Bacterial Meningitis
Learning Activity
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Bacterial Meningitis
• Acute inflammation of meninges and spinal cord
• Usually caused by H. influenza type B, Streptococcus pneumonia, or
Neisseria meningitides
• Incidence has decreased under age 2 due to Haemophilus influenza type
B vaccine and pneumococcal conjugate vaccines (PCV).
• Organisms may enter bloodstream from infection in teeth, sinuses,
tonsils, and lungs, or directly through ear or skull.
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Meningitis
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Diagnostic Tests and Labs
• History and physical
• Blood cultures are sometimes positive when CSF is negative
• CSF (lumbar puncture)
• Cloudy
• Increased WBC
• Increased protein
• Decreased glucose culture
• Gram stain for causative organism
• Electrolytes and serum/urine osmolarities to detect SIADH
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Manifestations Newborn
• No illness at birth but it progresses within a
few days
• Manifestation vague and difficult to
diagnosis
– Poor muscle tone, weak cry, poor suck,
refuses feeding and vomiting or
diarrhea
– Possible fever or hypothermia
• Neck is supple without nuchal rigidity
• Bulging fontanels are a LATE sign
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Manifestations 3 months to 2 years
• Seizures with high-pitched cry
• Fever and irritability
• Bulging fontanels
• Possible nuchal rigidity
• Poor feeding
• Vomiting
• Brudzinski’s and Kernig’s signs not reliable for diagnosis
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Manifestation 2 years through adolescence
• Seizures (often initial sign)
• Nurchal regidity
• Positive Brudzinski’s sign
• (flexion of extremities occuring with deliberate flexion of the child’s neck
• Positive Kernig’s sign
• (resistance to extension of the child’s leg from a flexed position
• Fever and chills
• Headache
• Vomiting
• Irritability and restlessness that may progress to drowsiness, delirium,
stupor, and coma
• Petechia or purpuric type rash (seen with meningococcal and Hib)
• Involvement of joints (seen with meningococcal and HIB)
• Chronic draining ear (seen with pneumococcal infection
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Meningitis
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Nursing Interventions
• Administer antibiotics and steroids.
• 4th generation cephalosporins
• Provide respiratory isolation until 24 hr after antibiotics initiated.
• Obtain baseline vital signs and neurologic checks. Monitor.
• Administer IV fluids.
• Measure I&O.
• Acetaminophen for discomfort
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Nursing Interventions
• NPO then advance.
• Provide comfort measures.
• Quiet/dark room
• Rest periods
• Pain medications for headache.
• Initiate seizure precautions.
• Anticonvulsants for seizures
• Pad side rails
• Change position frequently.
• Restrict fluids if SIADH.
• Report occurrence to health department.
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Disease Prevention
• Complete recommended vaccine schedule.
• Take antibiotics as prescribed.
• Avoid cigarette smoke and smoking.
• Get plenty of rest.
• Do not come in close contact with people who are sick.
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High-Risk Behaviors
• Age
• Infants at higher risk
• Community setting
• Diseases spread more quickly in larger groups.
• College students in dormitories, military personnel.
• Medical conditions
• Diseases, medications and surgical procedures that weaken immune
system increase risk of meningitis
• Working with meningitis-causing pathogens
• Microbiologists
• Travel
• Travelers to Mecca during the annual Hajj and Umrah pilgrimage
• Travels to the meningitis belt in sub-Saharan Africa
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Learning Activity Review Questions
1. A 2-month-old child presents to the emergency department with a
temperature of 102.1° F, increased restlessness, irritability, severe
vomiting, high-pitched crying, and history of a recent episode of otitis
media. The nurse should expect the provider to perform what type of
procedure on the client?
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Learning Activity Review Questions
2. Which of the following household members is at the greatest risk for
contracting bacterial meningitis from the previous client?
a. School-age child.
b. 60-year-old grandmother
c. Mother with history of chronic migraines
d. Father with ongoing chemotherapy treatment
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Learning Activity Review Questions
3. A student nurse is working at a health fair at the local mall. A mother
begins to discuss problems of immunizations released by the media.
During the discussion, the nurse explains that bacterial meningitis has a
decreased prevalence since this vaccination has been initiated. What
vaccine is the nurse and mother discussing?
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Learning Activity Review Questions
4. A charge nurse received report on a client suspected of having bacterial
meningitis. What measures need to be taken prior to and during the
client’s arrival? (Select all that apply. )
A. Wear gloves when working with client belongings.
B. Assign client to negative flow room.
C. Wear respiratory isolation mask when in close contact.
D. Prepare isolation cart near room entrance.
E. Wear N95 mask when working with client.
F. Place client away from nursing station to decrease exposure to
others.
G. Wear gown and gloves when in close contact.
H. Pad side rails on bed.
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