Meningitis

Jerr

y Ca

rley

M

SN, R

N, C

NE

Uni

vers

ity o

f Sou

ther

n N

evad

aAd

ult H

ealth

IISu

mm

er 2

010

NURSE

Adult Health IINeurological Diseases

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

Click icon to add picture 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.

Click icon to add picture 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

Click icon to add picture 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

Click icon to add picture

*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)

Click icon to add picture 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

Click icon to add picture Nursing Care:1. Monitor Neurologic Status

(“Neuro Checks”) **Particular attention to

cranial nerves, especially CN III, IV, VI,& VIII

2. Observing for signs & symptoms of Increased intracranial pressure

3. 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