Adult Nursing Meningitis PDF

Adult Nursing Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd. Meningitis Lecturer: Dr. Mohammad Mahdi Saeed Learning Outcomes: Define meningitis Enumerate types and clinical manifestations Identify risk factors and ca...

Adult Nursing Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd. Meningitis Lecturer: Dr. Mohammad Mahdi Saeed Learning Outcomes: Define meningitis Enumerate types and clinical manifestations Identify risk factors and causes and common complications Nursing care during and after meningitis Medical managements and medications 1 Meningitis Over view Meningitis is inflammation of the meninges, which cover and protect the brain and spinal cord. The two main types of meningitis are bacterial and viral (Norris, 2019). Meningitis can be the main reason a patient is hospitalized, or it can develop during hospitalization; it is classified as septic or aseptic. Septic meningitis is caused by bacteria. The bacteria Streptococcus pneumoniae and Neisseria meningitidis are responsible for 80% to 90% of cases of bacterial meningitis in adults. In aseptic meningitis, the cause is viral or secondary to cancer or having a weakened immune system, such as in human immunodeficiency virus (HIV). The most common causative agents are the enteroviruses. Aseptic meningitis occurs more frequently in the summer and early fall. First-year college students and members of the military who have not been vaccinated are at higher risk for meningococcal meningitis. Although infections occur year-round, the peak incidence is in the winter and early spring. Factors that increase the risk of bacterial meningitis include tobacco use and viral upper respiratory infection, because they increase the amount of droplet production. Otitis media and mastoiditis increase the risk of bacterial meningitis, because the bacteria can cross the epithelial membrane and enter the subarachnoid space. People with immune system deficiencies are also at greater risk for development of bacterial meningitis. Pathophysiology Meningeal infections generally originate in one of two ways: through the bloodstream as a consequence of other infections or by direct spread, such as might occur after a traumatic injury to the facial bones or secondary to invasive procedures. 2 Once the causative organism enters the bloodstream, it crosses the blood– brain barrier and proliferates in the cerebrospinal fluid (CSF). The prognosis for bacterial meningitis depends on the causative organism, the severity of the infection and illness, and the timeliness of treatment. Clinical Manifestations Headache along with fever and chills are frequent initial symptoms. The following signs common to all types of meningitis: Neck immobility: Nuchal rigidity (a stiff and painful neck) can be an early sign, and any attempts at flexion of the head are difficult because of spasms in the muscles of the neck. Usually, the neck is supple, and the patient can easily bend the head and neck forward. Positive Kernig sign: When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended. When Kernig sign is bilateral, meningeal irritation is suspected. Positive Brudzinski sign: When the patient’s neck is flexed (after ruling out cervical trauma or injury), flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity. Brudzinski sign is a more sensitive indicator of meningeal irritation than Kernig sign. Photophobia (extreme sensitivity to light): This finding is common due to irritation of the meninges, especially around the diaphragm sellae. A rash can be a striking feature of meningococcal meningitides infection, occurring in about half of patients with this type of meningitis. Skin lesions develop, ranging from a petechial rash with purpuric lesions to large areas of ecchymosis. 3 Disorientation and memory impairment are common early in the course of the illness. In addition seizure , coma, lethargy, unresponsiveness, unconsciousness... Diagnostic Findings 1- Bacterial culture and Gram staining of CSF and blood are key diagnostic tests. 2- Computed tomography Prevention Vaccine should be given to youth at 11 to 12 years of age, with a booster dose at 16 years of age. 4 People in close contact with patients with meningococcal meningitis should be treated with antimicrobial chemoprophylaxis using rifampin, ciprofloxacin, or ceftriaxone. Therapy should be started within 24 hours after exposure because a delay limits the effectiveness of the prophylaxis. Medical Management The early administration of an antibiotic agent. Penicillin G in combination with one of the cephalosporins (e.g., ceftriaxone, cefotaxime) is most often administered intravenously (IV), emergently with suspected bacterial meningitis. Dexamethasone has been shown to be beneficial as adjunct therapy in the treatment of acute bacterial meningitis and in pneumococcal meningitis if it is given before or concurrently with the first dose of antibiotic. Nursing Management Most patients will need the following nursing interventions: 1. Instituting infection control precautions until 24 hours after initiation of antibiotic therapy (oral and nasal discharge is considered infectious) 2. Assisting with pain management due to overall body aches and neck pain 3. Assisting with getting rest in a quiet, darkened room 4. Implementing interventions to treat the elevated temperature, such as antipyretic agents and cooling blankets 5. Encouraging the patient to stay hydrated either orally or peripherally 6. Ensuring close neurologic monitoring. 7. Protecting the patient from injury secondary to seizure activity or altered LOC 8. Monitoring daily body weight; serum electrolytes; and urine volume, specific gravity, and osmolality, especially if syndrome of inappropriate antidiuretic hormone (SIADH) is suspected 5 9. Preventing complications associated with immobility, such as pressure injury and pneumonia. 6