#3 Infectious and Inflammatory - Meningitis

INFECTIOUS AND INFLAMMATORY
DISORDERS OF THE NERVOUS SYSTEM
Ns. Frengki Apryanto

Medical/Surgical Nursing X:
Neurobehavior
Four neurologic conditions have an

infectious or inflammatory cause:
meningitis , encephalitis, GuillainBarre syndrome, and brain abscess
(Fig. 1)
FIGURE 1. Sites of infectious and inflammatory disorders. (A)

Meningitis, (B) encephalitis, (C) brain abscess, and (D)
GuillainBarre syndrome.
MENINGITIS
MENINGITIS
Meningitis is an inflammation of the
meninges caused by various
infectious microorganisms such as
bacteria, viruses, fungi, or parasites.
Most adults with bacterial meningitis,
the most serious form of meningitis,
recover without permanent
neurologic damage or dysfunction.
Pathophysiology and
Etiology
The most highly contagious
(menular) and potentially lethal
(mematikan) form of meningitis is
caused by either of two bacteria,
meningococci ( Neisseria
meningitidis) and streptococci
( Streptococcus pneumoniae).
Meningococcal meningitis usually

affects school-aged children, young
adults, and immunosuppressed
people.
Viruses such as herpes simplex virus,
mumps virus, and enteroviruses,
which are common intestinal viruses,
can cause viral meningitis, a milder
form of the disease.
The infecting microorganisms

circulate from blood and lymph to
cerebral capillaries or by direct
extension from infected areas such
as the middle ear and the paranasal
sinuses.
When the pathogens arrive in the
cerebral circulation, they travel to
the subarachnoid space of the
meninges where the inflammatory
In virulent cases, cerebral edema and

inappropriate secretion of antidiuretic
hormone (ADH), which increases fluid
volume, cause increased ICP.
Cerebral vasculitis, inflammation of blood
vessels in the brain, may be present, and
cerebral blood flow may be decreased.
The client may develop seizures, a brain
abscess, neurologic changes, irreversible
coma, and death from brain herniation.
Assessment Findings
Signs and Symptoms
Classic symptoms include headache,
fever, nuchal rigidity (pain and
stiffness of the neck, inability to place
the chin on the chest).
Nausea, vomiting, photophobia
(aversion to light), restlessness
(gelisah), irritability, and seizures may
also develop.
Severe irritation of the meninges causes

opisthotonos, an extreme hyperextension
of the head and arching (melengkung) of
the back.
A positive Kernigs sign (inability to
extend the leg when the thigh is flexed on
the abdomen) and a positive
Brudzinskis sign (flexion of the neck
produces flexion of the knees and hips) are
seen (Fig. 2).
FIGURE 2.Signs of meningeal irritation. (A) Nuchal rigidity, (B)

opisthotonos, (C)
Kernigs sign, and (D) Brudzinskis sign
Diagnostic Findings
A lumbar puncture is performed and
samples of CSF are obtained . If the
meningitis is bacterial, the CSF
appears cloudy .
Medical Management
Taking precautions against diseases
and hand hygiene are important in
controlling the spread of infection.
The local public health department is
notified of all cases.
Intravenous (IV) fluids and
antimicrobial therapy are started
immediately when bacterial
meningitis is suspected .
The appropriate anti biotic, usually

penicillin, a cepha losporin, rifampin
(Rifadin), vancomycin (Vancocin), or
chlorampheni col (Chloromycetin).
Anticonvulsants are necessary if seizures
occur.
People who have had recent contact with a
person with meningococcal meningitis are
placed on prophylactic oral rifampin
(Rifadin).
Many colleges and universities now

recommend immunization for
meningococcal meningitis
(Menomune).
Immunization for Haemophilus
influenzae type b (Hib), which is part
of the series of childhood
immunizations.
Nursing Process for the Client with a

Neurologic Infectious or Inflammatory
Disorder
Assessment
Obtain a health history. Because the client
is acutely ill, interview a family member
to obtain information if the client cannot
participate in the data-gathering process.
Measure vital signs and perform a
neurologic examination.
Observe the rate and characteristics of
respirations, and auscultate the lungs
every 4 to 8 hours.
Evaluate the clients abilities to swallow and

clear the airway of secretions.
Provide for intake and output
measurements.
Record bowel elimination to ensure that
constipation does not develop.
Ask the client to indicate the severity of a
headache, when present.
If a seizure occurs, note its duration,
physical manifestations.
Thank you

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INFECTIOUS AND INFLAMMATORY

DISORDERS OF THE NERVOUS SYSTEM

Ns. Frengki Apryanto

Four neurologic conditions have an

FIGURE 1. Sites of infectious and inflammatory disorders. (A)

Meningococcal meningitis usually

The infecting microorganisms

In virulent cases, cerebral edema and

Severe irritation of the meninges causes

FIGURE 2.Signs of meningeal irritation. (A) Nuchal rigidity, (B)

The appropriate anti biotic, usually

Many colleges and universities now

Nursing Process for the Client with a

Evaluate the clients abilities to swallow and

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