patient with meningitis

Question 1

meningitis

Answer 1

Meningitis is an acute inflammation of the three membranes surrounding the brain and spinal cord ( pia mater, arachnoid, dura mater ).
Also can affect the optic nerves.
Is caused by bacteria, viruses and other organisms that can reach the CNS by :
1. blood, cerebral spinal fluid (CSF), lymph
2. direct extension from adjacent cranial structures from penetrating
wounds, ICP monitoring, nasal, sinus, ear and mastoid bone infections , and
skull fractures ( basilar).
Bacterial meningitis is considered a medical emergency. Untreated mortality rate can be 100%

Question 2

pathophysiology of meningitis

Answer 2

Organism must overcome host defense mechanisms to invade and replicate in the CSF.
Infection of the CSF and meninges causes an inflammatory response in the membranes and CSF.
The infection spreads rapidly throughout the meninges and eventually invades the ventricles.
Pathological alterations include hyperemia of meningeal vessels, edema of brain tissue, increased ICP, and a generalized inflammatory reaction with exudation of WBCs into the subarachnoid space.
Hydrocephalus may be caused by exudate blocking small passageways between the ventricles.
Infection usually occurs in fall, winter, and early spring and can be secondary to a viral respiratory infection.

Question 3

pneumococcal meningitis

Answer 3

by streptococcus pneumoniae. Most common type in adults, especially if history of pneumonia, sinus infection and trauma.

Question 4

haemophilius influenzae meningitis

Answer 4

caused by haemophilus influenzae. Most common in children especially if history of upper respiratory infection or ear infection.

Question 5

meningococcal meningitis

Answer 5

neisseria meningitidis. Highest incidence in children and young adults. Common outbreaks in college dorms and in military barracks. May have a petechial rash. About 10% develop overwhelming septicemia. Is highly contagious and has a high mortality rate if not treated immediately.

Question 6

risk factors for meningitis

Answer 6

Head trauma like the basilar fracture
Otitis media
Sinusitis
Systemic sepsis
Neurosurgery
Immunocompromised individuals

Question 7

manifestations of bacterial meningitis

Answer 7

Onset usually sudden with fever, severe headache, chills. Older adult may not have fever but exhibit confusion.
Restless, agitation, irritability, tachycardia.
Signs of meningeal irritation such as nuchal rigidity, Kernig’s sign and Brudzinski’s sign.
Altered LOC, confusion, photophobia, diplopia, vomiting, nausea, seizures in 1/3 of cases.
Petechial rash in meningococcal meningitis.
Coma is associated with a poor prognosis and occurs in 5-10% of cases.

Question 8

complications of meningitis

Answer 8

Increased ICP, altered mental status, residual neurological dysfunction.
Cranial nerve dysfunction especially #8 with deafness.
Hemiparesis, dysphagia, hemianopsia may occur. May resolve over time. If not, cerebral abscess, subdural empyema, subdural effusion or persistent meningitis suspected.
Acute cerebral edema can cause seizures, occulomotor 3 palsy, bradycardia, hypertensive coma and death.
Hydrocephalus
Friderichsen syndrome (meningococcal) with petechiae, DIC, hemorrhage and circulatory collapse.
Arthritis, thrombophlebitis may develop in cerebral vessels with infarction.

Question 9

diagnostics for meningitis

Answer 9

History and physical
Lumbar puncture for CSF
CBC, coagulation studies, electrolytes, blood culture
Counterimmunoelectrophoresis to determine presence of viruses/protozoa\
MRI, CT scan, PET scan

Question 10

collaborative care and treatment for meningitis

Answer 10

Immediate IV administration of antibiotics that cross the blood-brain barrier
Corticosteroids prior to first dose of antibiotic. New research shows that killing bacteria may release toxic by-products that accelerate the inflammatory reaction and possible death.
Strict respiratory isolation especially for meningococcal which is highly contagious. Recommended that patient remain on isolation for 24 hours after start of antibiotic.
Medications for headache, fever. Anticonvulsants if seizure activity.
Clear liquids as desired or tolerated. May need IV fluids
Mannitol to decrease ICP.

Question 11

nursing care for meningitis

Answer 11

Continual assessment of vs, neuro signs, ICP, neurological deficits, complications
Care of delirious patient, Give prn meds for anxiety, agitation to decrease fear and anxiety. Administer antibiotics and other meds as ordered.
Low stimulation environment for disoriented patient. Dark room for photophobia. Maintain bedrest at first.
Approach patient slowly and from the front to avoid stimulating and frightening the patient.

Question 12

ambulatory and home care for meningitis

Answer 12

Patient requires several weeks of convalescence before normal activities can be resumed.
Adequate nutrition—high protein, high calorie diet in small more frequent feedings.
Muscle rigidity may persist in neck and back of legs. Will need progressive ROJM. Warm baths may help. May need rehab for residual neurological deficits.
Activity is gradually increased as tolerated. Will need a good balance between rest and activity.