Meningitis Flashcards
What is meningitis?
Inflammation of the membranes and the fluid space surrounding the brain and spinal cord
What are different types of meningitis?
Bacterial (septic) meningitis
* Neisseria meningitidis** [most common]**
* Haemophilus influenzae
* Streptococcus pneumoniae)
Viral (aseptic) Meningitis owing to viral infection, lymphoma, leukemia, neurosurgical procedures, or brain abscess
What is the most common cause of bacterial meningitis?
Neisseria meningitidis
What is the triad of symptoms associated with meningitis?
Fever
Headache
Nuchal Rigidity
* Kernig’s Sign
* Brudzinski’s Sign
Aside from the triad of symptoms characteristic of meningitis (fever, headache, nuchal regidity), what are other symptoms?
Photophobia
Phonophobia
Lethargy
Generally, how is meningitis diagnosed?
Cerebrospinal Fluid (CSF) Analysis via Lumbar Puncture
What are characteristics of bacterial meningitis?
- Acute inflammation of meningeal tissue
- A medical emergency.
- Organisms enter CNS from respiratory tract or bloodstream.
- Increased CSF production
- Purulent secretions spread to other areas of brain through CSF.
What are clinical manifestations of bacterial meningitis?
Fever
Severe headache
Nausea, vomiting
Nuchal rigidity
- Positive Kernig’s sign
- Positive Brudzinski’s sign
Photophobia
↓ LOC
Signs of ↑ ICP*
Coma
Seizures*
What are complications of bacterial meningitis?
Acute complication is ↑ ICP.
Major cause of unconsciousness
Residual neurological dysfunction*
Optic nerve is compressed by increased ICP.
Hemiparesis, dysphagia, and hemianopsia
Acute cerebral edema
Noncommunicating hydrocephalus
Waterhouse-Friderichsen syndrome
How is bacterial meningitis diagnosed?
Blood culture
Lumbar puncture and analysis of CSF - Gram-stained smear to detect bacteria
X-rays of skull
CT scan
MRI
What is involved in the collaborative care of a client with bacterial meningitis?
- Rapid diagnosis based on history and physical exam
- Antibiotic therapy instituted after collection of specimens
- Collaborate to manage the headache, fever, and nuchal rigidity
What are characteristics of viral meningitis?
- Most common causes are enterovirus, arbovirus, HIV, and HSV.
- Usually presents as headache, fever, photophobia, and stiff neck
- Diagnostic testing of CSF
- Lymphocytosis
- No organisms from Gram-stained or acid-fast smears
- PCR to detect viral-specific DNA/RNA
- Symptomatic management with full recovery expected
What is involved in nursing management of meningitis?
Frequent or continual assessment
Protect patient from injury (seizure precautions)
Fluid Balance
- Daily weight, serum electrolytes, urine volume, specific gravity, and osmolality
Mobility
- Prevent complications associated with immobility
Infection control
Supportive care
Psychosocial
- Implement measures to facilitate coping of the patient and family
What is a common way that bacterial meningitis is spread?
Can spread in community living situations (such as students in dorms)
What is the difference in cerebrospinal fluid between bacterial and viral meningitis?
CSF is cloudy in bacterial, clear in viral
When is bacterial meningitis most prevalent in terms of seasons?
Winter and early spring
What are some signs for the nurse to watch for in terms of elevated ICP?
- changed level of consciousness
- vision changes
- BP (increases)
- pupillary response
- headache
What is the best way to prevent meningitis?
- Vaccination
- Antiobiotics prophylactically with exposure
What level of white blood cell count in 1 uL of CSF usually means meningitis?
> 5
What happens to pressure, glucose and proteins in the CSF with meningitis?
- Pressure increases
- Glucose concentration decreases
- Protein levels increase
What factors can increase the risk for bacterial meningitis?
- tobacco use
- otitis media
- mastoiditis
- immune system deficiencies
What causative agents lead to acute meningitis?
bacterial and viral meningitis
What causative agent causes chronic meningitis?
fungi
Which bacteria can cause bacterial meningitis?
- Group B streptococci
- E. coli
- listeria monocytogenes
- neisseria meningitidis
- streptococcus pneumoniae
- Tick borne: borrelia burgdorferi
Which viruses can cause viral meningitis?
More common:
enterovirus
arbovirus
herpes simplex
HIV
Less common:
mumps
varicella zoster
lymphocytic choriomeningitis
What treatment is common for bacterial meningitis?
Steroids, then antibiotics. Steroids are to address inflammation and prevent injury to the leptomeninges.
What can be done to prevent outbreaks of bacterial meningitis?
prophylactic antibiotics
(vaccination may be appropriate as well depending on age group)
What type of precaution is put in place for suspected or confirmed meningitis?
Droplet precautions
Also, seizure precautions
