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 cannotsurvive 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 proteinB. 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 hygieneB. contact with infected nasal secretionsC. coughingD. all of the above

3. All are symptoms of meningitis except:A. feverB. altered mental statusC. stiffneck D. tinnitus

4. Which classification of medications is essential in the treatment of meningitis?A. anticonvulsantsB. antibioticsC. corticosteroidsD. 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 cordB. inflammation of the spinal cord and pericardiumC. inflammation of the meninges that results in swelling of the brain and spinal tissue D. A and C only