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Lesson 29. Meningitis

2-29. MENINGITIS

a. Definition. Meningitis is inflammation of the meninges. The severity of the disease is dependent upon the specific microorganism involved, the presence of other neurological disorders, the general health of the patient, the speed of diagnosis, and the initiation of treatment.

b. Causes of Meningitis.

(1) Travel of infectious microorganisms to the meninges via the bloodstream or through direct extension from an infected area (such as the middle ear or paranasal sinuses). Common microorganisms include:
(a) Meningococcus.
(b) Streptococcus.
(c) Staphylococcus.
(d) Pneumococcus.
(2) Contaminated head injury.
3) Infected shunt.
(4) Contaminated lumbar puncture.

c.      Diagnostic Evaluation Techniques.

(1) Lumbar puncture to identify the causative organism in the cerebrospinal  fluid.
(2) Blood cultures.
(3) Physical examination.

d.     Signs and Symptoms.

(1) Elevated temperature.
(2) Chills.
(3) Headache (often severe).
(4) Nausea, vomiting.
(5) Nuchal rigidity (stiffness of the neck).
(6) Photophobia.
(7) Opisthotonos (extreme hyperextension of the head and arching of the back due to irritation of the meninges).
(8) Altered level of consciousness.
(9) Multiple petechiae on the body.

e. Nursing Management.

(1) Administer intravenous fluids and medications, as ordered by the physician.

(a) Antibiotics should be started immediately.
(b) Corticostertoids may be used for the critically ill patient.
(c) Drug therapy may be continued after the acute phase of the illness is over to prevent recurrence.
(d) Record intake and output carefully and observe patient closely for signs of dehydration due to insensible fluid loss.

(2) Monitor patient's vital signs and neurological status and record.

(a) Level of consciousness. Utilize GCS for accuracy and consistency.
(b) Monitor rectal temperature at least every 4 hours and, if elevated, provide for cooling measures such as a cooling mattress, cooling sponge baths, and administration of ordered antipyretics.
(3) If isolation measures are required, inform family members and ensure staff compliance of isolation procedures in accordance with (IAW) standard operating procedures (SOP).
(4) Provide basic patient care needs.
(a) The patient's level of consciousness will dictate whether the patient requires only assistance with activities of daily living or total care. If patient is not fully conscious, follow the guidelines for care of the unconscious patient (Part 5).
(b) Maintain dim lighting in the patient's room to reduce photophobic discomfort.

(5) Provide discharge planning information to the patient and family.

(a) Follow up appointments with the physician.
(b) Discharge medication instruction.
(c) Possible follow-up with the community health nurse.

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