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T4: Meningitis

Inflammatory Brain Disorders

An acute inflammation of meningeal tissue surrounding brain and spinal cord. meningitis
When does meningitis usually occur? fall, winter, or early spring
Meningitis is often secondary to what? viral respiratory disease
Who is at risk for meningitis? Older adults and persons who are debilitated as well as college students living in dorms, and individual living in institutions (e.g. prisoners)
This type of meningitis is a medical emergency and if left untreated has a near 100% mortality rate. bacterial meningitis
What are the leading causes of bacterial meningitis? Streptococcus pneumoniae, Neisseria meningitidis
This bacteria was once the most common cause for bacterial meningitis and why is it no longer the leading cause? Haemophilus influenzae; due to a vaccine
How is meningitis contracted? Organisms enter CNS from respiratory tract or bloodstream and may enter through wounds of skull or fractured sinuses.
The inflammatory response to the infection tends to increase what? CSF production with a moderate increase in ICP
What occurs with the purulent secretions in bacterial meningitis? They produce quickly and spread to other areas of the brain through the CSF and cover the cranial nerves and other intracranial structures.
All patients with meningitis must be observed closely for what? Manifestations of increased ICP, which is thought to be a result of swelliing around the dura and increased CSF volume.
What are the key signs of meningitis? fever, severe headache, nausea, vomiting, nuchal rigidity; coma is associated with poor prognosis; photophobia; decreased LOC; signs of increased ICP (seizures, headache)
If the infecting organism is meningococcus, what may be seen? a skin rash and petechiae
What is an acute complication of meningitis and is also a major cause of altered mental status? increased ICP
What cranial nerves can become dysfunctional with meningitis? CN III, IV, VI, VII, VIII
What nerve is compressed by increased ICP? optic nerve (CN II)
Ocular movements such as ptosis, unequal pupils, and diplopia are affected when these nerves are irritated.. CN III, IV, VI
When CN V is irritated what results? sensory loss and loss of corneal reflex
Irritation of CN VII results in what? facial paresis
Irritation of CN VIII causes what? tinnitus, vertigo, and deafness (hearing loss may be permanent)
What complications may occur and resolve over time? hemiparesis (weakness/paralysis affecting one side of the body), dysphagia (difficulty swallowing), and hemianopsia (blindness over half the field of vision
If complications of meningitis do not resolve, the following may be suspected. cerebral abscess, subdural empyema, subdural effusion, or persistent meningitis
Acute cerebral edema may cause what? seizures, CN III palsy, bradycardia, hypertensive coma, death
What diagnostics are done for meningitis? blood culture, CT scan, lumbar puncture and analysis of CSF, x-rays of skull, MRII
A lumbar puncture should only be completed after what has been done? After a CT scan has ruled out an obstruction in the foramen magnum in order to prevent a fluid shift resulting in herniation.
Specimens of CSF, sputum, and nasopharyngeal secretions are used for what? to identify causative organism
A gram-stained smear is used to detect what?/ bacteria
What occurs with protein levels in the CSF with meningitis? Usually elevated and are higher in bacteria than in viral meningitiis.
What occurs with the CSF glucose concentration with meningitis? Commonly decreased in bacterial meningitis but may be normal in viral meningitis.
What does the CSF look like in bacterial meningitis? purulent and turbid
What does the CSF look like in viral meningitis? may be purulent and turbid or clear
What is the predominant white blood cell type in the CSF during bacterial meningitis? neutrophils
X-rays of the skull may demonstrate what? infected sinuses
CT scans and MRIs may be normal in uncomplicated meningitis but it may also reveal? evidence of increased ICP or hydrocephalus
What are some commonly prescribed drugs for treating bacterial meningitis? ampicillin,, penicillin, vancomycin, cefuroxime (Ceftin), cefotaxime (Claforan), ceftriaxone (Rocephin), ceftizoxime (Cefizox), & ceftazidime (Ceptaz); dexamethasone (Decadron) a corticosteroid may be prescribed before or with 1st dose of antibiotics
Why is antibiotic therapy instituted after collection of specimens and before diagnosis is confirmed? able to cross the blood brain barrier (BBB)
Initial assessment of a patient with meningitis should include? vital signs, neurologic evaluation, fluid intake and output, evaluation of lungs and skin
What are the overall goals of care for meningitis? Return to maximal neurologic functioning; resolve the infection; control pain and discomfort
Vaccinations for this is important for prevention of respiratory infections. pneumococcal pneumonia and influenza
What are the 2 meningoococcal vaccines available in the US? meningococcal polysaccharide vaccine (MPSV4) and meningococcal conjugate vaccine (MCV4)
What should be given for anyone exposed to bacterial meningitis? prophylactic antibiotics
What does the patient with bacterial meningitis look like? They are usually acutely ill. The fever is high, & head pain is severe. Irritation of the cerebral cortex may result in seizures.
The changes in mental status and LOC depend on what? the degree of increased ICP
How should the patient be positioned? To the patient's comfort, often curled up with the head slightly extended. The HOB should be slightly elevated, when permitted after lumbar puncture.
What interventions can be done if the patient has photophobia? darken the room and a cool cloth over the eyes
Why is it important to vigorously manage fever with meningitis? Fever increases cerebral edema and the frequency of seizures. Neurologic damage may result from high, prolonged fever.
If the fever is resistant to aspirin or acetaminophen what should be done? use of a cooling blanket or tepid sponge baths with water
What can happen if you reduce the temperature too rapidly? Shivering may result, causing a rebound effect & increasing the temperature, which can raise ICP.
What should you do to assess for dehydration? evaluate fluid intake and output; compensate for diaphoresis in replacement fluids
How do you calculate replacement fluids? 800 mL/day for respiratory losses and 100 mL for each degree of temperature above 100.4 F
Which cause of meningitis is highly contagious? meningococcal meningitis
What are some residual effects of meningitis? dementia,, seizures, deafness, hemiplegia,, and hydrocephalus
What can be done for muscle rigidity? progressive ROM exercises and warm baths
What are the most common causes of viral meningitis? enterovirus, arbovirus, HIV, and HSV; most often spread through direct contact with respiratory secretions
What are the CM of viral meningitis? headache, fever (moderate or high), photophobia, and stiff neck
How is viral meningitis diagnosed? Testing of CSF. Rapid diagnosis with Xpert EV test (sample of CSF is evaluated for enterovirus); lumbar puncture (CSF may be clear or cloudy), lymphocytosis; PCR to detect viral-specific DNA/RNA
This is used to detect viral-specific DNA or RNA and is a highly sensitive method for diagnosing CNS viral infections. polymerase chain reaction (PCR)
How is viral meningitis treated? Treat w/antibiotics after obtaining diagnostic sample but before receiving test results (can be easily discontinued if meningitis is found to be viral); symptomatic management; full recovery expected.
This is an acute inflammation of the brain caused by a number of viruses, some are endemic to specific geographic areas and seasone, and can be transmitted by ticks or mosquitoes. encephalitis
What kind of encephalitis can ticks and mosquitoes transmit? epidemic encephalitis such as Eastern equine encephalitis, La Crosse encephalitis, St. Louis encephalitis, West Nile encephalitis, and Western equine encephalitis
Nonepidemic encephalitis may occur as a complication of what? measles, chickenpox, or mumps
What is the most common cause of acute nonepidemic viral encephalitis? HSV encephalitis
This type of encephalitis is common with AIDS. CMV encephalitis
What are the CM of encephalitis? fever, headache, nausea, vomiting; any CNS abnormality can occur including hemiparesis, tremors, seizures, cranial nerve palsies, personality changes, memory impairment, amnesia, & dysphasia
When do signs of encephalitis typically occur? in 2-3 days; may vary from minimal alterations in mental status to coma
What diagnostics are done for encephalitis? CT, MRI, PET, PCR tests for HSV DNA/RNA, blood test for West Nile viral RNA
What can be done to help prevent epidemic encephalitis? mosquito control such as cleaning rain gutters, removing old tires, draining bird baths, and removing water where mosquitoes can breed as well as using insect repellant
What drugs are used for HSV infection? acyclovir (Zovirax), vidarabine (Vira-A); antiseizure drugs (may be prophylaxis);
Created by: eblanc1