Meningitis

  1. General information
    1. Inflammation of the meninges of the brain and spinal cord
    2. Caused by bacteria, viruses, or other microorganisms
    3. May reach CNS
      1. Via the blood, CSF, lymph
      2. By direct extension from adjacent cranial structures (nasal sinuses, mastoid bone, ear, skull fracture)
      3. By oral or nasopharyngeal route
    4. Most common organisms: meningococcus, pneumococcus, H. influenzae, streptococcus
  2. Assessment findings
    1. Headache, photophobia, malaise, irritability
    2. Chills and fever
    3. Signs of meningeal irritation
      1. Nuchal rigidity: stiff neck
      2. Kernig's sign: contraction or pain in the hamstring muscle when attempting to extend the leg when the hip is flexed
      3. Opisthotonos: head and heels bent backward and body arched forward
      4. Brudzinski's sign: flexion at the hip and knee in response to forward flexion of the neck
    4. Vomiting
    5. Possible seizures and decreasing LOC
    6. Diagnostic test: lumbar puncture (measurement and analysis of CSF shows increased pressure, elevated WBC and protein, decreased glucose and culture positive for specific microorganism)
  3. Nursing interventions
    1. Administer large doses of antibiotics IV as ordered.
    2. Enforce respiratory isolation for 24 hours after initiation of antibiotic therapy for some types of meningitis (consult hospital's infection control manual for specific directions).
    3. Provide nursing care for increased ICP, seizures, and hyperthermia if they occur.
    4. Provide nursing care for delirious or unconscious client as needed.
    5. Provide bed rest; keep room quiet and dark if client has headache or photophobia.
    6. Administer analgesics for headache as ordered.
    7. Maintain fluid and electrolyte balance.
    8. Prevent complications of immobility.
    9. Monitor vital signs and neuro checks frequently.
    10. Provide client teaching and discharge planning concerning
      1. Importance of good diet: high protein, high calorie with small, frequent feedings
      2. Rehabilitation program for residual deficits.

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