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Sunday, May 31, 2020



  • Meningitis is an inflammation of the meninges, which are the membranes that protect the brain and spinal cord.
  • Viral or aseptic, meningitis is the most common form of meningitis and most commonly resolves without treatment.
  • Fungal meningitis is the most common in clients who have AIDS.
  • Bacterial, or septic, meningitis is a contagious infection with a high mortality rate. The prognosis depends on how quickly care is initiated.
  • There are three vaccines for different pathogens that cause bacterial meningitis. One is available for high-risk populations, such as residential college students.


  •  Haemophilus influenzae  type b (Hib) vaccine - Ensure infants receive vaccine for bacterial meningitis on  scheduled
  • Pneumococcal polysaccharide vaccine (PPSV) - Vaccinate adult who are immunocompromised, who have a chronic disease, who smoke cigarettes, or who lives in a long term care facility. CDC guidelines should be followed for vaccination. Give one dose to adults older than 65 years of age who have not previously been vaccinated nor have history of disease.
  •  Meningococcal vaccine (MCV4)( Neisseria meningitis )- Ensure that adolescents receive the vaccine on schedule and prior to living in a residential setting in college. Individuals in other communal living conditions (military) also should be immunized.



  • Viral illness such as mumps, measles, herpes, and arboviruses.
  • There is no vaccine against viral meningitis.

  • Fulminant fungal- based infection of the sinuses are from the organism Cryptococcus neoformans

Bacterial based infection, such as otitis media, pneumonia, OR sinusitis in which the infectious micro-organism is Neisseria meningitides, Streptococcus pneumonia, or Haemophilus influenzae
  • immunosuppression
  • Invasive procedure, skull fracture, or penetrating head wound (direct access to cerebrospinal fluid)
  • Overcrowded or communal living conditions


  • Excruciating, constant headache 
  • Nuchal rigidity (stiff neck)
  • Photophobia (sensitivity to light)


Physical assessment findings

  • Fever and chills
  • Nausea and vomiting
  • Altered level of consciousness  (confusion, disorientation, lethargy, difficulty arousing, coma)
  • Positive Kernig"s sign (resistance and pain with extension of the client's leg from a flexed position)
  • Positive Brudzinski"s sign (flexion  of extremities occurring with  deliberate flexion of the client's neck)
  • Hyperactive deep tendon reflexes
  • Tachycardia
  • Seizure 
  • Red macular rash (meningococcal meningitis)
  • Restlessness, irritability

Laboratory Tests 

  • Urine, throat, nose, and blood culture and sensitivity. 
  • perform culture and sensitivity of various body fluid to identify possible infectious bacteria and an appropriate broad-spectrum antibiotic. Not definitive for meningitis but can guide initial selection of antimicrobial.
  • CBC
    • Elevated WBC count 
  • Cerebrospinal fluid (CSF) analysis
    • CSF analysis is the most definitive diagnostic procedure. CSF is collected during lumbar puncture performed by the provider
    • Results indicative of meningitis 
      • Appearance of  CSF - cloudy (bacterial) or clear(viral)
      • Elevated WBC
      • Elevated protein
      • Decreased glucose (bacterial)
      • Elevated CSF pressure 
    • New enteroviral diagnostic test, called counterimmunoelectrophoresis (CIE), can be done on CSF to determine whether infectious agent is viral protozoa. The diagnostic study is also indicated if the client has received antibiotics before the CSF was collected.
  • CT scan and MRI
    • A CT scan or an MRI may be performed to identify increased intracranial pressure (ICP) or an abscess.


  • Nursing care
    • Isolate the client as soon as meningitis is suspected.
    • Maintain isolation precautions per hospital policy.
      • This should be droplet precautions,  which requires a private room. Droplet precautions should continue until antibiotics have been administered for 24 hours and when oral-nasal secretions are no longer infectious.
      • Standard precautions are implemented for all clients who have meningitis. Clients who have bacterial meningitis should remain on droplet precaution continuously.
    • Implement fever-reduction measures, such as a cooling blanket, if necessary.
    • Decrease environmental stimuli.
      • Provide a quiet environment.
      • Minimize exposure to bright light (natural and electric)
    • Maintain bed rest with the head of the bed elevated to 30 degree  
    • Monitor the client for increased intracranial (ICP)
      • Tell the client to avoid coughing and sneezing which increase ICP
    • Maintain client safety, such as seizure precautions.
    • Replace fluid and electrolytes as indicated by laboratory values.


  • Ceftriaxone or cefotaxime in combination with vancocin 
    • Antibiotics are given until culture and sensitivity reports are available. Effective for bacterial infections.
  • Phenytoin
    • Anticonvulsants are given if ICP increase or client experiences a seizure.
  • Decadron
  • Corticosteroid, , may improve outcome in adults if given before first dose of antibiotics.
  • Acetaminophen or ibuprofen
    • Analgesic for headache and fever- nonopioid to avoid masking changes in the level of consciousness.
  • Ciprofloxacin, rifampin or ceftriaxone 
    • Prophylactic antibiotics given to individuals in close contact with the client


  • Increased ICP 
    • Nursing action
      • monitor for signs of increasing ICP (decreased level of consciousness, pupillary changes, impaired extraocular movement)
      • Provide intervention to reduce ICP 
      • Mannitol can be administered via IV.
  • Syndrome of inappropriate antidiuretic hormone (SIADH)
    • SIADH can be complication of meningitis by abnormal stimulation to the hypothalamic area of brain, causing excess secretion of antidiuretic hormone.
    • Nursing action
      • Monitor for sings and symptoms 
      • Provide interventions, such as the administration of Declomycin and restriction of fluid. 
  • Septic emboli( leading to disseminated intravascular coagulation or cardiovascular accident. 
  • Septic emboli can form during meningitis and travel to other parts of the body,  particularly the hands and feet.
  • Development of gangrene will necessitate an amputation. 

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