3. Key Points Meningitis (spinal meningitis) is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord (the meninges), caused by an infection of the fluid surrounding the brain and spinal cord.  Viral, or aseptic, meningitis is the most common form of meningitis and commonly self-limited.  Bacterial, or septic, meningitis is a contagious infection with a high mortality rate.  A meningitis vaccine is available for high-risk populations.

4. Risk Factors  For Viral Meningitis:  Viral illnesses (mumps, measles, and herpes)  For Bacterial Meningitis:  Bacterial infections (Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae), such as upper respiratory infections (otitis media, pneumonia, sinusitis), GE, osteomyelitis  Immunosuppression  Invasive procedures (skull fracture )  Overcrowded living conditions

6. Diagnostic Procedures and Nursing Interventions  CSF analysis is the most definitive diagnostic procedure.  LP: empty bladder, fetal position, clean the skin, and local anesthetic is injected.  Instruct the client to report any shooting pain or tingling  Pressure readings are taken, followed by the collection of three to five test tubes of CSF.  After the procedure, apply sterile dressing with pressure.  Appropriately label specimens and deliver them to the laboratory.

7. Diagnostic Procedures and Nursing Interventions  The client should remain in bed for 4 to 8 hr in a flat position to prevent leakage and a resulting spinal headache.  Monitor the site for hematoma or infection.  Results indicative of meningitis:  Appearance of CSF: Cloudy (bacterial) or clear (viral)  Elevated WBC  Elevated protein (40-60 mg/dl)  Decreased glucose (bacterial) (normal: 60% of blood glucose)  Elevated CSF pressure  Perform blood C&S to identify an appropriate broad- spectrum AB  CT /MRI may to identify increased ICP and/or an abscess.

9. Assessment  Terrible, pounding headache  Fever and chills  Photophobia  N&V  Altered LOC  Nuchal rigidity  Positive Kernig’s sign (resistance to extension of the client’s leg from a flexed position)  Positive Brudzinski’s sign (flexion of extremities occurring with deliberate flexion of the client’s neck)  Tachycardia  Seizures  Red macular rash (meningococcal meningitis)

16. Frequently assess/monitor  Airway, breathing, and circulation.  VS (Monitor for signs of shock).  Neurological checks.  Cranial nerve function.  Intake and output.  Signs of increased intracranial pressure (change in level of consciousness, widening of pulse pressure, pupil changes).

17. NANDA Nursing Diagnoses  Ineffective airway clearance  Impaired spontaneous ventilation  Risk for injury  Acute confusion  Deficient fluid volume  Ineffective thermoregulation

18. Nursing Interventions  Maintain isolation precautions per hospital policy.  Manage fever.  Report meningococcal infections to the public health department.  Decrease environmental stimuli (calm, minimize bright light).  Maintain bed rest with the head of the bed elevated to 30°.  Maintain client safety, such as seizure precautions.

19. Nursing Interventions  Administer medications as prescribed.  Antibiotics (bacterial infections) – such as ceftriaxone (Rocephin) or cefotaxime (Claforan) until C&S results are available  Anticonvulsants – phenytoin (Dilantin)  Antipyretics – acetaminophen (Tylenol)  Analgesics – non-opioid to avoid masking changes in the level of consciousness  Fluid and electrolyte replacement as indicated by laboratory values  Prophylactic antibiotics to individuals in close contact with the client

20. Complications and Nursing Implications  Increased ICP (possibly to the point of brain herniation)  Monitor for signs of increasing ICP  Provide interventions to reduce ICP, such as positioning and avoidance of coughing and straining.  Syndrome of Inappropriate Antidiuretic Hormone (SIADH)  Monitor for S&Sx (dilute blood, concentrated urine).  Provide interventions, such as the administration of demeclocycline (Declomycin) and restriction of fluid.  Septic Emboli (leading to DIC or CVA)  Monitor circulatory status.  Monitor coagulation.