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NURS 640 > Neuro chapter 11 Meningitis > Flashcards

Neuro chapter 11 Meningitis Flashcards

1
Q

Description

A

inflammation of brain and spinal cord meninges, from bacteria, viruses, or fungi
- occassionally, parasites, or disorders such as SLE or Kawasaki disease are responsible

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2
Q

Etiology

Bacterial Meningitis

A
  • Group B or D streptococcus
  • E. Coli
  • Staphylococcus species
  • Streptococcus pneumoniae (most common in adults, children and adolescents)
  • Haemophilus influenzae (incidence greatly diminished with advent of Hib vaccine)
  • Listeria monocytogenes (unpasteurized dairy or deli meats)
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3
Q

Etiology

Viral Meningitis

A
  • Enterovirus is the most common cause; includes Coxsackie A and B, polioviruses, echoviruses
  • herpes simplex virus
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4
Q

Etiology

Fungal Meningitis

A
  • Candida species
  • Aspergillus
  • Cryptococcus neoformans
  • histoplasmosis
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5
Q

Parasitic meningitis

A
  • Angiostrongylus cantonensis

- Amoebic meningitis (freshwater swimming)

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6
Q

Noninfectious meningitis

A
  • cancers
  • SLE
  • secondary to medications
  • brain surgery
  • head injury
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7
Q

3 most common bacterial causes

A

Neisseria meningitidis
streptococcus pneumoniae
haemophilus influenzae

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8
Q

Bacterial Meningococcal meningitis is highly contagious:

A
  • 2,600 cases/year
  • high-risk groups: infants younger than 1 year, immunocompromised patients, travelers to endemic areas, college students in dorms.
  • 10-15% of cases are fatal.
  • 10-15% of infections cause brain damage or other serious side effects.
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9
Q

Viral Incidence

A
  • affects all ages
  • infants and immunocompromised at higher risk of serious disease
  • 10,000 cases annually.
  • common in summer and early fall.
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10
Q

Fungal incidence

A
  • Cryptococcal meningitis is most common in immunocompromised adults, especially in those with AIDS
  • candida species most common in premature infants and other immunocompromised adults
  • NOT CONTAGIOUS
  • rare
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11
Q

Parasitic incidence

A

Naegleria fowleri - most common in southern US. freshwater lakes/rivers, poorly maintained swimming pools, hot springs, soil

  • parasite enters through nose or via nasal rinses
  • Almost all are fatal, even with treatment
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12
Q

Meningitis

Risk Factors

A
  • young children
  • young adults
  • crowded living conditions
  • college and military dormitories
  • coexisting viral infections
  • immunocompromised (asplenia, diabetes, HIV)
  • active or passive smoking
  • close contact with patient with meningitis
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13
Q

Bacterial Assessment findings

A
  • recent URI
  • becomes ill quickly
  • pyrexia
  • nausea / vomiting
  • irritable / unsettled mood
  • ill appearance
  • poor appetite / poor feeding
  • fatigue
  • Nuchal rigidity
  • headache
  • myalgia or arthalgia
  • respiratory symptoms, dyspnea
  • decreased LOC, seizures
  • meningococcal septicemia rash
  • bulging or full fontanel
  • positive Kernig and Brudzinski signs
  • paresis
  • neurological deficits
  • shock symptoms
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14
Q

Kernig sign

A

Complete extension of leg causes neck pain and flexion.

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15
Q

Brudzinski sign

A

flexion of hips and knees if neck is passively flexed.

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16
Q

Viral assessment findings

A
  • incubation period is +/- 3 weeks
  • headache
  • malaise
  • fever
  • stiff neck
  • photophobia
  • rash
  • seizures
  • illness lasts 2-6 days
17
Q

Fungal assessment findings

A
  • worsening headaches over a period of days

- vomiting for days or weeks

18
Q

Parasitic assessment findings

A
  • same as bacterial
19
Q

Noninfectious assessment findings

A
  • same as bacterial plus symptoms from causative factors
20
Q

Meningitis

Differential Diagnosis

A
  • bacterial vs viral vs fungal vs tuberculous meningitis
  • meningitis caused by other infectious agents (syphilis, amoeba)
  • seizure disorder
  • encephalopathy
  • brain abscess
    VIRAL MENINGITIS IS RARE IN OLDER ADULTS. STRONGLY CONSIDER OTHER DIFFERENTIAL IN THIS POPULATION.
21
Q

Diagnostic tests

Lumbar puncture: CSF will show…

A
  • may be turbid, protein levels elevated, CSF pressure elevated.
22
Q

If bacterial, CSF will show…

A

decreased glucose

23
Q

CSF Ziehl-Nielsen staining for acid-fast bacilli will to rule out…

A

tuberculous meningitis

24
Q

CBC will show

A

elevated WBC

25
Q

CMP will show

A

electrolyte imbalance

26
Q

Blood cultures will be positive in…

A

80% of bacterial meningitis patients

27
Q

Meningitis

Prevention

A
  • strict aseptic technique during neurosurgical dressing changes
  • treat URI infections promptly
  • meningococcal immunization as part of routine immunizations
  • Hib immunizations according to schedule
  • pneumococcal and influenza vaccines
  • avoid contact with known causes if possible
28
Q

Meningitis

Nonpharmacologic management

A
  • vigorous supportive care
  • measures to prevent dehydration
  • good handwashing
  • isolation procedures may be warranted
  • minimize external stimulation, specifically light
  • anticipatory guidance for family
  • frequent neurological examinations
29
Q

Meningitis

Pharmacologic management

A
  • antibiotics specific for culture result
  • high-dose anti-fungals for fungal meningitis
  • antibiotics urgently; if cultures prove viral, d/c
  • Dexamethasone: may decrease M&M
  • O2 therapy
  • treat shock if present
  • antipyretics
  • analgesics for headache
  • antiemetics
  • anticonvulsants as needed
  • sedatives for restlessness
  • antiviral agents not recommended
  • noninfectious causes require treating underlying disease
  • DEPENDING ON ETIOLOGY, PROPHYLAXIS FOR CONTACTS
30
Q

Meningitis

Consultation / Referral

A
  • refer to ED / neurologist immediately

- refer to ID

31
Q

Meningitis

Follow-up

A
  • depends on severity
32
Q

Meningitis
Expected Course
Bacterial

A
  • fatality rate 14%
  • afebrile in 7-10 days
  • headache and other symptoms persist intermittently for 2 weeks.
  • prognosis dependent on timing of antibiotic initiation
33
Q

Meningitis
Expected Course
Viral

A
  • recovery in 4-10 days
  • headache and other symptoms may persist intermittently for 2 weeks
  • in most cases, not fatal.
34
Q

Meningitis
Expected Course
Fungal

A
  • poor prognosis usually related to overall health of patient.
35
Q

Meningitis
Expected course
parasitic

A
  • high mortality rate
36
Q

Meningitis
Expected course
noninfectious causes

A
  • dependent on cause
37
Q

Meningitis
Possible Complications
Epilepsy and seizures common in….

A
  • common in bacterial

- but rare in viral

38
Q

Possible complications

A
  • septic shock
  • bacteremia, resulting in gangrene
  • cerebral edema
  • problems with concentration and memory
  • sensorineural hearing loss
  • irritability
  • hydrocephaly
  • renal impairment
  • bone and joint problems
  • stroke
  • motor disability
  • cognitive dysfunction
  • behavioral disorders.

NURS 640 (12 decks)

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