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Adult Health II
Neurological Diseases
Meningitis
Adult Health II
Summer 2010
Jerry Carley MSN, RN, CNE
University of Southern Nevada
NURSE
Defined:
…an inflammation of the
arachnoid and pia mater of
the brain and spinal cord and
cerbrospinal fluid (CSF).
Three Major Categories:
I.
Viral
II. Fungal
III. Bacterial
I. Viral Meningitis
A. The most commonly
encountered form of
meningitis.
B. Sequela to viral illnesses
such as measles, mumps,
herpes simplex, herpes
zoster.
C. Fever, photophobia,
headache, myalgias,
nausea.
D. Treatment is symptomatic.
II. Fungal Meningitis
A. Typically seen in
immunosuppressed
individuals, usually HIV
B. Cryptococcus neoformans
is the usual culprit.
C. Clinical presentation
varies, depending upon
how intact the
individual’s immune
system is. Headache,
nausea, decreased
mental status.
D. Treatment: Symptomatic;
IV antifungals.
Cryptococcus neoformans
III. Bacterial Meningitis
A. MEDICAL EMERGENCY
MORTALITY RATE ~ 25%
USA Cases: ~ 17,500 / year
B.
Strep. pneumoniae
Neisseria meningitidis
C.
Meningococcal meningitis
occurs in outbreaks: areas of
high population density.
Meningococcal vaccine
(Menomune)
D.
Becky Werner: Developed flu-like illness
In February, 2004. Died within 48 hours.
www.shots4meningitis.com/about.htm
*With Symptoms of Meningitis,
always assume the worst, and
treat for meningococcal
meningitis immediately.
*If you wait for the culture
results, and they show / grow
meningococcal meningitis or
other bacterial meningitis, it is
already too late!
Physical Assessment:
Signs of meningeal Irritation / Inflammation: headache, nausea, vomiting,
fever. Photophobia.
Nuchal rigidity.
+ Kernig’s, + Brudzinski’s signs (~ 10%) of cases
Seizures, decreased mental status
Signs of increased intracranial pressure (IICP)
Laboratory / Diagnostics:
1. Lumbar Puncture:
-CSF for gross appearance,
WBC’s, Glucose, pressure
-Gram stain
-Culture & Sensitivity
2. CBC with Diff
3. Blood cultures
4. CT or MRI
Nursing Care:
1. Monitor Neurologic Status
(“Neuro Checks”)
**Particular attention to
cranial nerves, especially
CN III, IV, VI,& VIII
2. Observing for signs &
symptoms of Increased
intracranial pressure
3. Seizure precautions
4. Septic shock & DIC
Medications:
Broad-spectrum antibiotic,
changed to appropriate
one after gram-stain and
C&S.
Others symptomatic
Patient Care, Client with Meningitis
-Vital signs at least q2-4 hours.
-Neuro checks, particularly Cranial Nerves, especially
CH III, IV, VI, VII, & VIII
-Pain management
-I&O
-Decrease environmental stimuli
-Bedrest, HOB elevated 30*
-Isolation precautions
-Prevent Complications:
IICP
Vascular dysfunction
F & E Imbalance
Seizures
Shock
Incidence of
Meningococcal
Meningitis
500 cases per 100,000 people annually
46 cases per 100,00 people annually
3 cases per 100,000 people annually
Incidence of
meningococcal
meningitis