Meningitis

Key Points Meningitis (spinal meningitis) is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord (the meninges), caused by an infection of the fluid surrounding the brain and spinal cord. Viral, or aseptic, meningitis is the most common form of meningitis and commonly self-limited. Bacterial, or septic, meningitis is a contagious infection with a high mortality rate. A meningitis vaccine is available for high-risk populations.

Risk Factors For Viral Meningitis: For Bacterial Meningitis: Viral illnesses (mumps, measles, and herpes) For Bacterial Meningitis: Bacterial infections (Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae), such as upper respiratory infections (otitis media, pneumonia, sinusitis), GE, osteomyelitis Immunosuppression Invasive procedures (skull fracture ) Overcrowded living conditions

Diagnostic Procedures and Nursing Interventions CSF analysis is the most definitive diagnostic procedure. LP: empty bladder, fetal position , clean the skin, and local anesthetic is injected. Instruct the client to report any shooting pain or tingling Pressure readings are taken, followed by the collection of three to five test tubes of CSF. After the procedure, apply sterile dressing with pressure. Appropriately label specimens and deliver them to the laboratory.

Diagnostic Procedures and Nursing Interventions The client should remain in bed for 4 to 8 hr in a flat position to prevent leakage and a resulting spinal headache. Monitor the site for hematoma or infection. Results indicative of meningitis: Appearance of CSF: Cloudy (bacterial) or clear (viral) Elevated WBC Elevated protein (40-60 mg/dl) Decreased glucose (bacterial) (normal: 60% of blood glucose) Elevated CSF pressure Perform blood C&S to identify an appropriate broad- spectrum AB CT /MRI may to identify increased ICP and/or an abscess.

Assessment Terrible, pounding headache Fever and chills Photophobia N&V Altered LOC Nuchal rigidity Positive Kernig’s sign (resistance to extension of the client’s leg from a flexed position) Positive Brudzinski’s sign (flexion of extremities occurring with deliberate flexion of the client’s neck) Tachycardia Seizures Red macular rash (meningococcal meningitis)

Frequently assess/monitor Airway, breathing, and circulation. VS (Monitor for signs of shock). Neurological checks. Cranial nerve function. Intake and output. Signs of increased intracranial pressure (change in level of consciousness, widening of pulse pressure, pupil changes).

NANDA Nursing Diagnoses Ineffective airway clearance Impaired spontaneous ventilation Risk for injury Acute confusion Deficient fluid volume Ineffective thermoregulation

Nursing Interventions Maintain isolation precautions per hospital policy. Manage fever. Report meningococcal infections to the public health department. Decrease environmental stimuli (calm, minimize bright light). Maintain bed rest with the head of the bed elevated to 30°. Maintain client safety, such as seizure precautions.

Nursing Interventions Administer medications as prescribed. Antibiotics (bacterial infections) – such as ceftriaxone (Rocephin) or cefotaxime (Claforan) until C&S results are available Anticonvulsants – phenytoin (Dilantin) Antipyretics – acetaminophen (Tylenol) Analgesics – non-opioid to avoid masking changes in the level of consciousness Fluid and electrolyte replacement as indicated by laboratory values Prophylactic antibiotics to individuals in close contact with the client

Complications and Nursing Implications Increased ICP (possibly to the point of brain herniation) Monitor for signs of increasing ICP Provide interventions to reduce ICP, such as positioning and avoidance of coughing and straining. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Monitor for S&Sx (dilute blood, concentrated urine). Provide interventions, such as the administration of demeclocycline (Declomycin) and restriction of fluid. Septic Emboli (leading to DIC or CVA) Monitor circulatory status. Monitor coagulation.