Meningitis Viral and Bacterial

Meningitis Nursing Management Interventions Care Plans

Meningitis Nursing Diagnosis Interventions and Care Plans

Nursing Study Guide: Meningitis

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
  • 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

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

  1. 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.
  2. 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 Care Plans for Meningitis

  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.

InterventionsRationales
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 1
  • 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.

InterventionsRationales
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 2

Other Nursing Diagnoses for Meningitis:

  • Deficient Knowledge
  • Acute Pain
  • Risk for Infection (Cross-contamination)

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.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). 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. (2018). 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

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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