Unit 7 Chapter 39 Meningitis

Question 1

What is meningitis

Answer 1

Meningitis is an infection or inflamation of the meninges of the brain and spinal cord, specifically the pia mater and arachnoid.

Question 2

What can meningitis cause?

Answer 2

This inflammation causes a
blockage of CSF, blood flow and can lead to clot formation, which increases ICP

Question 3

What are the types of Meningitis?

Answer 3

Bacterial or Viral

Question 4

What medications can cause meningitis

Answer 4

Bacterial and viral organisms are most often responsible for meningitis, although fungal and protozoal meningitis also occur. Cancer and some drugs, notably NSAIDs, antibiotics, and IV immunoglobulins, can also cause sterile meningitis. Regardless of cause of meningitis, the symptoms are similar.
-living in a closed dorm , closed facility or nursing home

Question 5

Which of these patients are at high risk for contracting Meningitis?
A. The client who has a multiple sclerosis
B. The client who has sustained a femur
C. The college student who has been in living in a shared dormitory.
D. The patient who has sustained a concussion

Answer 5

C. The college student who has been in living in a shared dormitory.

-living in a closed dorm, closed facility or nursing home
-previous viral infection

Mandatory vaccination programs for school enrollment and proof of vaccination as a prerequisite for group home or dormitory experiences have significantly reduced the incidence of meningitis.

Question 6

Which of these disorders can lead to meningitis?
A. Skull fracture
B. Femur fracture
C. Concussion
D. Headache

Answer 6

A. Skull fracture

A basilar skull fracture may lead to meningitis as a result of the direct communication of cerebrospinal fluid (CSF) with the ear or nasal passages, manifested by otorrhea (ear discharge) or rhinorrhea (nasal discharge, or “runny nose”) that is actually CSF.

Question 7

If meningitis is caught quickly, What is the prognosis?
A. Good
B. Bad

Answer 7

A. Good

If treated quickly
* Prognosis is good * Complications are rare
* If not recognized

Question 8

S/s of Meningitis

Answer 8

-nuchal rigidity
Disorientation to person, place, and time
* Pupil reaction and eye movements:
photophobia (sensitivity to light)
* Nystagmus (involuntary condition in which the eyes make repetitive uncontrolled movements)

• Motor response:
• Normal early in disease process
• Hemiparesis (weakness on one side of the body), hemiplegia
  (paralysis on one side of the body), and decreased muscle tone
• Decreased level of consciousness
  possible later
• Cranial nerve dysfunction, especially CN III, IV, VI, VII, VIII
• Memory changes:
• A ttention span (usually short)
• Personality and behavior changes
• Severe, unrelenting headaches
• Generalized muscle aches and pain (myalgia)
• Nausea and vomiting
• Fever and chills
• Tachycardia
  -nuchal rigidity (stiff neck) and
  -positive Kernig
  -Brudzinski
• Red macular rash (meningococcal meningitis)

Question 9

What precaution is Bacterial Meningitis?
A. Contact
B. Standard
C. Airborne
D. Droplet

Answer 9

D. Droplet

Standard Precautions are appropriate for all patients with meningitis unless the patient has a bacterial type that is transmitted by droplets, such as N. meningitides and H. influenzae.

Question 10

What precaution is Viral Meningitis?
A. Contact
B. Standard
C. Airborne
D. Droplet

Answer 10

B. Standard

Standard Precautions are appropriate for all patients with meningitis unless the patient has a bacterial type that is transmitted by droplets, such as N. meningitides and H. influenzae.

Question 11

Nursing Intervention for Droplet Precautions

Answer 11

-Stay at least 3 feet from the patient unless wearing a mask.
-Patients who are transported outside of the room should wear a mask

Question 12

What is the normal range for ICP?
A. 20-30
B. 10-15
C. 20-40
D. 12-20

Answer 12

B. 10-15

Question 13

How do you dx Meningitis?

Answer 13

.The most significant laboratory test used in the diagnosis of meningitis is the analysis of the cerebrospinal fluid (CSF) by lumbar puncture

Question 14

Which of the following medications are typically given prior to a lumbar puncture?
A. Penicillin
B. Morphine
C. Fluconazole
D. Acetominophen

Answer 14

A. Penicillin

A broad-spectrum antibiotic should be given before the lumbar puncture.**

The CSF is analyzed for red blood cell count, differential count, and protein. Glucose concentrations are determined, and culture, sensitivity, and Gram stain studies are performed.

Question 15

What are some complications of Meningitis if it is not treated accordingly?

Answer 15

• Seizures
• Increased Intracranial Pressure
• Septic shock
• Visual impairment
  *Fluid and electrolyte imabalce
• Deafness
• Paralysis: due to too much pressure on the spinal cord
• Hydrocephalus

Question 16

What is the normal range for Blood glucose?

Answer 16

70-110

Question 17

How would you differentiate bacterial meningitis from viral meningitis?

Answer 17

Bacterial has decreased glucose while viral has increased glucose

Question 18

What are patients with Meningitis at risk for?
A. syndrome of inappropriate antidiuretic hormone
B. Diabetes inpidus
C. Hypotension
D. weak thread pulse

Answer 18

A. syndrome of inappropriate antidiuretic hormone

This syndrome of inappropriate antidiuretic hormone (see SIADH discussion elsewhere in this textbook) may lead to further increases in ICP.

Question 19

Bacterial Meningits s/s

Answer 19

CSF from LP cloudy
* CSF pressure ↑
* * Glucose concentration ↓
* * Protein levels ↑
* * WBC, RBC counts ↑
* * C & S to identify bacteria

Question 20

Viral meningitis s/s

Answer 20

• C & S negative * WBC

Question 21

medical Tx for bacterial menigitis

Answer 21

*Bacterial includes a 2-week course of IV antibiotics, after dx should be initiated after 1-2 hours
* Decrease increased intracranial pressure via mannitol which is a diuretic that affects fluid overload in cranium spaces
* Steroids
Treat/Prevent seizures: keep lights dimmed, low environmental stimuli
log roll patient; moving the body as one unit with a team to keep ICP down

Question 22

Nursing Care for Meningitis

Answer 22

• Prioritize care to maintain airway, breathing, and circulation.
• Take vital signs and perform neurologic checks every 2 to 4 hours, as needed.
• Perform cranial nerve assessment, with particular a ttention to cranial nerves III, IV, VI, VII, and VIII, and monitor for changes.
• Manage pain with drug and nondrug methods.
  *neutral position -full unit
• Perform vascular assessment and monitor for changes.
• Give drugs and IV fluids as prescribed and document the patient’s response.
• Record intake and output carefully to maintain fluid balance and prevent fluid overload.
• Monitor body weight to identify fluid retention early.
• Monitor laboratory values closely; report abnormal findings to the physician or nurse practitioner promptly.
• Position carefully to prevent pressure injuries.
• Perform range-of-motion exercises every 4 hours as needed.
• Decrease environmental stimuli:
• Provide a quiet environment.
• Minimize exposure to bright lights from windows and overhead lights.
• Maintain bedrest with head of bed elevated 30 degrees.
• Maintain Transmission-Based Precautions per hospital policy (for bacterial meningitis).
• Monitor for complications:
• Increased intracranial pressure
• Vascular dysfunction
• Fluid and electrolyte imbalance
• Seizures
• Shock

Question 23

What is one way to prevent Meningitis?
A. Obtaining the HPV vaccine
B. Getting a lumbar puncture
C. Obtaining the varicella vaccine
D. Getting a CT screening

Answer 23

C. Obtaining the varicella vaccine

Prevent meningitis by teaching people to obtain vaccination.
Vaccines are available to protect against Haemophilus influenzae type B (Hib), pneumococcal, mumps, varicella, and meningococcal organisms.

Question 24

Should cranial nerve testing be done routinely for a client with Meningitis?
A. Yes
B. No

Answer 24

A. Yes

Cranial nerve testing is included as part of the routine neurologic assessment because of possible cranial nerve involvement. A sixth cranial nerve defect (inability to move the eyes laterally) may indicate the development of hydrocephalus (excessive accumulation of CSF within the brain’s ventricles).

Question 25

Nursing action Alert , Meningitis (neuro)

Answer 25

For the patient with meningitis, assess his or her neurologic status and vital signs at least every 4 hours or more often if clinically indicated. The priority for care is to monitor for early neurologic changes that may indicate increased ICP, such as decreased level of consciousness (LOC). The patient is also at risk for seizure activity.

Question 26

If the patient is exposed to meningitis, what is the plan of care?

Answer 26

People who have been in close contact with a patient with N. meningitidis should have prophylaxis (preventive) treatment with rifampin, ciprofloxacin, or ceftriaxone. Preventive treatment with rifampin may be prescribed for those in close contact with a patient with H. influenzae meningitis