Nurse Study Guide: Meningitis

In this nurse study guide, you will learn the important topics covering Meningitis in order to pass your next nursing exam.

Meningitis is the inflammation of the meninges, the membranes enclosing the brain and spinal cord, is known as meningitis.

The inflammation of the meninges, the membranes enclosing the brain and spinal cord, is known as meningitis.

The most common type of meningitis is viral, or aseptic, meningitis, which usually goes away on its own without medical intervention. Fungal meningitis is common in individuals who have AIDS. Meningitis caused by bacteria, also referred to as septic meningitis, is a highly fatal infectious disease. The timing of the initiation of care determines the prognosis. There are three vaccines for different pathogens that cause bacterial meningitis. One is available for high-risk populations, such as residential college students.

Causes

Causes of meningitis include bacteria, viruses, fungi, parasites, and drugs. 

• Bacteria. S pneumoniae, a gram-positive coccus, is the most common bacterial cause of meningitis.

• Viruses. Enteroviruses account for of the majority of cases of aseptic meningitis in children; the nonpolio enteroviruses (NPEVs) account for approximately 90% of cases of viral meningitis in which a specific pathogen can be identified; the mumps virus is the most common cause of aseptic meningitis in unimmunized populations, occurring in 30% of all patients with mumps.

• Fungi. Cryptococcus neoformans is an encapsulated, yeast like fungus that is ubiquitous; Coccidioides immitis is a soil-based, dimorphic fungus that exists in mycelial and yeast (spherule) forms; blastomyces dermatitidis is a dimorphic fungus that has been reported to be endemic in North America.

Manifestations

• Fever

• Chills 

• Nausea and vomiting

• Altered level of consciousness

• Positive Kernig’s sign 

• Positive Brudzinski’s sign 

• Hyperactive deep tendon reflexes 

• Tachycardia

• Seizures

• Red macular rash

Diagnostics 

Laboratory tests include the following: 

Urine throat, nose and blood culture and sensitivity - Culture and sensitivity of various body fluids identify possible infectious bacteria and an appropriate broad spectrum antibiotic. 

CBC- elevated white blood cell count.

Cerebral spinal fluid analysis (CSF) - CSF analysis is the most definitive diagnostic procedure. It is collected during the lumber puncture performed by the provider.

Results Indicative of Meningitis

Appearance of CSF - if cloudy (bacterial) or clear (viral).

Elevated white blood cell count.

Elevated protein.

Decrease glucose, which indicates bacterial elevated cerebral spinal fluid pressure.

Nursing Interventions 

• Isolate the client as soon as meningitis is suspected

• Maintain isolation precautions per hospital policy

• Initiate droplet precautions, which require a private room. Continue droplet precautions until antibiotics have been administered for 24 hours. Standard precautions are implemented for all clients who have meningitis

• Implement fever reduction measures such as a cooling blanket if necessary Report mention oral infractions to the public health department.

• Environmental stimuli provide a quiet environment.

• Minimize exposure to bright light maintain bed with the head of the bed elevated to 30°.

• Monitor for increase ICP.

• Tell the client to avoid coughing and sneezing, which increase ICP.

Medications for Meningitis

Ceftriaxone or cefotaxime in combination with vancomycin: antibiotics given until cultural and sensitivity results are available effective for bacterial infections.

Phenytoin: Anti-convulsants given if ICP increases or client experiences a seizure

Acetaminophen, iduprofen: analgesic for headache and/or fever. Non-opioid to avoid masking changes and the level of consciousness.

Ciprofloxacin, rifampin or cefriaxone: prophylactic antibiotics given to individuals and close contact with the client.

Complications 

Increased ICP

Meningitis can cause ICP to increase, possibly to the point of brain herniation

Nursing Actions for Increased ICP

Monitor for indications of increasing ICP, which will indicate a decrease level of consciousness, pupillary changes, and impaired extraocular movements.

Provide interventions to reduce ICP, such as positioning with the head of the bed elevated at 30° and avoiding coughing and straining

Mannitol can be administered via IV

SIADH

SIADH can be a complication of meningitis due to abnormal stimulation to the hypothalamic area of the brain, causing excess secretion of anti-diuretic hormone, also known as vasopressin.

Nursing actions for SIADH

Monitor for manifestations, such as dilute blood and/or concentrated urine

Provide interventions, such as the administration of demeclocycline and restriction of fluid.

Monitor the client's weight daily. 

Septic Emboli

Septic emboli can form during meningitis and travel to other parts of the body, particularly their hands, but can occur in the feet as well.

The development of gangrene creates a need for an amputation. 

Septic emboli can lead to disseminated intravascular coagulation or stroke.

Nursing Actions for Septic Embolic

Monitor the circulatory status of extremities and coagulation studies.

Report any alterations immediately to the provider. 

Care Plan 

Goals for a patient with bacterial meningitis include:

• Protection against injury.

• Prevention of infection.

• Restoring normal cognitive functions.

• Prevention of complications.