Transcript Meningitis
Meningitis - What Every Teen Needs to Know Stacy A. Morehead, RN, BSN Whitney Benson, RN, BSN Good Samaritan Hospital Objective • Upon completion of this lecture, participants will be able to : – Describe the meningitis disease process – Define causes, manifestations, and medical care – Explain preventative measures. 4/12/2016 2 Meningitis • Definition: an inflammation of the meninges, the protective membrane that surround the brain and spinal cord. 4/12/2016 3 Meninges • Dura • Arachnoid • Pia http://www.nlm.nih.gov/medlineplus/ency/imagepages/19080.htm Dura • Thick non-elastic structure • Lines the inside of the skull and the vertebral column • Blood supply – External carotid artery – Middle meningeal artery • Falx Cerebri • Tentorium Cerebelli Arachnoid • Arachnoid Villi – Responsible for reabsorption of CSF – Transfer of CSF to venous system Pia Mater • Thin, transparent membrane adherent to the surface of the brain Subtypes • Aseptic: the cause is viral or due to lymphoma, leukemia, or brain abscess • Septic: caused by bacteria – Streptococcus pneumoniae = pneumococcal meningitis – Neisseria meningitidis = meningococcal meningitis – Haemophilus influenzae = Hib meningitis Causes – Through the bloodstream as a consequence of other infections: • Otitis Media & mastoiditis • Infected shunt • Recent dental surgery – Traumatic injury to the facial bones – Secondary to invasive procedures • Contaminated lumbar puncture 4/12/2016 9 Bacterial Meningitis • Peak incidence is in winter and early spring • Who is at higher risk? • Populations in dense community groups ie: college campuses and military • Tobacco users • Viral upper respiratory infections • Immune system deficiencies – AIDS – Lyme Disease – Organ transplantation 4/12/2016 10 Signs and Symptoms Classic Triad – Headache – Fever – Nuchal rigidity (stiff neck) Nausea/ vomiting Photophobia Rash Disorientation and memory impairment Behavioral changes Seizures and increased ICP 4/12/2016 11 Signs and Symptoms (continued) 4/12/2016 12 Diagnostic Testing • Lumbar puncture • CSF studies: cell count, protein and glucose levels, culture, cytological analysis, and Gram’s staining • Cultures: blood, sputum, nasopharyngeal specimen, rash aspirate • Hematology: chemistry and coagulation panels • Serology (antigen tests) • CT of head • Chest & sinus Xray • EEG 4/12/2016 13 CT Scan • Head CT demonstrates enlargement of the temporal horns indicating increased intracranial pressure. • Small intracerebral hemorrhage foci on the right temporal lobe • The effect of increased intracranial pressure on the EEG • An electroencephalogram (EEG) study is sometimes useful to document irritable electrical patterns that may predispose the patient to seizures. Lumbar Puncture • Involves the introduction of a hollow needle with a stylet onto the lumbar subarachnoid space of the spinal canal using strict aseptic technique. – Adult landmarks L3-L4 or L4L5 4/12/2016 • Therapeutic indications – Spinal anesthesia – Intrathecal injection – Removal of CSF to reduce pressure • Diagnostic indications – Measurement of CSF pressures – Collection of sample for cytologic, chemical, and bacterial examination – Evaluation of spinal dynamics for signs of blockage of CSF flow – Injection of radiopaque media for visualization of parts of the nervous system 16 • Help the patient lay on their side along the edge of the bed, arching the back so that the knees are flexed on the chest with the chin touching the knees. • The lumbar site is prepared, draped, and locally anesthetized. • The needle is introduced into the appropriate subarachnoid space, the stylet is removed, and a manometer is affixed to measure and record opening pressures. • The manometer is removed and samples of CSF are collected into sterile test tubes for visual and laboratory examination. • When the procedure is completed, the needle is removed, and a Band-Aid is applied directly over the puncture site. • Tubes are labeled according to draw order and promptly hand delivered to lab. 4/12/2016 17 • Post procedural care – Have patient lay flat in bed for 6-8 hours – Monitor neurological and vital signs frequently – Encourage fluids – Administer pain medications as needed – Monitor puncture site – Notify physician of severe headache, voiding problems, nuchal rigidity, rise in temperature, or back spasms 4/12/2016 18 CSF Values Diagnostic for Meningitis Parameter Normal CSF Bacterial Meningitis Viral Meningitis Culture Negative Positive Color Straw colored Cloudy, purulent Leukocyte count (wbc/mm3) 0-5 Increased 1000-5000 Increased 50-1000 Protein (mg/dL) 18-45 Elevated 100-500 Normal or Elevated <200 Glucose (ml/dL) 45-80; 0.6 times blood glucose level 5-40; low levels >45 normal 4/12/2016 negative 19 Nursing Management • • • • Vital signs, Intake/Output Advanced neurological assessment, GCS Monitoring of lab values Protect patient from injury secondary to seizure of altered level of consciousness • Isolation precautions – Droplet precautions • Administration of antibiotics, IV fluids, corticosteroids, and antiepileptic medications 4/12/2016 20 Medical Treatment • Bacterial – Broad spectrum antibiotics until organism is identified – Corticosteroids may be used for inflammation – Consultation with infectious disease, neurosurgery • Viral – Antiviral drugs (Acylcovir) – May resolve without specific treatment – Supportive therapy Outcomes • Most patients with meningococcal meningitis recover completely if appropriate antibiotic therapy is instituted promptly. • The prognosis for meningococcal meningitis is fair if the patient does not have focal neurologic deficits and is not stuporous or comatose. • The prognosis for meningococcal disease is poor when the infection has a septicemic component. Potential Complications • • • • • Hearing or vision loss Seizures Brain Abscess Hydrocephalus Respiratory complications • Weight loss, nausea, fatigue Prevention • Vaccination • Antimicrobial chemoprophylaxis should be given to anyone in close contact with patients diagnosed with meningococcal meningitis 4/12/2016 24 Case Study • Drey Mingo – – – – – – Hometown: Atlanta, GA Co-Captain Senior at Purdue Position: Forward Height: 6’2” Named third team All-Big Ten by coaches – Set school season record for three-point field goal percentage – Named to the Preseason WNIT All-Tournament Team Case Study Update • I didn’t know just how bad I was until afterwards. I don’t think people wanted to freak me out because I was still kind of fragile in that moment in time… It’s crazy how bad things could have been and just where I am now, I am so thankful.” • “Knowing that I can’t hear as well as them, I think that will be a definite challenge. I actually recently went to the doctor and from my first hearing test – I just had a recent hearing testmy hearing has improved more than they thought. They just didn’t think that it would get any better at all.” References • FDA Approves New Meningitis Vaccine • Yael Waknine February 23, 2010 Medscape Medical News © 2010 Medscape, LLC http://www.medscape.com/viewarticle/717441 • Meningococcal Meningitis Author: Francisco de Assis Aquino Gondim, MD, MSc, PhD; Chief Editor: Karen L Roos, MD http://emedicine.medscape.com/article/1165557-overview Copyright © 1994-2011 by WebMD LLC. • Cuevas LE, Hart CA. Chemoprophylaxis of bacterial meningitis. J Antimicrob Chemother. Feb 1993;31 Suppl B:79-91. • Bader, Mary Kay, & Littlejohns, L.R. (2004). AANN Core Curriculum for Neuroscience Nursing. Fourth edition. Glenview , IL : American Association of Neuroscience Nursing.