DEFINITION:
Meningitis is an inflammation
of the meninges. The meninges
are three membranes that cover
the brain and spinal cord.
Meningitis can occur when
fluid surrounding the meninges
becomes infected.
CLASSIFICATION
1. SEPTIC MENINGITIS: Septic meningitis is caused by bacteria. The
most common type of bacteria that cause bacterial meningitis are:
Streptococcus pneumonia ( gram-positive) found in the respiratory
tract, sinus, and nasal cavity and can cause “ pneumococcal
meningitis”
Neisseria meningitidis (gram negative), which is spread through saliva
and other respiratory fluid and caused “ meningococcal meningitis”.
Haemophilus influenzae: Which can cause not only meningitis but
infection of blood, inflammation of the windpipe, cellulitis and
infectious arthritis
Listeria monocytogenes (gram –positive bacilli), which is a foodborne
bacteria
2. Aseptic meningitis:
The cause is viral or secondary lymphoma, leukemia, or human
immunodeficiency virus, HIV (fungal meningitis, cryptococcus
neoformans). Viruses in the enterovirus categories cause about 10-
15 millions infections per year, but only a small percentage of
people who get infected will develop meningitis.
Viral meningitis is self limiting and management is supportive.
Usually caused by nonpolioenterovirus (90%)
This organism spread by feco-anal route and through sewage.
Other viruses can cause meningitis. These includes: West Nile virus,
influenza, mumps, HIV, measles, herpes viruses.
PATHOPHYSIOLOGY
Due to etiological factors
Organisms colonizes in cerebrospinal fluid
Inflammation of the meninges
Inflammation of arteries that supply to meninges and subarachnoid
Hydrocephalus, rupture or thrombosis of old vessels
Increased intracranial pressure, cerebral edema
Appearance of various clinical manifestation
SIGN AND SYMPTOMS
1. Nuchal rigidity is the
inability to flex the
neck forward due to
rigidity of the neck
muscles: if flexion of
the neck is painful but
full range of motion is
present, nuchal
rigidity is absent.
COMPLICATION
These complications are typically associated with meningitis:
Bacterial meningitis --- Particularly in children, may result
in deafness, learning difficulties, or cranial nerve disorder.
Increased ICP: result in cerebral edema decreased perfusion
and tissue damage, AIDs patient resulted in severe visual loss
Seizures --- occur in majority of cases
Herniation or compression of brain stem: Results from
severe brain edema.
ASSESSMENT AND DIAGNOSTIC
FINDINGS
Thorough History and physical examination.
Neurological assessment (Reflexes, change in conscious
level) – to look for symptoms of meningitis.
Lumber puncture: CSF routine, culture and gram staining
CSF by lumber puncture shows: Cloudy purulent CSF, increase
neutrophils, high protein level and reduced glucose level
CT scan MRI: CT may show brain abscess or sinusitis.
X-ray Chest: Presence of pneumonia, tuberculosis or fungal
infections.
Complete blood count:
It checks the number of red and white blood cells in blood. White
blood cells fight infection. The count is usually elevated in
meningitis.
Blood culture identify bacteria in the blood. Bacteria can travel
from the blood to the brain. N meningitidis and S.pneumoniae can
cause both sepsis and meningitis.
Urine analysis: Body fluids that are easily obtainable are
preferred for this route of diagnosis and urine is the specimen of
choice as it can be obtained non-invasively.
PREVENTION
Vaccinations can also protect against certain types of meningitis.
Vaccines that can prevent meningitis include the following:
Haemophilus influenzae type B (Hib) Vaccine
Pneumococcal conjugate vaccine
Meningococcal vaccine
TREATMENT
Medical management
The treatment of infection with antimicrobial therapy.
Antibiotic penicillin, e.g. ampicillin penicillin
Dexamethasone or other corticosteriods
Antifungal agent
Phenytoin to treat seizures
B (fungizone), fluconazole is indicated for cryptococcal meningitis.
Analgesics
Antipyretics
Fluid management
Oxygen therapy
NURSING MANAGEMENT
Nursing diagnosis: Hyperthermia related to disease process as evidence
by increased body temperature, fever,chills.
Goal: Patient will maintain a body temperature within the normal range
for their age.
Intervention:
Assess and monitor the patient’s vital signs, especially the temperature
Provide a tepid sponge bath and other comfort measures.
Provide oral or intravenous fluids as ordered.
Administer medications as indicated.
Instruct on signs of hyperthermia.
Nursing diagnosis: ineffective tissue perfusion related
to cerebral edema as evidenced by hypercapnia.
Goal: to prevent the patient from developing complications
at the end of nursing care.
Intervention:
Assess LOC, vital signs and neurological parameters
closely
Observe signs and symptoms of increased ICP such
altered as LOC, dilated pupils, increasing pulse pressure.
Maintain quiet and calm environment.
Observe patient for any deterioration in health status such
as worsening LOC, seizure activity etc.
Nursing diagnosis: Risk for Increased Intracranial Pressure
Related to Inflammation of the meninges.
Goal : Patient will be alert, oriented, and calm without any
alterations in the level of consciousness
Intervention:
Monitor for any signs and symptoms of increased ICP
Monitor arterial blood gas (ABG) values.
Elevate the head of the bed 30° to 45° unless contraindicated
Provide safety in the event of a seizure.
Avoid activities that increase ICP.
Administer osmotic diuretics (Mannitol).
