MENINGITIS Flashcards
inflammation of the leptomeninges
Meningitis
Protective covering of the brain and spinal cord
Meninges
Outer most layer
Dura mater
Tough, thick, inelastic, and fibrous
Dura mater
Contains epidural and subdural space
Dura mater
Space in between the dura and the skull
Epidural
Space below the dura
Subdural space
Thin, delicate middle membrane
Arachnoid mater
Innermost, thin, transparent membrane that hugs the brain closely and extends into every fold of the brain’s surface
Pia mater
Combination of Arachnoid and Pia mater
Leptomeninges
Etiology of Meningitis
-Bacterial
- Viral
- Fungal
A type of meningitis that is caused by bacteria
Septic Meningitis
Causative agent of Septic Meningitis
-Streptococcus pneumoniae
-Neisseria meningitis
A type of meningitis that is caused by a virus or cancer/weakened immune system
Aseptic Meningitis
Enterovirus most commonly causes aseptic type
Aseptic Meningitis
Manifestations of Septic Meningitis
(+) signs/symptoms of meningeal irritation
(+) CSF culture for bacteria
Classic Triad of Meningitis
-Fever
-Headache
-Nuchal Rigidity
sign of meningeal irritation
Nuchal Rigidity
Other manifestations of Meningitis
-Nausea
-Vomiting
-Photalgia
-Sleepiness
-Confusion
-Irritability
- Delirium
-Coma
-Only 44% of adults manifest the classic triad
-25% has acute presentation (within 24 hours of onset of symptoms)
-Seizures occur late in the course of illness
Bacterial Meningitis
-(+) history of preceding systemic symptoms (e.g., myalgias, fatigue, anorexia)
-If caused by mumps virus, (+) classic triad following onset of parotitis
Viral Meningitis
(+) lethargy
(-) signs of meningeal irritation
Atypical Meningitis
Signs of Meningeal Irritation
- Kernig Sign
- Brudzinski Sign
Elicits pain or limited extension
Kernig Sign
Elicits hip and knee flexion
Brudzinski Sign
Kernig Sign
- Knee is flexed to 90 degrees
- Hip is flexed to 90 degrees
- Extension of the knee is painful or limited in extension
Brudzinski Sign
- Passive flexion of neck
Traditionally used to evaluate patients with suspected meningitis and determines need for lumbar puncture
Kernig Sign and Brudzinski Sign
Diagnostics for Meningitis
Lumbar Puncture (Spinal Tap)
Carried out by inserting a needle into the lumbar subarachnoid space to withdraw CSF.
Lumbar Puncture (Spinal Tap)
What needle must be used in the Lumbar Puncture?
Uses spinal needle
Where the spinal needle is inserted?
It is inserted into the subarachnoid space
Location for the needle to be inserted
Needle is inserted between L3 and L4 or L4 and L5
Why the small pillow must be placed under the patient’s head?
A small pillow may be placed under the patient’s head to maintain the spine in a horizontal position; a pillow may be placed between the legs to prevent the upper leg from rolling forward.
What kind of anesthetic is used in Lumbar Puncture?
Local Anesthetic Agent
How many test tube is collected when removing a specimen of cerebrospinal fluid?
Collected in three test tubes
Post-Procedure Position of Lumbar Puncture
Lie prone position
The risk of Postprocedure in Lumbar Puncture is headache. What is the best nursing intervention to perform?
Encourage the patient to increased fluid intake to reduce the risk of postprocedure headache.
-Caused by Neisseria Meningitidis
Meningococcemia
(+) non-blanching petechiae and cutaneous hemorrhages are commonly seen
Meningococcemia
What is the mode of transmission of Meningococcemia?
Droplet spread and lengthy direct contact
Mortality rate of Meningococcemia
10 to 15 out of 100
Complication of fulminant meningococcemia
Waterhouse- Friedrichsen Syndrome
Characterized by large petechial/bullous in skin and mucous membranes, DIC, septic shock
Waterhouse-Friedrichsen Syndrome
Meningococcal Conjugated Vaccine
-A preventive management for Meningitis
-Given to youth at 11 to 12 years of age
-Booster dose at 16 years of age
-Available brands: Menactra, Nimenrix
For close contacts:
Meningococcemia Chemoprophylaxis
-Rifampicin
-Ciprofloxacin
- Ceftriaxone
-Started within 24 hours after exposure
Medical Management
-Antibiotic Therapy
-Penicillin + Ceftriaxone given intravenously
-Optimally given with 30 minutes of hospital arrival
-Dexamethasone
Improves the outcomes in adults and does not increase the risk of gastrointestinal bleeding
Dexamethasone
Nursing Care for Patients With Meningitis
- Institute infection control precautions until 24 hours after initiation of antibiotic therapy (oral and nasal discharge is considered infectious)
- Assist with pain management due to overall body aches and neck pain
- Assist with getting rest in a quiet, darkened room
- Implement interventions to treat the elevated temperature, such as antipyretic agents and cooling blankets
- Encourage the patient to stay hydrated orally or facilitate IV hydration peripherally
- Ensure close neurologic monitoring
