Hi, I'm Cathy with Level Up RN. In this video, I am going to talk about meningitis,
and at the end of the video, I'm going to give you guys a little quiz
to test your knowledge of some of the key points I'll be covering in this video,
so definitely stay tuned for that. And if you have our Level Up RN Pediatric Nursing flashcards,
definitely pay close attention to the bold red text on these cards because those are going to
be particularly important facts for you to know. Meningitis is the inflammation of the meninges,
which are the membranes that surround and protect the brain and the spinal cord.
So the pathophysiology behind this disorder is that you have an infectious organism,
which could be a bacteria or a virus that enters the central nervous system and the meninges
either through the bloodstream or directly through trauma. So viral meningitis usually resolves
without treatment. Bacterial meningitis is usually more severe and does require antibiotics
and can be life-threatening. In terms of the risk factors associated with meningitis, this includes
crowded conditions such as dorms or prisons, for example, immunosuppression and travel exposure.
In terms of prevention, infants are given the HIB and the PCB vaccines, which helps to protect them
from meningitis. Teenagers are given a meningitis vaccine, particularly before they go to college
and live in a dorm, which is a crowded living condition. So I just sent my son up to college,
and we definitely made sure that he had his meningitis A and his meningitis B
vaccines prior to moving up there. Signs and symptoms of meningitis include a
fever, headache, nausea and vomiting, as well as nuchal rigidity, which means
neck stiffness. And then the patient may also have photophobia, which is sensitivity to the light,
and then they will also exhibit a positive Brudzinski sign as well as a positive Kernig sign.
So I'm going to explain these two signs here. So a positive Brudzinski sign,
if you want to test for that sign, you would have the patient kind of lay down flat on their back
and you would place one hand on their chest and the other hand behind their head, and you
attempt to pull up their head like this. And that will cause them pain such that they flex in their
knees and hips. So the way I remember the sign, if you look at the word Brudzinski, it starts
with brud. So if you try to pull up your patient's head, they'll be like, "Brah, that hurts." So
that's how I remember that sign. And then with the Kernig sign, Kernig starts with K and knee, the
word knee starts with K. So with this test, you would have the patient lay flat, you would have
them bend their knee, and you would attempt to straighten out their leg. And I'm a little stiff.
But if that really hurts and they're unable to do that, then that would be a positive Kernig sign.
So hopefully that little demonstration helped you. Other signs of symptoms can include altered
mental status, tachycardia, and seizures. In terms of diagnosis, we are going to
obtain a cerebral spinal fluid sample through a lumbar puncture. We're going to analyze this CSF.
And depending on whether the patient has bacterial meningitis or viral meningitis,
we will have different findings with the CSF. So if the patient has bacterial meningitis,
that CSF will be cloudy, the glucose content will be decreased, the protein will be increased, and
the white blood cell content will be increased. And then we will have a positive gram stain.
If the patient has viral meningitis, that CSF will be clear, and the glucose level
will typically be normal. We may see a slight increase in protein and white blood cells,
and we will have a negative gram stain. So in terms of treatment, we would give antibiotics for
bacterial meningitis. We can give analgesics for either type to help with the pain, and we can give
anti-convulsants if seizures are a concern for the patient. Nursing care associated with meningitis
includes the implementation of droplet precautions for any patient with suspected or confirmed
bacterial meningitis, so they will need to stay on those droplet precautions for the first 24 hours
with antibiotic therapy. So our little cool chicken hint for remembering this, if you
happen to know the song It's Raining Men, which is by the Weathergirls, and it came out in the 80s.
And I have to admit that I was around when the song was big. If you don't know it, you got to
Google it, but it goes, "It's raining men." And so that will help you remember that with
meningitis, you will have droplet precautions. So like rain drops. So it's raining men,
meningitis requires droplet precautions. The other thing you're going to want to do
is implement seizure precautions. So that means patting the side rails of the bed, making sure
you have oxygen equipment available. You want to monitor your patient's neurological status.
You want to provide a quiet room with dim lights because of that photophobia and then you want to
minimize your patient's intracranial pressure. So we want to maintain the head of the bed
at 30 degrees. We're going to want to keep their head midline and minimize any suctioning.
All right, it's time for a quiz. I have three questions for you.
First question, what is the difference in CSF appearance between viral and bacterial meningitis?
The answer is with viral meningitis, the CSF will be clear, and with bacterial meningitis,
the CSF will be cloudy. Second question. A patient with meningitis
may have a positive Kernig sign and a positive Brudzinski sign. True or false?
The answer is true. So those were the signs that I so eloquently
demonstrated for you guys earlier in this video. Question number three, what type of precautions
should the patient be put on for suspected bacterial meningitis? The answer is droplet
precautions. Okay, that's it for this video. If you've enjoyed it, be sure to like this video.
Leave me a comment. Take care and good luck with studying.
They will need to be on droplet precautions for the first 24 hours with antibiotic therapy. And
then they can be that the really-- the do, de, do. [laughter] Sorry. I'm going to try again.
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