Bacterial Meningitis Presentation

7/24/2019 Bacterial Meningitis Presentation

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Bacterial MeningitisBy LeAnna Ceglia


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What is Bacterial Meningitis?

Acute inflammation ofthe meningeal tissues

that surround andprotect the brain andspinal cord

More specifically, refersto infection of the

arachnoid mater and thecerebral spinal fluid


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Etiology

According to the Centerfor Disease Control andPrevention, there were4,100 cases in the UnitedStates, with 500 deaths

between 2003-2007(2014)

According to the NationalInstitute of NeurologicalDisorders and Stroke,about 6,000 cases are

reported of pneumococcalmeningitis in the U.S.while 2,600 cases arereported of meningococcalmeningitis


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Pathophysiology

The bacterial organismgains entry to the CNSthrough the bloodstreamor upper respiratory tract

Inflammatory response

to infection causesincrease of CSFproductions andmoderate increase in ICP.

This increased purulentsecretion production

spreads quickly to otherareas of the brain viaCSF, covering cranialnerves and otherintracranial structurescausing neurological

problems


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Causes and Risk Factors

Causes

Streptococcuspneumonia

Neisseria meningitidis

Haemophilus influenzae

Now decreased due toH. influenza vaccine

Risk Factors

Occur usually in the fall,winter, or early spring

Often secondary to viralrespiratory disease

Older adults

Debilitation

Living in confined spaceswith multiple people(prison, college dorms,

etc.) Immunosuppression

Invasive procedures

Skull fracture

Penetrating head wound


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Signs and Symptoms

Common clinicalmanifestations

Fever

Severe headache

Nausea/vomiting

Neck stiffness

Photophobia

Decreased LOC

Signs of increased ICP

Other possiblemanifestations

Coma

occurs in 5-10% ofpatients with a poor

prognosis Seizures

Occurs in 1/3 of allcases

Skin rash and petechiae

If infecting organism ismeningococcus


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Complications

ICP

Most commoncomplication

Most common cause for

altered mental status

Cranial Nerve Dysfunction

occurs with CN III, IV, VI,VII, or VIII

Acute Cerebral Edema

Causes seizures, CN IIIpalsy, hypertensive coma,bradycardia, and death

Hemiparesis

Dysphasia

Hemianopsia

Headaches that continueuntil swelling andinflammation has been

completely resolved Noncommunicating

hydrocephalus

Waterhouse-Friderichsensyndrom

Petechiae, disseminated

intravascular coagulation,adrenal hemorrhage, andcirculatory collapse


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Assessment/Diagnostics

Patient history andphysical exam

A blood culture

CT scan, MRI, and PETscan

Lumbar puncture toanalyze cerebrospinalfluid

Assess CSF for protein,WBC, glucose, Gram

stain, and culture CBC-coagulation profile,

electrolyte levels,glucose levels, andplatelet count

Skull x-ray


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Results for Positive Bacterial Meningitis

Cerebrospinal fluidappears cloudy

WBCs elevated

Protein levelselevated

Glucose levelsdecreased

Cerebrospinal fluid

pressure increased Increased intracranial

pressure shown withCT scan or MRI


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Collaborative Care

Place patient in isolationas soon as meningitis issuspected

Maintain hospitalprecautions per hospital

policy Implement droplet

precaution until antibioticshave been administeredfor 24 hours

Use fever-reductionmeasures

Report infection to thepublic health department

Decrease environmentalstimuli to ensure rest

Maintain bedrest with HOBat least 30

Maintain safety andseizure precautions

Maintain fluid andelectrolyte therapy asindicated by lab results

Administer antibiotics


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Treatment

Rocephen or Claforan

Antibiotic given untilsensitivity and cultureresults are available

Ampicillin or penicillin

Antibiotic given to treatbacterial meningitis

Decadron

To prevent neurologicalcomplication of bacterial

meningitis (septic shock,acute respiratory distress,disseminatedintravascular coagulation

Mannitol

A diuretic to decrease ICP

Dilantin

Anticonvulsant given ifpatient experiences aseizure or the ICPincreases

Acetaminophen, ibuprofen

Analgesic to help withheadaches and/or fever Anonopioid to preventmasking any changes inlevel of consciousness

Ciprofloxan, rifampin

A prophylactic antibioticgiven to individuals whohave had close contactwith patient


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Preventative Measures

Always wash your hands

Haemophilus influenzaetype b (Hib) vaccine asan infant

Meningococcal vaccine

(MCV4) as an adolescentprior to living in dormsor other communal livingconditions such asmilitary

Pneumococcalpolysaccharide vaccine(PPSV) ifimmunocompromised,have chronic disease,smoke cigarettes, live in

long-term care facility


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Resources

Center for Disease and Control Prevention (2014, April 1).Bacterial Meningits [Web log post]. Retrieved fromhttp://www.cdc.gov/meningitis/bacterial.html

Knippa, A., Sommer, S., Ball, B., Churchill, L., Elkins, C.,Janowski, M. J, Roberts, K, & Wright, M. (2012). RN

adult medical surgical nursing edition 8.0. Menigitis(pp.59-63). Assessment Technologies Institute, LLC.

Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., &Camera, I. (2011). Medical-surgical nursing:assessment and management of clinical problems.

Acute Intracranial Problems(pp.1425-1458). St. Louis,

MI: Elsevier MosbyNational Institute of Neurological Disorders and Stroke

(2014). Meningitis and encephalitis fact sheet.Retrieved fromhttp://www.ninds.nih.gov/disorders/encephalitis_menin

gitis/detail_encephalitis_meningitis.htm


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Review Questions

What vaccine is appropriate for a freshman in college toreceive?

A.) Haemophilus influenzae type b (Hib)B.) Meningococcal vaccine (MCV4)

C.) Pneumococcal polysaccharide vaccine (PPSV)


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Review Questions

Which bacteria are responsible for causing bacterialmeningitis? (select all that apply)

A.) Streptococcus pneumonia

B.) Escherichia coliare

C.)Neisseria meningitidis

D.) Bacillus anthracis


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Review Questions

Signs and symptoms of bacterial meningitis include flu-likesymptoms accompanied by

A.) tinnitus

B.) neck stiffness

C.) bloody stool

D.) decreased temperature

Documents

Bacterial Meningitis Presentation