In this note, we are going to discuss Explain meningitis , Signsand symptoms, Diagnosis, Treatment & Nursing Care. Meningitis is the inflammation of the covering of the brain(meninges)It is a serious condition that can be caused by bacteria, viruses, fungi, protozoa, medications, autoimmune conditions, or malignant diseases.
Causes of meningitis
- bacteria example: Haemophilus influenzae type b (Hib, Neisseria meningitidis, Listeria monocytogenes, Group B Streptococcus, Streptococcus pneumoniae.
- Viruses examples: Enteroviruses, Herpes viruses, Mumps virus, HIV, Varicella-Zoster Virus.
- Fungal Meningitis.Candida species, Cryptococcus neoformans
- protozoa: Plasmodium
- medications.
- Autoimmune
- Malignant (carcinomatous meningitis)
- Chemical.
predisposing factors
- hiv infection
- unvaccinated child
- children
- newborn baby
- premature baby
- preterm baby
Pathophysiology
- The infection usually begins when microorganisms enter the body through: The nose or throat, the bloodstream, or direct entry due to head injury, surgery, or skull fracture.
- After entering the body, the organism multiplies and spreads into the blood.
- From the blood, it travels toward the central nervous system (CNS).
- The microorganisms then cross the blood–brain barrier(BBB)it is a protective layer that normally prevents harmful substances from reaching the brain.
- Once this barrier is breached, the organisms enter the cerebrospinal fluid (CSF).
- The organisms multiply rapidly because the CSF has few immune defences, so in the process the presence of microorganisms triggers the body’s immune response.
- The immune system releases inflammatory chemicals (cytokines) to fight the infection.
- This causes: Inflammation of the meninges, increased white blood cells in the CSF, and increased capillary permeability
- Inflammation then leads to: Swelling of brain tissue (cerebral oedema), Increased production and reduced absorption of CSF
- This raises intracranial pressure, which can reduce blood flow to the brain.
- Reduced blood flow and pressure on brain tissue lead to symptoms such as:Severe headache, Fever, Neck stiffness, Vomiting, Altered consciousness, Seizures (in severe cases)
Signs and symptoms
the patient will present with the following clinical future.
Children
- High pitch crying
- Bulging fontanel
- Restlessness
- Stiff neck
- Convulsions
- Sever headache
- High grade fever
- Photophobia
- Unconsciousness
- Nausea and Vomiting
Adult
- Stiff neck
- Convulsions
- Severe headache
- High grade fever
- Photophobia
- Unconsciousness
- Nausea and Vomiting
Differential diagnosis for menigitis
- Brain abscess
- Brain tumour
- Drug reaction.
Investigations to confirm menigitis
History taking
Take the patient’s medical history, surgical history, and any drugs taken
Physical examination
- Do the general physical examination from head to toe.
- Do the Glasco coma scale rating the level of consciousness
- Do the kernig sign and Brudzinski sign it is the confirmatory tests for meningitis.
Laboratory investigations.
- Lumbar puncture looking at the colour of the CSF, the speed at which it is flowing.
- CSF analysis looking for white blood cell count, sugar, protein, and pus cells.
- CSF culture and sensitivity
- CSF Gram stain, also Gene Expert
- Blood for CBC and serological examination
Imaging investigation
- Mri
- Ct scan
Management
Management depends on the cause.
For bacteria
Give antibiotics. Ceftriaxone high dose 2g can be divided it to 2 devided dosage ie ceftrazon 1g twice a day for 7days for adults. Ampicillin 2g 6 hourly can also be added.
For children, give 100mg/kg body weight. For example, if the child’s weight is 10 kilogram, then multiply the weight by 100mg, that is 1000mg (1g), and divide it into 2 dosages (bd)
You can use cefradin if cefriaxon not available.
Other antibiotics
· Benzylpenicillin
· Antituberclosis medications
· Clxacillin
· Gentamicine
· Ceftaxin(neonate)
If virus give antiverial drug like acyclovir iv or oral depending on the condition
If protozoa give antiprotozoal, e.g., malaria, give an antimalarial drug.
If fungi administer antifungal medications
In other management, you manage the symptoms.
Convulsions are treated with anticonvulsants like phenobarbitone, diazepam, and phenytoin.
Monitor the laboratory results
Fever is managed with antipyretics
Vomiting administer antiemetic
Nursing management (specific nursing management /nursing care) for a patient admitted with meningitis.
1. Monitor level of consciousness using the Glasgow Coma Scale
2. Take and monitor vital signs such as temperature, pulse, respiration and blood pressure
3. Control fever by tepid sponging, giving an antipyretic like Panadol
4. Administer medications as prescribed by the doctor, for example, antibiotics and antifungals.
5. Provide a dimly lit room for the patient because of the fear of the light.
6. Educate the patient or attendant on meningitis management, the possible complications, and the prognosis.
7. Carry out psychological care by counselling the patient and attendant about the situation.
8. Encourage a well-balanced diet to meet the body’s demand for energy and other nutrients if they cannot eat, a nasogastric tube for feeding and oral drug administration.
9. Monitor the input and output by maintaining the fluid balance chart.
10. Provide safety precautions for the patient who is having an episode of convulsion.
11. Encourage exercise to keep the muscle activities
12. Ensure good hygiene by doing bed bath, oral care and changing of linen and bed making.
13. Regular changing of the position to prevent pressure sores.
14. Elevate the head of the bed to reduce intracranial pressure
15. Link to neurologist
16. Document for continuous nursing care
Nursing diagnosis for meningitis
Actual nursing diagnosis
1. Hyperthermia related to infection as evidenced by the patient being hot on touch, thermometer reading of 39.9 degrees Celsius, patient sweating, rapid heart rate, and convulsing.
2. Acute pain related to inflammation of the meninges as evidenced by the patient complaining of severe headache, stiff neck.
3. Disturbed visual sensory perception related to inflammation of the membrane covering the brain, as evidenced by the patient fearing light.
4. Impaired cerebral tissue perfusion related to increased intracranial pressure as evidenced by patient’s altered level of consciousness.
5. Ineffective airway clearance related to excessive secretions as evidenced by abnormal breath sounds.
6. Impaired Physical Mobility, altered neurological and muscle function as evidenced by a stiff neck.
7. Impaired Verbal Communication related to altered mental status, evidenced by inability to speak or respond to words appropriately.
8. Disturbed sleep pattern related to severe headache, fever, and environmental stimuli as evidenced by difficulty falling or staying asleep.
9. Unstable glucose level related to lack of appetite, inability to eat, and unconsciousness as evidenced by glucometer reading of 0.9mm/dl.
10. Fatigue related to hyper parasitaemia as evidenced by patient complaining of general body weakness,tiredness.
11. Knowledge deficits related to lack of knowledge about meningitis as evidenced by the patient asking a lot of questions
Risky nursing diagnosis
1 Risk for fluid Valium deficit related to vomiting
2. Risk for injury related to convulsion
3. Risk for nutrition less than body’s requirement related to increased body demand
4. Risk for electrolyte imbalance related to vomiting
5. Risk for Increased Intracranial Pressure related to meningeal inflammation.
6. Risk for Impaired Cerebral Tissue Perfusion related to increased intracranial pressure.
7. Risk for Impaired Skin Integrity related to immobility.
8. Risk for unstable glucose level related to vomiting
9. Risk for Seizures related to irritation of the brain by inflamed meninges.
10. Risk for Aspiration related to vomiting and decreased level of consciousness.