MENINGITIS

WRITTEN BY ;LITIA WAMUNYIMA

 INTRODUCTION
• There are three membrane that cover and protect the
brain and the spinal cord these are ; Dura ,arachnoid
and pia matter.
• These membranes are called meninges.
• These membrane they can be inflamed due to
infection or trauma (head injuries and spinal injury)
• The inflammation of meninges is called Meningitis
 DEFINATION
MENINGITIS is the inflammation of the
meninges, which cover and protect the brain and
spinal cord caused by either bacteria, virus or
fungal characterized by positive Kernig’s sign
(inability to extend the leg when the thigh is flexed
on the abdomen) and a positive Brudzinski’s sign
(flexion of the neck produces flexion of the knees
and hips) (Litia, 2022).
 CAUSES
• Meningitis is caused by either the Bacteria,Virus or
Fungal.
• Bacterial and viral organisms are most often
responsible for meningitis.
• The following are the cause;
Bacteria
Streptococcus pneumoniae and Neisseria
meningitidis are the leading causes of bacterial
meningitis.
Haemophilus influenzae was once the most common
cause of bacterial meningitis.However, the use of H.
influenzae vaccine has resulted in a significant
decrease in meningitis from this organism.
Virus
The most common causes of viral meningitis are
enteroviruses,arboviruses, human
immunodeficiency virus, and herpes simplex virus
(HSV).
Fungal
Cryptococcus neoformans
 RISK FACTORS FOR MENINGITIS
Penetrating trauma on the brain or spine,
Surgical procedures on the brain or spine
Ruptured brain abscess.
The patient with an infection in the head (i.e., eye,
ear, nose,mouth) or neck has an increased risk for
meningitis because of the proximity of anatomic
structures. These infection are otitis media, acute or
chronic sinusitis, and tooth abscess
Low immunity as in HIV/AID
TRANSMISSION OF MENINGITIS
• The mode of transmission for meningitis are;
Via bloodstream
Airborne droplets or contact with oral secretions
from infected individual
Direct contamination as in penetrating skull fracture
or wound
 CLASSIFICATION/TYPES OF
MENINGITIS
• The classification of meningitis is according to the
causative organism.
• The following are the classification of meningitis:
i. Bacterial (Septic or Pyogenic) meningitis
• Bacterial meningitis is also called Septic meningitis.
• Septic meningitis is a any meningitis caused by
bacteria
• The most frequently involved organisms responsible
for bacterial meningococcal meningitis are
Streptococcus pneumoniae and Neisseria
meningitidis.
The meningitis that is caused by Streptococcus
pneumoniae is called pneumococcal meningitis
The meningitis that is caused by Neisseria
meningitides is called Meningococcal meningitis
• Meningococcal meningitis is a medical emergency
with a fairly high mortality rate, often within 24
hours.
• Unlike other types, this disorder is highly contagious.
• Outbreaks of meningococcal meningitis are most
likely to occur in areas of high population density,
such as college dormitories, military barracks,
and crowded living areas
• Other causes of bacterial meningitis are ;
Mycobacterium tubacle
Pseudomonas
Proteus
Pseudomonas
Klebsiella
ii. Viral(Aseptic) Meningitis
• Viral meningitis is also called Aseptic meningitis.
• Aseptic meningitis is a any meningitis caused by virus
• Its aseptic because no organisms are typically isolated
from culture of the CSF.
• This type of meningitis is self limit and doe not require
extensive treatment
• Common viral organisms causing meningitis are
enterovirus, herpes simplex virus–2 (HSV-2),
varicella zoster virus, mumps virus, and the
humanimmune deficiency virus (HIV).
• Treatment may include the administration of
antiviral agents.
iii. Fungal Meningitis
• The meningitis caused by fungal is called fungal
meningitis.
• The most common cause of fungal meningitis is
Cryptococcus neoformans.
• The meningitis caused by Cryptococcus
neoformans is called Cryptococcal meningitis
Cryptococcal meningitis is the most common fungal
infection of the central nervous system in patients
with AIDS due to low immunity
• Fulminant invasive fungal sinusitis is also a
recognized cause of fungal meningitis.
• Treatment for Fungal meningitis is symptomatic and
includes IV antifungal agents.
PATHOPHYSILOGY OF MENINGITIS
• The organisms usually gain entry to the CNS through the
upper respiratory tract or bloodstream.
• However, they may enter by direct extension from
penetrating wounds of the skull or through fractured
sinuses in basilar skull fractures.
• Once the causative organism enters the bloodstream, it
crosses the blood–brain barrier and find itself in the
subarachnoid space.
• The presence of microorganism in the subarachnoid
space trigger the inflammation of the pia and arachnoid
matter
• This inflammation increases the production of CSF with
a moderate increase in intracranial pressure(ICP).
• Due to increased intracranial pressure, they will be
severe headache,nausea and vomiting.
• The increased intracranial pressure and the presence
of microorganism can affect the brain leading to
photophobia (light sensitivity), phonophobia (noise
sensitivity), headache, myalgia (muscle aches).
The patient may also have positive Kernig’s sign
(inability to extend the leg when the thigh is flexed
on the abdomen) and a positive Brudzinski’s sign
(flexion of the neck produces flexion of the knees
and hips).
• The swelling of the pia,arachnoid and dura matter
result in nuchal rigidity (pain and stiffness of the
neck, inability to place the chin on the chest).
 SIGNS AND SYMPTOMS
• Fever due to infection
• Photophobia (light sensitivity)
• Phonophobia (noise sensitivity)
• Myalgia (muscle aches).
• Nuchal rigidity (pain and stiffness of the neck,
inability to place the chin on the chest).
• A positive Kernig’s sign (inability to extend the leg
when the thigh is flexed on the abdomen)
• Positive Brudzinski sign: When the patient’s neck is
flexed, flexion of the knees and hips is produced;
when the lower extremity of one side is passively
flexed, a similar movement is seen in the opposite
extremity.
Brudzinski sign is a more sensitive indicator of
meningeal irritation than Kernig sign.
• Opisthotonos (Arching of the back)
• Decreased level of conscious(drowsiness,stupor and
coma)
• Convulsion (seizure) due to brain involvement
• In meningicoccal meningitis the patient may have
macular pink rash
• PICTURE NEEDED FROM INTRODUCTION PAGE 523
 MEDICAL MANAGEMENT
DIAGNOSIS
History taking will reveal symptoms of meningitis
Physical examination on will reveal stiff neck and
Brudzinski sign.
INVESTIGATIONS
Lumbar puncture will confirm the diagnosis and
reveal the causative organism;
In Bacterial meningitis the CSF is cloud or turbid
In Viral meningitis the CSF is clear
FBC for culture and sensitivity
Malaria blood slide to rule out malaria
 TREATMENT
i.Bacterial Meningitis
 X-pen 2-4m.u iv qid for 7/7 days
 Gentamycin 80mg-240mg iv tds for 7/7
 Chloraphenical 500-1gm iv qid for 7/7
ii.Viral Meningitis
• Mostly viral meningitis is treated according to the
symptoms.
 But you can give the following drug;
 Acyclovir 800mg 5 times daily iv or po
iii. Fungal Meningitis
 Fluconazole 800mg stat ten 200mg od iv
When the patient stabilizes give 200mg bd po for
life or when CD4 rises above 350
 Amphotericin B (more toxic , when react to direct
sunlight , can cause renal failure)
iv. Supportive treatment
 Give Panadol 1g tds for 3/7 for antipyretic and
analgesic
 Vallium 10mg PRN to treat convulsion
 Hydrocortsone 100mg to treat cerebral edema
 Osmotic diuretic ( Mannitol) to reduce edema and
intracranial pressure
COMPLICATION OF MENINGITIS
• The following are the complication of meningitis;
i. Increased intracranial pressure
ii. Thrombophlebitis
iii. Encephalitis
iv. Dysfunction of cranial nerve
v. Hemiparesis and Hemianopsia
vi. Waterhouse-Friderichsen syndrome;
This is a complication of meningococcal meningitis
The syndrome is manifested by
petechae,disseminated intravascular coagulation
(DIC) ,adrenal hemorrhage and circulation collapse.
 NURSING MANAGEMENT
i. Aims
To prevent complication
To promote quick recoverly
To prevent spread of infection
ii. Maintain proper gaseous exchange
• Patient with meningitis is at risk of impared gaseous
because the airway may be blocked or due to
aspiration
• Do the following intervention;
 Keep an oral airway at the bedside; insert it
immediately if respiratory distress develops. An oral
airway holds the tongue forward so it does not
occlude the pharynx.
Administer oxygen as prescribed. Supplemental oxygen
increases the percentage of oxygen in inhaled gas higher
than that in room air.
Report respiratory difficulty, which may require
emergency intubation.Respiratory distress that is
unrelieved by repositioning the head, inserting an oral
airway, and administering oxygen may require medical
interventions to prevent hypoxemia.
Elevate the head of the bed. Head elevation lowers
abdominal organs away from the diaphragm, which
facilitates inhalation of a greater volume of air.
Hyperoxygenate and hyperventilate before and after
airway suctioning. Suctioning removes oxygen as well
as secretions from the respiratory passages.
Use caution when giving oral fluids, food, or
medications to a lethargic client. A client who is not
fully alert may aspirate food,fluids, and oral
medications.
iii. Managing Hyperthermia
Administer prescribed antipyretics. They alter the set
point in the hypothalamus.
Remove unnecessary clothing and blankets. Layers
of fabric trap body heat and prevent its convection
into the environment.
Administer tepid sponge baths. Applying moisture to
the body’s surface promotes heat loss through
evaporation.
Apply a cooling blanket beneath the client, but avoid
shivering.It promotes heat loss by conduction.
Shivering increases ICP.
Maintain adequate hydration. Adequate fluid volume
compensates for fluid loss from perspiration and
ensures fluid is availableto continue this heat-
regulating process. Fluid restriction may be
necessary if the client develops cerebral edema and
hypervolemia from syndrome of inappropriate
antidiuretic hormone (SIADH).
iv. Managing Pain
Assess the location and intensity of discomfort
whenever you assess vital signs. Gathering data about
pain is considered the fifth vital sign.
Report a continuous headache or one that is unrelieved.
An intense or unrelieved headache suggests rising ICP
from acute meningeal irritation.
Give a prescribed mild analgesic that does not affect
pupil size or reaction. Opioids cause the pupils to
constrict, which interferes with accurate neurologic
assessment.
Facilitate rest and reduced environmental stimuli.
Reduced activity and sensory stimulation help increase
pain tolerance.
v. Managing Seizures
Raise and pad side rails with soft material. Modifying
the environment helps reduce the potential for injuries
during a seizure
Stay with the client if a seizure develops and call for
assistance. A client is defenseless during a seizure. The
airway can become obstructed or aspiration can occur if
a client is alone during a seizure.
Turn client to the side during a seizure. A lateral
position reduces the potential for aspiration of saliva or
stomach contents.
Do not restrain client’s movements. Doing so during a
seizure can cause fractures or other musculoskeletal
injuries.
• PICTURE NEEDED FROM INTRODUCTION 524
Provide privacy. Privacy protects the client’s dignity.
Insert a padded tongue blade in the mouth only if the
teeth are not tightly shut. Protecting the tongue and
teeth with soft material is dangerous once a seizure
begins; if the client experiences an aura before a
seizure, there may be time to protect the mouth.
Suction client’s mouth and pharynx after the seizure.
Suctioning clears accumulated secretions from the
airway.
Provide oxygen during and after the seizure.
Hypoxemia develops when the client’s diaphragm
contracts and breathing is irregular throughout the
seizure.
Reorient client to the surroundings and provide rest
after the seizure. Commonly, clients are sleepy and
confused after a seizure.
Check for injuries. A client who experiences a
seizure may have oral injuries or contusions to the
skin.
Administer prescribed anticonvulsants. They
decrease the excitability of neurons in the brain and
reduce the potential for additional seizures.
 THE END

LITUMEZI AHULU
 REFERENCES
Barbra K.Timmyand Nancy
(2010).INTRODUCTION TO MEDICAL
SURGICAL NURSING .10 edition.
USA:WorkersKluwer
Brunner and Suddarth (2018).MEDICAL-
SURGICAL NURSING 14 edition. USA;Wolters
Kluwer
Donna D.Ignatavicius (2016).MEDICAL-
SURGICAL NURSING: PATIENT-CENTERED
COLLABORATION CARE. 8 edition.
Canada;Elsevier
Lewis Dirksen (2018).MEDICAL-SURGICAL
NURSING: ASSESSMENT AND MANAGEMENT
OF CLINICAL PROBLEM. 11 edition . Elsevier