MENINGITISHEATHER WACHOLZ RN, BSN, CCRN-CMC, CNRN

TCCCJANUARY 27, 2015

QUESTION

IS THE FOLLOWING STATEMENT TRUE OR FALSE?

MENINGITIS IS AN INFLAMMATION OF THE PIA MATER, THE ARACHNOID, AND THE CEREBROSPINAL FLUID–FILLED SUBARACHNOID SPACE

ANSWER

TRUE

MENINGITIS IS AN INFLAMMATION OF THE PIA MATER, THE ARACHNOID, AND THE CEREBROSPINAL FLUID–FILLED SUBARACHNOID SPACE.

MENINGITIS

• INFLAMMATION OF THE MEMBRANES AND THE FLUID SPACE SURROUNDING THE BRAIN AND SPINAL CORD

• TYPES• SEPTIC CAUSED BY BACTERIA (STREPTOCOCCUS PNEUMONIAE, NEISSERIA

MENINGITIDIS)• ASEPTIC CAUSED BY VIRAL INFECTION, LYMPHOMA, LEUKEMIA, OR BRAIN ABSCESS

• N. MENINGITIDIS IS TRANSMITTED BY SECRETIONS OR AEROSOL CONTAMINATION, AND INFECTION IS MOST LIKELY IN DENSE COMMUNITY GROUPS SUCH AS COLLEGE CAMPUSES

• MANIFESTATIONS INCLUDE HEADACHE, FEVER, CHANGES IN LOC, BEHAVIORAL CHANGES, NUCHAL RIGIDITY (STIFF NECK), POSITIVE KERNIG'S SIGN, POSITIVE BRUDZINSKI’S SIGN, AND PHOTOPHOBIA

MENINGITIS

• INFLAMMATION OF THE LINING AROUND THE BRAIN AND SPINAL CORD• CAUSED BY BACTERIA OR VIRUS• 80% ARE CAUSED BY THE BACTERIA STREPTOCOCCUS PNEUMONIAE AND

NEISSERIA MENINGITIDES

• VIRAL INFECTIONS ARE USUALLY CAUSED BY MUMPS, HERPES, OR MOSQUITOES OR OTHER INSECTS.

MENINGOCOCCAL MENINGITIS

KERNIG’S SIGNCANNOT EXTEND LEG

BRUDZINSKI’S SIGNWHEN NECK IS FLEXED AUTOMATIC

FLEXION OF KNEES AND HIP

MONRO KELLIE HYPOTHESIS INCREASED INTRACRANIAL PRESSURE (ICP)

DIFFUSE BRAIN SWELLING

MEDICAL MANAGEMENT

• PREVENTION BY VACCINATION AGAINST HAEMOPHILUS INFLUENZAE AND S. PNEUMONIAE FOR ALL CHILDREN AND ALL AT-RISK ADULTS

• PREVENTION BY MENINGOCOCCAL VACCINATION FOR ADOLESCENTS AND HIGH-RISK GROUPS

• EARLY ADMINISTRATION OF HIGH DOSES OF APPROPRIATE IV ANTIBIOTICS FOR BACTERIAL MENINGITIS

• DEXAMETHASONE • TREATMENT DEHYDRATION, SHOCK, AND SEIZURES

NURSING MANAGEMENT

• FREQUENT OR CONTINUAL ASSESSMENT, INCLUDING VS AND LOC• PROTECT PATIENT FORM INJURY RELATED TO SEIZURE ACTIVITY OR ALTERED LOC• MONITOR DAILY WEIGHT, SERUM ELECTROLYTES, URINE VOLUME, SPECIFIC GRAVITY,

AND OSMOLALITY• PREVENT COMPLICATIONS ASSOCIATED WITH IMMOBILITY • INFECTION CONTROL PRECAUTIONS• SUPPORTIVE CARE• MEASURES TO FACILITATE COPING OF PATIENT AND FAMILY

LUMBAR PUNCTUREDIAGNOSTIC PROCEDURE

CEREBROSPINAL FLUID

Parameter Normal CSF Bacterial Meningitis

Viral Meningitis

Fungal Meningitis

Opening pressure (mm H20)

100-180 200-500 <250 >200

Leukocyte count (WBC/mm3)

0-5 Increased 100-5,000

Increased 50-1000

Increased > 20

Neutrophils (%) 0 > 80 < 40

Protein (mg/dL) 18-45 Elevated 100-500

Elevated < 200 Elevated > 45

Glucose 45-80; 0.6 times blood glucose level

5-40; < 0.3 times blood glucose level

> 45 < 40

INTERVENTIONS

• PROTECT CLIENTS

• EDUCATE CLIENTS

• MAINTAIN OWN WORKER HEALTH

• GIVE ANTIMICROBIALS

• BE AWARE OF S&S OF INFECTION

• PRACTICE MEDICAL AND SURGICAL ASEPSIS

COMPLICATIONS

• VISION AND HEARING IMPAIRMENTS• SEIZURES• HYDROCEPHALUS• PARALYSIS• SEPTIC SHOCK• BRAIN DAMAGE

POPULATIONS AT RISK AND SEASONS FOR OCCURRENCE OF MENINGITIS

Community Groups

Day Care/Schools

College Campuses

Military Installations

Winter Early Spring

FACTORS THAT INCREASE RISK

Smoking Viral Upper Respiratory Infection

Otitis Media Immune System Deficiencies

ASSESSMENT AND DIAGNOSTIC FINDINGS

• CT SCAN• MRI• LP FOR SPINAL FLUID ANALYSIS• BEDSIDE RISK SCORE; OF R EXAMPLE, UNFAVORABLE OUTCOMES: OLD AGE,

HR > 120/MIN, DECREASED GCS, CRANIAL NERVE PALSIES, AND A GRAM POSITIVE STAIN ONE HOUR AFTER HOSPITALIZATION

NURSES ROLE IN PREVENTION

• CDC RECOMMENDATIONS• MENINGOCOCCAL CONJUGATED VACCINE GIVEN AGE OF 11-12 YEARS AND A

BOOSTER AT 16 YEARS• EDUCATION ON MENINGITIS• AVAILABILITY OF VACCINE• PEOPLE IN CONTACT WITH MENINGITIS SHOULD RECEIVE RIFAMPIN, CIPRO,

OR ROCEPHIN THIS SHOULD BE STARTED 24 HOURS AFTER EXPOSURE

NURSING CARE PLAN

NURSING CARE PLAN CONTINUED

REFERENCE

• HINKLE, J. L., & CHEEVER, K. H. (2014). BRUNNER & SUDDARTH'S TEXTBOOK OF MEDICAL-SURGICAL NURSING. BETHLEHEM, PENNSYLVANIA: WOLTERS KLUWER/LIPPINCOTT WILLIAMS & WILKIN