Prospects for preventing bacterial meningitis Prospects for preventing bacterial meningitis
Bacterial Meningitis Presentation
Transcript of Bacterial Meningitis Presentation
-
7/24/2019 Bacterial Meningitis Presentation
1/16
Bacterial MeningitisBy LeAnna Ceglia
-
7/24/2019 Bacterial Meningitis Presentation
2/16
What is Bacterial Meningitis?
Acute inflammation ofthe meningeal tissues
that surround andprotect the brain andspinal cord
More specifically, refersto infection of the
arachnoid mater and thecerebral spinal fluid
-
7/24/2019 Bacterial Meningitis Presentation
3/16
Etiology
According to the Centerfor Disease Control andPrevention, there were4,100 cases in the UnitedStates, with 500 deaths
between 2003-2007(2014)
According to the NationalInstitute of NeurologicalDisorders and Stroke,about 6,000 cases are
reported of pneumococcalmeningitis in the U.S.while 2,600 cases arereported of meningococcalmeningitis
-
7/24/2019 Bacterial Meningitis Presentation
4/16
Pathophysiology
The bacterial organismgains entry to the CNSthrough the bloodstreamor upper respiratory tract
Inflammatory response
to infection causesincrease of CSFproductions andmoderate increase in ICP.
This increased purulentsecretion production
spreads quickly to otherareas of the brain viaCSF, covering cranialnerves and otherintracranial structurescausing neurological
problems
-
7/24/2019 Bacterial Meningitis Presentation
5/16
Causes and Risk Factors
Causes
Streptococcuspneumonia
Neisseria meningitidis
Haemophilus influenzae
Now decreased due toH. influenza vaccine
Risk Factors
Occur usually in the fall,winter, or early spring
Often secondary to viralrespiratory disease
Older adults
Debilitation
Living in confined spaceswith multiple people(prison, college dorms,
etc.) Immunosuppression
Invasive procedures
Skull fracture
Penetrating head wound
-
7/24/2019 Bacterial Meningitis Presentation
6/16
Signs and Symptoms
Common clinicalmanifestations
Fever
Severe headache
Nausea/vomiting
Neck stiffness
Photophobia
Decreased LOC
Signs of increased ICP
Other possiblemanifestations
Coma
occurs in 5-10% ofpatients with a poor
prognosis Seizures
Occurs in 1/3 of allcases
Skin rash and petechiae
If infecting organism ismeningococcus
-
7/24/2019 Bacterial Meningitis Presentation
7/16
Complications
ICP
Most commoncomplication
Most common cause for
altered mental status
Cranial Nerve Dysfunction
occurs with CN III, IV, VI,VII, or VIII
Acute Cerebral Edema
Causes seizures, CN IIIpalsy, hypertensive coma,bradycardia, and death
Hemiparesis
Dysphasia
Hemianopsia
Headaches that continueuntil swelling andinflammation has been
completely resolved Noncommunicating
hydrocephalus
Waterhouse-Friderichsensyndrom
Petechiae, disseminated
intravascular coagulation,adrenal hemorrhage, andcirculatory collapse
-
7/24/2019 Bacterial Meningitis Presentation
8/16
Assessment/Diagnostics
Patient history andphysical exam
A blood culture
CT scan, MRI, and PETscan
Lumbar puncture toanalyze cerebrospinalfluid
Assess CSF for protein,WBC, glucose, Gram
stain, and culture CBC-coagulation profile,
electrolyte levels,glucose levels, andplatelet count
Skull x-ray
-
7/24/2019 Bacterial Meningitis Presentation
9/16
Results for Positive Bacterial Meningitis
Cerebrospinal fluidappears cloudy
WBCs elevated
Protein levelselevated
Glucose levelsdecreased
Cerebrospinal fluid
pressure increased Increased intracranial
pressure shown withCT scan or MRI
-
7/24/2019 Bacterial Meningitis Presentation
10/16
Collaborative Care
Place patient in isolationas soon as meningitis issuspected
Maintain hospitalprecautions per hospital
policy Implement droplet
precaution until antibioticshave been administeredfor 24 hours
Use fever-reductionmeasures
Report infection to thepublic health department
Decrease environmentalstimuli to ensure rest
Maintain bedrest with HOBat least 30
Maintain safety andseizure precautions
Maintain fluid andelectrolyte therapy asindicated by lab results
Administer antibiotics
-
7/24/2019 Bacterial Meningitis Presentation
11/16
Treatment
Rocephen or Claforan
Antibiotic given untilsensitivity and cultureresults are available
Ampicillin or penicillin
Antibiotic given to treatbacterial meningitis
Decadron
To prevent neurologicalcomplication of bacterial
meningitis (septic shock,acute respiratory distress,disseminatedintravascular coagulation
Mannitol
A diuretic to decrease ICP
Dilantin
Anticonvulsant given ifpatient experiences aseizure or the ICPincreases
Acetaminophen, ibuprofen
Analgesic to help withheadaches and/or fever Anonopioid to preventmasking any changes inlevel of consciousness
Ciprofloxan, rifampin
A prophylactic antibioticgiven to individuals whohave had close contactwith patient
-
7/24/2019 Bacterial Meningitis Presentation
12/16
Preventative Measures
Always wash your hands
Haemophilus influenzaetype b (Hib) vaccine asan infant
Meningococcal vaccine
(MCV4) as an adolescentprior to living in dormsor other communal livingconditions such asmilitary
Pneumococcalpolysaccharide vaccine(PPSV) ifimmunocompromised,have chronic disease,smoke cigarettes, live in
long-term care facility
-
7/24/2019 Bacterial Meningitis Presentation
13/16
Resources
Center for Disease and Control Prevention (2014, April 1).Bacterial Meningits [Web log post]. Retrieved fromhttp://www.cdc.gov/meningitis/bacterial.html
Knippa, A., Sommer, S., Ball, B., Churchill, L., Elkins, C.,Janowski, M. J, Roberts, K, & Wright, M. (2012). RN
adult medical surgical nursing edition 8.0. Menigitis(pp.59-63). Assessment Technologies Institute, LLC.
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., &Camera, I. (2011). Medical-surgical nursing:assessment and management of clinical problems.
Acute Intracranial Problems(pp.1425-1458). St. Louis,
MI: Elsevier MosbyNational Institute of Neurological Disorders and Stroke
(2014). Meningitis and encephalitis fact sheet.Retrieved fromhttp://www.ninds.nih.gov/disorders/encephalitis_menin
gitis/detail_encephalitis_meningitis.htm
-
7/24/2019 Bacterial Meningitis Presentation
14/16
Review Questions
What vaccine is appropriate for a freshman in college toreceive?
A.) Haemophilus influenzae type b (Hib)B.) Meningococcal vaccine (MCV4)
C.) Pneumococcal polysaccharide vaccine (PPSV)
-
7/24/2019 Bacterial Meningitis Presentation
15/16
Review Questions
Which bacteria are responsible for causing bacterialmeningitis? (select all that apply)
A.) Streptococcus pneumonia
B.) Escherichia coliare
C.)Neisseria meningitidis
D.) Bacillus anthracis
-
7/24/2019 Bacterial Meningitis Presentation
16/16
Review Questions
Signs and symptoms of bacterial meningitis include flu-likesymptoms accompanied by
A.) tinnitus
B.) neck stiffness
C.) bloody stool
D.) decreased temperature