Meningitis Nursing Care Plans Diagnosis and Interventions
Meningitis NCLEX Review and Nursing Care Plans
Meningitis is a disease that involves the inflammation of the membranes that surround the brain and spinal cord, known as meninges.
The inflammation may be due to viral, bacterial, fungal or parasitic infections, but most cases in the U.S. are due to viruses.
Meningitis may develop as a complication of spinal lumbar surgery, although this is very rare. Meningitis affect both newborn babies and older people. Meningitis may lead to serious complications if left untreated.
Signs and Symptoms of Meningitis
Children age 2 and above, as well as adults may have the following:
- Sudden hyperthermia (high grade fever)
- Stiff neck
- Severe headache
- Nausea or vomiting
- Difficulty or lack of concentration
- Light sensitivity
- Loss of appetite/ thirst
- Sensitivity to light
- Skin rash (found in meningococcal meningitis)
Below age 2, infants and newborns may experience:
- Constant crying even when being held
- Poor feeding
- Body stiffness
- Excessive sleepiness
- Sluggish movements or inactivity
Causes and Risk Factors of Meningitis
Bacterial meningitis is caused by the spread of bacteria into the bloodstream until they reach the central nervous system.
It may also happen when the bacterial pathogens directly infect the meninges, such as in skull fracture, sinus or ear infection.
Streptococcus pneumoniae or pneumococcus bacteria are the most common cause of bacterial meningitis in the U.S. Meningococcus that originate from an upper respiratory tract infection into the bloodstream may travel to the brain and cause meningococcal meningitis.
Tuberculous meningitis may occur if Mycobacterium tuberculosis travels usually from the lungs via the blood stream and invades the meninges.
Bacterial meningitis is contagious via respiratory route. On the other hand, enteroviruses are the most common cause of viral meningitis. HIV and herpes simplex virus may also cause this.
Chronic meningitis, which develops over 2 weeks or more, is rare and is usually caused by fungi.
One of the risk factors that contribute to the development of meningitis includes the failure to complete vaccinations that protect against preventable meningitis, such as meningitis caused by the Hemophilus influenzae bacteria.
Age is also a factor, as children below 5 years old are more susceptible to viral meningitis, while bacterial meningitis is more common in young children and teens age 20 and below.
Pregnancy, weakened immune systems, and living in crowded places increase the risk of having meningitis.
Complications of Meningitis
The complications of meningitis may be life-threatening, especially that of bacterial meningitis. These are usually associated with neurological functioning.
Some of the complications of meningitis include seizures, brain damage, kidney failure, hearing loss, learning disabilities, gait problems, memory difficulty, shock, or death.
Diagnosis of Meningitis
- Physical examination and history taking –to check for any signs and symptoms of meningitis
- Blood tests – full blood count may show elevated WBCs which indicate an active infection; blood cultures and Gram’s stain will reveal the pathogen responsible for the infections; kidney function test may show any kidney problems as complications for severe meningitis
- Imaging – MRI or CT scan of the head will be performed to check for any inflammation or swelling; chest or sinus X-ray may be done to check for any infection that might have travelled to the brain via the bloodstream
- Lumbar puncture – also known as spinal tap, this is done by collecting cerebrospinal fluid (CSF) from the lumbar area of the spine to check for any signs of meningitis, such as elevated WBCs and protein, low glucose level, and causative agent
Treatment for Meningitis
- Antibiotics. Bacterial meningitis is urgently treated with antibiotics intravenously. The type of antibiotics depends on the specific bacteria that have caused the infection, but the doctor may prescribe broad-spectrum antibiotics at first while waiting for the blood culture and spinal tap results. A patient with bacterial meningitis is likely to be placed in an isolation room to prevent further spread of the infection.
- Symptomatic treatment. Viral meningitis may benefit from antiviral medications (such as in the case of herpes virus), but mild cases of viral meningitis resolve for at least 7 days even without treatment. Bed rest, increased fluid intake, and over-the-counter antipyretics and pain medications are included in the treatment of viral meningitis. Antifungal medications are used for fungal chronic meningitis. Corticosteroids may be prescribed to relieve the swelling in the brain.
Nursing Diagnosis for Meningitis
Meningitis Nursing Care Plan 1
Nursing Diagnosis: Ineffective Tissue Perfusion (Cerebral) related to cerebral edema and increased intracranial pressure (ICP) secondary to meningitis as evidenced by drowsiness, hallucinations, and hypercapnia
Desired Outcome: The patient will maintain cerebral tissue perfusion as evidenced by increased level of consciousness (i.e. awake and alert) and will have an oriented with persons, places, and things.
|Nursing Interventions Meningitis||Rationales|
|Assess the patient’s vital signs and neurological status at least every 4 hours, or more frequently if there is a change in them.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment for meningitis.|
|Observe the patient for any signs and symptoms of increased ICP, such as sudden headache, vomiting, and decreased alertness.||To facilitate early detection and management of increased ICP.|
Increased ICP can be life-threatening as it may lead to brain damage, stroke, or coma.
|Administer the prescribed antibiotic medications.||Use the antibiotic to treat bacterial meningitis, which is the underlying cause of the patient’s increased ICP.|
|Administer osmotic diuretics (e.g. Mannitol) as prescribed.||To promote blood flow to the brain and to reduce cerebral edema.|
|Elevate the head of the bed at 30 degrees.||To promote venous drainage from the patient’s head to the rest of the body in order to decrease ICP and reduce cerebral edema.|
Meningitis Nursing Care Plan 2
Nursing Diagnosis: Hyperthermia related to infective process of bacterial meningitis as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
|Nursing Interventions Meningitis||Rationales|
|Assess the patient’s vital signs at least every 4 hours.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Paracetamol) administered.|
|Remove excessive clothing, blankets and linens. Adjust the room temperature.||To regulate the temperature of the environment and make it more comfortable for the patient.|
|Administer the prescribed antibiotic and anti-pyretic medications.||Use the antibiotic to treat bacterial infection, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.|
|Offer a tepid sponge bath.||To facilitate the body in cooling down and to provide comfort.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
Meningitis Nursing Care Plan 3
Nursing Diagnosis: Acute Pain related to meningeal inflammation and elevated intracranial pressure secondary to meningitis as evidenced by stiffness in the neck, migraine, anxiety, and nuchal tightness.
- The patient will verbalize comfort and pain reduction sensations.
- The patient will also be able to manage other symptoms and complications of meningitis.
|Nursing Interventions Meningitis||Rationale|
|Examine the patient’s headaches and sensitivity to light.||Once the brain’s meninges become affected, it can induce swelling and severe headaches. Meningitis can also trigger photophobia. That is why this intervention is one of the most important ways to manage meningitis.|
|Examine Kernig’s sign to test pain and resistance on passive knee extension with hips completely flexed and Brudzinski’s sign to assess hips flex on forwarding head bending.||These signs are used to look for any indications of meningeal inflammation.|
|Keep the atmosphere calm and the patient’s room darker.||This intervention is beneficial since dimming the room will alleviate photophobia.|
|Minimize distractions and limit visitation.||Distractions can elevate intracranial pressure, exacerbating the symptoms.|
|Control the surroundings to promote relaxation.||Increased noise and dazzling light in the surroundings produce sensory overload, which causes cerebral inflammation and leads to seizures.|
|Turn the patient’s position frequently and carefully.||This approach improves the patient’s relaxation while reducing irritability and tension.|
|Motivate the patient to conduct Range of motion (ROM) exercises.||This intervention will prevent neck pain and joint stiffness.|
|As directed, take the antibiotic and corticosteroids prescribed.||Antibiotics and corticosteroid therapy are prescribed to decrease inflammation and pain.|
|As recommended, administer analgesics such as acetaminophen or NSAIDs if the pain becomes intolerable.||This intervention must be considered since NSAIDs are used to manage pain.|
Meningitis Nursing Care Plan 4
Nursing Diagnosis: Disturbed Sensory Perception related to reduced level of consciousness, elevated intracranial pressure, cerebral inflammation, and hydrocephalus secondary to meningitis as evidenced by the altered sensorium or nerve system.
- The patient will be able to maintain his or her typical level of consciousness.
- The patient will also be knowledgeable about the symptoms of meningitis and will know how to combat these.
|Nursing Interventions Meningitis||Rationale|
|Using the pediatric Glasgow coma scale, evaluate the patient’s level of consciousness.||The Glasgow coma scale is a dependable and accurate method of assessing the physical, cognitive, and sensory clues associated with the level of consciousness. Therefore, the level of damage in meningitis can be determined with the help of a neurological examination.|
|Monitor and inform the doctor if the patient’s level of consciousness continues to deteriorate.||If consciousness levels begin to decline, an additional or different treatment may be required. Changes in mentation, tremors, hypertension or high blood pressure, arrhythmia, or respiratory problems can suggest that intracranial pressure (ICP) rises due to decreasing cerebral perfusion pressure.|
|Examine for symptoms of cerebral edema such as vertigo, migraine, abnormal breathing, neck pain, nausea, and vomiting.||As the symptoms worsen, oxygen depletion, vasodilation, or vascular obstruction can cause cerebral edema due to elevated extracellular and intracellular fluid in the brain.|
|the patient’s ability to follow basic or comprehensive commands.||When one of the brain hemispheres is involved, cognitive performance suffers. That is why this intervention is necessary for evaluating the patient’s cognitive function.|
|Examine the presence or absence of defensive responses such as swallowing, gagging, blinking, and coughing.||This approach determines the absence of reflexes which indicates late symptoms of rising intracranial pressure.|
|Examine the patient’s meningeal irritation symptoms such as headache, photophobia or sensitivity to light, nuchal tightness, opisthotonic posture, Kernig’s sign, and Brudzinki’s sign.||Meningeal symptoms are fundamental aspects of meningeal irritation caused by meningitis, spinal root inflammation, and the accumulation of infectious exudates.|
|Upraise the bed head to 30° to 45° while keeping the patient’s head in a normal position.||This technique promotes venous circulation from the brain and aids in the reduction of intracranial pressure.|
|As necessary, reorient the patient to the surroundings.||It is critical to practice coping techniques regularly to improve cognitive performance.|
|Assist the patient in the diagnosing procedures such as the following: VentriculogramCerebrospinal Fluid (CSF) lumbar punctureElectroencephalogramMagnetic Resonance Imaging (MRI)Computed Tomography (CT Scan)||The following diagnostic tests are performed to determine intracranial pressure and the prevalence of harmful microorganisms.|
|Commence seizure prevention by observing and caring for the patient during the episode.||Providing adequate and exact care minimizes complications and further brain injury during a seizure.|
|Retain the atmosphere calm and the lighting dark.||This technique inhibits stimuli that could trigger or exacerbate a convulsion attack.|
|Throughout the first 24 hours, measure pupil size every 3 hours, then every 6 hours.||Increased intracranial pressure (ICP) causes irregular pupil diameters and a static enlarged pupil.|
|Monitor and report the patient’s seizure frequency and severity. Inform also the doctor if the patient is having seizures.||Variations in seizure patterns indicate the necessity for additional neurological testing, anti-seizure drugs, and therapy reassessment. Seizures typically occur antecedent to a rise in intracranial pressure (ICP). Appropriate infection treatment will prevent subsequent worsening and keep intracranial pressure within normal ranges.|
|Encourage parents to be involved in their patient’s care.||This method assists in better coping and anxiety reduction.|
|Administer and evaluate anticonvulsant medication dosages. .||Anticonvulsants are used for both management and cure. Therapy entails maintaining therapeutic serum concentrations to avoid convulsions|
Meningitis Nursing Care Plan 5
Nursing Diagnosis: Risk for Injury related to modified neurological regulatory function, disorientation, and restlessness secondary to meningitis.
As a risk nursing diagnosis, Risk for injury is not correlated with any signs and symptoms because it has not yet developed in the patient, and safety precautions will be undertaken instead.
Desired Outcome: The patient will be knowledgeable enough on avoiding injury and how to manage it if it occurs unexpectedly.
|Nursing Interventions Meningitis||Rationale|
|Assess neurologic condition, including VS pattern, awareness changes, behavior patterns, and pupillary or ocular responses suitable for age. Furthermore, if the patient is an infant, measure head circumference.||This method provides information that may indicate an elevation in intracranial pressure produced by brain inflammation and accompanying edema.|
|Integrate a cardiac and respiratory monitor to detect arrhythmia and oxygen depletion.||Elevated intracranial pressure causes a decline in heartbeat and respiration and widening pulse pressure, with pulse becoming erratic and respiratory rate becoming quick and shallow as ICP rises and the body seeks to reduce blood supply to the brain.|
|Observe any seizure activity, including the onset, recurrence, length, and movements before, during, and after the seizure. Moreover, pad the bed and eliminate any objects or toys from the bed, and provide any anticonvulsants that have been prescribed.||This intervention protects the patient from damage during a seizure, which is a consequence of meningitis.|
|Allow for rest periods between care or procedures, offer an excellent serene atmosphere devoid of bright lighting, limit visiting if irritated, and decrease gentle handling and care of the patient.||This method reduces irritation and improves comfort and repose.|
|Stay close to the patient and speak in a low voice.||During the acute period of the condition, it provides limited stimulation to the patient.|
|Maintain head alignment with a sandbag while elevating the head up to 30 degrees.||This technique reduces intracranial pressure by enabling blood to circulate from the brain via gravity or any impediment to venous outflow.|
|Reposition the patient every 2 hours to maximize convenience with the head of the bed (HOB) slightly raised, no pillow in bed, and place him or her in a side-lying position if nuchal rigidity is prevalent; avoid jerky movements such as trying to lift the head. Lastly, have oxygen and suctioning equipment ready to be utilized when considered necessary.||This approach improves airway patency and prevents discharge from obstructing it, which increases carbon dioxide retention and intracranial pressure.|
|Discuss to the patient the causes of increasing ICP and prevent further elevations.||This method allows for a better understanding of the high ICP and the potentially severe nature of such a disorder|
|Notify the parents of any changes in their patient’s condition, the reasons for physiological and mental changes, and the repercussions of the disease.||This method enhances understanding of the disease’s potential manifestations and consequences.|
|Notify the patient of the cause of the epileptic seizures and other indications and symptoms of the disease and the treatment required.||This method teaches seizure consequences and measures and responsibility in the prevention or treatment of this activity.|
|Communicate with parents about the danger of problems and the necessity for strict intracranial pressure monitoring. Therefore, go over the signs and symptoms of high intracranial pressure.||This strategy provides for continuing care and responsibility in minimizing neurological state changes.|
|As soon as antibiotics are prescribed, take them as directed based on cerebrospinal fluid (CSF) analyses and throat cultures.||This technique controls current infections and actually prevents infections from spreading; this is the exact mechanism by which antibiotics work against meningitis.|
|Use stool softeners, avoid restraints, and avoid or minimize crying outbursts.||This method prevents the Valsalva maneuver, which raises intracranial pressure.|
|Orient the patient to his or her environment and re-orient as needed. Place a call bell within reach and educate how to use it. Make sure to respond to the call quickly.||To avoid accidents, the patient must become accustomed to the arrangement of the surroundings. Items that are too far away from the patient may pose a risk.|
More Nursing Diagnoses for Meningitis:
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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