meningitis-20000000000729103712 (1).pptx

maningitis

1. Meningitis

2. Definition Meningitis is an inflammation of the brain and spinal cord that may be caused by either bacterial or viral infection. Any microorganism that enters the body can result in meningitis. Bacterial meningitis is a serious infection that is spread by direct contact with discharge from the respiratory tract of an infected person.

3. Etiology Bacterial Neisseria meningitidis Streptococcus pneumoniae Haemophilus influenzae type b (Hib) Listeria monocytogenes Viral Herpes simplex virus HIV, mumps West nile virus

4. Route of Entry Bloodstream Insect bite Otitis media Direct extension Fracture of frontal or facial bones Cerebrospinal fluid Dural tear Poor sterile technique during procedure Nose or mouth Meningococcus meningitis In utero Contamination of amniotic fluid Rubella Vaginal infection

5. Pathophysiology

6. Clinical manifestations Fever Headache Nuchal rigidity Altered mental status, confusion Petechial rash especially with N. meningitidis . Photophobia Positive Kernig’s sign: The patient is lying supine with the thigh flexed on the abdomen. Slowly extend the upper leg, resulting in pain and spasm of the hamstring muscle. Positive Brudzinski’s sign: To elicit Brudzinski's sign, place the patient supine and flex the head upward. Resulting flexion of hips, knees, and ankles with neck flexion indicates meningeal irritation.

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

8. Diagnostic Evaluation History collection Physical examination Complete blood count (CBC) Blood cultures are obtained to indicate the organism. Lumbar puncture : CSF evaluation for pressure, leukocytes, protein, glucose CSF normally has five or fewer lymphocytes or mononuclear cells/mm 3 . In acute bacterial meningitis, the CSF may indicate elevated pressure, elevated leukocytes (several thousand), elevated protein, elevated glucose. A culture and smear will identify the organism. WBC differential should be done by a stained smear of sediment. MRI/CT scan with and without contrast rules out other disorders. Serological test such as Latex agglutination may be positive for antigens in meningitis.

9. Management Early administration of an antibiotic that crosses the blood–brain barrier into the subarachnoid space in sufficient concentration to reduce the multiplication of bacteria. Vancomycin hydrochloride in combination with one of the cephalosporins ( eg , ceftriaxone sodium, cefotaxime sodium) is administered intravenously (IV) Antiviral drugs Dexamethasone ( Decadron ) is administered 15 to 20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days. Antipyretics Dehydration and shock are treated with fluid volume expanders. Seizures, are controlled with Phenytoin.

10. Nursing management Nursing 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.

11. Nursing Diagnoses Hyperthermia related to the infectious process and cerebral edema Ineffective Tissue Perfusion (cerebral) related to infectious process and cerebral edema Acute Pain related to meningeal irritation or nuchal rigidity Impaired Physical Mobility related to prolonged bed rest. Risk for Imbalanced Fluid Volume related to fever and decreased intake Risk for injury related to positive culture in CSF

12. Nursing Interventions Reducing Fever Administer antimicrobial agents on time to maintain optimal blood levels. Monitor temperature frequently or continuously, and administer antipyretics as ordered. Institute other cooling measures, such as a hypothermia blanket, as indicated. Maintaining Fluid Balance Prevent I.V. fluid overload, which may worsen cerebral edema. Monitor intake and output closely. Monitor CVP frequently. Enhancing Cerebral Perfusion Assess LOC, vital signs, and neurologic parameters frequently. Observe for signs and symptoms of ICP ( eg , 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. Notify the health care provider of signs of deterioration: increasing temperature, decreasing LOC, seizure activity, or altered respirations.

13. Reducing Pain Administer analgesics as ordered; monitor for response and adverse reactions. Avoid opioids, which may mask a decreasing LOC. 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.

14. THANK YOU