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Nursing 272: Final Semester > Unit 1: Meningitis > Flashcards

Unit 1: Meningitis Flashcards

1
Q

Meningitis

A

an inflammation of the meninges, the thin covering around the brain and spinal cord

  • acute or chronic
  • increased in settings where people live in close proximity (college dormitories, military barracks, and prisons)
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2
Q

Causes of Meningitis

A
  • bacterial infection
  • viral infection
  • fungal infection
  • aseptic meningitis
  • secondary to traumatic injury or transmission of organisms during surgery or from invasive procedures or device
  • can be caused by pericarditis (inflammation of the pericardium in the heart) and myocarditis (inflammation of heart muscle); assessment of heart murmurs and echocardiograms help r/o these causes
  • other causes: infection from a cochlear implant, conjunctivitis, and exposure to animals and animal bites
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3
Q

Acute Meningitis

A
  • bacterial cause
  • clinical manifestations occurring in hours to days
  • CSF pleocytosis (increased WBC in CSF)
  • the inflammatory process within the meninges leads to increased turbidity of CSF; sluggish flow of CSF; lead to increased ICP
  • acute = medical emergency
  • bacterial more severe than viral
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4
Q

Chronic Meningitis

A
  • onset of symptoms during weeks to months

- duration of symptoms longer than 4 weeks

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5
Q

Causes of Bacterial Infection

A
  • d/t local infection from the skin, upper respiratory infection, or from GI/GU tracts
  • occur secondary to traumatic injury or transmission of organisms during surgery, or from an invasive procedure or device
  • can be caused by pericarditis and myocarditis; assessment of heart murmurs and echocardiograms help r/o these causes
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6
Q

Causes of Viral Infection

A

-herpes simplex virus, herpes zoster, mumps, and measles

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7
Q

Why is Meningitis a medical Emergency?

A

b/c the increased turbidity and sluggish flow of CSF can lead to increased ICP
-while ICP increases, herniation of the brain can occur b/c of displacement of brain tissue, CSF, and compression of blood vessels, culminating in severe brain damage, coma, and death

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8
Q

Viral Meningitis

A
  • self-limiting form

- causes cell necrosis or results in enzymatic or neurotransmitter alterations depending on pathogen and cells involved

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9
Q

Clinical Manifestations of Meningitis

A
  • fever (infections)
  • headache
  • altered mental status
  • photophobia (light sensitivity)
  • chills
  • nausea
  • vomiting
  • nuchal rigidity and opisthodomos d/t meningeal irritation
  • Brudzinski’s and Kernig’s sign
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10
Q

nuchal rigidity

A

neck stiffness

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11
Q

opisthodomos

A

severe hyperextension of the head w/ arching of the back

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12
Q

Clinical Manifestations of Meningeal Irritataion

A
  • Nuchal rigidity (neck stiffness)

- Opisthodomos (severe hyperextension of the head w/ arching of the back)

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13
Q

Presentation of meningococcal meningitis

A

-faint petechial rash can develop; which can develop into disseminated intravascular coagulation (DIC)

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14
Q

Brudzinski’s Sign

A

as the neck is fixed, there is stretch on the inflamed meninges and the knees flex involuntarily to decreased the pain caused by the stretching of the meninges

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15
Q

Kernig’s Sign

A

as the hip and knee are flexed and then straightened, there is pain in the hamstring secondary to scratching of the inflamed meninges

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16
Q

What is the Hallmark of Diagnosis Meningitis?

A

examination of CSF via lumbar puncture

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17
Q

Lumbar Puncture

A

the opening pressure at the time of the lumbar puncture is recorded, and specimens are tested for glucose, protein, WBC, gram stain and culture
-suspicion for space-occupying lesions, new onset seizures and those w/ moderate to severe altered LOC require CT of the head before the procedure b/c they are at higher risk for herniation

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18
Q

What the examination of Lumbar Puncture (CSF) results look like

A
  • decreased glucose (bacteria thriving; eats sugar up)
  • increased protein
  • increased WBC
  • a gram stain and culture is done to identify the organism
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19
Q

Normal Cerebrospinal Fluid Exam

A
  • Glucose: 50-75 mg/dl
  • Protein: 14-40 mg/dl
  • WBC: 0-5; lymphocytes
  • Microbiology: negative
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20
Q

Bacterial Meningitis Cerebrospinal Fluid Exam

A
  • Glucose: less than 40 mg/dl
  • Protein: higher than 100 mg/dl
  • WBC: 100-500 w/ more than 80% polymorphonuclear (PMN) lymphocytes
  • Microbiology: gram stain and cultures (+) for specific pathogen
21
Q

Medical Management of Meningitis

A
  • Lumbar Puncture (LP)
  • CT of the Head (before LP; risk for herniation)
  • 14 to 21 days of antibiotic treatment (bacterial meningitis)
22
Q

Medications

A

on basis of initial assessment and presumptive diagnosis, and before confirmation from microbiological data, Broad-spectrum antibiotics are initiated

  • tx requires 14 to 21 days of antibiotics
  • long-term IV access (peripherally inserted central line [PICC] or other central venous access) initiated b/c of need for long-term antibiotics
23
Q

Complications of Meningitis

A
  • Increased ICP
  • Reduction of hearing loss (caused by H influenzae)
  • Seizure activity
  • Risk for syndrome of antidiuretic hormone (SIADH) and Diabetes Insipidus (DI)
24
Q

Complication of Meningitis: Increased ICP

A
  • life-threatening

- early signs are identified during neurological exam; requiring frequent assessments

25
Q

Nursing Management: Assessment + Analysis

A 
clinical manifestations are r/t irritation and inflammation of the meninges that surround the brain and spinal cord
-Change in LOC
-Fever 
-Headache
-Photophobia
-Nausea/Vomiting
-Rhinorrhea (runny nose)
-Nuchal Rigidity
-Brudzinski's Sign
-Kernig's Sign
>Neurological exam = most significant nursing intervention in the care of a patient w/ meningitis
26
Q

Nursing Diagnoses

A
  • Disturbed sensory perception r/t meningeal irritation
  • Activity intolerance r/t pain and fatigue
  • Ineffective Coping r/t the complexity of the treatment regimen to manage meningitis
27
Q

Nursing Assessments

A
  • Neurological Assessment: Look for S/S of meningeal irritation (nuchal rigidity, opisthodomos, Brudzinski’s sign, Kernig’s sign)
  • Vital Signs
  • Fluid Balance
  • Headache
  • Cranial Nerve Assessment (CN III, CN IV, and CN VI)
  • CSF results
  • Daily Weight
  • Renal Function
  • Vascular Assessment
28
Q

Assessments: Neurological Assessment

A

b/c of the risk of increased ICP secondary to increased turbidity of CSF

  • essential to recognize subtle signs
  • changes in LOC is earliest sign of increased ICP; be reported immediately
  • also Look for S/S of meningeal irritation (nuchal rigidity, opisthodomos, Brudzinski’s sign, Kernig’s sign)
29
Q

Assessment: Vital Signs

A
  • elevated temperature develops secondary to the infectious process
  • if increased ICP develops, the blood pressure increased w/ widening pulse pressure and decrease in HR
30
Q

Assessment: Fluid volume

A
  • monitor blood pressure for signs of hypo/hypertension and HR
  • if develops SIADH, fluid is retained and there may be an increased in BP
  • W/ diabetes insipidus (DI), the patient has an increased output of dilute urine and is at risk for hypovolemia, hypotension, and tachycardia
31
Q

Assessments: Headache

A

inflammation of meninges may lead to headache

32
Q

Assessment: Cranial Nerve Assessment (CN III, CN IV, CN VI)

A

the eye on the affected side can deviate down and out b/c of a dilated, light-fixed pupil

33
Q

CN III, IV, and VI

A
  • CN III (Oculomotor): pupillary constriction
  • CN IV (Trochlear): eyes look down toward nose
  • CN VI: (Abducens) eyes move to the sides; look toward ears
34
Q

Cerebrospinal Fluid (CSF) Results

A

-treatment of meningitis (bacterial) is directed to the specific organism that is isolated on the CSF sample

35
Q

Assessment: Daily Weight

A

changes in fluid volume status correspond to changes in body weight

36
Q

Assessment: Renal Function

A

many antibiotics are cleared by the kidneys

-increases of BUN and Creatinine may demonstrate damage to the renal system

37
Q

Assessment: Vascular Assessment

A

in patients who develop DIC, there may be increased bleeding; decreased peripheral perfusion
-may see rash on patient; petechiae

38
Q

Nursing Actions

A
  • Administer IV fluids
  • Administer Antibiotics as ordered
  • Decrease Environmental Stimuli
  • Maintain HOB elevated to 30 degrees
  • Pain Management
  • Transmission Precautions
  • Maintain Normothermia
39
Q

Nursing Actions: Administer IV Fluids

A

may have change in fluid volume status r/t increased fluid loss w/ elevated temperatures (fever from infection), or development of diabetes insipidus (increased urine output)

40
Q

Nursing Actions: Administer Antibiotics as ordered

A
  • antibiotics initiated w/o delay

- antibiotics that require therapeutic dosing should be monitored to facilitate their therapeutic goal

41
Q

Nursing Actions: Diminish Environmental Stimuli

A
  • dim the lights, exposure to bright lights from windows (may be photosensitive)
  • quiet environment
42
Q

Nursing Actions: Maintain HOB elevated to 30 degrees

A

increases venous outflow and may decrease ICP that may be elevated d/t turbidity of CSF

43
Q

Nursing Actions: Pain Management

A

b/c of associated headaches, implement pharmacological and nonpharmacological interventions to promote patient comfort

44
Q

Nursing Actions: Transmission Precautions

A
  • standard precautions are maintained for all patients

- droplet precautions (bacterial meningitis)

45
Q

Nursing Actions: Maintain Normothermia

A
  • decreases metabolic activity and decreases CNS oxygen demand
  • antipyretics, cooling baths, cooling blankets
46
Q

Nursing Teachings

A
  • Importance of follow-up appointments

- Importance of taking full course of antibiotics

47
Q

Importance of follow up appointments

A

-recovery from meningitis may take weeks to months and requires frequent assessment and evaluation

48
Q

Importance of taking full course of antibiotics

A

extended antibiotic therapy may be indicated to lessen the chances of reoccurrence of the infectious process

49
Q

Evaluating Care Outcomes

A
  • management of meningitis requires eradication of the infectious organism
  • during acute phase, pt chief complaints are pain, neck stiffness, and photophobia
  • definitive interventions focus on antibiotic therapies and comfort measures
  • antipyretics for fever
  • monitoring for increased ICP
  • at discharge the patient will be neurologically and hemodynamically stable; knowledgeable of signs of recurrent infection and increased ICP to seek emergent treatment; compliance with antibiotic therapy

Nursing 272: Final Semester (79 decks)

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