The document discusses meningitis, including its definition, risk factors, types, causes, symptoms, diagnostic tests, complications, management, and nursing care. Meningitis is an inflammation of the meninges surrounding the brain and spinal cord. It is mostly caused by bacteria like Neisseria meningitidis. Risk factors include age under 5 years, lack of vaccination, and compromised immunity. Symptoms include high fever, headache, neck stiffness, seizures, and coma. Diagnosis involves physical exam, CSF analysis, and imaging tests. Complications can include hearing loss, learning disabilities, and death. Treatment involves antibiotics, antipyretics, IV fluids, and nursing care focused on reducing fever, pain, maintaining fluid

1. Meningitis

2. Ground rules
Be attentive and Listen carefully
Don't leave the classroom during presentation
Don't create disturbance
Switch off cell phones and shut down your laptops
Questions and answers will be entertained at the end of presentation

3. Objectives
By the end of presentation learners will be able to;
To introduce and define the topic.
To review the general anatomy of CNS and Meninges
To enlist the risk factors and etiology.
To explain clinical manifestation and diagnostic evaluation.
To elaborate pharmacological and non-pharmacological management and health education of the meningitis.
References

4. Brain and Meninges

5. Definition
Meningitis is an inflammation of the fluid
and membranes (meninges) surrounding
your brain and spinal cord.

6. Risk factors
Skipping vaccinations. Risk rises for
anyone who hasn't completed the
recommended childhood or adult
vaccination schedule.
Age. Most cases of viral meningitis occur
in children younger than age 5. ...
Living in a community setting. ...
Pregnancy. ...
Compromised immune
system.

7. TYPES OF MENINIGITIS:
Viral meningitis
Bacterial meningitis
Fungal meningitis
Parasitic meningitis

8. Etiology
Primary --- NIESSIERISA MENINGITIDIS
Secondary E-coli
Haemophilius influenza
Streptococus pneumonia

9. Pathophysiology

10. Clinical manifestation
High temperature (fever)
Headache.
Petechial rashes
Neck stiffness.
Vomiting and Photophobia may seen.
Drowsiness or unresponsiveness.
Resistance to the passive extension of the knee with the hip
flexed (Kerning Sign).
Thigh flexion upon the flexion of neck (Brudzink’s sign)
Acute confusion
Seizures (fits)
Coma in severe cases

11. Diagnostic Evaluation
• History taking
• Physical examination
• Blood culture
• CSF analysis
• CBC, electrolytes level
• CT scan and MRI
• Skull X-ray (may demonstrate infected
sinuses)

12. Complications
• Hearing loss
• Learning disabilities
• Recurrent seizures (epilepsy)
• problems with memory and concentration.
• co-ordination, movement and balance
problems
• Kidney failure
• Shock
• Death

13. Management
1- Medical management:
A: pharmacological management
Antibiotics, penicillin ampicillin and amoxicillin
Antiviral: Tenofovir
Antifungal: fluconazole
Corticosteroids: Dexamethasone
I/v Mannitol for diuresis
I/v phenytoin
Antipyretics: paracetmol

14. Non _ pharmacological management
Maintenance of fluid electrolytes balance by i/v therapy
Nasogastric tube feeding
Vitamin supplementation
Head end elevation 30-45 degree
Emotional support and necessary information for continuation of care at home,
follow up and rehabilitation.

15. Nursing Management
Assessment:
• Obtain history of recent infection such as upper respiratory infection and exposure to
causative agents.
• Assess neurologic status and vital signs.
• Evaluate for signs of meningeal irritation.
• Assess vision and hearing loss ,cranial nerve damage (facial nerve palsy) and diminish
cognitive functions.

16. Nursing diagnosis
• Ineffective tissue perfusion ( cerebral) related to infectious process and cerebral
edema.
• Risk for imbalance fluid volume related to fever and decrease intake.
• Acute pain related to meningeal irritation.
• Hyperthermia related to the infectious process and cerebral edema.
• Impaired physical mobility related to prolonged bed rest.

17. Planning
• To enhance cerebral tissue perfusion
• To reduce fever
• To maintain fluid balance
• To reduce pain
• To return to optimal level of functioning / mobility.

18. Nursing interventions
Enhancing cerebral perfusion
• Check vital signs and neurologic parameters frequently. Observe for signs and symptoms of ICP
(decreased LOC , dilated pupils , widening pulse pressure).
• Maintain a quiet, calm environment to prevent agitation, which may cause an increased ICP.
• Prepare patient for a LP for CSF evaluation and repeat spinal tap, if indicated.
• Notify the health care provider signs of deterioration: increasing temperature, decreasing LOC ,
seizure or altered respiration.
• Administer IV mannitol.

19. Reducing fever
• Administer antibiotics on time to maintain optimal blood levels.
• Monitor temperature frequently and continuously.
• Institute other cooling measures, such as hypothermia blanket and taped
sponging as indicated.
• Administer antipyretics as ordered.

20. Maintain Fluid Balance
• Prevent IV fluid overload , which may worsen cerebral edema.
• Monitor intake and output closely.
• Monitor CVP frequently.
• Administration of osmotic diuretics, Mannitol.

21. Reducing Pain
• Assess level , intensity, duration & location of pain.
• Darken the room if photophobia is present.
• Assist with position of comfort for neck stiffness, and turn patient slowly and carefully with
head and neck alignment.
• Elevate the head of the bed to decrease ICP and reduce pain.
• Administer analgesics as ordered ; monitor for response and adverse reactions.

22. Promoting return to optimal level of
functioning
• Implement rehabilitation interventions after admission ( e.g 2 hourly positioning).
• Progress from passive to active exercises based on the patients neurologic status.

23. Expected outcomes
• Enhanced cerebral tissue perfusion
• Fluid balance maintained
• Reduced fever
• Reduced pain
• Return to optimal level of functioning

25. meningitis
Inflammation of
meninges
Mostly bacterial Neisseria
meningitides
Children under
age 5yrs &
unvaccinated
 High grade
fever
 Headache
 Neck stiffness
 Seizures
 coma
 Physical
examination
(kerning &
brudzinski
sign positive)
 CSF analysis
 CBS
 CT/MRI
 Hearing loss
 Epilepsy
 Learning
disabilities
 Gait
problems
 Shock
 death
Pharmacological
management
 Antibiotics
 Antiviral
 Antipyretics
 Anticonvulsants
 Mannitol,diuretics
 IV fluids therapy
 Reduce
fever
 Reduce
pain
 Maintain
fluid
balance
 Emotional
support
meningitis

26. Discussion session
1) An acute inflammation of tissue surrounding the brain and spinal cord is called…
a) Brain abscess
b) Meningitis
c) Encephalitis
d) Headache
2) The primary agent of meningitis is…
a) E-coli
b) H. Influenza
c) Neisseria meningitides
d) Streptococcus pneumonia

27. Cont…
The less common symptoms of meningitis is…
a)Neck stiffness
b)Headache
c)High grade fever
d)Coma
4) The most significant investigation for meningitis is…
a)CSF analysis
b)Skull x-ray
c)CBC
d)Electrolytes

28. References
• Basavanthappa, B. T. (2009). Medical surgical nursing (pp. 197-236). Jaypee Bros.
• Lewis, Sharon Mantik. Lewis's medical-surgical nursing: Assessment and
management of clinical problems. Elsevier Australia, 2007.
• Lippincott manual of nursing practice handbook. Lippincott Williams & Wilkins;
2001.
• Boyer, M. J. (2010). Brunner and Suddarth's Textbook of Medical-surgical Nursing.
Lippincott Williams & Wilkins.