Video Library
Please set your exam date
Meningitis
Study Questions
Practice Exercise 1
A nurse is reviewing information about meningitis with a new graduate nurse. Which of the following best describes meningitis?
Explanation
Meningitis is the inflammation of the meninges, which are the protective membranes covering the brain and spinal cord. It can result from infectious causes such as bacteria, viruses, fungi, or parasites, or from non-infectious triggers such as medications or malignancy.
Rationale for Correct Answer:
C. An inflammation of the meninges surrounding the brain and spinal cord: This accurately defines meningitis and highlights its primary characteristic, which is central nervous system membrane inflammation.
Rationale for Incorrect Answers:
A. Autoimmune destruction of myelin occurs in conditions like multiple sclerosis, not meningitis.
B. Progressive degeneration of neurons is typical of disorders like Alzheimer’s disease.
D. Vascular inflammation may be associated with vasculitis but does not define meningitis.
Key Takeaways:
- Meningitis involves inflammation of the protective membranes of the brain and spinal cord.
- It may be infectious or non-infectious in origin.
- Prompt recognition is critical due to risk of serious neurologic complications.
Which of the following statements about meningitis are true? Select all that apply
Explanation
Viral meningitis typically has a milder course and is often self-limiting. Meningitis may result from multiple infectious agents. Bacterial meningitis is a medical emergency requiring prompt antibiotic treatment.
Rationale for Correct Answers:
A. Viral meningitis: Often resolves on its own and is less severe than bacterial forms.
B. Causes: Meningitis can be bacterial, viral, fungal, or parasitic.
D. Bacterial meningitis: Needs immediate treatment to prevent death or severe complications.
Rationale for Incorrect Answers:
C. It affects individuals across all age groups, not just pediatric patients.
E. Neurological damage, including hearing loss and cognitive deficits, can result from severe or untreated meningitis.
Key Takeaways:
- Meningitis has diverse causes and can affect all ages.
- Bacterial forms are more severe and require urgent care.
- Neurologic sequelae may occur if not promptly treated.
Practice Exercise 2
Which of the following individuals is at highest risk for developing meningococcal meningitis?
Explanation
Close living quarters such as dormitories increase the risk for meningococcal transmission. College students are a priority population for meningococcal vaccination.
Rationale for Correct Answer:
C. Dormitory living increases exposure to respiratory secretions in crowded environments.
Rationale for Incorrect Answers:
A. Although infants are at risk, the child is vaccinated and not in a communal setting.
B. The 45-year-old has no specific risk factors.
D. The 70-year-old may be more susceptible to pneumococcal meningitis, not meningococcal.
Key Takeaways:
- Close living conditions elevate meningococcal meningitis risk.
- College students and military recruits are considered high-risk groups.
- Vaccination is key in prevention.
Which are recognized risk factors for bacterial meningitis? Select all that apply
Explanation
These factors either impair the immune system or facilitate the spread of organisms to the central nervous system.
Rationale for Correct Answers:
A. Skull fractures: Create a direct path for organisms.
B. URI: Can spread to the meninges.
D. Immunosuppressed clients have a reduced ability to fight infection.
E. Crowded living conditions promote airborne/droplet transmission.
Rationale for Incorrect Answer:
C. Vaccination helps prevent meningitis and reduces risk, not increases it.
Key Takeaways:
- Anatomical disruption, immunosuppression, and environmental exposure increase meningitis risk.
- Vaccines are protective, not a risk factor.
Practice Exercise 3
In bacterial meningitis, what pathophysiological event most directly leads to increased intracranial pressure (ICP)?
Explanation
Meningeal inflammation interferes with cerebrospinal fluid reabsorption, leading to accumulation and increased ICP.
Rationale for Correct Answer:
B. Obstruction of CSF flow causes fluid accumulation and elevated pressure.
Rationale for Incorrect Answers:
A. Hypothalamic damage affects temperature and endocrine regulation, not ICP.
C. Spinal compression is more associated with trauma.
D. Acetylcholine receptor destruction is seen in myasthenia gravis.
Key Takeaways:
- Inflammation in meningitis can block CSF absorption.
- Elevated ICP is a dangerous and common complication.
The nurse is assessing a client with suspected meningitis. Which symptom should take highest priority for immediate reporting?
Explanation
A sudden change in level of consciousness suggests rapidly increasing intracranial pressure or impending neurologic deterioration and warrants immediate intervention.
Rationale for Correct Answer:
D. Sudden change in LOC indicates possible brain herniation or elevated ICP—both life-threatening.
Rationale for Incorrect Answers:
A. Nuchal rigidity is a classic sign but not as immediately life-threatening.
B. Photophobia is common but not an emergent finding.
C. Headache, though severe, is not as urgent as LOC changes
Key Takeaways:
- Altered mental status is an early indicator of worsening neurologic function.
- LOC changes require immediate action in meningitis.
- Classic signs must be interpreted with severity and acuity in mind.
Practice Exercise 4
Which clinical manifestations are consistent with bacterial meningitis? Select all that apply
Explanation
Brudzinski’s sign, N/V, and seizures are typical features of meningitis due to meningeal irritation and elevated ICP.
Rationale for Correct Answers:
A. Brudzinski’s sign indicates meningeal irritation.
C. Nausea and vomiting occur from raised ICP.
D. Seizures may result from cortical irritation.
Rationale for Incorrect Answers:
B. Widened pulse pressure occurs in Cushing’s triad but is not a hallmark of meningitis.
E. Reflexes may remain normal or be increased; decreased DTRs are not specific to meningitis.
Key Takeaways:
- Classic signs include nuchal rigidity, positive Brudzinski/Kernig’s signs.
- Neurologic complications include seizures and LOC changes.
- ICP-related symptoms may be present.
Practice Exercise 5
Which diagnostic test is most definitive for confirming meningitis?
Explanation
Lumbar puncture with CSF analysis confirms meningitis by revealing cellular, protein, and glucose changes along with organism identification.
Rationale for Correct Answer:
B. LP directly samples the CSF and can confirm infectious causes.
Rationale for Incorrect Answers:
A. MRI may show complications but doesn’t confirm diagnosis.
C. WBC count is nonspecific.
D. EEG may show generalized slowing but is not diagnostic.
Key Takeaways:
- CSF analysis is the gold standard for meningitis diagnosis.
- CT may precede LP to rule out herniation risk.
- CSF parameters vary by etiology.
What findings are typically associated with bacterial meningitis in cerebrospinal fluid (CSF)? Select all that apply
Explanation
Bacterial meningitis CSF shows turbid fluid, elevated WBCs (neutrophils), high protein, and low glucose due to bacterial metabolism.
Rationale for Correct Answers:
A. Turbidity reflects purulent fluid.
B. Proteins are elevated due to inflammation.
D. Glucose is consumed by bacteria.
E. Neutrophil-dominant pleocytosis is typical.
Rationale for Incorrect Answer:
C. Elevated glucose is more consistent with viral or normal CSF.
Key Takeaways:
- Low CSF glucose and high neutrophils suggest bacterial etiology.
- CSF appearance and cell count are critical for diagnosis.
Practice Exercise 6
The nurse receives new orders for a patient diagnosed with suspected bacterial meningitis. Which order should the nurse implement first?
Explanation
Blood cultures should be obtained before starting antibiotics to allow for pathogen identification.
Rationale for Correct Answer:
C. Blood cultures must precede antibiotics to ensure accurate organism identification.
Rationale for Incorrect Answers:
A. IV fluids are supportive but not time-sensitive.
B. CT may be done prior to LP but doesn’t delay cultures.
D. Antibiotics should be given after cultures are drawn.
Key Takeaways:
- Culture before antibiotics to guide treatment.
- Time-sensitive actions affect patient outcomes.
Which nursing interventions are appropriate for a client with acute bacterial meningitis? Select all that apply
Explanation
These interventions help reduce ICP, manage fever, and monitor neurologic stability.
Rationale for Correct Answers:
A. Reduces environmental stimulation.
B. Promotes venous drainage from brain.
D. Fever control limits metabolic demand.
E. Frequent neuro checks detect deterioration.
Rationale for Incorrect Answer:
C. Droplet (not airborne) precautions are used.
Key Takeaways:
- Elevate HOB and control stimuli to prevent ICP elevation.
- Use droplet precautions.
- Monitor for deterioration.
Practice Exercise 7
A client recovering from bacterial meningitis is now experiencing hearing loss. The nurse understands this complication is most likely due to:
Explanation
Cranial nerve VIII involvement can result from inflammation or direct damage.
Rationale for Correct Answer:
B. CN VIII (vestibulocochlear) controls hearing; damage may be permanent.
Rationale for Incorrect Answers:
A. Frontal lobe is unrelated to hearing.
C. Ototoxicity may occur, but CN damage is more likely.
D. Hypoglycemia is not commonly a complication.
Key Takeaways:
- CN involvement is a common cause of hearing loss post-meningitis.
- Audiologic testing is important during recovery.
Which are potential complications of untreated or severe meningitis? Select all that apply
Explanation
These are common consequences of uncontrolled meningitis and systemic involvement.
Rationale for Correct Answers:
A. Blocked CSF reabsorption leads to hydrocephalus.
B. Infection may localize into an abscess.
C. Sepsis from bacteremia is life-threatening.
E. Cognitive changes may be long-term sequelae.
Rationale for Incorrect Answer:
D. Myasthenia gravis is autoimmune and unrelated to meningitis.
Key Takeaways:
- Meningitis complications can be neurological and systemic.
- Early treatment reduces long-term sequelae.
Practice Exercise 8
A college health nurse is reviewing records of new students. Which vaccination is most important to confirm for meningitis prevention?
Explanation
MenACWY protects against meningococcal strains responsible for outbreaks in young adults.
Rationale for Correct Answer:
C. This vaccine targets N. meningitidis, common in college outbreaks.
Rationale for Incorrect Answers:
A. MMR prevents viral illnesses like mumps, not bacterial meningitis.
B. HPV is unrelated.
D. Hepatitis A affects the liver, not CNS.
Key Takeaways:
- Meningococcal vaccine is required for students in communal living.
- Prevention is key to controlling outbreaks.
Which actions help prevent the spread of bacterial meningitis in a healthcare or community setting? Select all that apply
Explanation
These steps are evidence-based public health interventions for meningococcal control.
Rationale for Correct Answers:
A. Droplet precautions reduce transmission.
B. Chemoprophylaxis for contacts prevents further spread.
D. Vaccines prevent outbreaks.
E. Early isolation limits exposure.
Rationale for Incorrect Answer:
C. Antivirals are not used for bacterial meningitis.
Key Takeaways:
- Prevention includes vaccines, isolation, and contact treatment.
- Public health coordination is essential during outbreaks.
Comprehensive Questions
A patient is admitted to the hospital with possible bacterial meningitis. During the initial assessment, the nurse questions the patient about a recent history of what?
Explanation
Bacterial meningitis is a life-threatening infection of the meninges, often resulting from the spread of pathogens from nearby sites. One of the most common preceding events is an upper respiratory infection (URI), particularly with organisms like Streptococcus pneumoniae and Haemophilus influenzae. The nurse’s assessment must focus on identifying recent infections that could have provided a route for bacterial entry into the central nervous system.
Rationale for Correct Answer:
D. An upper respiratory infection: A recent upper respiratory infection is a common precursor to bacterial meningitis. Bacteria can spread from the nasopharynx, sinuses, or middle ear into the cerebrospinal fluid, especially in clients with weakened immune defenses. Recognizing a history of URI is essential for early detection and treatment.
Rationale for Incorrect Answers:
A. Mosquito or tick bites: These are associated with viral encephalitis (e.g., West Nile virus or Lyme disease–related neurologic complications), not bacterial meningitis. They are not typically considered relevant when evaluating potential bacterial causes.
B. Chickenpox or measles: These viral exanthems may lead to viral complications such as encephalitis, but they are not linked to bacterial meningitis. Their occurrence does not support a bacterial etiology.
C. Cold sores or fever blisters: Caused by herpes simplex virus, these lesions are more suggestive of viral encephalitis, particularly HSV-1, and are not related to bacterial meningitis. While both conditions involve the CNS, the pathogens and pathophysiology differ.
Key Takeaways:
- Recent upper respiratory infections are a major risk factor for bacterial meningitis.
- Differentiating bacterial from viral etiologies is crucial for treatment decisions.
- A thorough infection history helps guide early diagnosis and appropriate isolation or antibiotic therapy.
What are the key manifestations of bacterial meningitis?
Explanation
Bacterial meningitis is a rapidly progressing infection of the meninges that typically presents with a triad of high fever, nuchal rigidity (stiff neck), and severe headache. These hallmark symptoms result from inflammation and increased intracranial pressure. Early recognition of these signs is critical, as delayed treatment may lead to seizures, neurologic deficits, or death.
Rationale for Correct Answer:
B. High fever, nuchal rigidity, and severe headache: These are the classic symptoms of bacterial meningitis. The fever reflects the body’s systemic response to infection, nuchal rigidity indicates meningeal irritation, and headache results from inflammation and increased pressure within the central nervous system.
Rationale for Incorrect Answers:
A. Papilledema and psychomotor seizures: While these may occur later in the disease due to increased intracranial pressure or cerebral edema, they are not the most common initial presenting symptoms of bacterial meningitis. They suggest progression to complications.
C. Behavioral changes with memory loss and lethargy: These are more typical of viral or chronic neurologic conditions. While confusion or lethargy can occur in bacterial meningitis, memory loss and behavioral changes are not specific early signs.
D. Jerky eye movements, loss of corneal reflex, and hemiparesis: These signs suggest cranial nerve involvement or brainstem herniation, which are late and severe complications rather than key early manifestations.
Key Takeaways:
- The triad of fever, nuchal rigidity, and headache is central to diagnosing bacterial meningitis.
- Early symptoms result from meningeal inflammation and elevated ICP, not focal neurologic deficits.
- Prompt recognition and treatment of initial signs are essential to prevent neurologic deterioration.
Vigorous control of fever in the patient with meningitis is required to prevent complications of increased cerebral edema, seizure frequency, neurologic damage, and fluid loss. What nursing care should be included?
Explanation
Fever in bacterial meningitis significantly raises cerebral metabolic demand, which can worsen cerebral edema and lead to seizures and neurologic injury. Monitoring level of consciousness (LOC) helps the nurse identify early changes in neurologic function related to rising intracranial pressure or worsening cerebral inflammation. Gradual and controlled fever management, paired with neurologic monitoring, is essential to reduce complications.
Rationale for Correct Answer:
B. Monitor LOC related to increased brain metabolism: Elevated temperature increases cerebral oxygen and glucose consumption, which may result in altered LOC or further neurologic decline. Frequent LOC monitoring allows for early detection of deterioration and guides interventions to maintain cerebral perfusion.
Rationale for Incorrect Answers:
A. Administer analgesics as ordered: While analgesics may relieve headache and discomfort, they do not directly address the fever or neurologic complications. Analgesics alone are not sufficient for managing the effects of fever on brain metabolism.
C. Rapidly decrease temperature with a cooling blanket: Rapid cooling can lead to shivering, which increases metabolic demand and may worsen intracranial pressure. Controlled, gradual temperature reduction is safer and more effective in preventing cerebral stress.
D. Assess for peripheral edema from rapid fluid infusion: Although fluid management is important, peripheral edema is not the primary concern in meningitis-related fever. The focus should be on neurologic status and intracranial complications.
Key Takeaways:
- Monitoring LOC is crucial when managing fever in meningitis due to the risk of increased brain metabolism and ICP.
- Gradual temperature control is preferred over rapid cooling to avoid increased cerebral workload.
- Fever management in meningitis focuses on neurologic preservation, not just symptom relief.
A nurse is assessing a client who reports severe headache and a stiff neck. The nurse’s assessment reveals positive Kernig’s and Brudzinski’s signs. Which of the following actions should the nurse perform first?
Explanation
Bacterial meningitis is a highly contagious condition that can be transmitted via respiratory droplets, especially during the initial phase. The presence of severe headache, stiff neck, and positive Kernig’s and Brudzinski’s signs strongly indicates meningitis, and droplet precautions must be implemented immediately to prevent transmission to others, including healthcare personnel and other clients.
Rationale for Correct Answer:
B. Implement droplet isolation precautions: Infection control is a priority in suspected bacterial meningitis. Placing the client on droplet precautions immediately reduces the risk of transmission while diagnostic testing and treatment are initiated. This is a safety-first approach to protect others from a potentially fatal infection.
Rationale for Incorrect Answers:
A. Administer antibiotics: Although antibiotics are critical and should be started promptly, they must follow initial infection control measures. Administering antibiotics requires time and IV access, and precautions should already be in place before these interventions begin.
C. Initiate IV access: IV access is necessary for medication administration but is not the first priority. Infection prevention takes precedence over procedural tasks when a communicable disease is suspected.
D. Decrease bright lights: Photophobia is common in meningitis, and reducing light can enhance comfort, but it is not urgent. Comfort measures are secondary to interventions that reduce transmission and initiate lifesaving treatment.
Key Takeaways:
- Droplet precautions must be implemented immediately when bacterial meningitis is suspected.
- Infection control is prioritized before diagnostic testing or treatment administration.
- Classic signs like Kernig’s and Brudzinski’s indicate the need for immediate isolation.
A nurse is assessing for the presence of Brudzinski’s sign in a client who has suspected meningitis. Which of the following are appropriate actions by the nurse when performing this technique? Select all that apply
Explanation
Brudzinski’s sign is a classic indicator of meningeal irritation in suspected bacterial meningitis. It is elicited by passively flexing the client’s neck while in a supine position. A positive response occurs when this neck flexion causes involuntary flexion of the hips and knees, reflecting irritation of the meninges.
Rationale for Correct Answers:
A. Place client in supine position: The client should lie flat on their back to allow for proper observation of reflexive leg movement during the test. This position is essential for accurate assessment.
C. Place hands behind the client’s neck: The nurse supports the neck to gently guide the head into flexion, minimizing strain and ensuring safety. This helps isolate the response and prevents resistance.
D. Bend client’s head toward chest: Passive flexion of the neck is the main action to elicit Brudzinski’s sign. If the hips and knees flex involuntarily during this movement, the sign is positive.
Rationale for Incorrect Answers:
B. Flex client’s hip and knee: This maneuver is used to assess Kernig’s sign, not Brudzinski’s. It evaluates meningeal irritation by detecting pain or resistance when extending the leg after flexion.
E. Straighten the client’s flexed leg at the knee: Again, this describes the technique for Kernig’s sign, not Brudzinski’s. It is inappropriate when specifically testing for Brudzinski’s response.
Key Takeaways:
- Brudzinski’s sign is elicited by passively flexing the neck in a supine client.
- A positive response is involuntary hip and knee flexion, indicating meningeal irritation.
- Do not confuse Brudzinski’s with Kernig’s, which involves leg movements.
A nurse is reviewing the health record of a student newly admitted to a university and living in a dormitory. The health record indicates the student requires follow-up immunizations. Which of the following organisms should the nurse plan to vaccinate the student against?
Explanation
Neisseria meningitidis is a significant cause of bacterial meningitis among adolescents and young adults, particularly those in communal living environments such as college dormitories. Vaccination is a critical preventive measure to reduce the risk of meningococcal outbreaks in high-risk settings like universities.
Rationale for Correct Answer:
B. Neisseria meningitidis: This organism causes meningococcal meningitis, which spreads easily in crowded living conditions such as dormitories. The meningococcal vaccine is recommended for students entering college to protect against potentially fatal meningococcal infections.
Rationale for Incorrect Answers:
A. Streptococcus pneumoniae: While it can cause bacterial meningitis, pneumococcal vaccination is primarily indicated for infants, older adults, and those with chronic conditions, not routinely for healthy college-aged students.
C. Bartonella henselae: This is the causative agent of cat-scratch disease, a non-communicable condition not associated with dormitory outbreaks. No vaccine exists for this pathogen.
D. Rickettsia rickettsii: This organism causes Rocky Mountain spotted fever, a tick-borne illness. It is not spread person to person and is not a concern in a college dormitory setting.
Key Takeaways:
- Neisseria meningitidis poses a high risk in communal living environments such as college dormitories.
- Meningococcal vaccination is an essential preventive strategy for college students.
- Other pathogens listed are either not vaccine-preventable or not relevant in this context.
A nurse is planning care for a client who has meningitis and is at risk for increased intracranial pressure (ICP). Which of the following are appropriate nursing actions? Select all that apply
Explanation
Meningitis can lead to increased intracranial pressure due to inflammation and cerebral edema. Nursing care focuses on minimizing stimuli, monitoring for neurologic deterioration, and managing symptoms to prevent complications such as seizures or herniation. Frequent assessments, a quiet environment, pain management, and seizure precautions are critical components of care.
Rationale for Correct Answers:
A. Implement seizure precautions: Seizures are a common complication of meningitis due to cortical irritation and elevated ICP. Seizure precautions reduce the risk of injury and facilitate prompt intervention.
D. Turn off room lights and television: Clients with meningitis are often photophobic and hypersensitive to noise. A quiet, dark environment reduces stimulation, helping to lower ICP and increase comfort.
E. Monitor for impaired extraocular movements: Impaired eye movements may indicate cranial nerve involvement or rising ICP. Early detection of neurologic changes allows for timely intervention.
Rationale for Incorrect Answers:
B. Perform neurological checks four times a day: Clients at risk for increased ICP require more frequent neurologic assessments—typically every 1 to 2 hours—to detect subtle changes early. Every 6 hours is insufficient in the acute phase.
C. Administer morphine for the report of neck and generalized pain: This is not an appropriate nursing action because the nurse should avoid administering opioids to a client who is at risk for ICP. Opioids can mask changes in the client’s level of consciousness.
F. Encourage the client to cough frequently: Coughing increases intrathoracic pressure and can raise ICP. This should be avoided unless airway clearance is absolutely necessary and done with caution.
Key Takeaways:
- Seizure precautions and low-stimulation environments are vital for clients with meningitis at risk for increased ICP.
- Neurologic function must be assessed frequently to detect early signs of deterioration.
- Pain control and cranial nerve monitoring support comfort and early detection of complications.
A nurse is planning care for a client who has bacterial meningitis. Which of the following actions should the nurse include in the plan of care? Select all that apply
Explanation
Bacterial meningitis is a serious infection that may cause fever, nausea, vomiting, photophobia, and neurologic deficits. Nursing care should address comfort, fever control, and prevention of complications such as pressure injuries and increased intracranial pressure. Supportive interventions should be tailored to both systemic and neurologic manifestations of the disease.
Rationale for Correct Answers:
B. Provide an emesis basin at the bedside: Nausea and vomiting are common due to increased intracranial pressure and photophobia. Having an emesis basin readily available helps maintain hygiene and comfort and prevents aspiration.
C. Administer antipyretic medication as prescribed: Fever increases cerebral metabolism and ICP. Antipyretics such as acetaminophen help reduce fever, decrease metabolic demand, and promote client comfort.
D. Perform a skin assessment: Clients with meningitis may be immobile and at risk for pressure injuries. Additionally, meningococcal infections can lead to skin manifestations like petechiae or purpura, which require prompt recognition and documentation.
Rationale for Incorrect Answers:
A. Monitor for bradycardia: While vital signs should be monitored closely, bradycardia is not a typical early finding. More often, tachycardia and fever are present. Bradycardia may occur as a late sign of increased ICP (as part of Cushing’s triad), but it is not the focus of routine monitoring.
E. Keep the head of the bed flat: Keeping the head elevated at 30 degrees helps reduce ICP and promotes venous drainage from the brain. A flat position can worsen cerebral edema and is contraindicated in clients at risk for increased ICP.
Key Takeaways:
- Nursing care for bacterial meningitis includes fever control, skin monitoring, and managing nausea.
- Head-of-bed elevation supports ICP management and should be maintained unless contraindicated.
- Routine assessments should focus on expected complications, including neurologic changes and skin integrity.
The nurse is caring for four patients on a neurological unit. Which patient should the nurse assess first?
Explanation
Bacterial meningitis can rapidly progress to increased intracranial pressure (ICP), seizures, or brain herniation, especially if the client develops sudden agitation and severe headache. These are urgent neurologic changes that require immediate assessment and intervention to prevent irreversible damage or death.
Rationale for Correct Answer:
C. A patient diagnosed with meningitis who has become suddenly agitated and is reporting a headache rated 10 out of 10: Sudden agitation and a severe headache are signs of rising ICP and neurologic deterioration. This patient is at immediate risk for complications such as brain herniation and requires urgent assessment and possible escalation of care.
Rationale for Incorrect Answers:
A. A patient with a skull fracture who has active nasal bleeding: While concerning, nasal bleeding may be related to sinus involvement or cerebrospinal fluid leak. Unless accompanied by signs of neurologic deterioration, it is not the most urgent.
B. An older adult patient with a history of stroke who is confused, with their daughter at the bedside: Confusion in this context may be chronic or related to prior stroke. The presence of a family member offers reassurance, and there are no acute changes reported.
D. A patient who is three days postoperative from a craniotomy for a brain tumor and has had persistent vomiting: Vomiting may indicate increased ICP, but the situation appears to be subacute. This patient should be reassessed soon, but the change in the meningitis patient is more urgent.
Key Takeaways:
- Sudden agitation and severe headache in meningitis may signal rising ICP or neurologic decline.
- Clients with acute neurologic changes take priority over those with stable or chronic symptoms.
- Early intervention can prevent life-threatening complications in deteriorating neurologic patients.
The wife of the client diagnosed with septic meningitis asks the nurse, "I am so scared. What is meningitis?" Which statement would be the most appropriate response by the nurse?
Explanation
Septic (bacterial) meningitis is a serious infection caused by bacteria that invade the meninges, which are the protective membranes surrounding the brain and spinal cord. It triggers a strong inflammatory response, leading to symptoms such as fever, headache, neck stiffness, and altered mental status. Clear and accurate explanations help reduce anxiety and promote understanding for family members.
Rationale for Correct Answer:
C. This is a bacterial infection of the tissues that cover the brain and spinal cord: This statement provides an accurate, concise explanation of septic meningitis. It clarifies that the infection is bacterial and affects the meninges, offering appropriate education while reducing fear through understanding.
Rationale for Incorrect Answers:
A. There is bleeding into his brain causing irritation of the meninges: This describes a hemorrhagic event, not bacterial meningitis. It is misleading and inaccurately describes the pathophysiology.
B. A virus has infected the brain and meninges, causing inflammation: This refers to viral meningitis, not septic (bacterial) meningitis. The causative agent and management differ significantly.
D. This is an inflammation of the brain parenchyma caused by a mosquito bite: This describes viral encephalitis (e.g., West Nile virus), not meningitis. It inaccurately defines both the cause and location of the inflammation.
Key Takeaways:
- Septic meningitis is a bacterial infection of the meninges.
- Providing accurate, calm explanations reduces fear and promotes understanding for families.
- Avoid confusing viral causes or hemorrhagic events when discussing bacterial meningitis.
The public health nurse is giving a lecture on potential outbreaks of infectious meningitis. Which population is most at risk for an outbreak?
Explanation
Infectious meningitis, particularly meningococcal meningitis, is more likely to cause outbreaks in populations living in close quarters, such as college dormitories. The close proximity facilitates respiratory droplet transmission of Neisseria meningitidis, the most common organism responsible for outbreaks in this setting. Vaccination and early identification of symptoms are key to prevention.
Rationale for Correct Answer:
B. Residents of a college dormitory: College dormitories are high-risk environments for meningococcal outbreaks due to crowded living conditions and frequent close contact. This setting allows for rapid spread of respiratory pathogens, making residents especially vulnerable.
Rationale for Incorrect Answers:
A. Clients recently discharged from the hospital: While hospitalized individuals may be immunocompromised, there is no increased population-based outbreak risk after discharge. Infection control measures in hospitals reduce transmission risk.
C. Individuals who visit a third world country: Travel may increase exposure to infectious diseases, but isolated travel does not create the close-contact conditions necessary for an outbreak.
D. Employees in a high-rise office building: While many people work in these buildings, the typical interaction patterns and ventilation reduce the likelihood of person-to-person transmission of meningitis in this environment.
Key Takeaways:
- Close-contact environments, such as college dorms, are high-risk for meningitis outbreaks.
- Neisseria meningitidis spreads through respiratory droplets, making shared living spaces vulnerable.
- Public health education should prioritize vaccination and awareness in communal living populations.
The nurse is assessing the client diagnosed with bacterial meningitis. Which clinical manifestations would support the diagnosis of bacterial meningitis?
Explanation
Bacterial meningitis typically presents with signs of meningeal irritation, including nuchal rigidity (stiff neck) and positive Kernig’s sign. These findings indicate inflammation of the meninges and are often accompanied by headache, fever, photophobia, and altered mental status. Kernig’s sign is elicited by extending the knee with the hip flexed, causing pain due to meningeal irritation.
Rationale for Correct Answer:
C. Positive Kernig's sign and nuchal rigidity: Both are hallmark signs of meningitis. Kernig’s sign indicates pain and resistance with passive leg extension, and nuchal rigidity is a classic finding reflecting inflammation of the meninges, strongly supporting a diagnosis of bacterial meningitis.
Rationale for Incorrect Answers:
A. Positive Babinski's sign and peripheral paresthesia: Babinski's sign may be seen in upper motor neuron lesions but is not characteristic of meningitis. Peripheral paresthesia suggests peripheral nerve involvement rather than central meningeal inflammation.
B. Negative Chvostek's sign and facial tingling: Chvostek’s sign is related to hypocalcemia, not meningitis. Facial tingling also points to electrolyte imbalance or nerve issues rather than meningeal irritation.
D. Negative Trousseau's sign and nystagmus: Trousseau’s sign is also associated with hypocalcemia, and nystagmus may indicate cerebellar or vestibular disorders, not bacterial meningitis.
Key Takeaways:
- Kernig’s sign and nuchal rigidity are classic indicators of meningeal inflammation.
- Other neurologic signs (e.g., Babinski’s, Chvostek’s) point to different pathologies, not meningitis.
- Accurate physical assessment aids in prompt recognition and treatment of bacterial meningitis.
The nurse is caring for a client diagnosed with meningitis. Which collaborative intervention should be prioritized?
Explanation
Bacterial meningitis requires immediate antibiotic therapy as a life-saving collaborative intervention between the nurse and the healthcare provider. Once prescribed, antibiotics must be administered without delay to reduce the risk of neurologic damage, sepsis, and death. This is a collaborative intervention because it involves a provider’s order and nursing implementation.
Rationale for Correct Answer:
A. Administer antibiotics: This is the priority collaborative intervention for bacterial meningitis. Early administration of broad-spectrum antibiotics improves survival and outcomes. It requires collaboration with the provider for prescription and with pharmacy for preparation and delivery.
Rationale for Incorrect Answers:
B. Obtain a sputum culture: While cultures may be needed, meningitis is typically diagnosed through blood and cerebrospinal fluid cultures, not sputum. This is not a primary or routine collaborative intervention in meningitis care.
C. Monitor the pulse oximeter: This is an independent nursing intervention. While it is important for general monitoring, it does not require provider collaboration and is not specific to the treatment of meningitis.
D. Assess intake and output: This is also an independent nursing action that helps monitor hydration and renal function but is not a collaborative intervention directly aimed at treating meningitis.
Key Takeaways:
- Administering antibiotics is the most critical collaborative intervention for bacterial meningitis.
- Collaborative interventions require interdisciplinary coordination involving provider orders.
- Timely antibiotic therapy significantly reduces complications and mortality.
The 29-year-old client is admitted to the medical floor diagnosed with meningitis. Which assessment by the nurse has priority?
Explanation
In bacterial meningitis, monitoring for changes in level of consciousness (LOC) is the highest priority because it can indicate increased intracranial pressure (ICP), worsening cerebral edema, or impending brain herniation. Early detection of altered mental status allows for timely intervention and may be life-saving.
Rationale for Correct Answer:
D. Assess level of consciousness: LOC is the most sensitive indicator of neurologic deterioration in clients with meningitis. Subtle changes may precede seizures, coma, or herniation, making frequent neurologic assessments a critical priority.
Rationale for Incorrect Answers:
A. Assess lung sounds: While important, lung assessment is not the primary concern unless respiratory symptoms are present. It does not provide immediate information about neurologic status.
B. Assess the six cardinal fields of gaze: This assesses cranial nerve function and may reveal ICP-related deficits, but it is not as comprehensive or urgent as evaluating LOC.
C. Assess apical pulse: Vital signs are essential, but in meningitis, LOC changes are more direct indicators of complications like ICP or cerebral involvement.
Key Takeaways:
- Level of consciousness is the priority assessment in clients with meningitis.
- Changes in LOC may signal increased ICP or neurologic deterioration.
- Frequent neurologic checks are essential for early detection of complications.
A 65-year-old immunosuppressed client presents with altered mental status, low-grade fever, and no signs of meningeal irritation. A CT scan shows mild hydrocephalus, and cerebrospinal fluid (CSF) analysis reveals a mildly elevated protein level, normal glucose, and lymphocytic predominance. Which action should the nurse anticipate next based on the most likely causative organism?
Explanation
In immunosuppressed clients, subacute or chronic meningitis with symptoms such as altered mental status, minimal meningeal signs, and CSF with normal glucose, mildly elevated protein, and lymphocytic predominance is highly suggestive of cryptococcal meningitis, caused by Cryptococcus neoformans. This fungal infection is common in patients with AIDS, hematologic malignancies, or those on immunosuppressive therapy. Diagnostic confirmation is typically made through CSF cryptococcal antigen testing, and treatment involves amphotericin B.
Rationale for Correct Answer:
C. Initiate amphotericin B therapy and obtain serum cryptococcal antigen testing: The clinical picture and CSF findings strongly suggest cryptococcal meningitis. Amphotericin B is the antifungal of choice, often followed by flucytosine. Serum or CSF cryptococcal antigen testing confirms the diagnosis. Early initiation of therapy is essential to reduce morbidity and mortality.
Rationale for Incorrect Answers:
A. Prepare the client for immediate droplet isolation and administer intravenous ceftriaxone: This is appropriate for acute bacterial meningitis, especially caused by Neisseria meningitidis, which presents with high fever, neck stiffness, and purulent CSF. These findings are absent in this client.
B. Administer acyclovir and monitor renal function closely: Acyclovir is used for viral (especially HSV) encephalitis. HSV usually causes a rapid onset of fever, seizures, and focal neurologic deficits, and the CSF often shows elevated RBCs. This client’s presentation is more consistent with a fungal cause.
D. Begin vancomycin and dexamethasone and notify public health authorities: This is indicated for suspected bacterial meningitis due to Streptococcus pneumoniae. Public health notification is required for Neisseria meningitidis outbreaks, but there is no indication of a reportable bacterial pathogen in this case.
Key Takeaways:
- Cryptococcal meningitis is common in immunosuppressed clients and often presents with subtle neurologic signs.
- CSF findings with normal glucose, elevated protein, and lymphocytic predominance suggest a fungal or viral etiology, not bacterial.
- Amphotericin B and cryptococcal antigen testing are appropriate first steps in diagnosis and treatment.
Exams on Meningitis
Custom Exams
Login to Create a Quiz
Click here to loginLessons
Naxlex
Just Now
- Objectives
- Introduction
- Practice Exercise 1
- Risk Factors
- Practice Exercise 2
- Pathophysiology
- Practice Exercise 3
- Clinical Features
- Practice Exercise 4
- Diagnostics
- Practice Exercise 5
- Management
- Practice Exercise 6
- Complications
- Practice Exercise 7
- Preventions
- Practice Exercise 8
- Summary
- Comprehensive Questions
Notes Highlighting is available once you sign in. Login Here.
Objectives
- Define meningitis, differentiate between its main types, and briefly describe their general prognoses.
- Identify significant risk factors for developing meningitis, including age, immune status, community settings, and specific predisposing conditions.
- Describe the pathophysiological cascade of meningitis, from pathogen entry into the CNS to the resulting inflammatory response, increased intracranial pressure, and neurological damage.
- Recognize the classic clinical features of meningitis and identify variations in presentation across different age groups.
- Outline the definitive diagnostic procedures for meningitis, particularly lumbar puncture with CSF analysis, and interpret key CSF findings to differentiate between bacterial and viral causes.
- Develop a comprehensive management plan for meningitis, distinguishing between the urgent, specific treatments for bacterial meningitis and the supportive care for viral meningitis.
- List and describe common and severe complications of meningitis, including neurological and systemic sequelae.
- Explain primary prevention strategies for meningitis, with an emphasis on recommended vaccinations and the role of prophylactic antibiotics for close contacts.
Introduction
Meningitis is an acute inflammation of the meninges, which are the protective membranes surrounding the brain and spinal cord. It is a serious condition that can lead to severe neurological deficits or even death if not promptly diagnosed and treated.
- Definition: Inflammation of the arachnoid and pia mater of the brain and spinal cord.
- Types of Meningitis:
- Bacterial Meningitis: A medical emergency. It is a more severe form, often associated with high mortality and morbidity rates if untreated. Common causative organisms include Streptococcus pneumoniae, Neisseria meningitidis (meningococcus), and Haemophilus influenzae type b (Hib).
- Viral Meningitis (Aseptic Meningitis): More common and generally less severe than bacterial meningitis. It is often caused by enteroviruses, but can also be due to arboviruses, human immunodeficiency virus (HIV), and herpes simplex virus (HSV). Patients usually recover completely.
- Fungal Meningitis: Less common, typically seen in individuals with compromised immune systems (e.g., HIV/AIDS, immunosuppressive therapy).
- Parasitic Meningitis: Rare.
Risk Factors
Several factors can increase an individual's susceptibility to developing meningitis. These risk factors vary depending on the type of meningitis.
- General Risk Factors:
- Immunosuppression: Conditions or treatments that weaken the immune system, such as HIV/AIDS, cancer chemotherapy, organ transplantation, or chronic use of corticosteroids.
- Surgical Procedures: Recent neurosurgery or spinal procedures that compromise the meningeal barrier.
- Trauma: Head trauma, especially with a skull fracture, which can provide a direct route for pathogens to enter the CNS.
- Infections: Other systemic infections, particularly respiratory tract infections, that can lead to bacteremia or viremia and subsequent spread to the meninges.
- Shunts/Devices: Presence of ventricular peritoneal (VP) shunts, external ventricular drains (EVDs), or other indwelling CNS devices.
- Contaminated Equipment: Use of contaminated medical equipment in procedures involving the CNS.
- Community Settings: Living in close quarters or communal environments (e.g., college dormitories, military barracks, prisons) increases the risk of transmission, particularly for bacterial meningitis like meningococcal disease.
- Age:
- Infants and Young Children (under 5 years old): Are at higher risk for bacterial meningitis due to their immature immune systems.
- Adolescents and Young Adults (16-21 years old): Are at increased risk for meningococcal meningitis due to living in close communities.
- Older Adults: Also have increased susceptibility due to age-related decline in immune function and underlying comorbidities.
- Specific Risk Factors for Bacterial Meningitis
- Otitis Media/Sinusitis: Untreated or recurrent ear or sinus infections can lead to direct spread of bacteria to the meninges.
- Pneumonia: Streptococcus pneumoniae is a common cause of both pneumonia and meningitis.
- Splenectomy: Individuals without a spleen are at increased risk for encapsulated bacterial infections, including Streptococcus pneumoniae and Neisseria meningitidis.
- Alcoholism: Can lead to a compromised immune system and increased risk of various infections.
- Diabetes Mellitus: Impairs immune function.
- Specific Risk Factors for Viral Meningitis
- Mumps, Measles, Herpes Simplex Virus (HSV): History of these viral infections.
- Enterovirus Exposure: Exposure to individuals infected with enteroviruses, common in summer and fall.
- Lack of Vaccinations: While specific viral meningitis vaccines are limited, overall vaccination against childhood diseases can reduce the risk of certain viral infections that could lead to meningitis.
Pathophysiology
- The causative organism enters the bloodstream.
- It crosses the blood–brain barrier and reaches the central nervous system.
- An inflammatory response is triggered in the meninges.
- Inflammation affects the subarachnoid space and pia mater, regardless of the specific organism.
- This inflammation leads to increased intracranial pressure (ICP).
- Meningeal infections typically originate through:
- Hematogenous spread from distant infections (e.g., cellulitis).
- Direct extension from nearby infections or trauma (e.g., facial bone fractures).
- Bacterial or meningococcal meningitis may occur as:
- An opportunistic infection in individuals with HIV/AIDS.
- A complication of Lyme disease.
- Bacterial meningitis is the most serious form of the disease.
- The most common bacterial pathogens include:
- Neisseria meningitidis (meningococcal meningitis).
- Streptococcus pneumoniae – together, these account for 80% of adult cases.
- Haemophilus influenzae was previously a major cause in children but has become rare in developed countries due to widespread vaccination.
Clinical Features
The clinical presentation of meningitis can vary depending on the type (bacterial vs. viral), the patient's age, and the severity of the infection. However, a classic triad of symptoms is commonly observed.
- Classic Triad of Meningitis:
- Fever: Often high and sudden onset.
- Severe Headache: Persistent and throbbing, often the worst headache the patient has ever experienced.
- Nuchal Rigidity (Stiff Neck): Inability to flex the neck forward due to spasm of the neck muscles. It is an early and key sign.
- Other Common Symptoms:
- Photophobia: Sensitivity to light.
- Altered Mental Status: Can range from lethargy, drowsiness, and irritability to confusion, disorientation, decreased level of consciousness, and coma in severe cases.
- Nausea and Vomiting: Often projectile, due to increased ICP.
- Signs of Increased Intracranial Pressure (ICP): Besides headache and vomiting, these can include:
- Decreased level of consciousness.
- Papilledema (swelling of the optic disc, a late sign).
- Cushing's triad (bradycardia, widened pulse pressure, irregular respirations), indicating severe brainstem compression.
- Rash (particularly with meningococcal meningitis):
- Petechial rash: Small, pinpoint, reddish-purple spots.
- Purpuric lesions: Larger, bruise-like patches.
- These non-blanching rashes indicate disseminated intravascular coagulation (DIC) and are a serious sign requiring immediate medical attention.
- Seizures: Can occur due to irritation of the cerebral cortex by the inflammatory process or cerebral edema.
- Muscle Aches and Arthralgia (joint pain).
- Signs of Meningeal Irritation:
- Kernig's Sign: Pain in the hamstrings and resistance to extension of the knee when the hip is flexed to 90 degrees.
- Brudzinski's Sign: Involuntary flexion of the hips and knees when the patient's neck is passively flexed forward.
Diagnostics
The diagnosis of meningitis relies on a combination of patient history, physical examination findings, and laboratory tests. Prompt and accurate diagnosis is critical, especially for bacterial meningitis, to ensure timely initiation of treatment.
1. Lumbar Puncture (LP) with Cerebrospinal Fluid (CSF) Analysis:
- This is the definitive diagnostic test for meningitis. CSF is collected from the subarachnoid space, typically between the L3-L4 or L4-L5 vertebrae.
- Pre-LP Considerations:
- Before performing an LP, especially if increased intracranial pressure (ICP) is suspected (e.g., altered mental status, papilledema, focal neurological deficits, new-onset seizures, or immunocompromised state), a computed tomography (CT) scan of the head may be performed to rule out a space-occupying lesion (like a brain abscess or tumor) that could lead to brain herniation during the LP.
- Ensure coagulation studies are within normal limits to prevent bleeding complications.
- Obtain informed consent.
- CSF Analysis Components:
- Appearance:
- Bacterial: Cloudy, turbid, or purulent.
- Viral: Clear.
- Protein Content:
- Bacterial: Significantly elevated (due to increased permeability of BBB and bacterial/inflammatory proteins).
- Viral: Normal or slightly elevated.
- Glucose Content: (compared to blood glucose)
- Bacterial: Decreased (bacteria consume glucose).
- Viral: Normal.
- White Blood Cell (WBC) Count with Differential:
- Bacterial: Markedly elevated (hundreds to thousands of cells/mm3), predominantly neutrophils (polymorphonuclear leukocytes).
- Viral: Moderately elevated (tens to hundreds of cells/mm3), predominantly lymphocytes.
- Gram Stain: Performed on CSF to identify bacterial morphology and Gram staining characteristics (positive or negative). This can provide a rapid preliminary identification of the causative bacterium (e.g., Gram-negative cocci for Neisseria meningitidis, Gram-positive cocci for Streptococcus pneumoniae).
- Culture and Sensitivity: CSF is cultured to definitively identify the pathogen and determine its susceptibility to antibiotics. This takes longer (24-72 hours) but guides targeted antibiotic therapy.
- Polymerase Chain Reaction (PCR): Can rapidly detect viral or bacterial DNA/RNA in the CSF, especially useful for viral meningitis (e.g., enteroviruses, HSV).
- Lactate Levels: Elevated CSF lactate levels often suggest bacterial meningitis, distinguishing it from viral.
- Appearance:
2. Blood Tests
- Complete Blood Count (CBC): Usually shows an elevated white blood cell count (leukocytosis) with a shift to the left (increased neutrophils), particularly in bacterial meningitis.
- Blood Cultures: Should be obtained before antibiotic administration. Positive blood cultures can identify the causative organism and confirm bacteremia, even if CSF culture is negative.
- Electrolytes: To monitor for complications like Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
- Coagulation Studies (PT, PTT, INR): Essential if a lumbar puncture is planned or if disseminated intravascular coagulation (DIC) is suspected (especially with meningococcal meningitis).
- C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR): Non-specific inflammatory markers that are often elevated.
3. Imaging Studies
- Computed Tomography (CT) Scan of the Head:
- Often performed before a lumbar puncture if there are signs of increased ICP or focal neurological deficits to rule out brain abscess, hemorrhage, or significant cerebral edema that could lead to herniation.
- May show cerebral edema, hydrocephalus, or abscess formation in advanced cases.
- Magnetic Resonance Imaging (MRI):
- More detailed than CT, can detect subtle changes, inflammation, or complications like cerebral venous thrombosis, or vasculitis, especially if neurological deficits persist.
- Nose and Throat Swabs: May be done to identify the presence of common causative organisms in the nasopharynx, though not definitive for meningitis diagnosis.
Management
The management of meningitis varies significantly depending on whether it is bacterial, viral, or fungal, with bacterial meningitis requiring urgent and aggressive treatment. General supportive care is critical for all types.
1. General Supportive Care
- Maintain Airway, Breathing, Circulation (ABC): Prioritize respiratory and circulatory support. Intubation and mechanical ventilation may be required for patients with altered mental status or respiratory compromise.
- Manage Increased Intracranial Pressure (ICP):
- Head of bed elevated to 30 degrees.
- Maintain neutral head and neck alignment.
- Avoid activities that increase ICP (e.g., Valsalva maneuvers, coughing, sneezing).
- Administer osmotic diuretics (e.g., mannitol) or hypertonic saline as prescribed.
- Consider CSF drainage via an external ventricular drain if hydrocephalus is present.
- Fluid and Electrolyte Balance:
- Administer intravenous (IV) fluids cautiously to prevent dehydration and maintain cerebral perfusion, but avoid overhydration, which can worsen cerebral edema.
- Monitor serum sodium, as hyponatremia can occur due to SIADH.
- Fever Management:
- Administer antipyretics (e.g., acetaminophen).
- Implement cooling measures (e.g., cooling blankets) to reduce metabolic demands and cerebral edema.
- Seizure Management:
- Implement seizure precautions.
- Administer antiseizure medications (e.g., phenytoin, levetiracetam) as prescribed, especially if seizures occur or there is a high risk.
- Pain Management:
- Administer analgesics for headache (e.g., codeine, acetaminophen). Opioids should be used cautiously as they can mask changes in neurological status.
- Provide a quiet, darkened environment to reduce photophobia and headache.
- Nutritional Support: Ensure adequate nutrition, often via IV fluids initially, progressing to enteral feeding if indicated.
- Prevention of Complications:
- Monitor for signs of complications like DIC, shock, SIADH, and hydrocephalus.
- Provide skin care and repositioning to prevent pressure injuries.
- Deep vein thrombosis (DVT) prophylaxis.
2. Specific Management for Bacterial Meningitis:
- Antibiotic Therapy:
- Initiation: Prompt administration of broad-spectrum IV antibiotics is crucial as soon as bacterial meningitis is suspected, even before definitive CSF culture results are back. This is often done immediately after CSF collection, or even before if LP is delayed by a CT scan. Delay significantly increases morbidity and mortality.
- Empiric Therapy: Initial antibiotics are chosen empirically based on age, local resistance patterns, and suspected pathogen (e.g., third-generation cephalosporins like ceftriaxone or cefotaxime, often combined with vancomycin).
- Targeted Therapy: Once the specific pathogen and its antibiotic sensitivities are identified from cultures (CSF, blood), antibiotic therapy is adjusted to a narrow-spectrum agent.
- Duration: Antibiotic courses are typically 10-21 days, depending on the pathogen and patient response.
- Corticosteroid Therapy (Dexamethasone):
- Often administered concurrently with or just before the first dose of antibiotics, particularly for bacterial meningitis caused by Streptococcus pneumoniae or in children with H. influenzae type b.
- Dexamethasone helps to reduce the inflammatory response in the subarachnoid space, which can decrease cerebral edema, hearing loss, and other neurological complications.
3. Specific Management for Viral Meningitis:
- Symptomatic and Supportive Care: Since antibiotics are ineffective against viruses, treatment is primarily aimed at relieving symptoms and supporting the patient's recovery.
- Fluid and Electrolyte Management: As above.
- Pain and Fever Management: As above.
- Rest: Encourage bed rest.
- Antiviral Medications: May be used if a specific treatable virus is identified (e.g., acyclovir for herpes simplex virus [HSV] meningitis). This is less common than for typical enteroviral meningitis.
- Specific Management for Fungal/Parasitic Meningitis:
- Requires specific antifungal (e.g., amphotericin B, fluconazole) or antiparasitic medications, which can be long-term and have significant side effects. Often seen in immunocompromised patients.
Complications
Meningitis, particularly bacterial meningitis, can lead to a range of severe and potentially life-threatening complications, both acute and long-term. Viral meningitis generally has a lower risk of severe complications, but some can still occur.
1. Neurological Complications
- Increased Intracranial Pressure (ICP): A primary concern, leading to decreased cerebral perfusion, brain herniation, and severe neurological damage or death.
- Hydrocephalus: Obstruction of CSF flow or reabsorption due to inflammatory exudates can lead to accumulation of CSF within the ventricles, requiring CSF diversion (e.g., shunt placement).
- Cerebral Edema: Swelling of brain tissue, worsening ICP.
- Seizures: Can be a direct result of cortical irritation, fever, or cerebral ischemia. They can lead to further neuronal damage.
- Cranial Nerve Damage: Inflammation can directly damage cranial nerves, leading to specific deficits:
- CN VIII (Vestibulocochlear): Most commonly affected, leading to hearing loss (ranging from mild to profound, unilateral or bilateral), and/or vestibular dysfunction (balance problems, dizziness). This can be permanent.
- CN III, IV, VI (Oculomotor, Trochlear, Abducens): Can cause ocular palsies (difficulty moving eyes), strabismus, or diplopia (double vision).
- CN VII (Facial): Can lead to facial paresis or paralysis.
- Cerebral Ischemia/Infarction: Inflammation of cerebral blood vessels (vasculitis) can lead to thrombosis, stroke, and permanent brain injury.
- Cognitive Impairment: Learning disabilities, memory deficits, attention deficits, and behavioral changes can occur, particularly in children who have had bacterial meningitis.
- Developmental Delay: In infants and young children, severe meningitis can lead to significant developmental delays.
- Brain Abscess: Localized collection of pus within the brain tissue, a serious focal infection.
2. Systemic Complications
- Septicemia/Sepsis: The bacteria can spread throughout the bloodstream, leading to a systemic inflammatory response syndrome (SIRS) and septic shock.
- Disseminated Intravascular Coagulation (DIC): A life-threatening condition characterized by widespread activation of clotting leading to consumption of clotting factors and widespread bleeding, often presenting as petechial or purpuric rash, especially in meningococcal disease.
- Waterhouse-Friderichsen Syndrome: A severe, often fatal complication of meningococcal meningitis, characterized by massive bilateral adrenal hemorrhage, leading to acute adrenal insufficiency, shock, and DIC.
- Syndrome of Inappropriate Antidiuretic Hormone (SIADH): Excessive release of ADH leads to water retention, dilutional hyponatremia, and can worsen cerebral edema.
- Arthritis: Joint inflammation can occur, particularly in meningococcal disease.
- Gangrene: Severe cases of DIC can lead to tissue necrosis and gangrene of the extremities, sometimes requiring amputation.
- Pneumonia, Endocarditis: Other systemic infections may develop.
3. Long-Term Sequelae​​​​​​​
- Persistent headaches.
- Dizziness or vertigo.
- Fatigue.
- Behavioral problems.
- Visual or hearing impairment.
- Hydrocephalus.
- Epilepsy (recurrent seizures).
- Learning difficulties in children.
Preventions
Preventing meningitis largely focuses on vaccination, prompt treatment of other infections, and general hygiene measures.
- Vaccinations: Immunization is the most effective way to prevent several forms of bacterial meningitis.
- Haemophilus influenzae type b (Hib) Vaccine:
- Administered to infants and young children (part of routine childhood immunizations).
- Has dramatically reduced the incidence of Hib meningitis, which was once a leading cause of bacterial meningitis in children.
- Pneumococcal Vaccines: Protect against Streptococcus pneumoniae, a common cause of bacterial meningitis, pneumonia, and otitis media.
- Pneumococcal Conjugate Vaccine (PCV13, e.g., Prevnar 13): Recommended for infants and young children as a series, and sometimes for older children and adults with certain medical conditions.
- Pneumococcal Polysaccharide Vaccine (PPSV23, e.g., Pneumovax 23): Recommended for all adults 65 years or older, and for individuals aged 2-64 years with certain underlying medical conditions (e.g., chronic lung or heart disease, diabetes, immunocompromised states).
- Meningococcal Vaccines: Protect against Neisseria meningitidis, the cause of meningococcal meningitis.
- Meningococcal Conjugate Vaccines (MenACWY, e.g., Menactra, Menveo): Recommended for adolescents (first dose around 11-12 years, booster at 16 years) and certain high-risk groups (e.g., college students in dorms, military recruits, travelers to endemic areas, individuals with complement deficiencies or asplenia).
- Meningococcal B Vaccines (MenB, e.g., Bexsero, Trumenba): Recommended for individuals aged 10 years or older who are at increased risk for serogroup B meningococcal disease (e.g., during outbreaks) and may be given to adolescents and young adults aged 16-23 years for short-term protection.
- Other Vaccines: Vaccines against certain viruses (e.g., measles, mumps, chickenpox, influenza) can indirectly reduce the risk of viral meningitis by preventing the primary viral infection.
- Haemophilus influenzae type b (Hib) Vaccine:
- Prophylactic Antibiotics (Post-Exposure Prophylaxis):
- Administered to close contacts of individuals diagnosed with bacterial meningitis, especially meningococcal meningitis or Hib meningitis, to prevent secondary cases.
- Commonly used antibiotics for prophylaxis include rifampin, ciprofloxacin, or ceftriaxone. This should be done promptly after exposure.
- Healthcare workers with significant exposure to patient secretions may also require prophylaxis.
- Good Hygiene Practices:
- Hand Washing: Frequent and thorough hand washing, especially after coughing, sneezing, or contact with respiratory secretions.
- Respiratory Etiquette: Covering the mouth and nose when coughing or sneezing, ideally with a tissue or into the elbow.
- Avoid Sharing Personal Items: Do not share eating utensils, drinking glasses, lip balms, or cigarettes, particularly in close living quarters.
- Stay Home When Sick: To prevent spreading infections, especially respiratory ones.
- Prompt Treatment of Other Infections:
- Prompt and effective treatment of conditions like otitis media (ear infections), sinusitis, and pneumonia can prevent the spread of bacteria to the meninges.
- Management of Immunocompromised Individuals:
- Healthcare providers should be vigilant in monitoring and managing potential infections in immunocompromised patients, as they are at higher risk for meningitis, including fungal types.
Summary
- Meningitis is an acute inflammation of the brain and spinal cord membranes, primarily caused by bacteria or viruses.
- Pathogen entry into the CNS triggers inflammation in the CSF, leading to increased intracranial pressure, cerebral edema, and potential neurological damage.
- Classic signs include fever, severe headache, and stiff neck; diagnosis is confirmed by lumbar puncture and CSF analysis revealing specific fluid characteristics for bacterial vs. viral types.
- Management involves immediate, aggressive IV antibiotics and corticosteroids for bacterial forms, while viral meningitis is treated symptomatically; supportive care for ICP and complications is crucial for both.
- Serious complications can include permanent neurological deficits and systemic issues like sepsis and DIC.
- Prevention is primarily achieved through widespread vaccination against Hib, pneumococcal, and meningococcal bacteria, alongside post-exposure prophylaxis for close contacts.
Naxlex
Videos
Login to View Video
Click here to loginTake Notes on Meningitis
This filled cannot be empty
Join Naxlex Nursing for nursing questions & guides! Sign Up Now
