Meningitis

Jerr

y Ca

rley

MSN

, RN

, CN

EU

nive

rsity

of S

outh

ern

Nev

ada

Adul

t Hea

lth II

Sprin

g, 2

009

NURSE

Defined:…an inflammation of the arachnoid and pia mater of the brain and spinal cord and cerbrospinal fluid (CSF).

Three Major Categories: I.ViralII.FungalIII.Bacterial

I. Viral Meningitis A. The most commonly

encountered form of meningitis.

B. Sequela to viral illnesses such as measles, mumps, herpes simplex, herpes zoster.

C. Fever, photophobia, headache, myalgias, nausea.

D. Treatment is symptomatic.

II. Fungal Meningitis A. Typically seen in

immunosuppressed individuals, usually HIV

B. Cryptococcus neoformans is the usual culprit.

C. Clinical presentation varies, depending upon how intact the individual’s immune system is. Headache, nausea, decreased mental status.

D. Treatment: Symptomatic; IV antifungals.

Cryptococcus neoformans

III. Bacterial MeningitisA. MEDICAL EMERGENCYMORTALITY RATE ~ 25%USA Cases: ~ 17,500 / year

B. Strep. pneumoniae Neisseria meningitidis

C. Meningococcal meningitis occurs in outbreaks: areas of high population density.

D. Meningococcal vaccine (Menomune)

Becky Werner: Developed flu-like illnessIn February, 2004. Died within 48 hours.

www.shots4meningitis.com/about.htm

*With Symptoms of Meningitis, always assume the worst, and treat for meningococcal meningitis immediately.

*If you wait for the culture results, and they show / grow meningococcal meningitis or other bacterial meningitis, it is already too late!

Physical Assessment:Signs of meningeal Irritation / Inflammation: headache, nausea, vomiting, fever. Photophobia.

Nuchal rigidity.+ Kernig’s, + Brudzinski’s signs (~ 10%) of casesSeizures, decreased mental status

Signs of increased intracranial pressure (IICP)

Laboratory / Diagnostics:1. Lumbar Puncture:-CSF for gross appearance, WBC’s, Glucose, pressure-Gram stain-Culture & Sensitivity2. CBC with Diff3. Blood cultures4. CT or MRI

Nursing Care:1.Monitor Neurologic Status (“Neuro Checks”) **Particular attention to cranial nerves, especially CN III, IV, VI,& VIII2. Observing for signs & symptoms of Increased intracranial pressure3.Seizure precautions4.Septic shock & DIC

Medications:Broad-spectrum antibiotic, changed to appropriate one after gram-stain and C&S.Others symptomatic

Patient Care, Client with Meningitis-Vital signs at least q2-4 hours.-Neuro checks, particularly Cranial Nerves, especially CH III, IV, VI, VII, & VIII-Pain management-I&O-Decrease environmental stimuli-Bedrest, HOB elevated 30*-Isolation precautions-Prevent Complications: IICP Vascular dysfunction F & E Imbalance Seizures Shock

Incidence of meningococcal meningitis

3 cases per 100,000 people annually

46 cases per 100,00 people annually

500 cases per 100,000 people annuallyIncidence ofMeningococcalMeningitis