MENINGITIS

MENINGITIS

Is an infection or inflammation of the meninges covering the brain and spinal cord.

Causes / Risk Factors

• Bacteria (less common but usually of acute onset) e.g streptococcus pneumonia, neisseria or hemophilic influenza.

• Viral infection (usually insidious)

• Fungal and protozoa

• Invasive neurosurgical procedures

• Skull fracture

• Upper respiratory tract infections

• Use of nasal spray

• Compromised immune system

• Lumbar puncture

• High population

• Crowded living areas

• Prisons

Clinical Manifestations of meningitis

• Headache

• Backpain

• Vomiting 

• Photophobia

• Fever and chills

• Severe neck pain

• Muscle ache

• Tachycardia

• Twitching

• Seizures

• Altered level of consciousness

• Abdominal and chest pain in viral meningitis

• Poor sucking or feeding in children

• Bulging fontanelles in children

• Brudzinkis sign (severe neck stiffness causes patients hip and knees to flexion)

• Kernings sign (severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed at 90 degrees)

• Opisthotonos (spasm in which the back and extremities arch backward so that the body rests on the head and heels)

Diagnostic Evaluation

• History taking

• Physical examination

• Lumbar puncture for CSF analysis reveals positive cultures with invading micro organisms and elevated cloudy CSF

• WBC counts reveals leucocytosis

• CT scan and MRI to rule our disorder such as cerebral hematoma, hemorrhage or tumor

Nursing Management

• Admit patient into a quiet environment with low light and less environmental stimulation.

• Assessment and maintenance of ABCs are essential. Intubation, mechanical ventilation and hyperventilation may occur if the patients airway and breathing are threatened. Especially temperature

• Assess vital signs and level of consciousness

• Institute bed rest and a calm environment with dim light to reduce irritation

• Monitor intake and output and prevent fluid overload which may worsen cerebral  oedema

• Monitor for seizure activity and initiate precautions to prevent injuries

• Maintain isolation precautions as necessary with bacterial meningitis

• Maintain urine and stool precautions with viral meningitis. Elevate the head of the bed 30 degrees and avoid neck flexion and extreme flexion

• Institute measure to decrease fever such as exposure to air and use of prescribed antipyretics

• Give prescribed analgesics for pain and assist with position of comfort(usually side lying position)

• Give nourishing diet through naso gastric tube if swallowing is a problem because of the seizure or spasm

• Care of pressure areas and adequate bed bath and oral care are instituted.

• Passive and active exercise are carried out based on patients neurological status

• Instruct patient to notify the primary health care provider for signs and symptoms of complications

• Identify family contact who may require prophylactic treatment administer vaccination as indicated

• Encourage patient to follow medication regimen as directed to fully eradicate the infections agents

• Encourage follow up and prompt attention to infection in future

Medical Management

• Initiate antibiotics therapy  e.g. penicillin or one of the cephalosporin intraveneously

• Prophylactic antibiotics may also be used after ventricular shunting procedures

• Osmotic diuretics such as manitol to treat cerebral oedema

• Anti convulsants or sedatives e.g diazepam to control seizures and restlessness

• Aspirin or acetaminophen to relieve headache and fever

• Fluid therapy to prevent dehydration from vomiting

• Surgically CSF drainage is carried out to prevent neurological deficits from hydrocephalus or cerebra abscess

Complications of meningitis

• Encephalitis

• Hydrocephalus

• Loss of vision

• Paralysis

• Epilepsy in children

• Mental retardation in children