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

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

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.

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

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, 2004. Died within 48 hours. www.shots4meningitis.com/about.htm

*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 cases Seizures, decreased mental status Signs of increased intracranial pressure (IICP)

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

Nursing Care: 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 Seizure precautions 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 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