MENINGITIS.pptx

medical surgical nursing

1. MENINGITIS KIRAN NAYYAR

2. INTRODUCTION Meningitis is inflammation of the protective membrane covering the brain and spinal cord, known as meninges. It is most common inflammatory of the brain and spinal cord. Inflammation can be caused by bacteria, viruses, fungi and chemicals (contrast media used in diagnostic tests or blood in the subarachnoid space).

3. DEFINITION Meningitis is an  acute   inflammation  of the protective membranes covering the  brain  and  spinal cord , known collectively as the  meninges . Meningitis is the infection and inflammation of the meninges (covering of the brain and spinal cord: dura mater, arachnoid, and pia mater) and the cerebrospinal fluid.

4. ROUTE ENTRY IN CNS Thoroughly overlying skin Up through nose Anatomical defect Congenital- spina bifida Acquired- skull fracture Binding to surface receptors Area of damage

5. ROUTE ENTRY IN CNS

6. ETIOLOGY

7. Pathophysiology

8. BACTERIAL MENINGITIS

9. Consider as a medical emergency. Also known as septic meningitis. Untreated bacterial meningitis has a mortality approaching 100%. The organisms usually gain entry to the CNS through the upper respiratory tract or the blood stream. B ut they may enter by direct extension from penetrating wounds of the skull.

10. CAUSATIVE AGENTS

11. CLINICAL MANIFESTATION Fever Headache Neck stiffness Nausea/vomiting A positive Kernig’s sign A positive Brudzinski’s sign Photophobia Decreased LOC Sign of increased ICP may also be present Change in mental status, such as disorientation, restlessness and mental confusion Headache. Blurred vision. Confusion. High blood pressure. Shallow breathing. Vomiting. Changes in the behaviour. Weakness or problems with moving or talking.

12. DIAGNOSTIC EVALUATION Blood culture Lumber puncture with analysis of the CSF. Variation in the CSF depends on the causative organism. Protein level in the CSF is usually elevate and in higher in bacterial than viral meningitis. CSF glucose concentration is commonly decreased in bacterial meningitis. Specimen of the CSF, sputum and nasopharyngeal secretion are taken for culture before start of antibiotics therapy to identify the causative organism A gram stain is done to detect the bacteria. X-ray of the skull may demonstrate infected sinuses. CT scan MRI

13. COLLABARATIVE CARE History Physical examination Bed rest IV fluids Antibiotics IV Cephalosporin (ceftriaxone) Codeine for headache Dexamethasone Acetaminophen or aspirin for temperature above 100.4 o F Hypothermia Clear liquid as desired or tolerated Phenytoin IV Mannitol IV for diuresis

14. Viral meningitis usually begins with symptoms of a viral infection such as fever, a general feeling of illness, headache, and muscle aches. Later, people develop a headache and a stiff neck that makes lowering the chin to the chest difficult or impossible. Doctors suspect viral meningitis based on symptoms and do a spinal tap (lumbar puncture) to confirm the diagnosis. If people appear very ill, they are treated for bacterial meningitis until that diagnosis is ruled out. If the cause is human immunodeficiency virus (HIV) or a herpesvirus, drugs effective against those viruses are used. Also known as aseptic meningitis. More common than bacterial form and usually less serious. Less likely to have permanent brain damage after the infection resolves. Most patients recover completely on their own.

15. FUNGAL MENINGITIs

16. It is much less common than the infections. It is rare in healthy people but is more likely in person who have impaired immune system .

17. TUBERCULAR MENINGITIS

18. Tuberculous Meningitis (TBM) is a form of meningitis characterized by inflammation of the membranes (meninges) around the brain or spinal cord and caused by a specific bacterium known as Mycobacterium tuberculosis. In TBM, the disorder develops gradually . TB meningitis is caused by Mycobacterium tuberculi . Infection with this bacterium begins usually in the lungs. 1-2 % of cases the bacteria travel via the bloodstream. Unlike other type of meningitis its progresses very slowly and symptoms are vague.

19. CLINICAL MANIFESATION Fever Headache Irritability Drowsiness Malaise Seizures Positive kernig and Brudzinski signs

20. CSF FINDING

21. Complications

22. Management

23. Medical management

24. Third generation cephalosporins such as cefotaxime or ceftriaxone Vancomycin is added in the regime in case of resistance. Dexamethasone Dehydration and shock can be treated with fluid therapy. Phenytoin for seizure management. Bacterial meningitis

25. There is no specific treatment for viral meningitis. Most patients completely recover on their own within 7 to 10 days. It includes bed rest, plenty of fluids, good nutrition and over the counter pain medications to help reduce fever and relieve body ache. Seizure prophylaxis: Lorazepam or phenytoin or barbiturate. Increased ICP: injection Mannitol 1g/kg followed by 0.25-0.5g/kg. Adequate hydration is to be maintained. Antipyretics Antiemetics Viral meningitis

26. Intravenous therapy with amphotericin B is the most common treatment. It is often combined with an oral antifungal medicine called 5-flucytosine. Another oral drug, fluconazole, in high doses may also be effective. Fungal meningitis

27. NURSING MANAGEMENT Management resolves around prevention of dehydration, electrolyte imbalance, edema and fever. Rapid I/V fluid replacement may be prescribed but care to be taken not to over hydrate the patient because of risk for cerebral edema. Body weight, serum electrolyte and urine volume are closely monitored. Arterial pressure is monitored to assess cardiac or respiratory failure and risk of shock. Oxygen may be needed to maintain arterial pressure of oxygen. Assess patient’s neurologic status Constantly monitor vital sign.

28. ADMINISTER I/V FLUIDS Antibiotics should be started immediately. Corticosteroids should be used in sickness. Drug therapy continued after acute phase of illness is over. Record input/output carefully and observe for signs of dehydration.

29. MONITOR VITAL SIGNS AND NEUROLOGICAL STATUS Level of consciousness is assessed using Glasgow coma scale (GCS) Monitor rectal temperature every 4 hourly.

30. PROVIDE BASIC PATIENT CARE The patient level of consciousness will indicate whether patient requires only assistance with activities of daily living. Maintain dim light to prevent photophobic discomfort.

31. PREVENTION Close relatives of patient should be observed for fever and other sign and symptoms of meningitis. They are provided antimicrobial medication. E.g. Rifamipicin Vaccines are available which are given to the contact groups specially to the travelers, medical professionals, military persons etc

32. NURSING DIAGNOSIS 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 .

33. 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

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

35. 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.

36. 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.

37. 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 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

38. 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

39. EVALUATION Expected patient outcomes include: Avoidance of injury. Avoidance of infection. Restoration of normal cognitive functions. Prevention of complications.

40. DISCHARGE AND HOME CARE GUIDELINES After hospitalization, the patient at home should: Activities . Alternate rest and activity to conserve energy. Diet.  Consume safe, clean, and healthy foods. Asepsis . Promote simple infection control procedures at home. Infectious process.  Identify signs and symptoms of an infectious process and report to the physician promptly.

41. RECAPULIZATION

42. ASSISGNMENT

43. BIBLIOGRAPHY Chintamani; Lewis’s A text book of Medical Surgical Nursing; Edition- Seventh; Published by: Elsevier; Page no.- 674- 681. Brunner & Suddarth , ‟textbook of Medical-Surgical Nursing”, Published by Janice L. Hinkle and Kerry H. Cleever , 13th Edition, Volume 2; Page no.-1164-1169. Basavanthappa Bt ; Medical Surgical Nursing; Edition-2009 ; Published by: CBS brothers; Page no.- 463-454. Javed Ansari, Davinder Kaur, a test book of Medical Surgical Nursing-II second edition, pee vee publisher. Page no.- 339-343. https://nurseslabs.com/meningitis/ https://www.thoughtco.com/brain-anatomy-meninges-4018883 https://www.msdmanuals.com/en-in/home/brain,-spinal-cord,-and-nerve-disorders/meningitis/viral-meningitis https://www.cdc.gov/meningitis/fungal.html https://www.slideshare.net/ManojPrabhakar61/tb-meningitis-81523602 https://www.slideshare.net/Maheshkumar1029/meningitis-71600507 https://www.slideshare.net/MigronRubin/meningitis-203932138