Meningitis

Adult Health II
Spring, 2009

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
individuals 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.

C.

Strep. pneumoniae
Neisseria
meningitidis

Meningococcal
meningitis occurs in
outbreaks: areas of
Beckyhigh
Werner:population
Developed flu-like illness
In February, 2004. Died within 48 hours.
density.
www.shots4meningitis.com/about.htm
D. Meningococcal
vaccine (Menomune)

*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.
+ Kernigs, + Brudzinskis signs (~ 10%) of cases
Seizures, decreased mental status
Signs of increased intracranial pressure (IICP)

Laboratory /
Diagnostics:
1. Lumbar Puncture:
-CSF for gross appearance,
WBCs, Glucose, pressure
-Gram stain
-Culture & Sensitivity
2. CBC with Dif
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