Hi, welcome to Nursing School Explained! Today's topic is meningitis. Remember
that the meninges are the lining that covers the brain, the protective layer. So
when we have inflammation, or -itis, there it might cause some neurological
symptoms in the patient. So let's look at this.
So meningitis is the most common central nervous system infection and it can be
caused by viruses or bacteria. So examples of viruses would be mumps,
herpes or enterovirus, so really any virus can cause, can travel in the
bloodstream and then cause meningitis. Bacterial would be Hib, so haemophilus
influenza type B that's also the cause for epiglottitis in children, strep
pneumoniae, tuberculosis and Neisseria meningitidis. These are all primary causes
of meningitis. So this is directly related to these viruses or bacteria.
Now secondary causes of meningitis is basically, has to do with, somehow an
intrusion to the central nervous system, and that could be due to neurosurgery, so
somebody who might have a tumor or an aneurysm that needs repair, some sort of
a head trauma. Systemic infections can travel and
affect the meninges, as well as infections of their head, ears, eyes, nose,
and throat, so the HEENT system because they're so close to the brain, so they
can spread easily, causing inflammation of the meninges. So signs and symptoms
I have delineated it here for the pediatric as well as the adult
population. So in neonates, when they have neurological symptoms they might have
poor feeding and sucking therefore they're not going to develop the way that
they should. They might be irritable but they might also be lethargic, so
there's a wide spectrum here. They might have some vomiting and diarrhea,
they might have seizures because the central nervous system is so
irritated. They might be hypo- or hyperthermic, so increase or decrease in
temperature, and they might have bulging fontanelles, which is always a sign of
increase in intracranial pressure. And as with any inflammation, inflammatory
markers are gonna travel to the site and therefore in neonates, when the
fontanel is still open, we might see that bulging there, so that's always a warning
sign that there's something going on with the brain or the central nervous
system. Now in children or adults, they might be complaining of a headache, and
that is usually a pretty significant severity in the headache. They might have
photophobia, so sensitivity to light. They might also have increased intracranial
pressure, and then they might have nuchal rigidity, which basically means neck
stiffness. And there are two signs that are named after Mr. Kernig and Mr.
Brudzinski that we can assess for here in terms of this neck stiffness. So
Kernig's sign is resistance to the extension of the legs with hip or knee
flexion. So that is basically when we're holding the patient's leg in a flexed
position and we're trying to extend it, we're trying to straighten it, and that
causes irritation through the spinal canal all the way up to the central
nervous system and the brain, and the patient will resist because it makes
that headache and that intracranial pressure worse. Now Brudzinski's sign is
passive neck flexion causes the hips and needs to flex. So you would go to the
patient, you will ask him to relax, you would passively move their head down the
chin down to the chest, and because again this causes an increase in the pressure
here in the central nervous system and the spinal canal, they will passively
bend their hips, flex at the hips and knees. So those two signs are telltale
that there is nuchal rigidity or neck stiffness, which is a telltale sign for
meningitis. Patient, clearly, when there's whenever
there's inflammation or infection, one might have a fever. It's just like in
neonates patients might have vomiting and/or diarrhea, they might be agitated,
they might be lethargic, they might be very irritable, and have altered level of
consciousness. And if there's meningococcal infection, so if that's the
cause, then the patient might also have petichiae and purpura, which is
basically a leakage of the blood vessels that are underneath the skin. And
petechiae are basically tiny little red dots that we can see that are leaking
underneath the patient's skin, so it's not actively bleeding, but we can just
see these, these spots of blood, of discoloration underneath the skin. And
then purpura are basically petechiae that are exaggerated, so there's multiple
petechiae together and the patient will have big blotches of this purpura. And
these signs are telltale of meningitis! If you see that, this patient is
critically ill, they probably are very altered, and and they need to be admitted
to the intensive care, and the likelihood that something bad is going to happen
from there on, and they might not recover completely, is very high. So petechiae
and purpura, if you haven't seen or encountered that, I encourage you to
google search and see what that looks like so that you are aware. Now how do we
diagnose meningitis? So of course if there's a suspicion with any of these
signs and symptoms, and maybe a history of any of these infections or traumatic
interventions to the brain, we need to do a lumbar puncture, which is also called a
spinal tap, and sent that cerebral spinal fluid to the lab for
analysis.Now, because the patient, this is a significant infection, we're also going
to want to draw some blood cultures to see if this has spread systemically or
where the infection might come from and also what the causative organism is. And
we might also do a nose or throat culture if there is a
suspicion that it might come from the upper respiratory system, this infection
that has spread. Now, over here, for lumbar puncture, and we'll go over the care for
a patient during the procedure, but the CSF, once the provider or the physician
inserts that needle, and it's a consistency that's kind of not quite as
liquid or as viscous as water, so it's a little bit thicker than that, but not
quite as like a gel. So once that fluid is retrieved from the patient's lumbar
spine, we can look at that and so there will be differences whether it's viral
or bacterial in cause. So when it's viral, it will be clear, that fluid will be
clear, the white count when we get the results back from the lab will be
extremely, extremely elevated, protein levels might be slightly
increased or normal, and glucose levels will be normal. So those are some things
that we'll see on the CSF analysis. Now, in contrast, bacteria, remember whenever
there is a bacterial infection, the fluid will be cloudy. So think about any kind
of infection, really, sinus infection, the nasal congestion will be cloudy or more
yellow and greenish, if you have a wound infection and that's now draining, it
will be kind of turbid, malodorous, and very cloudy. So that always is a
telltale sign for bacterial infection, no matter where we get the analysis from.
But for CSF, so as soon as that cerebral spinal fluid is retrieved from the
patient's spinal canal, we will see that it's cloudy, but also the lab report will
tell us about that. White count might be mildly increased, and protein
levels will be extremely increased, and glucose levels will be decreased. And the
reason is: bacteria, as we know, love a warm, dark, sugary environment. They
to replicate there, so they eat up all the glucose and, in turn, they produce
proteins. So that's why the glucose level in bacterial meningitis of the cerebral
spinal fluid is decreased, the protein level is up, and the there's a mild
elevation in white count. So these are usually things that could come up on an
exam too, so I encourage you to memorize this small table down here. Complications
from meningitis. In infants or children it can be hydrocephalus, so increase in
intracranial pressure that might persist for some time. There might be permanent
or temporary vision or hearing loss, so again because it's the lining of the
brain, or it might, the infection might have come from the ears or sinuses, so
that can be a complication. As well as delayed growth, so now there is a central
nervous system infection in a very small child that can certainly lead to their
delayed growth and development. Because of the irritation of the meninges, the
patient might be prone to seizures, and that is during as well as
after the infection is over. There might be cranial nerve palsy, again because it
is an infection of the central nervous system and that might affect any cranial
nerve, so whatever cranial nerve you can think of and its function, it might not
be functioning normally. So this might be impaired
swallowing, it might be a droopy eyelid, it might be facial droop, it might be
impaired vision, impaired hearing, so all these functions that the cranial nerves
take care of. Certainly, when the patient has these significant findings of
petechiae and purpura, they're at high risk of death. And if they recover from the
meningitis they might be suffering from a headache for weeks or sometimes months
after the infection. Now for treatment, if it's bacterial we want to isolate the
patient because this is highly contagious and the patient will be
placed in a private room on droplet precautions until 24 hours after
the antibiotics are started. But for the most part hospitals will keep the
patient isolated for maybe even the duration of their stay. They will
certainly require IV antibiotics because we're dealing with a bacterial infection.
And certainly they are going to need IV fluids for hydration because, if they
have altered mental status, and they don't want to eat, then we need to make
sure we keep them hydrated by intravenous means. When the patient is
really sick, they might need ICU admission. And so bacterial meningitis
is very, very serious. Now viral meningitis is usually just
treated by supportive care. This can be done, managed as an outpatient and you
would treat that like any other viral infection by rest, taking
over-the-counter anti-inflammatories, hydrating, treating the fever with
antipyretics as needed, having a healthy nutrition, all those
good things that we educate our patients on. Now nursing care for when the
patient is admitted. Because of that irritation of the central nervous system,
we want to make sure we decrease environmental stimuli, as well as we're
going to be in charge of the administration of IV antibiotics and
fluids, and then we're going to do frequent neuro assessments to see how
the patient is progressing. Are they getting better or worse? Because clearly,
we always worry about their airway maintenance if they are altered. So if
they're getting worse, they might not be able to maintain their airway and they
might require mechanical ventilation. So the care during, the nursing care during
the lumbar puncture, what the goal is here is to assist the provider in,
number one, the sterile procedure, and then, number two, to position the patient so
that the procedure can be as atraumatic as possible. And because it is a sterile
procedure, everybody present in the room will need to be wearing a mask, because
we don't want to be coughing or breathing on the insertion side of that
needle, because it will be in lumbar spine, and so we can introduce
bacteria, or any kind of organism really, through that needle if we're not extra
cautious. And the easiest way to position the patient, so depending on their age, if
it's a neonate, we'll basically put them in the fetal position.
We will curl them up as much as possible, knees to the chest and then chin to the
chest. So basically curl them up so the space between the vertebra will open up
and it'll be easier for the provider to get that needle in there, in just the
right space to obtain that cerebral spinal fluid. If there's an adult or a
cooperating child we can ask the patient to sit on the side of the bed and
support themselves over the over bed table, which is basically very similar to
opening that lumbar spine space. We talked about sterile procedure.
Certainly, we need to send the CSF to the lab for analysis and afterwards we need
to keep the patient flat for an hour or two, because, if the patient moves around
and changes their position too soon after the procedure, they might have a
spinal headache. And the spinal headache can last for several days and is usually
pretty significant, and so if the patient is already having headaches and
neurological symptoms we do not want to give them a headache on top of that from
the procedure. Now keeping them flat might not be possible for small children
that are more active and don't really understand the explanation that
we would give them for this, so small, or younger children, they can play quietly
as long as they don't get too excited and start, you know, walking and playing
kind of wildly and walking around the room. So keep in mind meningitis is very,
very serious. Any of these signs and symptoms can lead to to death, really, if
it's not acknowledged and treated properly. And remember that we do have
vaccinations to treat meningitis and that's
usually given once the patient reaches adolescence, because in dorms and
crowded conditions, there have been some outbreaks lately that have been pretty
significant. So vaccination would be number one
priority to prevent meningitis. So thank you for watching this video on
meningitis. I hope you've enjoyed it and it helped you gain a better
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Thanks for watching, see you next time!