Meningitis

Question 1

What is meningitis?

Answer 1

Inflammation of the membranes and the fluid space surrounding the brain and spinal cord

Question 2

What are different types of meningitis?

Answer 2

Bacterial (septic) meningitis
* Neisseria meningitidis** [most common]**
* Haemophilus influenzae
* Streptococcus pneumoniae)

Viral (aseptic) Meningitis owing to viral infection, lymphoma, leukemia, neurosurgical procedures, or brain abscess

Question 3

What is the most common cause of bacterial meningitis?

Answer 3

Neisseria meningitidis

Question 4

What is the triad of symptoms associated with meningitis?

Answer 4

Fever
Headache
Nuchal Rigidity
* Kernig’s Sign
* Brudzinski’s Sign

Question 5

Aside from the triad of symptoms characteristic of meningitis (fever, headache, nuchal regidity), what are other symptoms?

Answer 5

Photophobia
Phonophobia
Lethargy

Question 6

Generally, how is meningitis diagnosed?

Answer 6

Cerebrospinal Fluid (CSF) Analysis via Lumbar Puncture

Question 7

What are characteristics of bacterial meningitis?

Answer 7

• Acute inflammation of meningeal tissue
• A medical emergency.
• Organisms enter CNS from respiratory tract or bloodstream.
• Increased CSF production
• Purulent secretions spread to other areas of brain through CSF.

Question 8

What are clinical manifestations of bacterial meningitis?

Answer 8

Fever
Severe headache
Nausea, vomiting
Nuchal rigidity
- Positive Kernig’s sign
- Positive Brudzinski’s sign
Photophobia
↓ LOC
Signs of ↑ ICP*
Coma
Seizures*

Question 9

What are complications of bacterial meningitis?

Answer 9

Acute complication is ↑ ICP.
Major cause of unconsciousness
Residual neurological dysfunction*
Optic nerve is compressed by increased ICP.
Hemiparesis, dysphagia, and hemianopsia
Acute cerebral edema
Noncommunicating hydrocephalus
Waterhouse-Friderichsen syndrome

Question 10

How is bacterial meningitis diagnosed?

Answer 10

Blood culture
Lumbar puncture and analysis of CSF - Gram-stained smear to detect bacteria
X-rays of skull
CT scan
MRI

Question 11

What is involved in the collaborative care of a client with bacterial meningitis?

Answer 11

• Rapid diagnosis based on history and physical exam
• Antibiotic therapy instituted after collection of specimens
• Collaborate to manage the headache, fever, and nuchal rigidity

Question 12

What are characteristics of viral meningitis?

Answer 12

• Most common causes are enterovirus, arbovirus, HIV, and HSV.
• Usually presents as headache, fever, photophobia, and stiff neck
• Diagnostic testing of CSF
• Lymphocytosis
• No organisms from Gram-stained or acid-fast smears
• PCR to detect viral-specific DNA/RNA
• Symptomatic management with full recovery expected

Question 13

What is involved in nursing management of meningitis?

Answer 13

Frequent or continual assessment
Protect patient from injury (seizure precautions)
Fluid Balance
- Daily weight, serum electrolytes, urine volume, specific gravity, and osmolality
Mobility
- Prevent complications associated with immobility
Infection control
Supportive care
Psychosocial
- Implement measures to facilitate coping of the patient and family

Question 14

What is a common way that bacterial meningitis is spread?

Answer 14

Can spread in community living situations (such as students in dorms)

Question 15

What is the difference in cerebrospinal fluid between bacterial and viral meningitis?

Answer 15

CSF is cloudy in bacterial, clear in viral

Question 16

When is bacterial meningitis most prevalent in terms of seasons?

Answer 16

Winter and early spring

Question 17

What are some signs for the nurse to watch for in terms of elevated ICP?

Answer 17

• changed level of consciousness
• vision changes
• BP (increases)
• pupillary response
• headache

Question 18

What is the best way to prevent meningitis?

Answer 18

• Vaccination
• Antiobiotics prophylactically with exposure

Question 19

What level of white blood cell count in 1 uL of CSF usually means meningitis?

Answer 19

> 5

Question 20

What happens to pressure, glucose and proteins in the CSF with meningitis?

Answer 20

• Pressure increases
• Glucose concentration decreases
• Protein levels increase

Question 21

What factors can increase the risk for bacterial meningitis?

Answer 21

• tobacco use
• otitis media
• mastoiditis
• immune system deficiencies

Question 22

What causative agents lead to acute meningitis?

Answer 22

bacterial and viral meningitis

Question 23

What causative agent causes chronic meningitis?

Answer 23

fungi

Question 24

Which bacteria can cause bacterial meningitis?

Answer 24

• Group B streptococci
• E. coli
• listeria monocytogenes
• neisseria meningitidis
• streptococcus pneumoniae
• Tick borne: borrelia burgdorferi

Question 25

Which viruses can cause viral meningitis?

Answer 25

More common:
enterovirus
arbovirus
herpes simplex
HIV

Less common:
mumps
varicella zoster
lymphocytic choriomeningitis

Question 26

What treatment is common for bacterial meningitis?

Answer 26

Steroids, then antibiotics. Steroids are to address inflammation and prevent injury to the leptomeninges.

Question 27

What can be done to prevent outbreaks of bacterial meningitis?

Answer 27

prophylactic antibiotics
(vaccination may be appropriate as well depending on age group)

Question 28

What type of precaution is put in place for suspected or confirmed meningitis?

Answer 28

Droplet precautions
Also, seizure precautions