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Is an inflammation of the meninges (membranes surrounding the brain and spinal cord).
Types of meningitis include aseptic, septic, and tuberculous. The aseptic form may be
viral or secondary to lymphoma, leukemia, or brain abscess. The septic form is caused
by bacteria such as Neisseria Meningitidis.
Pathophysiology
The causative organism enters the bloodstream, crosses the blood-brain barrier, and
triggers an inflammatory reaction in the meninges. Independent of the causative agent,
inflammation of the subarachnoid and pia mater occurs. Increased intracranial pressure
(ICP) results.meningeal infections generally originate in one of two ways: either through
the bloodstream from other infections (cellulitis) or by direct extension (after a traumatic
injury to the facial bones). In a few cases, the cause is iatrogenic or secondary to
invasive procedures (lumbar puncture) or devices (ICP monitoring devices) or to
opportunistic infections, such as acquired immunodeficiency sundrome (AIDS) or Lyme
disease.
Bacterial meningitis is the most significant form. The common bacterial pathogens are N.
meningitidis (meningococcal meningitis), Streptoccocus pneumonia (in adults), and
Haemophilus influenza (in children and young adults). These three organisms account
for about 75% of the cases. Mode of transmission is direct contact, including droplets
and discharges from the nose and throat of carriers or infected people. Bacterial
meningitis starts as an infection of the oropharynx and is followed by septicemia, which
extends to the meninges of the brain and upper region of the spinal cord.
Severe headache and fever are frequently initial symptoms; these symptoms result from
infection and increased ICP. Additional manifestations include changes in level of
consciousness and disorientation and memory impairment early in the illness. Lethargy,
unresponsiveness, and coma may develop as the illness progresses. Signs of
meningeal irritation include the following:
• Positive kernig’s sign: whenlying with thigh flexed on abdomen, patient cannot
completely extend leg
• Positive brudzinski’s sign: flexing patient’s neck produces flexion of the knees
and hips; passive flexion of lower extremity of one side produces similar
movement for opposite extremity.
• Rash (N. meningitidis):ranges from petechial rash with purpuric lesions to large
areas of ecchymosis
Clinical Manifestations of Meningococcal Meningitis
Ten percent of patients present with a fulminating infection, with signs of overwhelming
septicemia.
• In AIDS patients there are few if any symptoms because of the blunted
inflammatory response
Infecting organisms are usually identified through culture and Gram staining of
cerebrospinal fluid and blood (polysaccharide antigens support a diagnosis of bacterial
meningitis).
Prevention
People who have close contact with patients should be considered candidates for
antimicrobial prophylaxis (rifampin). Close contacts of patients should be observed and
examined immediately if ever or other signs and symptoms of meningitis developed.
Medical Management
Pharmacologic therapy
Prognosis depends largely on the supportive care provided. Related nursing intervention
include the following:
• Monitor vital signs constantly. Determine oxygenation from atrial blood gas
values and oximetry.
• Monitor central venous pressure (CVP) for in patient shock, which proceeds
cardiac or respiratory failure
• Reduce high fever to decreased load on heart and brain from oxygen demands
• Rapid intravenous fluid replacement maybe prescribed, but take care not to
overhydrate patient because of risk of cerebral edema
• Assess clinical status continuously; evaluate skin and oral hygiene; promote
comfort; and protect patient during seizures and while comatose
• Inform family about patient’s condition and permit family to see patient at
appropriate intervals.
MENINGITIS
BSN4J-J3
Clinical Instructor:
Ms. Gonzales