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52 Cards in this Set
- Front
- Back
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What is meningitis?
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An inflammation of the arachnoid and pia mater of the brain and spinal cord and the cerebrospinal fluid
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What are the types of meningitis?
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1. Bacterial meningitis
2. Viral meningitis 3. Fungal meningitis 4. Protozoal meningitis |
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What is the most common type of meningitis?
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Viral meningitis
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How do the bacteria cause meningitis?
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By entering the central nervous system via the bloodstream at the blood-brain barrier
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How do the bacteria enter the CNS?
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Direct routes of entry occur as a result of penetrating trauma, skull fracture, surgical procedures, or a ruptured cerebral abscess
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What can lead to viral meningitis?
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It often occurs as a sequela to a variety of viral illnesses, including measles, mumps, herpes simplex, and herpes zoster
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What are the clinical manifestations of viral meningitis?
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1. Fever
2. Photophobia 3. Headache 4. Myalgias 5. Nausea 6. Herpes simplex type 2 may cause genital lesions 7. A maculopapular rash is seen when the causative organism is an enterovirus |
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What are the treatments for viral meningitis?
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Treatment is symptomatic. If genital lesions are also present, acyclovir may be prescribed.
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What is the most common cause of fungal meningitis?
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Cryptococcus neoformans (affects the CNS of AIDS patients)
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What are the clinical manifestations of fungal meningitis?
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1. Headache
2. Nausea and vomiting 3. A decline in mental status |
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What are the treatments for fungal meningitis?
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Treatment is symptomatic and includes IV antifungal agents.
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What is the most common organisms causing bacterial meningitis?
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Streptococcus pneumoniae (pneumococcal disease) and Neisseria meningitidis
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Why is bacterial meningitis considered a medical emergency?
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Has a mortality rate of about 25%
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What are the key features of bacterial meningitis?
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1. Decreased (or change in) LOC
2. Disoriented to person, place, and year 3. Photophobia 4. Nystagmus or other abnormal eye movements 5. Motor response normal early in disease process 6. Hemiparesis, hemiplegia, and decreased muscle tone possible later 7. Cranial nerve dysfunction, especially CN III, IV, VI, VII, VIII 8. Attention span is usually short 9. Personality and behavior changes 10. Bewilderment 11. Severe, unrelenting headache 12. Generalized muscle aches and pain 13. Nausea and vomiting 14. Fever and chills 15. Tachycardia 16. Red macular rash (meningococcal meningitis) |
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What are the complications of bacterial meningitis?
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1. Increased ICP
2. Seizure 3. SIADH (which further increases ICP) 4. Septic emboli (leading to gangrene) 5. Excessive fibrinolysis 6. DIC 7. Hemiparesis |
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What is the most significant laboratory test used in the diagnosis of meningitis?
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The analysis of the cerebrospinal fluid
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What are the CSF results of bacterial meningitis?
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1. Cloudy, turbid appearance of CSF
2. Increased WBCs 3. Increased proteins 4. Decreased glucose 5. Elevated CSF pressure |
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What are the CSF results of viral meningitis?
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1. Clear apearance of CSF
2. Increased WBCs 3. Increased proteins 4. Normal glucose level 5. Varying CSF pressure |
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What diagnostic test may be performed to determine the presence of viruses or protozoa in the CSF?
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Counterimmunoelectrophoresis (CIE)
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What diagnostic tests are obtained to determine the presence of infection?
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X-rays of the chest, air sinuses, and mastoids
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What is the purpose of a computed tomography (CT) or magnetic resonance imaging (MRI) scan?
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To identify increased ICP, the presence of a brain abscess, or developing hydrocephalus
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What are the interventions for/care of the client with meningitis?
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1. Follow ABCs (airway, breathing, circulation)
2. Take vital signs and perform neurologic checks every 2 to 4 hours, as required 3. Perform cranial nerve assessment, with particular attention to cranial nerves III, IV, VI, VII, and VIII, and monitor for changes 4. Manage pain through drug and nondrug methods 5. Perform vascular assessment and monitor for changes 6. Give medications and IV fluids as prescribed, and document the client's response 7. Record intake and output 8. Decrease environmental stimuli 9. Provide a quiet environment. Minimize exposure to bright lights from windows and overhead lights 10. Maintain bedrest with head of bed elevated 30 degrees 11. Maintain isolation precautions per hospital policy (for meningococcal meningitis) 12. Monitor for and prevent complications a. Increased intracranial pressure b. Vascular dysfunction c. Fluid and electrolyte imbalance d. Seizures e. Shock |
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What is the treatment for Staphylococcus (bacterial) meningitis?
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1. Vancomycin
2. Ceftazidime |
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What is the treatment for H. influenzae (bacterial) meningitis?
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1. Cefotaxime
2. Ceftriaxone |
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What is the treatment for Streptococcus (bacterial) meningitis?
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1. Third-generation cephalosporins (ceftriaxone)
2. Rifampin 3. Vancomycin |
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What is the treatment for Neisseria meningitidis?
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1. Third-generation cephalosporins (ceftriaxone)
2. Other cephalosporins |
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What is the treatment for fungal meningitis?
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1. Amphotericin B
2. Flucytosine 3. Fluconazole |
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What are the complications of meningitis?
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1. Increased intracranial pressure
2. Vascular dysfunction 3. Fluid and electrolyte imbalance 4. Seizures 5. Shock 6. Prolonged fever 7. Gangrene |
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What is encephalitis?
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An inflammation of the brain parenchyma (brain tissue) and often the meninges
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What is the most common type of encephalitis?
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Viral encephalitis
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How does viral encephalitis occur?
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1. Viral encephalitis is almost always preceded by a viral infection
2. The virus gains access to the central nervous system (CNS) via the bloodstream, along peripheral or cranial nerves, or in the meninges (e.g., varicella zoster) |
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What are the complications of viral encephalitis?
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1. Hemorrhage
2. Edema 3. Necrosis 4. Development of small lacunae (hollow cavities) within the cerebral hemispheres 5. Widespread edema can cause compression of blood vessels, leading to a further increase in intracranial pressure (ICP) 6. Death may occur from herniation and increased ICP |
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How are arboviruses transmitted to humans?
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Through the bite of an infected mosquito or tick
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What are the most common types of encephalitis caused by arboviruses?
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1. Eastern or western equine encephalitis
2. St. Louis encephalitis 3. California encephalitis 4. West Nile virus |
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What are the signs and symptoms of West Nile encephalitis?
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In most cases the client is asymptomatic or has flu-like symptoms
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What are the diagnostic tests of West Nile encephalitis?
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1. Enzyme-linked immunosorbent assay (ELISA)
2. West Nile virus-specific IgM antibody in serum or cerebrospinal fluid (CSF) |
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What are the considerations for older adults regarding arboviruses?
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1. Older adults are more likely to have severe infections that can result in long-term residual fatigue and weakness, as well as death
2. Teach older adults to avoid areas where mosquitoes or ticks are likely to be, such as near rivers and lakes 3. When they are near these areas, instruct the older adults to wear long-sleeved shirts and long pants and to use insect repellent |
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What are the common enteroviruses associated with encephalitis?
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1. Echovirus
2. Coxsackievirus 3. Poliovirus 4. Herpes zoster 5. Viruses that cause mumps and chickenpox |
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What is the most common nonepidemic type of encephalitis in North America?
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Herpes simplex virus type 1 (HSV1) encephalitis
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What do clients with herpes encephalitis often have?
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A history of cold sores
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What are the mortality rates for HSV1 encephalitis?
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80%, whereas mortality for the other types is much lower
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What are the signs and symptoms of encephalitis?
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1. Fever
2. Nausea, vomiting 3. Stiff neck 4. Changes in LOC and mental status 5. Motor dysfunction 6. Focal neurologic deficits 7. Fatigue 8. Symptoms of increased intracranial pressure (ICP) 9. Vertigo 10. Nystagmus |
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What are the nursing interventions for encephalitis?
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1. Supportive nursing care and prompt recognition and treatment of increased ICP are essential components of management
2. A patent airway is maintained to prevent the development of atelectasis or pneumonia, which can lead to further brain hypoxia from inadequate amounts of oxygen in the circulating blood 3. Unlicensed assistive personnel help and encourage the client to turn, cough, and deep breathe at least every 2 hours 4. Deep tracheal suctioning may be performed, even in the presence of increased ICP, if the findings of the respiratory assessment indicate that respiratory status is compromised, possibly causing cerebral hypoxia 5. Assess vital signs and neurologic signs every 2 hours or more frequently if clinically indicated 6. Elevate the head of the bed 30 to 45 degrees unless contraindicated (e.g., after lumbar puncture or in the client with severe hypotension) |
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What are the drug therapies for encephalitis?
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1. Acyclovir (Zovirax) is the drug of choice for the treatment of herpes encephalitis and is associated with a significantly lower mortality rate than vidarabine (Vira-A)
2. Drug therapy is most effective if begun early, before the client becomes stuporous or comatose. This usually occurs within 4 to 6 days after the appearance of the initial neurologic symptoms. 3. No specific drug therapy is available for infection by arboviruses or enteroviruses |
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Which type of meningitis is often associated with epidemics?
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Neisseria meningitidis
(very contagious; occurs often in overcrowded prisons and even college dormitories) |
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Which strain of meningitis is common among kids under 5 yrs and the elderly?
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Streptococcus pneumoniae
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What are the clinical manifestations of meningitis?
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1. Headache
2. Fever (101-103, can reach 105) 3. Nuchal rigidity (stiff neck), Kernig's sign, Brudzinski's sign 4. Tachycardia, hypotension, increased RR 5. Chills, joint and muscle pain 6. Nausea and vomiting 7. Back pain 8. Seizures 9. Photophobia 10. Petechiae 11. Purpura 12. Irritability, confusion, increasingly drowsy, unresponsive possibly progressing to coma (altered LOC) |
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What causes the ALOC in meningitis?
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Increased ICP
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What causes the purpura?
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Clotting dysfunction
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What is a positive Brudsinski?
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Abnormal response of knee flexion during passive movement of chin to chest
(neck is stiff and there is resistance) |
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How would you test for Kernig's sign?
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Bend the leg at the hip and knee, then extend the leg
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What is a positive Kernig's sign?
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Pain at the knee or calf tenderness during subsequent extension of the leg (leading to resistance)
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