DESCRIPTION

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. Can develop when the microorganisms travel via the blood from another infection (sinusitis, mastoiditis, otitis media, neurosurgical procedures)

Viral meningitis Viral ("aseptic") is serious but rarely fatal in persons with a normal immune system Viruses, such as varicella zoster, mumps, HIV, herpes simplex virus (HSV) type 2, cause about 90% of cases. Fungal meningitis Cryptococcal meningitis is a serious and fatal form of the disease in patients with HIV/AIDS and a CD count of <200. Candida and aspergillus are other examples of fungi associated with meningitis. INCUBATION PERIOD The incubation period depends on the causative agent. For example the incubation period of meningococcal meningitis is 2-10 days while the incubation for hemophilus meningitis is much shorter ranging from 2-4 days. However the range of incubation for most organisms causing meningitis is 2 days to 2 weeks. PERIOD OF COMMUNICABILITY A person can pass the infection to others for as long as the bacteria are present in discharges from the nose and mouth. A person is no longer infectious within 24 to 48 hours after starting antibiotic treatment.

MODE OF TRANSMISSION

Direct contact Respiratory droplets

SIGNS AND SYMPTOMS Classical symptoms include:

Nuchal rigidity: stiff neck that creates pain when flexed toward chest
Positive Brudzinskis sign Positive Kernigs sign

THE PATHOGEN Bacterial meningitis Often severe and is a medical emergency. It progresses rapidly, and if left untreated, can cause permanent damage, example (hearing loss, loss of limb)

High fever (viral: never goes >104) Altered mental status Headache (severe, consistent) Photophobia

1. Streptococcus Pneumoniae (Pneumococcal) More common and serious in children <5yrs of age. CDC data: It has the highest mortality rate at 21%. 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.

DIAGNOSTIC TESTS CT Scan EEG Lumbar Puncture most important lab test

>extremes of age >Immunosuppresion

PATHOPHYSIOLOGY
>Exposure to droplets >Direct contact

(4) Provide basic patient care needs. (5) Provide discharge planning information to the patient and family. TREATMENT The treatment again depends on the causative organism. When meningitis is first suspected, broad spectrum antibiotics should be instituted depending on the age group of the patient (to cover for bacterial causes- as early treatment in such cases is vital). For example an infant should be started on Ampicillin plus cefotaxime plus vancomycin while an elderly person should be started on Ceftriaxone plus vancomycin. After the organism has been isolated from the CSF appropriate organism specific treatment should be instituted. Viral meningitis is treated supportively, and is not serious unless accompanied by encephalitis. HEALTH EDUCATION Good hygiene practices (hand washing, no sharing of items, utensils) Vaccines Post exposure antibiotics/traveling Adequate nutrition Avoid alcohol/drugs

MENINGITIS

Inhalation of contaminated droplets

invasion microorganisms through

mucous membranes Entry of microorganisms into the blood stream

Prepared by: CABALLEJOS, Peter John M.

Microorganism crosses the blood brain-barrier Inflammatory reaction

Increased ICP

Prof. LEVI DINGLASAN, RN,MAN Clinical Instructor

Adamson University COLLEGE of NURSING

Increased CSF cell count

Endothelial damage vasculat necrosis

NURSING MANAGEMENT (1) Administer intravenous fluids and medications, as ordered by the physician. (2) Monitor patient's vital signs and neurological status and record. (3) If isolation measures are required, inform family members and ensure staff compliance of isolation procedures

SAN LAZARO HOSPITAL