Pathophysiology: Inflammation of the meninges usually caused by bacteria or a virus. This inflammation caused symptoms of the CNS.
- Inflammation of the membranes around brain and spinal cord
- CSF is analyzed to determine diagnosis
- ↑ WBC
- ↓ Glucose
- Transmission usually occurs in areas of population density and crowded living spaces
- College Dorms
- Homeless Shelters
- Altered level of consciousness
- Nuchal rigidity
- Kernig’s sign
- Brudzinski’s sign
- Increased Intracranial Pressure
- Place in droplet isolation
- Consider Blood-Brain-Barrier
- Infection Control
- Isolation Precautions
- Assess LOC q2-4 hours
- Monitor ICP / CPP
- Seizure precautions
- Signs to report to provider
- Infection prevention
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
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Okay, let’s talk about meningitis and its nursing implications.
If we break down the word meningitis, we can determine that it is inflammation (that’s what -itis means) of the meninges. The meninges are the layers of tissue surrounding the brain. There’s the pia mater, arachnoid layer, and the dura mater. You’ll notice there are blood vessels and nerve endings in the arachnoid layer. Having bacteria or viruses in your bloodstream can cause them to possibly make their way into the brain and to these meninges. Another risk factor is any kind of skull fracture or surgical procedure that cuts into the skull. That exposes these layers and causes a high risk of infection. When these layers get infected, they can get inflamed and swollen and cause a lot of issues.
Patients will often have fevers because of the infection itself, as well as headaches from the irritation. Quite often they’ll have an altered LOC – ranging from drowsiness to confusion and delirium. One of the classic signs of meningitis is nuchal rigidity. The inflammation in the meninges causes the muscles in the neck to spasm and get stiff. The patient will not be able to tuck their chin to their chest. In the adjunct neuro assessments lesson, we talked in detail about Kernig’s and Brudzinski’s signs that point to nuchal rigidity. Patients may also be lethargic and have a sensitivity to light, known as photosensitivity. We will also eventually see signs of increased intracranial pressure. All of this can eventually lead to seizures and death if left untreated. I want you to picture Edgar from the movie Men in Black, His body was taken over by an alien bug. He became stiff, pale, looked like death, and just wasn’t himself anymore. Patients with meningitis have had their nervous system ‘taken over’ by a bug (virus, bacteria, etc.). Patients even describe ‘feeling like death’.
To diagnose meningitis, once we have a suspicious clinical picture, we do a lumbar puncture to analyze the patient’s CSF. If there is infection present, it will be cloudy instead of clear and we will likely find white blood cells in it. If the source is bacterial, we will also see low or no glucose in the CSF. This is because the bacteria actually feed on the glucose and eat it all up. Funny enough, Edgar from Men in Black even craved sugar water!
In terms of transmission, meningitis is spread via droplets and is common in overcrowded areas like prisons, college dorms, and homeless shelters. Proper hand hygiene and staying away from people who are sick is the best way to prevent the spread in the community.
Managing meningitis will vary depending on the source. If you remember from the Blood-Brain-Barrier lesson, we discussed that antibiotics are often unable to cross the blood brain barrier to address bacterial infections. Many times care ends up being supportive with these cases. Either way we’ll do our best to fight the infection, manage the symptoms, and prevent further transmission. We’ll put the patient in Droplet Isolation precautions, give analgesics and antipyretics, and antibiotics or antivirals as appropriate. Again, we will have sampled the cerebrospinal fluid to culture it and determine what the causative organism is so that we can treat it appropriately.
Our priority nursing concepts for a patient with meningitis are infection control, cognition, and safety. We need to give antimicrobials and prevent transmission, assess their LOC, and make sure to keep them safe from any complications or injury like seizures. Make sure you check out the care plan attached to this lesson for detailed nursing interventions and rationales.
So let’s recap quickly – meningitis is inflammation of the meninges of the brain due to infection, either bacterial, viral, fungal, or protozoan. We use a lumbar puncture to obtain and analyze cerebrospinal fluid to confirm the diagnosis based on our clinical suspicion. Classic symptoms of meningitis are fever, altered LOC, and nuchal rigidity. We will want to put the patient on droplet precautions as well as seizure precautions. If you need a refresher, we discussed droplet precautions in Module 3 of the Respiratory course and we talked about seizure precautions in Module 5 of the Neuro course. Remember our priorities of care are to fight the infection, manage symptoms, and prevent any further transmission.
Okay guys, so that’s meningitis, and that wraps up the Neuro course! Don’t hesitate to contact us if you have any questions. Now, go out and be your best selves today! And, as always, happy nursing!