Meningitis[1]

Meningitis
STUDENT : ‫ عبد الهادي محمد عيسى‬.

Out line :
• What is meningitis ?
• Etiology
• Causes of it .
• Pathophysiology
• Signs and symptoms
• Complication
• Who is most common to get
meningitis?
• Diagnosis
• Treatment
• Management
Meningitis is ?
 In meningitis, the brain and the spinal cord meninges

become inflamed. Such inflammation may involve all
three meningeal membranes—the dura mater, the
arachnoid membrane, and the pia mater. It is a
devastating disease and remains a major public health
challenge.
 The disease can be caused by many different
pathogens including bacteria, fungi or viruses.

Meninges divide for 3 layers :
 .inner layer: the pia mater.

 The middle layer: the arachnoid.
 3.The outer layer: the dura mater.
Etiology & types of meningitis:
 1.Infection:
 A bacterial (The most common cause.) Bacterial meningitis
Bacteria that enter the bloodstream and travel to the brain and spinal cord
cause bacterial meningitis. But bacterial meningitis also can occur when
bacteria directly invade the meninges
B viral Viral meningitis is usually mild and often clears on its own. Most cases
in the United States are caused by a group of viruses known as enteroviruses.
They're most common in late summer and early fall. Viruses such as herpes
simplex virus, HIV, and others also can cause viral meningitis.
or C fungi infection of the fluid surrounding the brain and spinal cord. It may
mimic acute bacterial meningitis. It's often contracted by breathing in fungal
spores that may be found in soil, decaying wood and bird droppings.
 2.Non-infectious processes
 (autoimmune disorders such as cancer).
Pathophysiology :
 Meningitis is an infection of the meninges, the membranes that
protect the spinal cord and the brain.
 When the meninges become infected, they start to swell, putting
pressure on the spinal cord or brain and causing life-threatening
complications. Meningitis is called an acute condition because
symptoms strike quickly and suddenly.
Who is most common to get
meningitis?
Anyone can potentially get meningitis, but it's more common in:
1- Babies and young children:
Babies, especially those under two months of age (Because their immune systems are
not well developed, the bacteria can get into the bloodstream more easily.)
Children with recurrent sinus infections
Children with recent serious head injuries and skull fractures
Children who have just had brain surgery
2.teenagers and young adults
3.older people
4.people with a weak immune system – for example,
those with HIV and those having chemotherapy
Signs and symptoms:
 1.Stiff neck( less common in young children)

 2. Severe headache.
 3.Limb-Joint-Muscle pain.
 4.Stomach pain:
 5.Diarrhea.
 6.Pale or mottled skin.
 7.Breathing fast(Tachycardiac).
 8.Rash (anywhere on the body).
 9. Sensitivity to light. ( photophobia)
 10. Kernig's and Brudzinski's sign
 To elicit the Kernig's sign[3]
 Step 1. The patient is positioned in supine with hip and knee

flexed to 90 degrees
 Step 2. The knee is then slowly extended by the examiner

(Repeat on both legs)
 Step 3. Resistance or pain and the inability to extend the

patient's knee beyond 135 degrees, because of pain, bilaterally
indicates a positive Kernig's sign
Complication
 Depending on the cause and severity of the illness, potential complications
of meningitis include:
 visual impairment,
 irritability,
 optic neuritis,
 cranial nerve palsies,
 deafness,
 personality change,
 headache,
 paresis or paralysis,
 endocarditis,
 coma,
Meningitis is usually a non-contagious disease.
 People spread meningococcal bacteria to other people by sharing
respiratory and throat secretions (saliva or spit). Generally, it
takes close (for example, coughing) or lengthy contact to spread
these bacteria.
 Viral meningitis is contagious. It's spread through direct contact
with body fluids, including mucus, feces, and saliva.
Diagnosis
• Lumbar puncture shows typical cerebrospinal fluid (CSF). findings
associated with meningitis (elevated CSF pressure, cloudy or milky
white CSF, high protein level, positive Gram stain and culture that
usually identifies the infecting organism [unless it's a virus] and
depressed CSF glucose concentration).
• Chest X-rays
• White blood cell count usually indicates leukocytosis, and serum

electrolyte levels often are abnormal.
• Serum C-reactive protein levels may also help differentiate

between viral and gram-negative bacterial meningitis.
Treatment
_ Meningitis is fatal in up to half of patients, when left untreated,

and should always be viewed as a medical emergency. Admission to
a hospital or health centre is necessary. Isolation of the patient is
not usually advised after 24 hours of treatment.
 Medical management of meningitis includes appropriate
antibiotic therapy and vigorous supportive care.
 Usually, I.V. antibiotics are given for at least 2 weeks, followed by

oral antibiotics. Such antibiotics include penicillin G, ampicillin, or
nafcillin
 However, if the patient is allergic to penicillin, anti-infective
therapy includes tetracycline, chloramphenicol, or kanamycin.
 Other drugs include a cardiac glycoside (such as digoxin) to

control arrhythmias, mannitol to decrease cerebral edema, an
anticonvulsant (usually given I.V.) or a sedative to reduce
restlessness, and aspirin or acetaminophen to relieve headache
and fever.
 Supportive measures consist of bed rest, hypothermia, and fluid
therapy to prevent dehydration. Isolation is necessary if nasal
cultures are positive. Treatment includes appropriate therapy for
any coexisting conditions, such as endocarditis or pneumonia.
Management:
 Continually assess the patient's clinical status, including
neurological function and vital signs.
 • Monitor for changes in LOC and signs of increased ICP

(vomiting, seizures, and changes in motor function and vital
signs).
 • Also watch for signs of cranial nerve involvement (ptosis,

strabismus, and diplopia).
 Monitor arterial blood gas measurements as ordered.(Blood gas
analyzers measure CSF-lactate)
 • Assess the patient's fluid volume.
 • Measure and record central venous pressure, and document

intake and output accurately.
 • Monitor for desired and adverse effects of prescribed

medications.
Meningitis Nursing Care Plans
 Diagnosos: Acute pain related to Increased intracranial pressure manifested
by irritability.
 Short term goal:The child will express feelings of comfort and relief of pain.
 Nursing Interventions and Rationale:
 1-Maintain a quiet environment and keep child’s room darkened.
Darkening the room may decrease photophobia.
2-Turn the client often and position the client carefully.
Promotes comfort and reduce irritation and agitation.
3- Administer antibiotic and corticosteroid as prescribed.
Antibiotic and corticosteroid therapy are used to reduce the inflammation and
therefore decrease pain.
Evaluation : child feel more comfortable so the goal was met .

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Meningitis

STUDENT : ‫ عبد الهادي محمد عيسى‬.

 In meningitis, the brain and the spinal cord meninges

 .inner layer: the pia mater.

 1.Stiff neck( less common in young children)

 Step 1. The patient is positioned in supine with hip and knee

 Step 2. The knee is then slowly extended by the examiner

 Step 3. Resistance or pain and the inability to extend the

• White blood cell count usually indicates leukocytosis, and serum

• Serum C-reactive protein levels may also help differentiate

_ Meningitis is fatal in up to half of patients, when left untreated,

 Usually, I.V. antibiotics are given for at least 2 weeks, followed by

 Other drugs include a cardiac glycoside (such as digoxin) to

 • Monitor for changes in LOC and signs of increased ICP

 • Also watch for signs of cranial nerve involvement (ptosis,

 • Assess the patient's fluid volume.

 • Measure and record central venous pressure, and document

 • Monitor for desired and adverse effects of prescribed

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