Meningitis Overview and Risk Factors

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Questions and Answers

Which of the following statements about viral meningitis is correct?

It is typically treated with antibiotics.

It generally has a high mortality rate.

There is a recommended vaccine available for prevention.

It is the most common form of meningitis. (correct)

What is a common risk factor for developing bacterial meningitis?

Being vaccinated against pneumonia.

Being immunocompromised. (correct)

Living in a rural area.

Having a history of viral meningitis.

What is the age group in which the meningococcal vaccine (MCV4) is primarily recommended?

Infants receiving the Hib vaccine.

Adolescents aged 11 to 12 years. (correct)

Children under 2 years.

Adults over 65 years.

Which of the following is NOT a typical pathogen associated with bacterial meningitis?

Cryptococcus neoformans. Signup and view all the answers

In what scenario should the pneumococcal polysaccharide vaccine (PPSV) be administered?

To adults who smoke and are over 65. Signup and view all the answers

Which group is considered at high risk for invasive procedures leading to meningitis?

Patients with chronic diseases. Signup and view all the answers

What is a key difference between viral and fungal meningitis?

Fungal meningitis often occurs in immunocompromised individuals. Signup and view all the answers

Which of the following correctly describes the prognosis of bacterial meningitis?

Prognosis depends on how quickly treatment is started. Signup and view all the answers

Which sign is indicative of potential meningitis when a client experiences pain during leg extension from a flexed position?

Positive Kernig’s sign Signup and view all the answers

What is the most definitive diagnostic procedure for diagnosing meningitis?

Cerebrospinal fluid (CSF) analysis Signup and view all the answers

Which of the following findings would most likely be observed in a patient with bacterial meningitis?

Hyperactive deep tendon reflexes Signup and view all the answers

What is the priority nursing action for a nurse caring for a client newly diagnosed with bacterial meningitis?

Initiate droplet precautions Signup and view all the answers

Which laboratory finding would be expected in a patient diagnosed with bacterial meningitis?

Cloudy appearance of CSF Signup and view all the answers

Which complication associated with meningitis involves the secretion of excess antidiuretic hormone?

Syndrome of Inappropriate Antidiuretic Hormone Excretion (SIADH) Signup and view all the answers

When assessing a patient for Brudzinski's sign, what should a nurse do?

Flex the patient's hip and knee while bending their neck Signup and view all the answers

What potential manifestation should a nurse monitor for in a patient at risk for SIADH due to meningitis?

Weight gain Signup and view all the answers

Which assessment finding indicates that a client with meningitis is experiencing a serious complication?

Seizures Signup and view all the answers

Which of the following interventions is most appropriate for managing increased intracranial pressure (ICP) in a patient with meningitis?

Elevate the head of the bed to 30° Signup and view all the answers

Which antibiotic regimen is typically initiated for a client suspected of having bacterial meningitis?

Ceftriaxone or cefotaxime combined with vancomycin Signup and view all the answers

Which of the following is a common objective finding in a patient with meningitis?

Fever and chills Signup and view all the answers

Which patient statement indicates a potential sign of photophobia associated with meningitis?

I can't stand the lights; they hurt my eyes. Signup and view all the answers

Which nursing diagnosis is appropriate for a client with possible meningitis experiencing confusion and lethargy?

Risk for injury Signup and view all the answers

Study Notes

Meningitis

Inflammation of the meninges, membranes protecting the brain and spinal cord.
Viral (aseptic) meningitis is most common, often resolving without treatment.
Fungal meningitis is prevalent among individuals with AIDS.
Bacterial (septic) meningitis is contagious with a high mortality rate.
Early treatment drastically affects prognosis.
Three vaccines protect against bacterial meningitis: Hib, PPSV, and MCV4.

Risk Factors

Viral Meningitis: Viral illnesses like measles, mumps, herpes, and arboviruses.
Fungal Meningitis: Cryptococcus neoformans infection of sinuses.
Bacterial Meningitis: Neisseria meningitidis, Streptococcus pneumoniae, or Haemophilus influenzae infections.
Other factors include immunosuppression, direct contamination of spinal fluid, invasive procedures, skull fractures, penetrating wounds, and overcrowded living conditions.

Expected Findings

Subjective: Excruciating headache, stiff neck, sensitivity to light.
Objective: Fever, chills, nausea, vomiting, altered consciousness, positive Kernig’s and Brudzinski’s signs, hyperactive reflexes, tachycardia, seizures, red macular rash, restlessness, irritability.

Laboratory Tests

Urine, throat, nose, and blood cultures: Identify potential bacteria and guide antibiotic choice.
CBC: Elevated white blood cell count.

Diagnostic Procedures

Cerebrospinal Fluid (CSF) Analysis: Most definitive diagnostic procedure.
- Cloudy CSF indicates bacterial meningitis, while clear CSF points to viral meningitis.
- Elevated white blood cells, protein, and pressure, and decreased glucose in CSF indicate bacterial meningitis.
Counterimmunoelectrophoresis (CIE): Determines viral or protozoal infection in CSF, especially if antibiotics were given prior to CSF collection.
CT Scan or MRI: Detects increased intracranial pressure and abscesses.

Nursing Care

Isolation: Isolate client as soon as suspected meningitis.
- Implement droplet precautions.
- Continue droplet precautions until antibiotics are given for 24 hours and oral/nasal secretions are no longer infectious.
Standard Precautions: Used for all meningitis patients.
Fever Reduction: Cooling blankets if necessary.
Environmental Management: Quiet environment, minimize light exposure, bed rest with head of bed elevated to 30 degrees.
Safety: Seizure precautions, avoid coughing and sneezing to reduce intracranial pressure.
Fluid & Electrolytes: Replace as indicated by laboratory results.
Septic Shock: Carefully monitor vital signs for signs of septic shock.

Medications

Antibiotics: Ceftriaxone or cefotaxime combined with vancomycin until culture results are available for bacterial infections.
Anticonvulsants: Phenytoin for increasing intracranial pressure or seizures.
Analgesics: Acetaminophen or ibuprofen for headache and fever, avoiding opioids to prevent masking changes in consciousness.
Prophylactic Antibiotics: Ciprofloxacin, rifampin, or ceftriaxone for individuals in close contact with the client.

Complications

Increased Intracranial Pressure (ICP): Monitor for decreased consciousness, pupillary changes, impaired eye movements, and provide interventions like elevation and avoiding coughing/straining.
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): Monitor for diluted blood, concentrated urine, weight gain, and administer demeclocycline or restrict fluids.
Septic Emboli: Monitor extremity circulation and coagulation studies and report alterations immediately.

Active Learning Scenario

Bacterial Meningitis: Inflammatory disease of the meninges caused by bacteria.
Medications:
- Ceftriaxone or cefotaxime: Broad-spectrum antibiotics used to treat bacterial meningitis.
- Vancomycin: Used for severe bacterial infections, especially those resistant to other antibiotics.
- Phenytoin: Anticonvulsant to prevent seizures, which can be a complication of meningitis.
Complications:
- Increased Intracranial Pressure (ICP): Can lead to brain herniation.
- Septic Emboli: Blood clots that can travel to other organs and cause complications like gangrene or stroke.

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Description

This quiz covers essential information about meningitis, including its types, risk factors, and expected findings. Learn about viral, fungal, and bacterial meningitis, along with their prevention strategies through vaccination.