meningitis
definition
Inflammation of the meninges , the
membranes covering the brain and the
spinal cord
Causes –bacteria , virus , fungi , parasite
Most common is bacterial meningitis
Classification
–septic caused by bacteria
-aseptic viral, secondary to cancer
or weakened immune system
Most common organisms –
meningiococci( neisseria meningitides)
Pneumococci ( streptococcus pneumoniae)
Haemophilus influenzae
Predisposing factors
Tobacco use
respiratory infection
Otitis media and mastoiditis
Immune system deficiencies
Open brain injury
Brain surgery
Systemic infections & illnesses
Anatomic defect of the skull
pathophysiology
Invasion of organisms through bloodstream or
direct spread or respiratory tract
Crosses BBB and Colonization of organisms in the
CSF
inflammation of meninges
inflammation of subarachnoid and pia mater
inflammation of arteries supplying subarachnoid
space
Increased ICP (As the cranium contains little
room for expansion)
brain stem herniation
Cranial nerve dysfunction and depresses the
centers of vital functions such as the
medulla
Inflammation of the meninges
exudate formation
Meninges become thickened & adhesions
forms
hydrocephalus
inflammation of arteries supplying
subarachnoid space
rupture or thrombosis
of these vessels
cerebral infraction
Classic manifestations
Clinical manifestations
classic manifestations include
1, nuchal rigidity
-stiff and painful neck
-flexion of the neck is
difficult
2, Brudzinski’s sign
flexion of the neck causing
bilateral flexion of the hips and knees
3, kernig’s sign
when the patient is lying with the
thigh flexed on the abdomen, the leg cannot
be completely extended
4, photophobia
extreme sensitivity to light
Headache - severe
Fever - high and through out the course
Tachycardia
Prostration (extreme weakness)
Chills
Nausea & Vomiting
Irritable at first-acutely ill,confused, coma
Seizure
Petechial / hemorrhagic rash ( neisseria
meningitidis)
Disorientation and memory impairment
Increased ICP - decreased LOC and focal
motor dysfunction
diagnosis
CTscan or MRI-to detect herniation prior to LP in
patients with suspected increased ICP
Lumbar puncture;--
CSF cloudy
elevated CSF pressure
’’ CSF protein level (nml=15-45mg/dl)
decreased CSF glucose level (nml=60-80’’)
Elevated WBC
Blood and CSF culture
X ray skull for infected sinuses
Tumbler test
complications
1. Increased ICP-hydrocephalus, brain swelling ,
herniation & fluid overload
2. Cranial nerve irritation
optic nerve (CNII) – papilledema and
blindness
oculomotor (CN III), trochlear (CN IV) and
abducens (CNVI) – ptosis and diplopia
Trigeminal (CN V)-loss of corneal reflex and
sensory loss
Facial nerve (CN VII)-facial paresis
Vestibulocochlear (CN VIII)-tinnitus,
vertigo ,deafness
1. Septic shock
2. Seizure
Waterhouse-friderichsen
syndrome
Manifested by petechiae, DIC, adrenal
hemorrhage and circulatory collapse
management
It is a medical emergency
Fatal within hrs to days
Bed rest
IV fluids
Antibiotics IV
pencillin G in combination with
one of the cephalosporins ( ceftriaxone
sodium or cefotaxime sodium ) within 30
mins of hospital arrival .
Codeine for headache
Corticosteroids
–dexamethasone
( 15-20 mins before the first dose of antibiotic
and every 6 hrs for the next 4 days)
Acetaminophen or aspirin for Temperature>100.4
degree
Phenytoin IV for seizure precaution
Mannitol for diuresis
Nursing management
Assessment
Instituting infection control precautions until
24 hrs after initiation of antibiotics ( oral
and nasal discharge is considered
infectious)
Pain and temperature management
(fever increases workload of the heart and
cerebral metabolism , ICP will increase in
response to increased cerebral metabolic
demand)
Provide Rest in quiet darkened room
( photophobia)
Encourage to stay hydrated
Close neurological monitoring
Pulse oximetry and ABG values are used to
identify the need for respiratory support
( increasing ICP may
compromise the brain stem.)
Intubation and Mechanical ventilation may
be necessary to maintain adequate tissue
oxygenation
Blood pressure monitoring
Protect from injury
Monitor daily wt, electrolytes ,urine volume
and specific gravity
Prevent complications associated with
immobility ( pressure ulcer and pneumonia)
Support the family
Nursing diagnoses
1,ineffective cerebral tissue perfusion r/t
cerebral edema
2,disturbed sensory perception r/t altered
cognitive function
3,acute pain r/t headache
4,hyperthermia r/t infection
Home care
Adequate nutrition – high protein high
calorie diet in small and frequent feedings
ROM exercise and warm bath
Gradual increase of activity
Adequate rest and sleep
prevention
Meningiococcal conjugated vaccine
–at 11-12 yrs of age , with a booster dose at 16 yrs
of age
People in close contact with Meningiococcal
meningitis should be treated with antimicrobial
chemoprophylaxis using Rifampin,ciprofloxacin
hydrochloride or ceftriaxone sodium.
For children and at-risk adults -Vaccination
against H.influenza and S.pneumoniae
