Discipline –Adult Health Nursing( ACN 1)
Topic
-
Meningitis
Submitted To,
MS. Zarnigar
Associate Prof.
Nursing Department
Superior University Lahore
Submitted By,
Misbah Arshad
Amina Iqbal
Sitara Hussain
B Sc. Post RN 1st Year
1st Semester (2022-2024)
Dated: 10-03-2023
1
Sr No.
Content
Page No.
1
Objectives
03
2
Introdution of Meningitis
04
3
Definition
05
4
Types of Meningitis
06
5
Causes
07
6
Risk Factor
08
7
Pathophysiology
09
8
Etiology and Epidemiology
10
9
Diagnosis
12-13
10
Sign and Symptoms of Meningitis
14
11
Complication
15
12
New Biomarker
16
13
Management
17
14
Treatment
18
15
Nursing Management
19
16
Prevention
20
17
Nursing Care Plan
21,22,23
18
Summary
24
19
References
25
2
Objectives
 General objective :

At the end of this assignement we will be able to gain in depth knowledge of
Meningitis.
 Specific objectives:

At the end of this assignement the students will be able to

Define of meningitis

Discuss the incident rate of Meningitis

Understand the pathophysiology and risk factor

Elaborate the types and causes of Meningitis

Evaluate the sign and symptoms

Describe the Diagnostic

Prevention of Meningitis
3
 Introdution of Meningitis

Meningitis is inflammation of the membrane that cover the brain and spinal cord.

Caused by viral and bacterial infection .

Viral Meningitis is less sever and clear up with specific treatment

Bacterial Meningitis can be quite sever and may result in brain damage , hearing
loss, or learning disabilities .

1990s type B Infleunza (Hib) was the leading cause of bacterial meningitis

The Hib vaccine is given to all children as part of their immunization routine .
4
Meningitis
DEFINATION:
Meningitis is inflammation of meninges , which cover and protect the brain and
spinal cord. The three major caused of meningitis are :
(1) bacterial
(2) viral
(3) fungal infection
(Bader , 2016 )
World Health Organization(2019) : Define as Meningococcal meningitisis
.
:
is an acute form of bacterial meningitis caused by Neisseria Meningitis.
Meningitis is an acute inflammation of the piamater and the arachnoid membrane
surrounding the brain and spinal cord. Therefore, meningitis is always
cerebrospinal infection.
( Basvanthapa, 2009)
5
Types of Meningitis
6
 Most common bacteria causing meningitis:

Meningitis is most common caused by a viral or bacterial infection

Neisseria meningitidis (meningococcus)

Haemophilus influenzae (haemophilus)

Listeria monocytogenes) (listeria

Streptococcus pneumonia

Group B Streptococcus

Escherichia coli
7

Extremes of age (< 5 or >60 years)

Diabetes mellitus, chronic kidney failure,

adrenal insufficiency, hypoparathyroidism, or cystic fibrosis.

Compromised immune system like AIDS, alcoholism ,use of immunosuppressant
drugs.

Recent exposure to others with meningitis,

with or without prophylaxis.

Malignancy.

Pregnancy.
8
Pathophysiology
Causative organism enter the blood stream
Cross the blood brain barrier
Inflammatory reaction in meninges
Inflammation of subarachnoid space and pia mater
Inflammation may cause increase Icp
CSF flows in subarachnoid space
CSF cloudiness or infected
CSF cell count increase
and increase brain endues and in cranial pressure
9
Etiology and Epidemiology
•
There are many microorganisms that can cause meningitis including bacteria,
viruses, fungi, parasites; also drugs may be a cause (e.g., NSAIDs, metronidazole,
and IV immunoglobulin).
10
 Bacteria that cause meningitis include :
•
Pachymeningitis.
•
Haemophilus influenzae meningitis.
•
Pneumococcal meningitis.
•
Streptococcus agalactiae meningitis
•
Meningococcal meningitis.
•
Listeria monocytogenes meningitis.
•
Gram-negative bacilli.
•
Staphylococcal meningitis: it colonized in the normal skin flora. S epidermidis is
the most common cause of meningitis in patients with CNS shunt
(ventriculoperitoneal).
•
Additional causes of meningitis: Congenital malformation of the stapedial
footplate, Head and neck surgery, penetrating head injury, comminuted skull
fracture, and osteomyelitic erosion, Skull fractures.
11

Characteristic clinical signs and symptoms
can be absent

Blood culture

imaging

spinal tab (lumber puncture)
 Blood cultures
•
Blood samples are placed in a special dish to see if it grows microorganisms,
particularly bacteria
•
limitation : Pretreatment with antibiotics decreases the yield.
12
 Spinal tap


(Normally computed tomography, CT) scans of the head may show swelling or
inflammation.
May lead to a substantial delay in the initiation of antibiotic treatment, which
leads to poor outcome.
 Spinal tap (lumbar puncture)
This fluid is sent to the lab and analyzed to determine if there is an infection.
“We determine:”

WBC(leukocyte) count increase

Protein concentration increase

Glucose concentration decrease
then we perform CSF culture and Gram stain
Is the procedure of taking
fluid from the spine (CSF) in
the lower back through a
hollow neddle.
 Kerning`s signs

One of the physically demonstrable symptoms of meningitis is Kernig's sign.
Severe stiffness of the hamstrings causes an inability to straighten the leg when
the hip is flexed to 90 degrees.
 Brudzinski`s signs

One of the physically
demonstrable symptoms of
meningitis is Brudzinski's
13
sign. Severe neck stiffness causes a patient's hips and knees to flex when the neck
is flexed.
 The first symptoms are usually

Fever , vomiting , headache and feeling unwell.

Limb pain ,pale skin ,and cold hands and feet often appear earlier than the rash,
neck stiffness , dislike of bright lights and confusion.

Septicemia can occur with or without meningitis .

Typical clinical features are
1. Headache
2. Nuchal rigidity
3. Photophobia
14
infants (<2years)
older than 2 years
Complications
•
Advanced bacterial meningitis may cause brain damage and death. 50% of
patients may have a serious complications within a week, however in 30% of
survivors long term sequlae are seen.
•
Complications include hearing loss, cortical blindness, other cranial nerve
dysfunction, paralysis, muscular hypertonia, ataxia, multiple seizures, mental
motor retardation, focal paralysis, subdural effusions, hydrocephalus and cerebral
atrophy.
15
New Biomarker
•
The differentiation between acute bacterial and non bacterial meningitis is
challenging because they share many similar clinical symptoms, such as fever and
headache.
•
A new biomarker (Procalcitonin) has been studied for the diagnosis of bacterial
meningitis.
16
Management
 Delay in treatment has been associated with a poorer outcome.
First:

we should start treatment with wide-spectrum antibiotics while confirmatory
tests .

After identification of the pathogen antibiotic therapy as appropriate for patient
age and condition.

Rapid transport to the emergency department (ED) because of the early severe
complications.
17
Treatment
Viral Meningitis
Bacterial Meningitis
Other Meningitis
Antiviral
Antibiotic
Based on the underlying
cause
Plenty of Fluids
Fluids
Anti-Fungal in fungal
infections
Antipyretics
Antipyretics
Symptomatically treatment
Pain killers
Pain killers
Antiemetic
Antiemetic
Cancer-related meningitis
requires therapy for the
specific cancer.
Allergic reaction or
autoimmune disease may
be treated with
corticosteroids.
Corticosteroids
Corticosteroids
Anticonvulsant
Bed Rest
18
Nursing Management
➢ Monitor Vital sign 4 hourly or when needed, check the level of consciousness.
➢ Maintain airway clear.
➢ Maintain Peripheral line.
➢ Administer prescribed medication timely immediately after sample collection.
➢ Care of unconscious pt (lung sounds, posture change, DVT prophylaxis etc)
➢ Maintain GCS, pupil reaction & size
➢ Monitor intake and output.
➢ Keep patient pain free.
➢ Prevent from hypoxia
➢ Mechanical ventilation, pco2 keep 30 -35mm
➢ Monitor ABG, S
➢ Infection control precaution.
➢ Give antipyretics
➢ Antihypertensive drugs and check for BP fall.
➢ Diuretics… assess for dehydration and electrolytes
➢ Anti convulsants
➢ Auscultate chest for over hydration and pneumonia
➢ Change posture, to Prevent from bed sore.
➢ Head side at 30 to 35 degree, keep head midline and do not flex head (prevent to inc ICP)
➢ Provide oral care to prevent from ulcer, assess skin integrity.
➢ Prevent patient from injury related to seizures or altered L
19
 These steps can help prevent meningitis:
1. Wash your hands.
2. Practice good hygiene.
3. Stay healthy.
4. Cover your mouth.
5. If you're pregnant, take care with food.
20
Nursing Care Plan
Assessment Nursing
Planning Implementation Rational
diagnosis
Subjective
data
Pt verbalized
Feeling
Fatigue
Weakness
Loss of
appetite
Restless Pale
Imbalance
nutrition
Less than
body
requirement
related to
inability to
ingest and
digest food
and
absorbed as
evidence by
loss of
appetite
Short
term goal
To maintain
adequate
fluid
balance and
nutrition in
8 hours
Objective
Data
Long
Term
Goal
B.P
90/60
Pulses
96b/min
Respiration
22b/minutes
Temperature
100F
After 1
week
Pt will be
able to
eating
proper.
Fever
settled.
To educate the
family
Assess general
To monitor
condition
body weight for
Monitor vital signs
fluid and
Identify risk for
nutritional
malnutrition
status .
Monitor pt`s weight.
Dietry patterns
Assess nutritional
daily pattern,including are considered
in planning
Food
meal.
preference,caloric
intake and diet history To maintain
pleasant
Provide comfortable
environement.
and delightful
Reduce
environment during
unpleasant
meal times.
factors that add
to appetite loss.
Independent
Dependent
Maintain i/v line
Administer
multivitamin
Vit .D as advised by
doctor.
Administer TPN as
order by doctor
Evaluti
on
Maintain
adequate
Nutrition
and fluid
balance.
A high
potassium diet
maintain
therapeutic,
serum
potassium
level..
21
Assesment
Nursing
Planning Implementation Rational
Diagnosis
Subjective
Data
Acute pain
related to
meningeal
irritation
Patient verbalized
having pain from
3 to 4 days.
Objective
Data
B.P 90/50
H/R 120 b/min
Res 16 b/min
Temp 100F
Short
Independent
-Note for the location ,
Term
scale, intensity and
Planning onset of pain.
After 4 hours
of nursing
interventions
the patient
will be able
to display
reduction of
pain .
Long
Term
Planning
After 2 to 3
days of
nursing
intervention
the patient
will identify
personal
triggers to
avoid having
migraine
attacks and
successfully
be headache
free.
-Maintain a calm and
quite enviromement
-Use relaxation
technique such as:
-Deep breathing
exercise
-Provide a dim light
and good ventilation.
-Offer back rubs
massage, slow
rhythmic breathing ,
repositioning and
other diversional
activity such as
listening music .
Dependent
Administer pain
medications as
ordered.
Evaluati
on
-To
determine the
nursing care
to be given to
the patient.
After 4 hours
of nursing
interventions,
goal met.
Patient
relieved of
-To minimize pain and
stimulus that there is no
could
non verbal
aggravate the indicators of
condition of
pain..
the patient .
-To promote
comfort and
relaxation.
-Serve as non
pharmacolog
ical methods
for reducing
pain and
promoting
comfort.
To help
relieve of
pain.
22
Assessment Diagnosis
Planning
Intervention Rational
Evaluation
Anxiety related
to actual or
perceived
I am not feeling threat to health
good since many to health as
days
evidenced by
the increased
tension.
Short
Independent -Different
-Assess the
level of
term
patient’s level of anxiety will
planning: anxiety
affect the
Goal met
After 4 hours of
nursing
interventions,
the patient was
relaxed was
reduced..
Subjective
data:
Objective
data:
Restlessness
Narrowed vision
Voice quivering
Hands tremors
Facial flushing
Sweating
B.P 160/90
H/R 110 b/min
Res 22 b/min
After 10 to 30
minutes of
nursing
intervention
the client will
be able to
know some
techniques on
how to lessen
the anxiety
such as deep
breathing and
exercise..
-Monitor vital
signs
-Acknowledge
awareness of
patient’s anxiety
-Instruct patient
to do deep
breathing
exercises.
long term
planning
-Provide accurate
information
After series of about the
situation
nursing
intervention
the clients
anxiety will
be
eliminated..
-Establish a
therapeutic
conversation.
coping
mechanism of
the client
-To identify
physical
responses
linked to
medical and
emotional
conditions ,
-This may
help the client
to relax.
-Helps the
client to
identify what
is reality
based.
-Using simple
language
-To avoid a
contagious
effect of
anxiety.
Dependent
-The will help
the client to
trust you.
Administer pain
medications as
ordered.
23
24
Summary
Meningitis is an inflammation of the protective membrane lining the brain and spinal
cord caused by most often by a viral or bacterial infection that crosses the body`s blood
brain barrier. Meningitis is diagnosed by a lumber punctur, in which a small amount of
fluid is collected from the spinal cord. There are two main types of Meningitis, Bacterial
and viral. Bacterial meningitis is less common, but more serious. Bacterial Meningitis is
treated with and antibiotics and the majority of patients make a full recovery. Viral
Meningitis usually required no treatment beyond painkillers. Most patients make a full
recovery from meningitis .A small number of infected people end with hearing or vision
loss or brain damage.
Reference
25
Basvathapa , BT.(2009). Medical surgical nursing. 2nd edition. New dheli (indial:japee
brother. Medical publisher
Linpincoh, (2004). Allied medicine . 12th edition .America.series edition .
Brunner and Suddarth`s , (2016).A text book of medical surgical nursing (14th edition ).
New Delhi.
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