ATI CHAPTER 5 MENINGITIS - MEDICAL SURGICAL NURSING

Meningitis

Inflammation of the meninges (membranes that protect the brain and spinal cord)

Medications used for Meningitis?

-Ceftriaxone or cefotaxime in combinationwith vancomycin. -Phenytoin -Acetaminophen, ibuprofen -Ciprofloxacin, rifampin, or ceftriaxone

What results are indicative of meningitis via CSF?

-Apperance of CSF: cloudy (bacterial) or clear (viral) -Elevated WBC -Elevated protein -Decreased glucose (bacterial) -Elevated CSF pressure.

Septic Emboli

-Can form during menigitis and travel to other parts of the body, particularly the hands, but can occur in the feet as well. -Development of gangrene can necessitate an amputation. -Septic emboli can lead to disseminated intravascular coagulation or stroke.

Other clinical findings of bacterial meningitis

-Fever and chills -N/V -Altered LOC- confusion, disorientation, lethargy, difficulty arousing, coma -Positive Kernig's sign- resistance and pain with extension of the client's leg from a fixed position -Positive Brudzinski's sign- flexion of extremities occurring with flexion of the client's neck -Tachycardia -Seizures -Red macular rash -Restlessness, irritability

Individuals at risk of Bacterial Meningitis

-Immunosuppression -Invasive procedure, skull fracture, or penetrating head wound (direct access to CSF) -Overcrowded or communal living conditions

What are the possible complications involved with meningitis?

-Increased ICP -SIADH -Septic Emboli

What should the nurse do to care for a patient with meningitis?

-Isolate the client as soon as meningitis is suspected. -Maintain isolation precautions per hospital policy. -Implement fever-reduction measures, such as a cooling blanket -Report meningococcal infections to the public health department. -Decrease environmental stimuli -Provide a quiet environment. -Minimize exposure to bright light -Maintain bed at 30 degrees -Monitor for increased ICP -Replace fluids and electrolytes as indicated by lab values.

What actions should the nurse take for a client with septic emboli due to meningitis?

-Monitor circulatory status extremities and coagulation studies. -Report any alterations immediately to the provider.

What actions should the nurse take for a client with increased ICP due to meningitis?

-Monitor for indications of increasing ICP (decreased level of consciousness, pupillary changes, impaired extraocular movements) -Provide interventions to reduce ICP (positions w/ head of bed at 30 degrees) -Avoid coughing and straining because can cause an increase. -Mannitol can be administered via IV>

What actions should the nurse take for a client with SIADH due to meningitis?

-Monitor for manifestations (dilute blood, concentrated urine) -Provide interventions, such as the administration of demeclocycline and restriction of fluid. -Monitor the clients weight daily.

Pneumococcal polysaccharide vaccine (PPSV)

-This immunization also decreases the risk for CNS infections. -Vaccinate adults who are immunocomprimised, have a chronic disease, smoke cigs, or live in a long term facility. -Give one dose to adults older than 65 who have not previously been immunized nor have history of disease.

What are the risk factors for delevoping meningitis?

-Viral meningitis -Fungal meningitis -Bacterial meningitis -Immunosupression -Direct contamination of spinal fluid -Invasive procedures, skull fracture or penetrating wound. -Environment

CT scan and MRI

A CT scan or an MRI can be performed to identify increased intracranial pressure (ICP) and/or an abscess.

Haeophilus influenzae type b (Hib) vaccine

A series of four doses is reccomended beginning at 2 months of age, with the final dose at 12 to 15 months.

(4) Acetaminophen (Tylenol) and Ibuprofen (Motrin)

Analgesics for H/A and/or fever- non-opioid to avoid masking changes in the LOC

What is Acetaminophen, ibuprofen used for in Meningitis cases?

Analgesics for headache and/or fever. Nonopiod to avoid masking changes in the level of consciousness.

Medications for Meningitis (1) Ceftriaxone (Rocephin) or cefotaxime (Claforan) in combination with vancocin (Vancomycin)

Antibiotics given until culture and sensitivity results are available

What is ceftriaxone or cefotaxime in combinationwith vancomycin used for?

Antibiotics given until culture and sensitivity results are available. Effective for bacterial infections.

(2) Phenytoin (Dilantin)

Anticonvulsants given if ICP increases or client experiences a seizure

What is Phenytoin used for?

Anticonvulsants given if ICP increases or client experiences a seizure.

Bacterial meningitis

Bacterial-based infections, such as otitis media, pneumonia, or sinusitis, in which the infectious microorganism is Neisseria meningitidis, Streptococcis pneumoniae, or Haemophilus infuenzae.

Which form of meningitis has the highest mortality rate?

Bacterial (or septic) meningitis is a contagious infection with a high mortality rate.

(2) Syndrome of inappropriate antidiuretic hormone (SIADH)

By abnormal stimulation of the hypothalamic area of the brain- causing excess secretion of antidiuretic hormone (vasopressin) Nursing actions: -Monitor for S/S: Dilute blood and concentrated urine -Interventions: administration of demeclocycline (Declomycin) and restriction of fluid

Counterimmunoelectrophoresis (CIE)

Can be done on CSF to determine whether the infectious agent is viral or protozoa. This diagnostic study is also indicated if the client received antibiotics before CSF was collected.

How to Diagnose Meningitis

Cerebrospinal fluid (CSF) analysis- most definite diagnostic; CSF is collected during a lumbar puncture Results indicative of Meningitis: -Appearance of CSF- Cloudy (bacterial) or clear (viral) -Elevated WBC, protein -Decreased glucose (bacterial) -Elevates CSF pressure -CT scan or MRI- to identify increased intracranial pressure (ICP) and/or abscess

What diagnostic procedures are used in patients with meningitis?

Cerebrospinal fluid analysis (CSF) Counterimmunoelectrophoreses (CIE) CT scan and MRI

Fungal meningitis

Common in children who have AIDS

Bacterial or septic meningitis

Contagious infection with a high mortality rate

2. A nurse is assessing for the presence of Brudzinski's sign in a client who has suspected meningitis. Which of the following are appropriate actions by the nurse when performing this technique? (Select all that apply) A. Place client in supine position B. Flex client's hip and knee C. Place hands behind the client's neck D. Bend client head toward chest E. Straighten the client's flexed leg at the knee

Correct Answer: A, C, D

4. A nurse is planning care for a client who has meningitis and is at risk for increased intracranial pressure (ICP). Which of the following are appropriate nursing actions? (Select all that apply) A. Implement seizure precautions B. Perform neurological check four times a day C. Administer morphine for the report of neck and generalized pain D. Turn off room lights and television E. Monitor for impaired extraocular movements E. Encourage the client to cough frequently

Correct Answer: A, D, E

3. A nurse is reviewing the health record of a student newly admitted to a university and living in a dormitory. The health record indicates the student requires follow-up immunizations. Which of the following organisms should the nurse plan to vaccinate the student against? A. Streptococcus Pneumoniae B. Neisseria meningitidis C. Bartonella henselae D. Rickettsia rickettsii

Correct Answer: B

Chapter 5 questions: 1. A nurse is assessing a client who reports severe H/A and a stiff neck. The nurse's assessment reveals positive kernig's and Brudzinski's signs. Which of the following actions should the nurse perform first? A. Administer antibiotics B. Implement droplet isolation precautions C. Initiate IV assess D. Decrease Bright lights

Correct Answer: B

5. A nurse is planning care for a client who has bacterial meningitis. Which of the following actions should the nurse include in the plan of care? (Select all that apply) A. Monitor for bradycardia B. Provide an emesis basin at the bedside C. Administer antipyretic medication as prescribed D. Perform a skin assessment E. Keep the head of the bed flat

Correct answer: B, C, D

(3) Meningococcal vaccine (MCV4)

Ensure adolescents receive vaccine on schedule and prior to living in a residential setting in college; individuals in other settings IE military should also be vaccinated

Three different vaccines for different pathogens of bacterial meningitis: (1) Haemophilus influenzae type b (Hib) vaccine

Ensure infants receive vaccine for bacterial meningitis on schedule

S/S of Bacterial Meningitis

Excruciating constant H/A Nuchal rigidity (Stiff neck) Photophobia (sensitivity to light)

Fungal meningitis

Fulminant fungal-based infection of the sinuses are from the organism Cryptococcus neoformans.

Which patients usually develop fungal meningitis?

Fungal meningitis is common in clients who have AIDS.

Viral or aseptic meningitis

Is the most common form and commonly resolve without treatment (no vaccine available)

Nursing interventions with meningitis

Isolate the client as soon as meningitis is expected Droplet precautions should continue until antibiotics have been taken for 24 hours and when oral and nasal secretions are no longer infectious -Fever-reduction measures IE cooling blanket -Decrease environmental stimuli= provide quiet environment; minimize exposure to bright light -Maintain bed rest with HOB elevated to 30 degrees -Monitor client for ICP- tell client to avoid coughing and sneezing that increases ICP -Seizure precautions -Older adult clients increased risk for secondary complications IE pneumonia

(3) Septic Emboli

Leading to disseminated intravascular coagulation or cardiovascular accident -Septic Emboli can form during meningitis and travel to other parts of the body especially the hands and feet *Development of gangrene will require amputation Nursing Actions: -Monitor circulatory status of extremities and coagulation studies -Report any alterations immediately

(3) Corticosteroid

May improve outcome in adults if given before first dose of antibiotic

Increased ICP

Meningitis can cause ICP to increase, possibly to the point of brain herniation.

Meningococcal vaccine (MCV4)

Neisseria meningitidis; Individuals in other communal living conditions should be immunized. An initial dose is recommended for healthy children between the ages of 11 to 12, with a booster administered at age 16.

Complications of meningitis (1) Increased ICP

Nursing actions: -Monitor for signs of increased ICP: decrease LOC, pupillary changes, impaired extraocular movements -Interventions to reduce ICP: positioning and avoidance of coughing and straining -Mannitol can be administered IV

(5) Ciproflaxican (Cipro), Rifampin (Rifandin), or ceftriaxone (Rocephin)

Prophylactic antibiotics given to individuals in close contact with the client

What is ciprofloxacin, rifampin, or ceftriaxone used for?

Prophylactic antibiotics given to individuals in close contact with the client.

Cerebrospinal fluid analysis (CSF)

The most definitive diagnostic procedure. Collected during a lumbar puncture preformed by the provider.

How many vaccines are available for meningitis?

There are three vaccines for different pathogens that cause bacterial meningitis.

(2) Pneumococcal polysaccharide Vaccine (PPSV)

Vaccinate adults who are immunocompromised, who have a chronic disease, who smoke cigarettes, or live in a long term care facility -Give one dose to adults older than 65 who have previously not been vaccinated nor have hx of disease

Viral meningitis

Viral illnesses such as the mumps, measles, herpes, and arboviruses (West Nile). No vaccine again viral meningitis.

What is the most common form of meningitis?

Viral, or aseptic, meningitis is the most common form of meningitis and commonly resolves without treatment.

Meningitis

an inflammation of the meninges, which are the membranes that protect the brain and spinal cord.

SIADH

can be a complication of meningitis due to abnormal stimulation to the hypothalamic area of the brain, causing excess secretion of antidiuretic hormone (vasopressin).