Meningitis

(Individual Report)

Submitted by:
Bianca G. Abarca
BSN 2-B

Submitted to:
Irish Camille Punsalang RN

April 2020
I. Overview/Definition

Meningitis is inflammation of the thin tissue that surrounds the brain and spinal

cord, called the meninges. There are several types of meningitis. The most common is

viral meningitis. You get it when a virus enters the body through the nose or mouth and

travels to the brain. Bacterial meningitis is rare, but can be deadly. It usually starts with

bacteria that cause a cold-like infection. It can cause stroke, hearing loss, and brain

damage. It can also harm other organs. Pneumococcal infections and meningococcal

infections are the most common causes of bacterial meningitis.

II. Signs and Symptoms

The classic triad of bacterial meningitis consists of the following:

 Fever

 Headache

 Neck stiffness

Other symptoms can include nausea, vomiting, photalgia (photophobia), sleepiness,

confusion, irritability, delirium, and coma. Patients with viral meningitis may have a

history of preceding systemic symptoms (eg, myalgias, fatigue, or anorexia).

Signs in newborns

Newborns and infants may show these signs:

 High fever

 Constant crying

 Excessive sleepiness or irritability

 Inactivity or sluggishness
  Poor feeding

 A bulge in the soft spot on top of a baby's head (fontanel)

 Stiffness in a baby's body and neck

III. Etiology

Viral infections are the most common cause of meningitis, followed by bacterial

infections and, rarely, fungal infections. Because bacterial infections can be life-

threatening, identifying the cause is essential.

Bacterial meningitis

Bacteria that enter the bloodstream and travel to the brain and spinal cord cause

acute bacterial meningitis. But it can also occur when bacteria directly invade the

meninges. This may be caused by an ear or sinus infection, a skull fracture, or, rarely,

after some surgeries.

Viral meningitis

Viral meningitis is usually mild and often clears on its own. Most cases in the

United States are caused by a group of viruses known as enteroviruses, which are most

common in late summer and early fall. Viruses such as herpes simplex virus, HIV,

mumps, West Nile virus and others also can cause viral meningitis.

Chronic meningitis

Slow-growing organisms (such as fungi and Mycobacterium tuberculosis) that

invade the membranes and fluid surrounding your brain cause chronic meningitis.

Chronic meningitis develops over two weeks or more. The signs and symptoms of
chronic meningitis — headaches, fever, vomiting and mental cloudiness — are similar to

those of acute meningitis.

Fungal meningitis

Fungal meningitis is relatively uncommon and causes chronic meningitis. It may

mimic acute bacterial meningitis. Fungal meningitis isn't contagious from person to

person. Cryptococcal meningitis is a common fungal form of the disease that affects

people with immune deficiencies, such as AIDS. It's life-threatening if not treated with an

antifungal medication.

Meningitis can also result from noninfectious causes, such as chemical reactions,

drug allergies, some types of cancer and inflammatory diseases such as sarcoidosis.

IV. Risk Factors

Risk factors for meningitis include:

 Skipping vaccinations. Risk rises for anyone who hasn't completed the

recommended childhood or adult vaccination schedule.

 Age. Most cases of viral meningitis occur in children younger than age 5.

Bacterial meningitis is common in those under age 20.

 Living in a community setting. College students living in dormitories, personnel

on military bases, and children in boarding schools and child care facilities are at

greater risk of meningococcal meningitis. This is probably because the bacterium is

spread by the respiratory route, and spreads quickly through large groups.
  Pregnancy. Pregnancy increases the risk of listeriosis — an infection caused by

listeria bacteria, which may also cause meningitis. Listeriosis increases the risk of

miscarriage, stillbirth and premature delivery.

 Compromised immune system. AIDS, alcoholism, diabetes, use of

immunosuppressant drugs and other factors that affect your immune system also

make you more susceptible to meningitis. Having your spleen removed also

increases your risk, and anyone without a spleen should get vaccinated to minimize

that risk.

V. Complications

Your treatment will depend on the type of meningitis you have.

Bacterial meningitis needs immediate treatment with antibiotics. Your doctor might give you

a general, or broad-spectrum, antibiotic even before they’ve found the exact bacteria that

caused your illness and then change to a drug that targets the specific bacteria they find. You

might also get corticosteroids to reduce inflammation

VI. Diagnostic

The diagnostic tests in patients with clinical findings of meningitis are as follows:

 Lumbar puncture. In general, whenever the diagnosis of meningitis is

strongly considered, a lumbar puncture should be promptly performed;

examination of the cerebrospinal fluid (CSF) is the cornerstone of the

diagnosis.
 CT scan. A screening computed tomography (CT) scan of the head may be

performed before LP to determine the risk of herniation.

 Blood studies. In patients with bacterial meningitis, a complete blood

count (CBC) with differential will demonstrate polymorphonuclear

leukocytosis with a left shift.

 Chest radiography. As many as 50% of patients with pneumococcal

meningitis also have evidence of pneumonia on initial chest radiography.

 Cultures and bacterial antigen testing. The utility of cultures is most evident

when LP is delayed until head imaging can rule out the risk of brain

herniation, in which cases antimicrobial therapy is rightfully initiated before

CSF samples can be obtained.

 Serum procalcitonin testing. increasing data suggest that serum procalcitonin

(PCT) levels can be used as a guide to distinguish between bacterial and

aseptic meningitis in children.

VII. Pathophysiology

Precipitating
Predisposing Factors: Direct/indirect contact with Factors:
- Age an infected person - Environment
- Poor Hygiene
- Malnutrition
Acquire Infectious Agents
like parasite, virus,
bacteria, and fungus.

Initially, the infectious agent colonizes or

establishes a localized infection in the host.

- Fever
Through infecting - Irritability
- Poor
Sucking
Reflex
Skin, nasopharynx,
respiratory tract,
gastrointestinal tract, or
genitourinary tract.

From this site, the organism invades the submucosa

by circumventing host defenses, like physical barriers,
local immunity, phagocytes/macrophages by

a retrograde neuronal pathway like

invasion of the like olfactory and peripheral nerves direct contiguous
bloodstream like spread like sinusitis,
bacteremia, viremia, and otitis media
fungemia,
parasitemia

M E N I N GI T I S

VIII. Prevention
 Common bacteria or viruses that can cause meningitis can spread through

coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette.

These steps can help prevent meningitis:

 Wash your hands. Careful hand-washing helps prevent the spread of germs.

Teach children to wash their hands often, especially before eating and after using

the toilet, spending time in a crowded public place or petting animals. Show them

how to vigorously and thoroughly wash and rinse their hands.

 Practice good hygiene. Don't share drinks, foods, straws, eating utensils, lip

balms or toothbrushes with anyone else. Teach children and teens to avoid sharing

these items too.

 Stay healthy. Maintain your immune system by getting enough rest, exercising

regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole

grains.

 Cover your mouth. When you need to cough or sneeze, be sure to cover your

mouth and nose.

 If you're pregnant, take care with food. Reduce your risk of listeriosis by

cooking meat, including hot dogs and deli meat, to 165 F (74 C). Avoid cheeses

made from unpasteurized milk. Choose cheeses that are clearly labeled as being

made with pasteurized milk.

Immunizations

Some forms of bacterial meningitis are preventable with the following vaccinations:

1. Haemophilus influenzae type b (Hib) vaccine

2. Pneumococcal conjugate vaccine (PCV13)

 3. Pneumococcal polysaccharide vaccine (PPSV23)

4. Meningococcal conjugate vaccine

IX. Treatment

The treatment depends on the type of meningitis you or your child has.

Bacterial meningitis

Acute bacterial meningitis must be treated immediately with intravenous

antibiotics and sometimes corticosteroids. This helps to ensure recovery and reduce the

risk of complications, such as brain swelling and seizures.

The antibiotic or combination of antibiotics depends on the type of bacteria causing the

infection. Your doctor may recommend a broad-spectrum antibiotic until he or she can

determine the exact cause of the meningitis.

Your doctor may drain any infected sinuses or mastoids — the bones behind the outer ear

that connect to the middle ear.

Viral meningitis

Antibiotics can't cure viral meningitis, and most cases improve on their own in

several weeks. Treatment of mild cases of viral meningitis usually includes:

 Bed rest

 Plenty of fluids

 Over-the-counter pain medications to help reduce fever and relieve body aches

Your doctor may prescribe corticosteroids to reduce swelling in the brain, and an

anticonvulsant medication to control seizures. If a herpes virus caused your meningitis,

an antiviral medication is available.

Other types of meningitis

If the cause of your meningitis is unclear, your doctor may start antiviral and

antibiotic treatment while the cause is determined.

X. Nursing Management

Nursing Assessment

Assessment of the patient with bacterial meningitis include:

 Neurologic status. Neurologic status and vital signs are continually assessed.

 Pulse oximetry and arterial blood gas values. These values are used to

quickly identify the need for respiratory support.

Nursing Interventions

Important components of nursing care include the following measures:

 Assess neurologic status and vital signs constantly. Determine oxygenation

from arterial blood gas values and pulse oximetry.

 Insert cuffed endotracheal tube (or tracheostomy), and position patient

on mechanical ventilation as prescribed.

 Assess blood pressure.  (usually monitored using an arterial line) for incipient

shock, which precedes cardiac or respiratory failure.

 Rapid IV fluid replacement may be prescribed, but take care not to

overhydrate patient because of risk of cerebral edema.

 Reduce high fever to decrease load on heart and brain from oxygen demands.

 Protect the patient from injury secondary to seizure activity or altered level of

consciousness (LOC).
 Monitor daily body weight; serum electrolytes; and urine volume, specific

gravity, and osmolality, especially if syndrome of inappropriate antidiuretic

hormone (SIADH) is suspected.

 Prevent complications associated with immobility, such as pressure

and pneumonia.

 Institute infection control precautions until 24 hours after initiation of

antibiotic therapy (oral and nasal discharge is considered infectious).

 Inform family about patient’s condition and permit family to see patient at

appropriate intervals.