Meningitis is a disease involving the inflammation of the membranes surrounding 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 lead to severe complications if left untreated.
Causes of Meningitis
- Bacterial Infection: Bacterial meningitis is often caused by bacteria such as Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae. Group B Streptococcus is the most common cause of bacterial meningitis in newborns.
- Viral Infection: Viral meningitis is usually caused by enteroviruses, herpes simplex virus, or the mumps virus. Viral infections are generally less severe than bacterial infections and often resolve independently.
- Fungal Infection: Fungal meningitis is relatively rare but can occur in people with weakened immune systems, such as those with HIV/AIDS or individuals who have undergone organ transplantation.
- Parasitic Infection: Parasitic meningitis is uncommon but can be caused by parasites like Naegleria fowleri, found in warm freshwater environments, or by parasites transmitted through the bites of infected insects, such as mosquitoes.
Signs and Symptoms of Meningitis
Children age 2 and above, as well as adults may have the following:
- Sudden hyperthermia (high grade fever)
- Nuchal rigidity (Stiff neck)
- Severe headache
- Nausea or vomiting
- Confusion
- Difficulty or lack of concentration
- Light sensitivity
- Drowsiness
- Loss of appetite/ thirst
- Seizures
- Sensitivity to light
- Skin rash (found in meningococcal meningitis)
Below age 2, infants and newborns may experience:
- Hyperthermia
- Constant crying even when being held
- Poor feeding
- Body stiffness
- Excessive sleepiness
- Irritability
- Sluggish movements or inactivity
Meningitis Diagnosis
- Physical examination and history taking –to check for any signs and symptoms of meningitis.
- Blood tests – complete 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; a chest or sinus X-ray may be done to check for any infection that might have traveled to the brain via the bloodstream
- Lumbar puncture – also known as a spinal tap, 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 the causative agent
Meningitis Treatment
Antibiotics. Bacterial meningitis is urgently treated with antibiotics intravenously. The type of antibiotics depends on the specific bacteria that have caused the infection. A patient with bacterial meningitis will likely be placed in an isolation room to prevent further spread of the infection.
Symptomatic treatment. Viral meningitis may benefit from antiviral medications (such as herpes virus), but mild cases of viral meningitis resolve for at least seven days, even without treatment. Antifungal medications are used for chronic fungal meningitis. Corticosteroids may be prescribed to relieve the swelling in the brain.
Meningitis Nursing Precautions
Isolation Precautions: Meningitis, especially bacterial and viral types, can be highly contagious. Therefore, implementing appropriate isolation precautions is crucial. The specific type of precautions depends on the causative organism and mode of transmission. Generally, droplet precautions are followed for suspected or confirmed bacterial or viral meningitis cases.
Hand Hygiene: Strict adherence to hand hygiene practices is vital in preventing the spread of meningitis.
Personal Protective Equipment (PPE): Nurses should utilize appropriate personal protective equipment when caring for patients with meningitis. This typically includes wearing gloves, a gown, and a mask.
Environmental Cleaning: Regular and thorough cleaning and disinfection of the patient’s environment are essential to prevent meningitis transmission.
Respiratory Hygiene/Cough Etiquette:
- Educate the patient and their visitors about respiratory hygiene and cough etiquette.
- Encourage the patient to cover their mouth and nose with a tissue or their elbow when coughing or sneezing to prevent the spread of respiratory droplets.
- Provide tissues and hand sanitizers in patient care areas for easy access.
Visitor Restrictions: Restricting the number of visitors and implementing visitor screening protocols can help minimize the risk of meningitis transmission. Visitors with respiratory symptoms or may have been exposed to the infection should be advised to refrain from visiting until they are symptom-free or have received medical clearance.
Nursing Goals and Expected Outcomes for Meningitis
Timely Diagnosis and Treatment: The patient receives prompt and accurate diagnosis of meningitis, followed by appropriate and timely treatment. Early intervention helps to control the infection, alleviate symptoms, and prevent complications.
Infection Control: The patient’s condition does not worsen, and the infection does not spread to others. Strict adherence to isolation precautions, proper hand hygiene, and other infection control measures prevent the transmission of the infection to healthcare providers, other patients, and visitors.
Stable Vital Signs: Maintaining stable vital signs is essential in managing meningitis.
Effective Pain Management: The patient’s pain associated with meningitis, such as headaches and body aches, is adequately managed.
Adequate Hydration and Nutrition: The patient maintains proper hydration and nutrition throughout the course of the illness.
Neurological Stability: The patient maintains or improves their level of consciousness and neurological functioning.
Emotional and Psychosocial Support: The patient and their family receive emotional support and coping strategies to navigate the challenges associated with meningitis.
Meningitis Nursing Assessment & Rationales
Health History: Obtain a comprehensive health history, including information about the onset and progression of symptoms, recent illnesses, immunization history, exposure to infectious diseases, and any relevant medical conditions. Rationale: This helps identify potential causes and risk factors for meningitis.
Vital Signs: Assess and document the patient’s temperature, heart rate, blood pressure, and respiratory rate. Rationale: Meningitis can cause fever and hemodynamic instability, and monitoring vital signs helps evaluate the infection’s severity and guide treatment decisions.
Neurological Assessment: Perform a thorough neurological examination, including the patient’s level of consciousness (LOC), orientation, pupillary response, motor function, and sensory perception. Rationale: Meningitis can cause neurological changes such as altered LOC, irritability, seizures, and abnormal reflexes. Assessing these parameters helps monitor the disease’s progression and identify any complications.
Head-to-Toe Assessment: Conduct a head-to-toe assessment to identify any physical signs associated with meningitis, such as neck stiffness (nuchal rigidity), Brudzinski’s and Kernig’s signs, skin rash (in some cases of meningococcal meningitis), and any other abnormalities. Rationale: This assessment aids in confirming the diagnosis and detecting potential complications.
Pain Assessment: Assess the patient’s pain level using appropriate pain scales and document the pain’s location, intensity, and characteristics. Rationale: Meningitis often causes severe headaches and body pain. Accurate pain assessment guides appropriate pain management interventions.
Fluid and Electrolyte Assessment: Monitor the patient’s fluid intake and output and assess for signs of dehydration, such as dry mucous membranes, decreased urine output, and poor skin turgor. Rationale: Meningitis can lead to fluid and electrolyte imbalances due to fever, decreased oral intake, and increased fluid losses. Regular assessment helps in maintaining adequate hydration and electrolyte balance.
Psychosocial Assessment: Assess the patient’s mental and emotional state, including their level of anxiety, fear, and coping mechanisms. Rationale: Meningitis can be a distressing experience for patients and their families. Identifying psychosocial needs allows nurses to provide appropriate support and interventions.
Meningitis Nursing Interventions & Rationales
Isolation Precautions: Implement appropriate isolation precautions based on the infectious agent causing meningitis (e.g., droplet precautions for bacterial meningitis). Rationale: Isolation helps prevent the spread of the infection to other patients, healthcare workers, and visitors.
Administer Prescribed Medications: Ensure timely administration of prescribed medications, such as antibiotics for bacterial meningitis or antiviral medications for viral meningitis. Rationale: Administering medications as ordered helps control the infection, reduce inflammation, and promote recovery.
Pain Management: Assess the patient’s pain level and provide appropriate pain relief measures. Administer analgesics as prescribed and utilize non-pharmacological interventions like positioning, providing a quiet environment, and using relaxation techniques. Rationale: Effective pain management improves patient comfort and promotes rest.
Fluid and Electrolyte Balance: Monitor the patient’s fluid intake and output, and administer intravenous fluids as prescribed. Maintain electrolyte balance by monitoring serum electrolyte levels and administering supplements as ordered. Rationale: Adequate hydration and electrolyte balance support recovery and prevent complications.
Monitor Vital Signs and Neurological Status:
- Continuously monitor the patient’s vital signs, including temperature, heart rate, blood pressure, and respiratory rate.
- Perform regular neurological assessments to evaluate changes in the level of consciousness, pupillary response, and motor function.
- Promptly report any significant changes to the healthcare team for early intervention.
Provide Comfort Measures: Create a comfortable environment by ensuring appropriate lighting, temperature, and noise levels. Use soft bedding, provide extra pillows for positioning. Rationale: Frequent position changes to relieve discomfort associated with headaches, muscle aches, and body stiffness.
Seizure Precautions: Implement seizure precautions as necessary, especially if the patient has a history of seizures or exhibits signs of increased intracranial pressure. Rationale: Maintain a safe environment, provide seizure pads, and administer anticonvulsant medications as prescribed to prevent and manage seizures.
Education and Support: Provide education to the patient and their family about meningitis, its treatment, potential complications, and the importance of adhering to the prescribed medication regimen. Offer emotional support, address concerns, and provide resources for ongoing care and rehabilitation, if needed.
Meningitis Nursing Care Plans
Ineffective Tissue Perfusion
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.
Hyperthermia
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.
Acute Pain
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.
Desired Outcomes:
- The patient will verbalize comfort and pain reduction sensations.
- The patient will also be able to manage other symptoms and complications of meningitis.
Disturbed Sensory Perception
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.
Desired Outcomes:
- 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.
Risk for Injury
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.
More Nursing Diagnoses for Meningitis:
- Deficient Knowledge
- Risk for Infection (Cross-contamination)
Sample NCLEX Nursing Test Questions for Meningitis
Question 1: Which of the following signs and symptoms is a classic finding in a patient with meningitis?
A) Nuchal rigidity
B) Decreased heart rate
C) Increased blood pressure
D) Hypoactive bowel sounds
Answer and Rationale: A) Nuchal rigidity Rationale: Nuchal rigidity, or neck stiffness, is a classic sign of meningitis. It is caused by inflammation of the meninges, which leads to resistance and pain when attempting to flex the neck forward.
Question 2: Which organism is the most common cause of bacterial meningitis in newborns?
A) Streptococcus pneumoniae
B) Haemophilus influenzae
C) Neisseria meningitidis
D) Group B Streptococcus
Answer and Rationale: D) Group B Streptococcus Rationale: Group B Streptococcus is the most common cause of bacterial meningitis in newborns. Pregnant women are screened for Group B Streptococcus colonization during late pregnancy, and if positive, intrapartum antibiotics are administered to prevent transmission to the newborn.
Question 3: Which precaution should the nurse take when caring for a patient with suspected bacterial meningitis?
A) Standard precautions
B) Droplet precautions
C) Contact precautions
D) Airborne precautions
Answer and Rationale: B) Droplet precautions Rationale: Bacterial meningitis is spread through respiratory droplets, so the nurse should implement droplet precautions. These precautions involve wearing a mask, maintaining a distance of at least 3 feet from the patient, and placing the patient in a private room or with another patient with the same infection.
Question 4: Which diagnostic test is most commonly used to confirm the diagnosis of bacterial meningitis?
A) Lumbar puncture
B) Computed tomography (CT) scan
C) Magnetic resonance imaging (MRI)
D) Blood culture
Answer and Rationale: A) Lumbar puncture Rationale: Lumbar puncture is the most commonly used diagnostic test to confirm the diagnosis of bacterial meningitis. Cerebrospinal fluid (CSF) is collected through a needle inserted into the subarachnoid space of the spinal column and sent for analysis, including cell count, culture, and sensitivity testing.
Question 5: Which statement by a nursing student indicates an understanding of the prevention of meningococcal meningitis?
A) “Hand hygiene is essential in preventing the spread of meningococcal meningitis.”
B) “Meningococcal meningitis is primarily transmitted through contaminated food and water.”
C) “Meningococcal meningitis can only be prevented by complete isolation of the patient.”
D) “Wearing a gown and gloves is necessary when caring for a patient with meningococcal meningitis.”
Answer and Rationale: A) “Hand hygiene is essential in preventing the spread of meningococcal meningitis.” Rationale: Meningococcal meningitis is primarily spread through respiratory droplets. Practicing good hand hygiene, such as washing hands with soap and water or using alcohol-based hand sanitizers, is essential in preventing the spread of the infection.
Nursing References
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.
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
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.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
Best Nursing Books and Resources
These are the nursing books and resources that we recommend.
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The Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care
This is an excellent reference for nurses and nursing students. While it is a great resource for writing nursing care plans and nursing diagnoses, it also helps guide the nurse to match the nursing diagnosis to the patient assessment and diagnosis.
This handbook has been updated with NANDA-I approved Nursing Diagnoses that incorporates NOC and NIC taxonomies and evidenced based nursing interventions and much more.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
All introductory chapters in this updated version of a ground-breaking text have been completely rewritten to give nurses the knowledge they require to appreciate assessment, its relationship to diagnosis and clinical reasoning, and the goal and use of taxonomic organization at the bedside.
Nursing Care Plans: Nursing Diagnosis and Intervention
It contains more than 200 care plans that adhere to the newest evidence-based recommendations.
Additionally, it distinguishes between nursing and collaborative approaches and highlights QSEN competencies.
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