Meningitis
Content
MENINGITIS
(from Ancient Greek μῆνιγξ/méniŋks, "membrane" and the medical suffix -itis, "inflammation")
-
-
is an inflammation of the leptomeninges and underlying subarachnoid cerebrospinal fluid (CSF) it is the inflammation of the protective membranes covering the central nervous, known collectively as the meninges Abnormal WBC in CSF The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs. can be caused from a direct spread of a severe infection such as an ear infection or sinus infection In some cases, meningitis is noted after head trauma or an injury to the head or brain. Causes: Bacterial infection, Viral infection, Fungal infection, A reaction to medications, A reaction to medical treatments, Lupus, Some forms of cancer, A trauma to the head or back. Anyone can catch meningitis. This is especially true if your immune system is weak.
Anatomy and Physiology
Meningitis, in general, is the inflammation of the protective membranes surrounding the brain and spinal cord. In order to inflame these protective membranes, the bacteria, viruses or other microorganisms must somehow enter the bloodstream and bypass the blood-brain barrier. Blood-Brain Barrier
Since the brain is such a delicate organ, nature has taken extra measures to protect the brain by creating the blood-brain barrier to limit the diffusion of substances from the bloodstream into brain tissue selectively.
The blood-brain barrier mainly consists of tight junctions, which seals the endothelial cells that line the brain capillaries. Astrocytes, a type of neuroglia from the brain, closely attached to the endothelial cells and release chemicals to regulate the permeabilities of the tight junctions. The major sites of the blood brain barrier are the arachnoid membrane, choroid plexus epithelium, and the cerebral microvascular endothelium. Only a few kinds water-soluble substance can move across the blood-brain barrier, such as glucose by active transport, urea, creatinine, and ions move across by slow diffusion. On the other hand, lipid-soluble substances can easily cross the blood-brain barrier, such as oxygen, carbon dioxide, alcohol, and most anesthetic agents. When bacteria break through the blood-brain barrier, an infection occurs in the cerebrospinal fluid. Cerebrospinal Fluid
Cerebrospinal fluid (CSF) is a colorless, transparent liquid that continuously circulates through the cavities of the brain and spinal cord, and as such, it acts as an internal circulation system to transport nutrients and wastes between the bloodstream and the brain and spinal cord. This reducdant circulation protects the brain and spinal cord from chemical injuries similar to the function of the blood-brain barrier. The CSF also protects the brain and spinal cord from physical injuries by acting as a shock absorber between the brain and spinal cord from the skeletal structures (cranium and vertebrae). CSF is produced in the choroid plexuses, which are networks of capillaries in the
ventricles. The choroid plexuses filter out blood plasma from the bloodstream, which is the main component of CSF. The choroid plexuses are covered by ependymal cells that are sealed together with tight junctions. These tight junctions force the blood plasma to pass through these ependymal cells, which further filter out the blood plasma, producing CSF. From the choroid plexuses of each lateral ventricle, CSF flows into the third ventricle through the interventricular foramina, which are two narrow oval openings. The choroid plexuses in the third ventricle add more CSF. Then, CSF flows into the fourth ventricle through the cerebral aqueduct. Again, the choroid plexuses in the fourth ventricle add more CSF. The fluid then enters the subarachnoid space through the three openings in the roof of the fourth ventricle. These three openings are a median aperture and a pair of lateral apertures. Then, CSF circulates in the central canal of the spinal cord and in the subarachnoid space around the surface of the brain and spinal cord. Meninges
The meninges are three connective tissue coverings that encircle the spinal cord and brain. The spinal meninges surround the spinal cord and are continuous with the cranial meninges, which encircle the brain.
The meninges lined the cranial and vertebral cavities to protect the brain and the spinal cord, and they are also attached to the cranial bones' inner surfaces, which facilitate the crainal bones to stabilize the positions of the brain, blood vessels,
lymphatic vessels,
and
nerves.
These three connective tissue coverings are dura mater, which is composed of dense, irregular connective tissue), arachnoid mater, which is composed of delicate collagen fibers and some elastic fibers in a spider’s web arrangement, and pia mater, which is a thin transparent connective tissue layer consists of squamous to cuboidal cells within interlacing bundles of collagen fibers and some fine elastic fibers. The most superficial of the three spinal meninges, the dura mater, forms a sac from the level of the foramen magnum in the occipital bone, where it is continuous with the dura mater of the brain, to the second sacral vertebra. The spinal cord is also protected by a cushion of fat
and connective tissue located in the epidural space, a space between the dura mater and the wall of the vertebral canal. The middle meninx is an avascular covering called the arachnoid mater. It is deep to the dura mater and is continuous with the arachnoid mater of the brain. Between the dura mater and the arachnoid mater is a thin subdural space, which contains interstitial fluid. The innermost meninx is the pia mater, which adheres to the surface of the spinal cord and brain. Within the pia mater are many blood vessels that supply oxygen and nutrients to the spinal cord. Between the arachnoid mater and the pia mater is the subarachnoid space, which contains cerebrospinal fluid that serves as a shock absorber and suspension system for the spinal cord and brain. All three spinal meninges cover the spinal nerve roots, structures that connect spinal nerves to the spinal cord, up to the point where they exit the spinal column through the intervertebral foramina. Triangular-shaped membranous extensions of the pia mater suspend the spinal cord in the middle of its dural sheath. These extensions, called denticulate ligaments, are thickenings of the pia mater. They project laterally and fuse with the arachnoid mater and inner surface of the dura mater between the anterior and posterior nerve roots of spinal nerves on either side. Extending all along the length of the spinal cord, the denticulate ligaments protect the spinal cord against sudden displacement that could result in shock.
Pathophysiology
Predisposing Factor: Age (2 and ½ yrs. old) Environment Incomplete vaccine Precipitating Factor: Hx of URTI
Droplet infection
Pathogens enter the host (Tubercle bacilli-bacteremia, viruses, etc)
Seed to the meninges or brain parenchyma MENINGITIS Rich foci
Ruptured in the subarchnoid space
Adhesion
Bacillary Replication
CSF WBC (neutrophil = 0.78)
Basal cistern
Interpendicular fossa
HYDROCEPHALUS
CN PALSIES
Vasculitis
Encephalitis
Stroke
Cerebral Edema
↑ ICP
NUCHAL RIGIDITY
WEAKNESS
LETHARGY
SEIZURE
Meningitis Complications: Complications such as the following can develop during the course of meningitis: Disseminated intravascular coagulation (DIC; blood-clotting disorder) Encephalitis Persistent fever
Seizures
Syndrome of inappropriate antidiuretic hormone (SIADH; causes fluid build-up)
Prompt medical treatment decreases the risk for brain damage and long-term complications, including these: Behavioral and personality changes
Vision loss (partial or total) Cerebral palsy Hearing loss (partial or total) Learning disabilities or mental retardation Paralysis (partial or total) Speech loss (partial or total)
Severe bacterial meningitis also may cause the head and heels to bend backward and the body to bow forward (called opisthotonos), coma, and death. Newborns and young children may develop heart, liver, intestinal problems, or malformed limbs.
Medical Management
Treatment is determined by the type of meningitis and the organism causing the disease. Viral meningitis usually requires only symptom relief (palliative care). Palliative care may include bed rest, increased fluid intake to prevent dehydration, and analgesics (e.g., aspirin, acetaminophen) to reduce fever and relieve body aches. Meningitis caused by herpesvirus can be treated using antiviral medication such as acyclovir (Zovirax®) or ribavirin (Virazole®). Side effects of these medications include nausea, vomiting, and headache. Suspected bacterial meningitis requires prompt intravenous (IV) antibiotic treatment in the hospital to prevent serious complications and neurological damage. If symptoms are severe, IV treatment may be initiated before the lumbar puncture is performed. Severly ill patients are treated immediately with a combination of antibiotics. Penicillin combined with a cephalosporin (e.g., ceftriaxone [Rocephin®], cefotaxime [Claforan®]) is commonly used. Because some bacteria are resistant to these drugs, vancomycin, with or without rifampin, ampicillin, and gentamicin may be added to cover resistant pneumococcal strains of bacteria and Listeria monocytogenes. Side effects include abdominal pain, nausea, vomiting, and diarrhea. Once the CSF culture has revealed the disease-causing organism (pathogen), antibiotic treatment is adjusted accordingly. Amphotericin B and fluconazole (Diflucan®) are effective against most disease-causing fungi and are the drugs of choice for treatment of fungal meningitis. They may be administered singly or as combined therapy. Both drugs are well tolerated in most patients. Possible side effects of fluconazole include nausea and vomiting, diarrhea, headache, skin rash, and abdominal pain. Intravenously administered amphotericin B may produce the same side effects, as well as shaking chills and fever, slowed heart rate, low blood pressure (hypotension), body ache, and weight loss. Parasitic meningitis usually is treated with a benzimidazole derivative or other antihelminthic agent. Complications that develop also must be treated. Corticosteroids (e.g., dexamethasone) may be administered to reduce the risk for hearing loss. Increased intracranial pressure may be reduced with diuretics (e.g., mannitol) and a surgically placed shunt that drains excess fluid.
Nursing Management
Acute Pain
Related to: Infection process Toxin in the circulation
Nursing Interventions: Place the ice bag on his head, cool clothing above the eyes, provide a comfortable head position a little bit high, range of motion exercises and active or passive massage neck muscles. Support to find a comfortable position (head rather high-). Give range of motion exercises active / passive. Use a warm moisturizer, neck or hip.
Impaired Physical Mobility
Related to: Neuromuscular damage. Nursing Interventions: Assess the degree of immobilization of the patient. Assistive range of motion exercises. Give skin care, massage with moisturizer. Check the area experiencing tenderness, give air mattresses or water body alignment are functionally notice. Provide training programs and the use of mobilization.
References: http://en.wikipedia.org/wiki/Meningitis http://bacterial-meningitis.weebly.com/physiology.html http://meningitis.com.au/signs_and_symptoms/meningitis.phtml http://www.healthcommunities.com/meningitis/complications.shtml http://www.healthcommunities.com/meningitis/treatment.shtml http://pediatricnurses.blogspot.com/2012/01/nursing-care-plan-for-meningitis.html
Submitted by: CHARMAINE ERICKA Q. DEL ROSARIO BSN IV – C January 27-28, 2014 7-3 Pedia Ward
(from Ancient Greek μῆνιγξ/méniŋks, "membrane" and the medical suffix -itis, "inflammation")
-
-
is an inflammation of the leptomeninges and underlying subarachnoid cerebrospinal fluid (CSF) it is the inflammation of the protective membranes covering the central nervous, known collectively as the meninges Abnormal WBC in CSF The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs. can be caused from a direct spread of a severe infection such as an ear infection or sinus infection In some cases, meningitis is noted after head trauma or an injury to the head or brain. Causes: Bacterial infection, Viral infection, Fungal infection, A reaction to medications, A reaction to medical treatments, Lupus, Some forms of cancer, A trauma to the head or back. Anyone can catch meningitis. This is especially true if your immune system is weak.
Anatomy and Physiology
Meningitis, in general, is the inflammation of the protective membranes surrounding the brain and spinal cord. In order to inflame these protective membranes, the bacteria, viruses or other microorganisms must somehow enter the bloodstream and bypass the blood-brain barrier. Blood-Brain Barrier
Since the brain is such a delicate organ, nature has taken extra measures to protect the brain by creating the blood-brain barrier to limit the diffusion of substances from the bloodstream into brain tissue selectively.
The blood-brain barrier mainly consists of tight junctions, which seals the endothelial cells that line the brain capillaries. Astrocytes, a type of neuroglia from the brain, closely attached to the endothelial cells and release chemicals to regulate the permeabilities of the tight junctions. The major sites of the blood brain barrier are the arachnoid membrane, choroid plexus epithelium, and the cerebral microvascular endothelium. Only a few kinds water-soluble substance can move across the blood-brain barrier, such as glucose by active transport, urea, creatinine, and ions move across by slow diffusion. On the other hand, lipid-soluble substances can easily cross the blood-brain barrier, such as oxygen, carbon dioxide, alcohol, and most anesthetic agents. When bacteria break through the blood-brain barrier, an infection occurs in the cerebrospinal fluid. Cerebrospinal Fluid
Cerebrospinal fluid (CSF) is a colorless, transparent liquid that continuously circulates through the cavities of the brain and spinal cord, and as such, it acts as an internal circulation system to transport nutrients and wastes between the bloodstream and the brain and spinal cord. This reducdant circulation protects the brain and spinal cord from chemical injuries similar to the function of the blood-brain barrier. The CSF also protects the brain and spinal cord from physical injuries by acting as a shock absorber between the brain and spinal cord from the skeletal structures (cranium and vertebrae). CSF is produced in the choroid plexuses, which are networks of capillaries in the
ventricles. The choroid plexuses filter out blood plasma from the bloodstream, which is the main component of CSF. The choroid plexuses are covered by ependymal cells that are sealed together with tight junctions. These tight junctions force the blood plasma to pass through these ependymal cells, which further filter out the blood plasma, producing CSF. From the choroid plexuses of each lateral ventricle, CSF flows into the third ventricle through the interventricular foramina, which are two narrow oval openings. The choroid plexuses in the third ventricle add more CSF. Then, CSF flows into the fourth ventricle through the cerebral aqueduct. Again, the choroid plexuses in the fourth ventricle add more CSF. The fluid then enters the subarachnoid space through the three openings in the roof of the fourth ventricle. These three openings are a median aperture and a pair of lateral apertures. Then, CSF circulates in the central canal of the spinal cord and in the subarachnoid space around the surface of the brain and spinal cord. Meninges
The meninges are three connective tissue coverings that encircle the spinal cord and brain. The spinal meninges surround the spinal cord and are continuous with the cranial meninges, which encircle the brain.
The meninges lined the cranial and vertebral cavities to protect the brain and the spinal cord, and they are also attached to the cranial bones' inner surfaces, which facilitate the crainal bones to stabilize the positions of the brain, blood vessels,
lymphatic vessels,
and
nerves.
These three connective tissue coverings are dura mater, which is composed of dense, irregular connective tissue), arachnoid mater, which is composed of delicate collagen fibers and some elastic fibers in a spider’s web arrangement, and pia mater, which is a thin transparent connective tissue layer consists of squamous to cuboidal cells within interlacing bundles of collagen fibers and some fine elastic fibers. The most superficial of the three spinal meninges, the dura mater, forms a sac from the level of the foramen magnum in the occipital bone, where it is continuous with the dura mater of the brain, to the second sacral vertebra. The spinal cord is also protected by a cushion of fat
and connective tissue located in the epidural space, a space between the dura mater and the wall of the vertebral canal. The middle meninx is an avascular covering called the arachnoid mater. It is deep to the dura mater and is continuous with the arachnoid mater of the brain. Between the dura mater and the arachnoid mater is a thin subdural space, which contains interstitial fluid. The innermost meninx is the pia mater, which adheres to the surface of the spinal cord and brain. Within the pia mater are many blood vessels that supply oxygen and nutrients to the spinal cord. Between the arachnoid mater and the pia mater is the subarachnoid space, which contains cerebrospinal fluid that serves as a shock absorber and suspension system for the spinal cord and brain. All three spinal meninges cover the spinal nerve roots, structures that connect spinal nerves to the spinal cord, up to the point where they exit the spinal column through the intervertebral foramina. Triangular-shaped membranous extensions of the pia mater suspend the spinal cord in the middle of its dural sheath. These extensions, called denticulate ligaments, are thickenings of the pia mater. They project laterally and fuse with the arachnoid mater and inner surface of the dura mater between the anterior and posterior nerve roots of spinal nerves on either side. Extending all along the length of the spinal cord, the denticulate ligaments protect the spinal cord against sudden displacement that could result in shock.
Pathophysiology
Predisposing Factor: Age (2 and ½ yrs. old) Environment Incomplete vaccine Precipitating Factor: Hx of URTI
Droplet infection
Pathogens enter the host (Tubercle bacilli-bacteremia, viruses, etc)
Seed to the meninges or brain parenchyma MENINGITIS Rich foci
Ruptured in the subarchnoid space
Adhesion
Bacillary Replication
CSF WBC (neutrophil = 0.78)
Basal cistern
Interpendicular fossa
HYDROCEPHALUS
CN PALSIES
Vasculitis
Encephalitis
Stroke
Cerebral Edema
↑ ICP
NUCHAL RIGIDITY
WEAKNESS
LETHARGY
SEIZURE
Meningitis Complications: Complications such as the following can develop during the course of meningitis: Disseminated intravascular coagulation (DIC; blood-clotting disorder) Encephalitis Persistent fever
Seizures
Syndrome of inappropriate antidiuretic hormone (SIADH; causes fluid build-up)
Prompt medical treatment decreases the risk for brain damage and long-term complications, including these: Behavioral and personality changes
Vision loss (partial or total) Cerebral palsy Hearing loss (partial or total) Learning disabilities or mental retardation Paralysis (partial or total) Speech loss (partial or total)
Severe bacterial meningitis also may cause the head and heels to bend backward and the body to bow forward (called opisthotonos), coma, and death. Newborns and young children may develop heart, liver, intestinal problems, or malformed limbs.
Medical Management
Treatment is determined by the type of meningitis and the organism causing the disease. Viral meningitis usually requires only symptom relief (palliative care). Palliative care may include bed rest, increased fluid intake to prevent dehydration, and analgesics (e.g., aspirin, acetaminophen) to reduce fever and relieve body aches. Meningitis caused by herpesvirus can be treated using antiviral medication such as acyclovir (Zovirax®) or ribavirin (Virazole®). Side effects of these medications include nausea, vomiting, and headache. Suspected bacterial meningitis requires prompt intravenous (IV) antibiotic treatment in the hospital to prevent serious complications and neurological damage. If symptoms are severe, IV treatment may be initiated before the lumbar puncture is performed. Severly ill patients are treated immediately with a combination of antibiotics. Penicillin combined with a cephalosporin (e.g., ceftriaxone [Rocephin®], cefotaxime [Claforan®]) is commonly used. Because some bacteria are resistant to these drugs, vancomycin, with or without rifampin, ampicillin, and gentamicin may be added to cover resistant pneumococcal strains of bacteria and Listeria monocytogenes. Side effects include abdominal pain, nausea, vomiting, and diarrhea. Once the CSF culture has revealed the disease-causing organism (pathogen), antibiotic treatment is adjusted accordingly. Amphotericin B and fluconazole (Diflucan®) are effective against most disease-causing fungi and are the drugs of choice for treatment of fungal meningitis. They may be administered singly or as combined therapy. Both drugs are well tolerated in most patients. Possible side effects of fluconazole include nausea and vomiting, diarrhea, headache, skin rash, and abdominal pain. Intravenously administered amphotericin B may produce the same side effects, as well as shaking chills and fever, slowed heart rate, low blood pressure (hypotension), body ache, and weight loss. Parasitic meningitis usually is treated with a benzimidazole derivative or other antihelminthic agent. Complications that develop also must be treated. Corticosteroids (e.g., dexamethasone) may be administered to reduce the risk for hearing loss. Increased intracranial pressure may be reduced with diuretics (e.g., mannitol) and a surgically placed shunt that drains excess fluid.
Nursing Management
Acute Pain
Related to: Infection process Toxin in the circulation
Nursing Interventions: Place the ice bag on his head, cool clothing above the eyes, provide a comfortable head position a little bit high, range of motion exercises and active or passive massage neck muscles. Support to find a comfortable position (head rather high-). Give range of motion exercises active / passive. Use a warm moisturizer, neck or hip.
Impaired Physical Mobility
Related to: Neuromuscular damage. Nursing Interventions: Assess the degree of immobilization of the patient. Assistive range of motion exercises. Give skin care, massage with moisturizer. Check the area experiencing tenderness, give air mattresses or water body alignment are functionally notice. Provide training programs and the use of mobilization.
References: http://en.wikipedia.org/wiki/Meningitis http://bacterial-meningitis.weebly.com/physiology.html http://meningitis.com.au/signs_and_symptoms/meningitis.phtml http://www.healthcommunities.com/meningitis/complications.shtml http://www.healthcommunities.com/meningitis/treatment.shtml http://pediatricnurses.blogspot.com/2012/01/nursing-care-plan-for-meningitis.html
Submitted by: CHARMAINE ERICKA Q. DEL ROSARIO BSN IV – C January 27-28, 2014 7-3 Pedia Ward
