MENINGITIS

PRESENTER: Zimba A
INTRODUCTION
• In meningitis, the brain and the spinal cord
meninges become inflammed.
• The inflammation may involve all the three
meningeal membranes, that is, the dura
mater, the arachnoid membrane and the
pia mater.
• If diagnosed early and treated, the
prognosis for this disease is usually good.
GENERAL OBJECTIVE
• At the end of this topic, student nurses
should be able to gain knowledge and
demonstrate an understanding of the
management of clients with meningitis.
SPECIFIC OBJECTIVE
• At the end of this lesson, student nurses
should be able to:
1. Define meningitis
2. Mention the causes of meningitis
3. Describe the pathophysiology of
meningitisIdentify the
4. Mode of spread of meningitis
5. State the signs and symptoms of
meningitis
6. Explain the investigations
7. Outline the treatment for meningitis
9. Describe the nursing care of a client with
meningitis
DEFINITION
• Meningitis is the inflammation of the
meninges, the protective membranes that
surround the brain and spinal cord
(Smelzer et al, 2010). OR
• It is the inflammation of the meninges
covering the brain and spinal cord caused
by bacterial, viral or fungi characterized by
fever, neck stiffness, fit and altered level of
consciousness
CLASSIFICATION OF MENINGITIS
A.Bacterial meningitis (Sepitc meningitis)
• Haemophilus influenza
• Neisseria Meningitidis
• Streptococcus Pneumoniae
• Staphylococcus aureus
• Escherichia Coli
• Mycobacterium tubercle
• Klebsiella
• Proteus
• Pseudomonas
• Listeria monocytogen
MODE OF TRANSMISSION
• Airborne droplets or contact with oral
secretions from infected individuals.
• From direct contamination (from a
penetrating skull wound or skull fracture).
• Via the blood stream (Pneumonia,
nasopharynx, sinuses, endocarditic, rotten
tooth Otitis media )
PATHOPHYSIOLOGY
• The organisms usually gain entry to the
CNS through the upper respiratory tract or
blood stream (wounds, fracture of the skull,
brain abscess, otitis media).
• Infection of CSF leads to an inflammatory
response within the meninges.
• Inflammatory response tend to increase
CSF production, with an increase in
intracranial pressure.
• In bacterial meningitis the purulent
secretions quickly spread to other areas of
the brain through CSF.
• Due to an inflammatory process, there will
be cerebral oedema (swelling around dura)
and increased intracranial pressure.
SIGNS AND SYMPTOMS
• Kernig’s signs – with the hip joint flexed,
extension at the knee causes spasm in the
hamstring muscles.
• Opisthotonus – backwards retraction of
head due to meningeal irritation.
• Brudzink’s sign – passive flexion of the
neck causes flexion of the thighs and
knees.
• Fever due to systemic infection.
• Headache due to increased intracranial
pressure as a result of infection of CSF.
• Neck stiffness due to meningeal irritation.
• Photophobia due to damage and irritation
to the optic nerve.
• Vomiting due to autonomic disturbances.
• Confusion due to increased ICP
• Restlessness due to headache and neck
stiffness
• Convulsions due to interruption of normal
cerebral functions.
• Cerebral Hypoxia which result from
reduced blood flow to the brain
DIAGNOSIS
• History will reveal signs and symptoms
suggestive of the disease.
• Physical assessment: Positive Brudzink’s
signs, Positive kernig’s signs and neck
rigidity.
• White blood cell count: indicates
leucocytosis and serum electrolyte levels
often are abnormal.
• Lumber puncture: shows typical cerebral
spinal fluid (CSF) will reveal elevated
cerebral spinal fluid (CSF) pressure, cloudy
or milky white (CSF) high protein level
gram stain and culture that usually
identifies and infecting organism, unless it’s
a virus and depressed glucose
concentration.
• Computed Tomography scan: can rule out
cerebral haematoma, haemorrhage or
tumour.
• Cryptoccoco Antigen Test(CAT) this is a
test which is done to detect cryptoccoco
antigen (capsular material) by culture of
cerebral spinal fluid , sputum and urine in
most cases of CNS or disseminated
diseases.
• Blood slide: to rule out malaria.
TREATMENT
• Respiratory precautions: Patient with N.
Meningitidis, H. Influenzae or in whom the
causative organism is in doubt requires
observation with special respiratory
Isolation for 24hours after initiation of the
appropriate antibiotic therapy.
• Parenteral antibiotics in bacterial
meningitis: The antibiotic must penetrate
the blood-brain barrier into the CSF.
Antibiotics include the following:
• Benzyl penicillin 2 - 4mega units im/iv
qid x 5/7.
• Side effects: diarrhoea, thrombophlebitis,
electrolyte imbalance
• Nursing implications
• Assess for and record any allergies,
symptoms of diarrhoea and abnormal liver
or renal function tests and if present
withhold the drug and report findings to the
doctor.
• Record temperature, pulse, respirations,
blood pressure and hydration status.
• Ampicillin 100mg – 200mg/ kg iv qid x
5/7.
• NOTE: Benzyl penicillin or ampicillin is
usually given with chloramphenicol or
gentamycin.
• Chloramphenicol 50 – 100mg/kg qid x
4/7
• Side effects: bone marrow depression,
aplastic anaemia, Grey Syndrome
characterised by circulatory collapse,
cyanosis, acidosis, abdominal distension,
coma and death.
• Nursing implications
• Do not administer drug to infants.
• Monitor signs related to anaemia and Grey
Syndrome.
• Gentamycin 80mg tid im/iv x 5/7.
• Side effects: nephrotoxicity, auditory or
vestibular ototoxicity, impairment of
neuromuscular transmission and
hypersensitivity reaction.
• Nursing implications
• Assess for any allergies and symptoms of
hearing loss or renal disease, if present
withhold the drug and report the doctor.
• Record TPR and blood pressure and
hydration status.
VIRAL MENINGITIS (ASEPTIC MENINGITIS).
• It is the most common type of meningitis as
compared to bacterial and fungal meningitis
but it is not fatal or deadly.It can resolve on
its own without treatment.
• It usually attacks young and old aged
people.
• Malnourished children, HIV positive and
patients on cytotoxic drugs are predisposed
to this type of meningitis because of their
compromised immunity.
CAUSES/PREDISPOSING FACTORS
• It is commonly caused by Echo
virus,coxsac, enterovirus [intestina],herpes
zoster virus,polio virus,rabies virus,measles
viruse.
TREATMENT
• Treatment in viral meningitis is
symptomatically [it is treated according to
the symptoms manifested].
• The chances of survival and recovery
largely depends on the type of the virus
causing the meningitis.
• Acyclovir for herpes virus can be given
200mg tds for 5 days.
• For headache give analgesia e.g pracetamol
1g tds for 3 days
• Vomiting,give antemetics such as
promethazine 25mg od for 3 days
• For cerebral oedema give manitol an
osmotic diuretic drug,200mg/kg body weights
• To suppress the inflammation, give
Dexamethasone 0.5mg/kg body weight for 4
days.
• NOTE: Viral meningitis is self-limiting
however, there arises a need to put the
patient on antibiotic treatment to prevent
bacterial invasion which would otherwise
thrive in viral infection.
FUNGAL MENINGITIS
• It is the inflammation of the meninges
caused by cryptococcus neoformans
characterised by pyrexia, blurred vision,
irritation of the brain and spinal cord.
PREDISPOSING FATORS
• Cryptococcosis is an opportunistic infection
for HIV/Aids.
• Other conditions that pose an increased
risk in contraction to the infection include:-
• Certain lymphomas, e.g. Hodgkin.
Lymphoma
• Sarcoidosis, liver cirrhosis
• Patients on long – term corticosteroids
therapy.
• People who come in contact with pigeons
dropping(or contaminated with those
droppings.
• Eucalyptus trees, blue gum tree.
First line
• The drug of choice for treatment of fungal
meningitis is Amphotericin B
• Dose: Amphotericin B 0.7 – 1.0 milligrams
per kg body weight per day intravenously
plus flucytosine (5-fc) 100mg/kg body
weight per day orally divided over 4 doses
for 2weeks the maintenance dose
fluconazole 400mg/day for 8weeks.
Second line:
• Amphotericin B 0.7-1mg/kg/day
intravenous plus flu cytosine 100mg/kg
body weight/day per oral divided over 4
doses for 6-10weeks; amphotericin B 0.7-
mg/kg body weight/day/per oral for 6-10
weeks ; fluconazole 400-800mg in day per
oral for 10-12 weeks ;
• Prophylaxis: fluconazole 200mg/kg body
weight until CD4 count goes up to 200 then
stop.
SUPPORTIVE TREATMENT FOR MENINGITIS

• Glucocorticosteroids: Dexamethasone-
High dose therapy to stabilize the cell
membrane and reduce inflammation and
cerebral oedema.
• Osmotic diuretic: Mannitol to reduce
cerebral oedema.
• Diazepam to control seizures.
• Analgesics e.g. paracetamol for headache
and as well as to control fever.
• Limitation of fluid to about 1500ml to keep
patient under hydrated and reduce cerebral
oedema and effects of inappropriate anti
diuretic hormone secretion.
COMPLICATIONS
• DIC (Disseminated Intravascular
Coagulation)
• Hydrocephalus due to adhesions formed
after inflammation causing CSF brockage
• Impaired hearing due to compression of
vestibulocochlear nerve by the inflamed
meninges.
• Mental retardation due to severe
inflammation of the brain tissue
• Encephalitis due to invasion of bacteria in
the brain tissue
• Visual impairment: due to compression of
nerves by the inflamed meninges.
• Brain damage: due to dissemination of the
infection to the brain from the meninges.
• Optic neuritis: due to the infection to the
optic nerve.
• Paralysis: due to nerve damage
• Gangrene due to toxins produced by
bacterias when they enter the blood that kill
healthy tissues.
• Cerebral Oedema; due to some exudate
that can seep away from the blood vessels
• Brain abscess due to presence of the
bacteria
Nursing care
• Objectives
• To relieve anxiety
• To maintain hydration status of patient
• To maintain body temperature within
normal ranges.
• To relieve pain
Environment
• Nurse the patient in a quiet and dim room
to promote rest and decrease photophobia.
Position
• Nurse a patient in coma in the lateral
position to allow postural drainage of
secretions from the mouth.
Observations
• Assess the patient’s clinical status,
neurological function and vital signs.
• Monitor for changes in the level of
consciousness and signs of increased
intracranial pressure, for instance vomiting,
seizures, a change in motor function and
vital signs.
• Also watch for signs of cranial nerve
involvement such as strabismus, diplopia.
Rehydration
• Maintain adequate fluid intake to avoid
dehydration, but avoid fluid overload
because of the danger of cerebral oedema.
• Record intake and out put on a fluid
balance chart.
Medication
• Administer prescribed drugs and note their
effects.
• Watch the adverse reactions of the drugs.
• Relief of pain
• Position the patient carefully to prevent joint
stiffness and neck pain.
• Turn him/her two hourly to prevent
pressure on the pressure points of the
body.
• Relieve headache with a non - narcotic
analgesic, such as aspirin as prescribed.
Nutrition
• Provide patient with small frequent meals
and these can be supplemented by
parenteral feeding.
• If patient is unable to tolarate feeds orally,
insert a ryles (NG) tube for feeding.
• To prevent constipation and minimise the
risk of increased intracranial pressure
resulting from straining at stool, give the
patient a mild laxative or stool softener as
precribed.
Psychological care
• Provide reassurance and support.
• The patient may be frightened by his illness
and frequent lumber punctures.
• If he is delirious or confused, attempt to
reorient him/her often.
• Reassure the family that the delirium and
behaviour changes caused by meningitis
usually disappear.
IEC
• Inform patient and his family of the
contagious risks, and tell them to notify
anyone who comes into close contact with
the patient.
• Such people require antimicrobial
prophylaxis and immediate medical
attention if fever or other signs of
meningitis.
• To help prevent the development of
meningitis, teach patients with chronic
sinusitis or other chronic infections the
importance of proper medical treatment.
SUMMARY

• Meningitis is the acute inflammation of the

meninges which covers the central nervous
system.
• The disease is caused by bacteriae, fungi
and viruses which are spread by
innoculation or droplet infection.
SUMMARY
• The main characteristics of this disease
include headache, fever, irritability,
opthotonus, neck stiffness, difficulties in
feeding and kening’s sign.
• Treatment include the administration of
antibiotics such as benzyl penicillin,
gentamycin or chloramphenicol in bacterial
infection and amphotericin B in fungal
infection.
SUMMARY
• The nursing management of the client
involves the identification of the presenting
problems which are managed accordingly.
• THANK YOU