Meningitis

Meningitis involves meninges
Viral meningitis
Bacterial meningitis
Fungal meningitis
Parasitic meningitis
Meningitis is an acute inflammation of the meningeal tissues surrounding the brain and the spinal cord (meninges).
Skipping vaccinations
Age-Viral meningitis occur in children younger than age 5. Bacterial meningitis is common in those under age 20.
Living in a community setting
Pregnancy. 
Compromised immune system. AIDS, alcoholism, diabetes, use of immunosuppressant drugs etc.
Primary- Neisseria meningitidis

Secondary- E. coli
Haemophilus influenzae
Streptococcus pneumoniae

Meningitis involves meninges
Viral meningitis
Bacterial meningitis
Fungal meningitis
Parasitic meningitis
Meningitis is an acute inflammation of the meningeal tissues surrounding the brain and the spinal cord (meninges).
Skipping vaccinations
Age-Viral meningitis occur in children younger than age 5. Bacterial meningitis is common in those under age 20.
Living in a community setting
Pregnancy. 
Compromised immune system. AIDS, alcoholism, diabetes, use of immunosuppressant drugs etc.
Primary- Neisseria meningitidis

Secondary- E. coli
Haemophilus influenzae
Streptococcus pneumoniae

1. CHIRAYU COLLEGE OF NURSING, BHOPAL SUBJECT- MEDICAL SURGICAL NURSING TOPIC- MENINGITIS PREPARED BY MR . MIGRON RUBIN Lecturer

2. OBJECTIVES To introduce & define the topic To enlist risk factors & etiology To explain clinical manifestation & diagnostic evaluation To explain management & health education of meningitis

3. INTRODUCTION Meningitis involves meninges

4. TYPES Viral meningitis Bacterial meningitis Fungal meningitis Parasitic meningitis

5. DEFINITION Meningitis is an acute inflammation of the meningeal tissues surrounding the brain and the spinal cord (meninges).

6. RISK FACTORS Skipping vaccinations Age- Viral meningitis occur in children younger than age 5. Bacterial meningitis is common in those under age 20. Living in a community setting Pregnancy.   Compromised immune system.  AIDS, alcoholism, diabetes, use of immunosuppressant drugs etc.

7. ETIOLOGY Primary- Neisseria meningitidis Secondary- E . coli Haemophilus influenzae Streptococcus pneumoniae

8. PATHOPHYSIOLOGY Invasion of microorganisms- usually upper respiratory tract infection ↓ Bacterial invasion leads to a rapidly increased blood supply to the meninges with massive neutrophil migration. ↓ The neutrophils then engulf the bacteria and disintegrate. Exudate from tissue destruction contributes to purulent material. ↓ The purulent material causes the meninges to become inflamed and increases ICP. ↓ Excessive release of ADH. ADH acts by inhibiting urination. This in turn leads to water retention, oliguria , hypervolemia , hyponatremia and further increase in ICP.

9. CLINICAL MANIFESTATION Fever Neck stiffness- Nuchal rigidity Thigh flexion upon flexion of the neck ( Brudzinski’s sign) Resistance to the passive extension of the knee with the hip flexed ( K ernig’s sign) Vomiting, photophobia may be seen Petechial rashes Acute confusion Seizures and cranial nerve palsy Coma in severe cases

10. DIAGNOSTIC EVALUATION History Collection Physical Examination Blood culture Analysis of CSF CBC , electrolyte levels, RBS CT scan, MRI, PET scan Skull x-ray X- rays of the skull may demonstrate infected sinuses.

11. COMPLICATIONS Hearing loss Memory difficulty Learning disabilities Brain damage Gait problems Seizures Kidney failure Shock Death

12. MANAGEMENT I. MEDICAL MANAGEMENT A. PHARMACOLOGICAL MANAGEMENT Antibiotics- ampicillin, penicillin, amoxycillin Antiviral- tenofovir Antifungal- fluconazole Corticosteroid- dexamethasone IV mannitol for diuresis IV phenytoin Antipyretics- Acetaminophen

13. B. NON PHARMACOLOGICAL MANAGEMENT Maintenance of fluid-electrolyte balance by IV fluid therapy Nasogastric tube feeding Vitamin supplementation Head end elevation 30- 45 degree Emotional support and necessary information for continuation of care at home, follow-up and rehabilitation.

14. SURGICAL MANAGEMENT Cochlear implantation rehabilitation due to deafness

15. NURSING MANAGEMENT ASSESSMENT Obtain a history of recent infections such as upper respiratory infection, and exposure to causative agents. Assess neurologic status and vital signs. Evaluate for signs of meningeal irritation. Assess sensorineural hearing loss (vision and hearing), cranial nerve damage ( eg , facial nerve palsy), and diminished cognitive function.

16. DIAGNOSIS Ineffective Tissue Perfusion (cerebral) related to infectious process and cerebral edema Hyperthermia related to the infectious process and cerebral edema Risk for Imbalanced Fluid Volume related to fever and decreased intake Acute Pain related to meningeal irritation Impaired Physical Mobility related to prolonged bed rest

17. GOAL To Enhanced Cerebral Tissue Perfusion To Reduce Fever To Maintain Fluid Balance To Reduce Pain To Return to Optimal Level of Functioning/ mobility

18. INTERVENTIONS Enhancing Cerebral Perfusion Assess LOC, vital signs, and neurologic parameters frequently. Observe for signs and symptoms of ICP ( e.g . decreased LOC, dilated pupils, widening pulse pressure). Maintain a quiet, calm environment to prevent agitation, which may cause an increased ICP. Prepare patient for a lumbar puncture for CSF evaluation, and repeat spinal tap, if indicated. Lumbar puncture typically precedes neuroimaging Notify the health care provider of signs of deterioration: increasing temperature, decreasing LOC, seizure activity, or altered respirations . I/V mannitol is administered.

19. Reducing Fever Administer antimicrobial agents on time to maintain optimal blood levels. Monitor temperature frequently or continuously . Institute other cooling measures, such as a hypothermia blanket, as indicated . Administer antipyretics as ordered like paracetamol.

20. Maintaining Fluid Balance Prevent I.V. fluid overload, which may worsen cerebral edema. Monitor intake and output closely. Monitor CVP frequently . Administration of osmotic diuretic- mannitol

21. Reducing Pain Assess level, intensity, duration & location of pain. Darken the room if photophobia is present. Assist with position of comfort for neck stiffness, and turn patient slowly and carefully with head and neck in alignment. Elevate the head of the bed to decrease ICP and reduce pain . Administer analgesics as ordered; monitor for response and adverse reactions. Avoid opioids, which may mask a decreasing LOC . Promoting Return to Optimal Level of Functioning Implement rehabilitation interventions after admission ( eg , turning, positioning). Progress from passive to active exercises based on the patient's neurologic status.

22. EXPECTED OUTCOMES Enhanced Cerebral Tissue Perfusion Fluid Balance Maintained Reduced Fever Reduced Pain Return to Optimal Level of Functioning

23. HEALTH EDUCATION Advise close contacts of the patient with meningitis that prophylactic treatment may be indicated; they should check with their health care providers or the local public health department. Encourage the patient to follow medication regimen as directed to fully eradicate the infectious agent. Encourage follow-up and prompt attention to infections in future.

24. SUMMARY We have discussed about meningitis, its cause, risk factor, pathophysiology, clinical manifestation, diagnostic evaluation & management

25. CONCLUSION Meningitis is an inflammation of the meninges. The meninges are the three membranes that cover the brain and spinal cord. Meningitis can occur when fluid surrounding the meninges becomes infected.

26. REFERENCES Boyer Jo Mary(2004 ), Textbook Of Medical Surgical Nursing, Philadelphia, Lippincott William & Wilkins. Lewis Mantik Sharon et. Al. (2000), Medical Surgical Nursing, Assessment & Management Of Clinical Problems, St. Louis, Missouri, Mosby Publishers. Lippincott (2001), M anual of Nursing Practice, J.P. Brothers, Philadelphia.