December 22, 2016

NURLIA

December 22, 2016

NURLIA

PENGERTIAN
MENINGITIS adalah Infeksi akut pada selaput
meningen ( selaput yang menutupi otak dan
medulla spinalis )
MENINGITIS adalah radang pada meningen
( membran yang mengelilingi otak dan medula
spinalis).
PENYEBAB
Bakteri : pneumococcus,
meningococcus,stapilococcus,streptococcus,
salmonela dll.
Virus : hemofilus influenza & herpes simplek
jamur
December 22, 2016

NURLIA

December 22, 2016

NURLIA

Klasifikasi
Asepsis
meningitis virus, yg
menyebabkan iritasi meningen ( abses
otak,ensefalitis,limfoma,leukemia, a/ darah
diruang subarakhnoid)
Sepsis
m. bakteria.
Tuberkulosa
basilus tuberkel

December 22, 2016

NURLIA

Mikroorganisme masuk melalui

Hematogen dan atau limfatik

Perkontuinitatum
Retrograd melalui syaraf perifer
Langsung masuk LCS

Faktor Predisposisi :
Luka/fraktur terbuka pd kepala
Infeksi pd telinga
Radang paru
Pembedahan otak & spinal
Sepsis
Lumbal punksi & anestesi lumbal
December 22, 2016

NURLIA

Patofisiologi
Masuknya MO ke SSP
Dgn bebgai cara

Invasi bakteri pd
meningen

Netropil

subaracnaoid

Eksudat
December 22, 2016

Peradangan

hidrosefalus

peningkatan TIK
NURLIA

 Caused by virus.

Less severe
Resolves without specific
treatment within a week or two
Also called as aseptic meningitis
Eg : Enteroviruses
(family of viruses)

Caused by bacteria
Quite severe and may
result in
a) brain damage
b) hearing loss
c) learning disability
It would also causes
death!

For bacterial meningitis, it is also important to know

which type of bacteria is causing the meningitis
because antibiotics can prevent some types from
Decemberspreading
22, 2016
NURLIA
and infecting
other people.

Meningitis bakteria
Adalah meningitis yg disebabkan oleh bakter. Bakteri
msk ke ssp mlli hematogen a/ langsung dari luar
( fr/luka terbuka)
Faktor predisposisi :

Trauma kepala
Infeksi sistemik/sepsis
Infeksi post pembedahan
Penyakit sistemik

Reaksi peradangan yg terjadi :

Bendungan LCS
Penumpukan eksudat
Perubahan arteri pd subaraknoid, pembesaran PD, ruftur &
trombosis.
Perubahan
jaringan sekitarnya
December
22, 2016
NURLIA ( edema )
9

 Haemophilus Influenzae type b (Hib)

Meningococcus

December 22, 2016

Pneumococcus
NURLIA

10

Meningococcus
common organisms that cause meningitis
in children.
caused by bacteria called Neisseria
meningitidis.
There are several strains of Neisseria
meningitidis.
Strain B causes about 75 percent of the
meningococcal cases and has the highest
fatality rate.
December 22, 2016

NURLIA

11

Haemophilus Influenzae type B

(Hib)
is caused by haemophilus bacteria. It was
once the most common form of bacterial
meningitis,
one of the deadliest childhood diseases.

December 22, 2016

NURLIA

12

Pneumococcus
is caused by pneumococcus bacteria,
which also cause several diseases of the
respiratory system, including pneumonia.
It has a fatality rate of about 20 percent.
It also results in a higher incidence of
brain damage than other forms of the
disease.
December 22, 2016

NURLIA

13

December 22, 2016

NURLIA

14

Manifestasi klinik

Nyeri kepala
Panas,
Mual muntah
Nyeri belakang kepala
Kejang umum
Keadaan lanjut

kaku kuduk ( nuchal rigidity)

Brudzinski +
Kernig +
December 22, 2016

NURLIA

15

Symptoms of meningitis
Fever
Altered consciousness, irritability,
photophobia
Vomiting, poor appetite
Seizures 20 - 30%
Bulging fontanel 30%
Stiff neck or nuchal rigidity
Meningismus (stiff neck + Brudzinski +
Kernig signs)
December 22, 2016

NURLIA

16

Symptoms

Symptoms of meningitis can come on very quickly or take a couple of days to

appear. Most cases of meningitis occur in the first 5 years of life,
life with the peak
incidence
3 and 5 months ofNURLIA
age.
December 22,between
2016
17

Clinical signs of meningeal

irritation

December 22, 2016

NURLIA

18

Diagnosis lumbar puncture

Contraindications:
Respiratory distress (positioning)
ICP reported to increase risk of herniation
Cellulitis at area of tap
Bleeding disorder
December 22, 2016

NURLIA

19

CSF evaluation
Condition

Normal

WBC
<7,
lymphs
mainly

Protein Glucose
(mg/dL) (mg/dL)
5-45

Bacterial, 100 60K

100-500
acute
PMNs
Bacterial,
1 10,000 100+
part rxd
December 22, 2016

NURLIA

>50
Low
Low to
normal
20

CSF Gram stain

Hemophilus influenza
(H flu)

December 22, 2016

NURLIA

Strep pneumoniae

21

Tanda LCS pd H. Influenzae

Adanya peningkatan tekanan CSF
Peningkatan kadar Protein >100mg/dl
Menurunya glukosa CSF
Meningkatnya sel darah putih
Pada tuberkulosa :
Warna : jernih atau santokrome
Sel : jumlah meningkat
Protein : meningkat
Glukosa : menurun
Terdapat kuman tuberkulosa
December 22, 2016

NURLIA

22

Pneumococcal meningitis

December 22, 2016

NURLIA

23

Meningitis virus
Masuk melalui sist, respirasi, mulut,
genetalia, atau melalui gigitan binatang.
Jenis penyakit

Measles, mumps, herpes simplex, & herpes

Zoster.
Manifestasi klinis : nyeri kepala, nyeri
sekitar muka & mata, photofobia, & adanya
kaku kuduk, kelemahan,rash, nyeri
ekstremitas,
December 22, 2016

NURLIA

24

Meningococcemia - Petechiae

December 22, 2016

NURLIA

25

Meningococcemia - Purpura
fulminans

December 22, 2016

NURLIA

26

TB meningitis
Children 6 months 6 years
Local microscopic granulomas on
meninges
Meningitis may present weeks to
months after primary pulmonary
process
CSF:
Profoundly low glucose
High protein
Acid-fast bacteria (AFB stain)
PCR

Steroids + antimicrobials
December 22, 2016

NURLIA

27

Test diagnostik
Laboratorium :
Darah SDP ( 10.000 40.000/mm3)
Kultur adanya mikroorganisme patogen

Urine : albumin, SDM,SDP dlm urine.

Radiografi : u/ menentukan sumber infeksi
( rontgen, scan otak )
Lumbal punksi

December 22, 2016

NURLIA

28

Karakteristik cairan serebrospinalis

pd meningitis
Karakteristik

Normal

Meningitis
Bakteri

Tekanan
Warna
Leukosit
Tipe sel
Protein
glukosA
Kultur
December 22, 2016

80 100
mmH20
Bening
0-8/mm3
15-45mg
45 -75/100
Negatif

virus

200 500

Normal/
Keruh/purulen Bening
500-10.000
Neutropil
Meningkat
Menurun

10 500
Limposit
Meningkat
Normal

Positif bakteri

Negatif
bakteri

NURLIA

29

Complications of Meningitis
One of the most common
problems resulting from
meningitis is hearing loss.
Anyone who has had meningitis
should take a hearing test.

Young children:
1. Babyish behavior
2. Forgetting recently
learned skills
3. Reverting to bed-wetting
December 22, 4.
2016 Babyish behavior
NURLIA

30

 Older people:
1. Lethargy
2. Recurring headaches
3. Difficulty in concentration
4. Short-term memory loss
5. Clumsiness
6. Balance problems
7. Depression

December 22, 2016

NURLIA

31

Serious complications

Other serious
complications can
include:

1. Brain damage
1. Epilepsy
2. Changes in eye
sight
December 22, 2016

NURLIA

32

Komplikasi

Peningkatan TIK
Hydrosefalus
Infark serebral
Defisit saraf kranial
Ensefalitis
Syndrome of in appropriate secretion of
antidiuretic hormon ( SIADH)
Abses otak
Kerusakan visual
Defisit intelektual
Kejang
Endokarditis
Pnemonia
December 22, 2016

NURLIA

33

December 22, 2016

NURLIA

34

Yup! It can!
Bacterial meningitis can be treated with a number of
effective antibiotics. It is important, however, that
treatment be started early in the course of the disease.
Appropriate antibiotic treatment of most common types
of bacterial meningitis should reduce the risk of dying
from meningitis to below 15%,
15% although the risk is higher
among the elderly.
Knowing whether meningitis is caused by a virus or a
bacterium is important because of differences in the
seriousness of the illness and the treatment needed.
December 22, 2016

NURLIA

35

Vaccine for meningitis~~

There are vaccines against Hib and against some
strains of N. meningitidis and many types of
Streptococcus pneumoniae. The vaccine against
haemophilus influenze (Hib) has reduced Hib
meningitis cases by 95 percent since 1985.
There are vaccines to prevent meningitis due to S.
pneumoniae. The pneumococcal polysaccharide
vaccine is recommended for all persons over 65 years
of age and younger persons at least 2 years old with
certain chronic medical problems.
December 22, 2016

NURLIA

36

Penatalaksanaan
P. umum :

Pasien diisolasi
Bedrest
Kontrol hypertermia dgn kompres,antipiretik
Kontrol kejang : diazepam,fenobarbital
Kontrol peningkatan TIK: manitol, kortikosteroid
Pemenuhan kebutuhan cairan, nutrisi

Pemberian antibiotik
Diberikan 10 -14 hari atau sedikitnya 7 hr bebas
panas.
Antibiotik yg umum diberikan :
ampisilin,gentamisin,kloramfenikol, sefalosporin
December 22, 2016

NURLIA

37

Pengkajian
1. Riwayat kesehatan sekarang :

Riwayat trauma kepala

R. pembedahan kpl, tindakan LP
R. TBC paru
R. tergigit binatang/ rabies, serangga
R. infeksi telinga,ISPA,mastoiditis,infeksi virus,
herpes
R. vaksinasi
R. penyakit jantung kronik,endokarditis
December 22, 2016

NURLIA

38

2. Psikososial

Usia
Pekerjaan
Peran keluarga
Penampilan sebelum sakit
Mekanisme koping
Tempat tinggal yang kumuh

December 22, 2016

NURLIA

39

3. Pemeriksaan fisik

Tk, kesadaran
Nyeri kepala
Nystagmus
Ptosis
Ggn pendengaran & penglihatan
Peningkatan suhu tubuh
Mual dan muntah
Paralisis / kelemahan otot
Perubahan pola napas
Kejang
Tanda TIK
Kaku kuduk
tanda Brudzinsgki, kernig
+
December 22, 2016
NURLIA

40

Diagnosa keperawatan
Perubahan perfusi jaringan serebral b/d proses
peradangan, peningkatan TIK
Intervensi :

Monitor status neurologi setiap 2 jam

Monitor TTV setiap 2 jam
Kurangi aktifitas yg dpt meningkatkan TIK
Berikan istirahat yg cukup u/ kurangi stimulus lingkungan.
Tinggikan posisi kepala 30 -45
Kolaborasi dalam pemberian : dieuretik
osmotik,steroid,oksigen,antibiotika.

December 22, 2016

NURLIA

41

Lanjutan DX. Kep

Resiko injuri; jatuh b/d kejang,penurunan kesadaran
Kerusakan mobilitas fisik b/d kelemahan umum, defisit
neurologik.
Hypertermia b/d infeksi
Ketidakseimbangan cairan b/d intake tdk adekuat,
kehilangan cairan
Perubahan nutrisi; kurang dari kebutuhan tubuhb/d
anoreksia, kelemahan, mual&muntah, intake yg tdk
adekuat.
Nyeri b/d nyeri kepala,kaku kuduk, iritasi meningeal.
December 22, 2016

NURLIA

42

December 22, 2016

NURLIA

43