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Meningitis Definition
o Inflammation of the brain and the spinal cord
Types of Meningitis
bacterial
viral
bacterial meningitis precautions
ICP precautions
Droplet precautions
who is more at risk for meningitis?
college students
-administer meningococcal booster before going to college
viral meningitis
§ treat the s/s
§ Usually self-limiting
§ Full recovery expected
Long term complications of meningitis
o Hearing loss
o Vision loss
o Temporary paralysis
Dysphagia
S/S of meningitis
o Nuchal rigidity (neck stiffness)
o Positive Kernig’s sign
o Positive Brudzinski’s sign
o Tachycardia
o Fever (Due to infection)
o N/V
o Severe headache
o Photophobia (Sensitivity to light)
o Decreased LOC (confusion)
o Increased ICP
o Seizures
what is Positive Kernig’s sign?
§ resistance and pain with extension of the client’s leg from a flexed position
THINK “K” for knee
what is Positive Brudzinski’s sign?
§ flexion of the knees and hips occurring with deliberate flexion of the client’s neck
THINK “B” for brain
Meningitis dx
o CT Scan - To rule out obstruction of the foramen magnum to prevent fluid shift resulting in herniation
o Lumbar puncture with CSF fluid analysis
what position should the pt be in for a lumbar puncture?
o Lying position on their side
o Sitting position tilting head forward
Meningitis: Lumbar Puncture – Nursing Care
o Informed consent
o Position patient
§ Bent over and sitting – to open vertebra
§ Side lying in fetal position – to open vertebra
o Send CSF to the lab
o Keep pt flat (If the pt sits up, they will complain of a headache)
§ Monitor pt’s for 1-4 hours
o Pt may complain of headache (Can give fluids and pain meds)
§ Do not report a headache to the PCP (It is expected)
o Check gauze (COCA – color, odor, consistency, and amount)
§ There are no stitches
§ Gauze and band aid only
what are the complications of a lumbar puncture?
§ CSK leak
§ Bleeding
§ Infection
§ Notify PCP
Meningitis Priority Nursing Care - For Increased ICP
§ Elevate HOB slightly
§ Report decreased LOC
§ Assess GCS/Neuro
§ Administer anti-seizure meds
§ Initiate seizure precautions
§ Administer mannitol
Meningitis Priority Nursing Care - For delirium and comfort
§ Dim lights
§ Administer analgesic for headache (Must be NON-OPIOID)
§ Decrease hallucinations by having family members around (familiar faces)
Meningitis Priority Nursing Care - For fever
high temp increase risk of seizures
· Initiate seizure precautions
· Administer anti-seizure meds (Phenytoin (Dilantin))
· Administer aspirin or acetaminophen (Must treat fever ASAP)
· Provide cooling blanket if the fever is severe
· Strict I/O’s (Fever = fluid loss)
Meningitis Priority Nursing Care - For infection
· Administer widespread ABX first
· Discharge ABX for viral meningitis
· Droplet precautions
Meningitis: Bacterial Complications
§ Increased ICP
§ SIADH
§ Septic embolism
Meningitis: Bacterial Complications - nursing actions
§ Isolation
§ Monitor vitals
· Treat fever to decrease risk for seizure (Administer Tylenol or aspirin)
§ Neuro assessment
§ Strict I/O’s
§ Initiate seizure precautions
Meningitis Meds - ABX
§ Vancomycin with a cephalosporin
· Cephalosporin could be cefuroxime, cefotaxime, ceftriaxone, ceftizoxime, ceftazidime
Meningitis Meds - pain meds
§ For stiff neck
· NSAID
Meningitis Meds - anti-seizure meds
§ Phenytoin (Dilantin)
§ Levetiracetam
Note 
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