic status
 Constantly monitor vital sign.

46. ADMINISTER I/V FLUIDS
 Antibiotics should be started
immediately.
 Corticosteroids should be used in
sickness.
 Drug therapy continued after acute
phase of illness is over.
 Record input/output carefully and
observe for signs of dehydration.

47. MONITOR VITAL SIGNS AND NEUROLOGICAL STATUS
 Level of consciousness is assessed using Glasgow coma scale (GCS)
 Monitor rectal temperature every 4 hourly.

48. PROVIDE BASIC PATIENT
CARE
 The patient level of
consciousness will indicate
whether patient requires only
assistance with activities of
daily living.
 Maintain dim light to prevent
photophobic discomfort.

49. PREVENTION
 Close relatives of patient should be observed for fever and other sign
and symptoms of meningitis. They are provided antimicrobial
medication. E.g. Rifamipicin
 Vaccines are available which are given to the contact groups specially
to the travelers, medical professionals, military persons etc

51. NURSING DIAGNOSIS
ASSESSMENT
 Neurologic status. Neurologic status and vital signs are continually
assessed.
 Pulse oximetry and arterial blood gas values. These values are used to
quickly identify the need for respiratory support.

52. 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

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

54. 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.

55. 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.

56. 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
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

57. 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

58. EVALUATION
Expected patient outcomes include:
 Avoidance of injury.
 Avoidance of infection.
 Restoration of normal cognitive functions.
 Prevention of complications.

59. DISCHARGE AND HOME CARE
GUIDELINES
After hospitalization, the patient at home should:
 Activities. Alternate rest and activity to conserve energy.
 Diet. Consume safe, clean, and healthy foods.
 Asepsis. Promote simple infection control procedures at home.
 Infectious process. Identify signs and symptoms of an infectious process and
report to the physician promptly.

62. RECAPULIZATION

63. ASSISGNMENT

64. BIBLIOGRAPHY
• Chintamani; Lewis’s A text book of Medical Surgical Nursing; Edition- Seventh; Published by: Elsevier; Page no.- 674- 681.
• Brunner & Suddarth, ‟textbook of Medical-Surgical Nursing”, Published by Janice L. Hinkle and Kerry H. Cleever, 13th Edition, Volume
2; Page no.-1164-1169.
• Basavanthappa Bt ; Medical Surgical Nursing; Edition-2009 ; Published by: CBS brothers; Page no.- 463-454.
• Javed Ansari, Davinder Kaur, a test book of Medical Surgical Nursing-II second edition, pee vee publisher. Page no.- 339-343.
• https://nurseslabs.com/meningitis/
• https://www.thoughtco.com/brain-anatomy-meninges-4018883
• https://www.msdmanuals.com/en-in/home/brain,-spinal-cord,-and-nerve-disorders/meningitis/viral-meningitis
• https://www.cdc.gov/meningitis/fungal.html
• https://www.slideshare.net/ManojPrabhakar61/tb-meningitis-81523602
• https://www.slideshare.net/Maheshkumar1029/meningitis-71600507
• https://www.slideshare.net/MigronRubin/meningitis-203932138