MENINGITIS
- is an inflammation (swelling) of the protective membranes covering the brain and spinal cord.
A bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the
swelling
Meningitis is a clinical syndrome characterized
by swelling of the meninges, the three layers of
membranes that enclose the brain and spinal
cord. These layers consist of the following:
Dura – A tough outer membrane.
Arachnoid – A lacy, weblike middle
membrane.
Subarachnoid space – A delicate, fibrous
inner layer that contains many of the
blood vessels that feed the brain and
spinal cord.
Anatomically, meningitis can be divided into inflammation of the dura, which is less common,
and leptomeningitis, which is more common and is defined as inflammation of the arachnoid
tissue and subarachnoid space.
Types of Meningitis
There are five types of Meningitis, each classified by the cause of the disease
Bacterial Meningitis - this form of meningitis usually occurs when bacteria gets into the
bloodstream and travels to the brain and spinal cord. Most bacteria that cause this form of
infection are spread through close personal contact, such as: coughing. sneezing.
Viral Meningitis - cases of viral meningitis are caused by enteroviruses and other
common viruses such as measles, mumps, and chicken pox.
Parasitic Meningitis – This form of the disease causes a brain infection that progresses
rapidly. The source for parasitic meningitis has been detected all over the world in warm
freshwater sources, soil, warm water discharged from industrial sources, poorly treated
swimming pools, and water heaters. These parasites normally infect animals not people.
People get infected primarily by eating infected animals or contaminated foods.
Fungal Meningitis – Fungal meningitis is most often caused by inhaling fungal spores
from contaminated soil or from bird or bat droppings. The type of fungus and state of the
patient's immune system determine the length of treatment.
Non – Infectious Meningitis – this form of meningitis cannot be caught from another
person. It typically occurs as the result of cancer, lupus, a head injury, brain surgery, or
from certain medications.
Signs and Symptoms
Symptoms of meningitis develop suddenly and can include:
Fever of 38C or above
Headache
Vomiting
Diarrhea
Muscle Pain
Stomach Cramps
Drowsiness or Unresponsiveness
Seizure
RISK FACTORS
Risk factors for meningitis include the following:
Extremes of age (< 5 or >60 years)
Diabetes mellitus, chronic kidney failure, adrenal insufficiency, hypoparathyroidism,
or cystic fibrosis
Immunosuppression, which increases the risk of opportunistic infections and acute
bacterial meningitis
Alcoholism and cirrhosis
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
through 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.
Assessment and Diagnostic Findings
Several tests may be carried out to confirm the diagnosis and check whether the condition is the
result of a viral or bacterial infection.
These tests may include:
Lumbar Puncture - where a sample of fluid is taken from the spine and checked for
bacteria or viruses. 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 to check for any problems with the brain, such as swelling
Blood studies in patients with bacterial meningitis, a complete blood count (CBC) with
differential will demonstrate polymorphonuclear leukocytosis with a left shift.
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.
As bacterial meningitis can be very serious, treatment with antibiotics will usually start before
the diagnosis is confirmed and will be stopped later on if tests show the condition is being caused
by a virus.
Treatment in hospital is recommended in all cases of bacterial meningitis, as the condition can
cause serious problems and requires close monitoring.
Severe viral meningitis may also be treated in hospital.
PREVENTION
The best way to prevent bacterial meningitis is through vaccination. Vaccines prepare the
immune system by exposing the body to a germ so that it is better able to fight an infection when
it occurs. Vaccines contain either parts of a germ, live but weakened germs, or inactivated (dead)
germs.
There are 2 types of meningococcal vaccines available in the United States: Meningococcal
conjugate or MenACWY vaccines (Menactra® and Menveo®) Serogroup B meningococcal
or MenB vaccines (Bexsero® and Trumenba®)
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.
Treatments
Treatment in hospital is recommended in all cases of bacterial meningitis, as the condition can
cause serious problems and requires close monitoring.
Antibiotics given directly into a vein
Fluids given directly into a vein to prevent dehydration
Oxygen through a face mask if there are any breathing difficulties
Steroid medication to help reduce any swelling around the brain, in some cases
People with meningitis may need to stay in hospital for a few days, and in certain cases treatment
may be needed for several weeks. Additional treatment and long-term support may also be
required if any complications of meningitis occur, such as hearing loss.
Nursing Management
Nursing management of the patient with meningitis include the following:
Nursing Assessment
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 Care Planning & Goals
Protection against injury.
Prevention of infection.
Restoring normal cognitive functions.
Prevention of complications.
Nursing Intervention for Meningitis Infected Patient
Nursing intervention for the hospitalized patient is very important. Some important nursing
interventions for meningitis infected patient are pointed out in the below:
The patient should place in a well-ventilated room, free from excessive light and noise.
The patient should be kept in a rail bed to prevent falling due to convulsion.
Undo the tight clothing around the neck, chest, and wrist.
The airway must be kept clear so that the patient can breathe easily.
Oxygen inhalation should be given if necessary.
Close monitoring of the patient because there is a risk for Injury related to convulsion,
restlessness, and disorientation (due to meningeal irritation) should be relieved by
sedative and brain relaxant medication like phenobarbitone, diazepam. (all medication
should be given according to doctor advice).
Intravenous fluids should be given to prevent dehydration, maintain nutrition and to
administer intravenous medication.
Acute pain related to severe headache, fever, neck pain, muscle aches should be relieved
by analgesics like paracetamol.
Monitor vital signs carefully and keep a record.
Obtain frequent temperature reading and record it.
Ensure tepid sponging of the whole body to reduce the temperature.
Maximize heat loss by minimizing the external covering of the patient’s body and
ensuring adequate ventilation.
Give antipyretic as per doctor order and check persons with no preexisting liver or kidney
disease.
Personal hygiene (including oral, eye, nose, ears and skin) should be maintained.
Encourage patients to drink plenty of water with electrolytes (approximately 2.5-3 liters
per day).
Maintain intake output chart during the acute phase for the hospitalized patient.
Instruct the patient to assume a comfortable position while in bed or sitting in a chair and
to avoid jerky movements.
The reassurance of the patient and relatives about the disease, physical condition, and
progress.
Discharge and Home Healthcare Guidelines
Explain all medications and include the mechanism of action, dosage, route, and side
effects.
Explain any drug interactions or food interactions.
Instruct the patient to notify the primary healthcare provider for signs and symptoms of
complications, such as fever, seizures, developmental delays, or behavior changes.
Provide referrals and teaching specific to the identified neurological deficits.
Encourage the parents to maintain appropriate activities to facilitate the growth and
development of the child
