What is bacterial meningitis?
Bacterial infection of meningeal tissues.
What is the most common bacteria associated with bacterial meingitis?
N. meningitis
What are the signs and symtpoms of bacterial meningitis?
- Fever
- Severe HA
- N/V
- Nuchal rigidity
- Photophobia
- Decreased LOC
- Seizures
- Petechia that do not fade when pressed (meningococcal meningitis)
What are the TNIs for bacterial meningitis?
- Isolation as soon as bacterial meningitis is suspected.
- Vaccinations (fly/meningitis), prophylactic antibiotics if exposed to bacterial meningitis
- Assess VS, LOC/neuro, I/O, lung sounds, skin. Measures to reduce ICP
- Codeine for pain; prevent injury; HOB slightly elevated
- Assess for dehydration and adequate fluid intake; maintain nutritional intake
- Darkened room, cool cloth is the patient has photophobia
- Low lighting to decrease hallucinations if patient is delirious; reduce environmental stimuli
- Avoid restraints if possible. Seizure precautions
- Meds: antibiotics, anti-seizure meds, anti-pyretics. Treat fever aggressively
What are the TNIs for acute bacterial meningitis?
- Isolation - droplet precautions. Start IV with 1/2 NS (NO SUGAR IN FLUIDS)
- Collect specimens for cultures, start antibiotics
- Assess for SIADH - common complication (strict I/O, fluid restrictions, measure specific gravity, seizure precautions, etc)
What are symptoms and TNIs of bacterial meningitis in peds?
- High-pitched cry, bulging fontanels, poor feeding, extreme irritability
- Measure head circumference. Kernig/Brudzinski's signs don't work on infants. Signs of meningitis in an infant look like increased ICP
What is viral meningitis?
Viral infection of arachnoid mater and CSF
What are the signs and symtpoms of viral meningitis?
- Fever
- HA
- Photophobia and stiff neck
- Flu like and self-limiting
- No symptoms of brain involvement
What are the TNIs for viral meningitis?
Supportive care based on symptoms (fluids, rest, anti-pyretics)
What is encephalitis?
acute inflammation of the brain caused by bacteria, fungi, parasites, viruses
What are the signs and symptoms of encephalitis?
- Nonspecific onset with fever
- HA
- N/V
- any CNS abnormality (hemipareis, tremors, seizures, cognitive and/or personality changes)
What are the TNIs of encephalitis?
- Mosquito control (clean gutters, drain bird baths, no standing water)
- Supportive care based on symptoms (fluids, rest, anti-pyretics)
- Seizure precautions
What is a brain abscess?
Accumulation of pus within the brain tissue; can result in a local or systemic infection. Ears, sinuses - most common sources of infection.
What are the signs and symptoms of brain abscess?
- HA
- Fever
- N/V
- Increased ICP
- Confusion
- Drowsiness
- Focal neurological deficits
- Seizures
What are the TNIs for brain abscess?
- Antimicrobial therapy with supportive care based on symptoms
- TNIs for brain surgery if patient had abscess drained (HOB down, seizure precautions)
How do you test for nuchal rigidity?
Ask patient to put their chin to their chest. If they can't do it or have pain, it indicates meningeal irritation.
How do you test for brudzinski's sign?
Have patient lie flat and flex the neck. If patient's knees come up on their own (involuntary hip flexion), it indicates meningeal irritation
How do you test for Kernig's sign?
Have patient lie flat and raise their legs to 90 degree angles and try to straighten legs. If patient has lower back pain or resistance to straightening, it indicates meningeal irritation.
What is opisthotonos?
Neck and back and hyper-extended; indicates severe meningeal irritation
How do you analyze CSF?
Lumbar puncture with needle inserted into lower back and spinal fluid removed. Cloudy, increased WBCs, increased protein, decreased glucose = bacterial meningitis. Clear, NL WBCs, increased protein, NL or low glucose = viral meningitis
Lumbar puncture TNIs:
- Explain procedure in terms patient/family can understand; signed consent needed
- VS/neuro checks before during and afterwards
- pt. side lying, knees to chest (hold behind neck and knees for proper positioning)
- reassure patient/family, make sure patient remains still
- post-procedure: assess for HA, blood patch may be used for severe HA
- Assess site for infection/bleeding. There shouldn't be any fluid leaking
- Band-aid to puncture site
What are the causes of bacterial meningitis?
- Strep pneumonia
- Neisseria meningitides
What are the complications of bacterial meningitis?
- Acute increased ICP
- Cranial nerve dysfunction
- Neurologic dysfunction
- hemiparesis
- dysphagia
- Noncommunicating hydrocephalus
- DIC
- Hearing loss
- hemiparesis
- dysphagia
What are the clinical manifestations of bacterial meningitis?
- Fever
- Severe HA
- N/V
- Nuchal rigidity
- Kernig and Brudzinski's signs
- Photophobia
- Decreased LOC
- Increased ICP and seizures
- Meningococcal patient may have petchiae which progresses to purpura or ecchymosis
What is the cause of viral meningitis?
Most common virus (can be fungal also)
What are the clinical manifestations of viral meningitis?
- HA
- Fever
- Photophobia
- Stiff neck
- Usually no symptoms of brain involvement
What is the cause of encephalitis?
- Usually viral
- Ticks and mosquitos transmit West Nile
What are the clinical manifestations of encephalitis?
- Nonspecific onset with fever, HA, N/V, and any CNS abnormaility (hemiparesis, tremors, seizures, cognitive and/or personality changes)
What are the causes of brain abcesses?
- Step and staph with blood bourne entry (sinus, ear, tooth infections)
What are the clinical manifestations of brain abscess?
