1. Neurological Diseases
NURSE
Jerry Carley MSN, RN, CNE
University of Southern Nevada
Adult Health II
Summer 2010
Meningitis
Adult Health II
Neurological Diseases

2. Defined:
…an inflammation of the arachnoid and pia mater of the brain and spinal cord and cerbrospinal fluid (CSF).
Three Major Categories:
Viral
Fungal
Bacterial

3. 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.

4. 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

5. Bacterial Meningitis A. MEDICAL EMERGENCY MORTALITY RATE ~ 25%
USA Cases: ~ 17,500 / year
Strep. pneumoniae
Neisseria meningitidis
Meningococcal meningitis occurs in outbreaks: areas of high population density.
Meningococcal vaccine (Menomune)
Becky Werner: Developed flu-like illness
In February, Died within 48 hours.

7. *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!

8. Physical Assessment:
Signs of meningeal Irritation / Inflammation: headache, nausea, vomiting, fever. Photophobia.
Nuchal rigidity.
+ Kernig’s, + Brudzinski’s signs (~ 10%) of cases
Seizures, decreased mental status
Signs of increased intracranial pressure (IICP)

9. Laboratory / Diagnostics:
1. Lumbar Puncture:
-CSF for gross appearance, WBC’s, Glucose, pressure
-Gram stain
-Culture & Sensitivity
2. CBC with Diff
3. Blood cultures
4. CT or MRI

10. Nursing Care:
Monitor Neurologic Status (“Neuro Checks”)
**Particular attention to cranial nerves, especially CN III, IV, VI,& VIII
Observing for signs & symptoms of Increased intracranial pressure
Seizure precautions
Septic shock & DIC
Medications:
Broad-spectrum antibiotic, changed to appropriate one after gram-stain and C&S.
Others symptomatic

11. 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

12. Incidence of Meningococcal Meningitis
500 cases per 100,000 people annually
46 cases per 100,00 people annually
3 cases per 100,000 people annually
Incidence of meningococcal meningitis