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Adult Meningitis

Bacterial & Viral

Faith Vaughn RN, BSN, MSN


Learning Objectives:
At the end of the presentation, the audience will be
able to:

• Describe causes of meningitis

• Identify causes and symptoms of meningitis

• State nursing interventions for meningitis


What is Meningitis

• Meningitis: is an inflammation of the meninges


(lining of the brain and spinal cord), which is
caused by various organisms such as bacterial,
viral, or fungi

• The disease is contagious, and can spread from


person to person by nasal or oral droplets
(kissing, sneezing, coughing) and direct close
contact with the discharges from the nose or
throat of an infected person. CDC data: 10-14% of
cases are fatal.
Inflammation of the Meninges
Cause of Meningitis
Bacterial meningitis:
• Can develop when the bacteria travel via the blood
from another infection (sinusitis, mastoiditis, otitis
media, neurosurgical procedures)

• Often severe and is a medical emergency. It


progresses rapidly, and if left untreated, can cause
permanent damage, example (hearing loss, loss of
limb)

• CDC data: 10% will die despite early diagnosis and


treatment.
(bacteria can live only seconds outside. It cannot
survive in air or on household objects such as
clothes, furniture etc)
Common Bacterial Organisms
1. Streptococcus Pneumoniae (Pneumococcal)
• More common and serious in children <5yrs of
age.
• CDC data: It has the highest mortality rate at
21%. Vaccine is available.

2. Neisseria Meningitidis (meningococcus)


• Leading cause of bacterial meningitis and is highly
contagious.
• Crowded living conditions increase the risk (such
as daycare centers, nursing homes, dorms
• Immunosuppressive pts, passive smoking, very
young & very old are affected.
• Prognosis: 5-10% mortality rate.
Viral meningitis:

• Viral ("aseptic") is serious but rarely fatal in


persons with a normal immune system

• Symptoms are similar to bacterial

• Viruses, such as varicella zoster, mumps, HIV,


herpes simplex virus (HSV) type 2, cause about
90% of cases.

• Decrease in locations where immunizations have


become routine (vaccines)
Assessment

Physical exam:
• Hx: depends on type of illness (URI, post-
exposure, recent travel)

• Focus is on neurological status: deterioration can


progress rapidly

• Diagnostic tests: Ct scan & EEG. *Lumbar


puncture: most important lab test.

• An increase in protein concentration and WBCs


indicates bacterial.

Alert: knowing whether the organism is viral or


bacterial is imperative to early, effective TX
Signs/Symptoms:

Classical symptoms include:


• Nuchal rigidity: stiff neck that creates pain when
flexed toward chest

• High fever (viral: never goes >104)

• Altered mental status

• Headache (severe, consistent)

• Photophobia

• Alert: If fever, neck stiffness, and altered mental


status are all absent, bacterial meningitis is
eliminated. (Visit MD if 2 or more symptoms)
Often mistaken for the cold or flu-like illness
Treatment:
• Need for hospitalization depends on severity of
illness (Immediate IV antibiotic is crucial, if
suspected, and can be adjusted after CSF results).

• Prophylaxis for exposure is Rifampin


Alert: (urine-orange reddish color)

• Viral is mostly supportive care based on


symptoms. MD recommends bed-rest, fluids,
Tylenol /aspirin for aches/pain. Symptoms usually
resolved in 7-10 dys.

• Isolation: droplet precautions for bacterial (Mask


on entering room).
Teaching & Prevention

• Good hygiene practices (hand washing, no sharing


of items, utensils)

• Vaccines/Post exposure antibiotics/traveling

• Adequate nutrition

• Avoid alcohol/drugs
Post-test
.
! Ms Jones has been admitted for meningitis. The lab analysis for CSF was reviewed by the primary
nurse. The nurse would expect to note:
A. an increase in protein
B. clear color
C. decrease in WBCs
2. Meningitis is contagious. From your knowledge of the disease, you would know the organism could
spread by:
A. poor hand hygiene
B. contact with infected nasal secretions
C. coughing
D. all of the above
3. All are symptoms of meningitis except:
A. fever
B. altered mental status
C. stiffneck
D. tinnitus
4. Which classification of medications is essential in the treatment of meningitis?
A. anticonvulsants
B. antibiotics
C. corticosteroids
D. none of the above .
5. Meningitis is define as:
A. a bacterial or non-bacterial infection that causes inflammation of the membranes covering the
brain and spinal cord
B. inflammation of the spinal cord and pericardium
C. inflammation of the meninges that results in swelling of the brain and spinal tissue
D. A and C only