INTRODUCTION
Bacterial meningitis is characterized by inflammation of the meninges, the membranes lining the brain and spinal cord.
In a recent survey by the Hib and Pneumococcal Working Group, the incidence of meningitis in 2000 varied from regions across the world. The overall incidence of pneumococcal meningitis was 17 cases per 100,000, with the highest incidence in Africa at 38 cases per 100,000 and the lowest incidence in Europe at 6 cases per 100,000. The overall death rate was 10 cases per 100,000. The highest death rate was 28 cases per 100,000 in Africa, and the lowest death rates were 3 cases per 100,000 in Europe and Western Pacific regions. (Hom, 2009)
Bacterial meningitis more frequently occurs in black and Hispanic children. This is thought to be related to socioeconomic rather than racial factors
The brain and spinal cord are remarkably resistant to infection, but when they become infected, the consequences are usually very serious. Infections may be caused by bacteria, viruses, fungi, and occasionally protozoa or parasites. The most common type of CNS infection is Bacterial Meningitis which is characterized by inflammation of the meninges, the membranes lining the brain and spinal cord. (Hom, 2009.
Almost any bacteria entering the body can cause meningitis. The most common are meningococci (Neisseria meningitidis), pneumococci (Streptococcus pneumonia), and Haemophilus influenza. Thtese organisms are often present in the nasopharynx. S. pneumonia and N. meningitides are found most often in adults. Factors predisposing to bacterial meningitis include any circumstance where the dura has been compromised, such as open brian injry or brain surgery, systemic infection, anatomic defects of the skull, immunocompromise, and other systemic illnesses. Close quarters, poor hygiene, and malnutrition also place people at risk.
THE BRAIN HAS 3 PROTECTIVE COVERINGS WHICH HELP TO PROTECT THE BRAIN FROM INJURY. FROM INNER TO OUTER COVERING, THERE IS A PAD:
P-IA MATER --- A-RACHNOID MATTER===D-URA MATTER
MENINGITIS MAY BE CAUSED BY A VIRUS,BACTERIA,FUNGI, TUMORS OR CHEMICAL IRRITANTS.
BM IS CAUSED Y INFLAMMATION OF THE MENINGEAL COVERINGS OF THE BRAIN AND SPINAL CORD.
THE BRAIN IS PROTECTED BY A BONY STRUCTURE( CRANIUM). THERE ARE THREE PROTECTIVE COVERINGS UNDER THE CRANIUM: DURA MATER, ARACHNOID MATER, AND PIA MATER. BENEATH THE ARACHNOID MATER IS A SPACE INSIDE THE BRAIN CALLED THE SUB-ARACHNOID SPACE. THERE ARE HOLLOW SPACES INSIDE THE BRAIN CALLED THE VENTRICLES.A TOTAL OF 4 VENTRICLES ARE USUALLY FOUND IN EACH BRAIN. CEREBROSPINAL FLUID(CSF) IS PRODUCED IN THE VENTRICLES BY VASCULAR CELLS CALLED CHOROID PLEXUS. CSF FLOWS WITHOUT OBSTRUCTION AROUND THE BRAIN AND SPINAL CORD. TYPICALLY 150 MLS OS CSF FLOWS AT ANY TIME AND APP 500MLS IS PRODUSED DAILY. CSF IS CLEAR AND ACTS AS A BUFFER.
CSF STUDIES: NORMAL VALUES: * COLOR: CLEAR: COLORLESS * OPENING PRESSURE: 7-20mmH2O * PROTEIN: <50mg/dL * GLUCOSE: <80mg/Dl * Cell count with diff: 0-5 cells,mononuclear: * RBC: NONE * CYTOLOGY: NO ABNORMAL CELLS
S&S:
* HIGH FEVER * SEVERE HEADACHE * NAUSEA AND VOMITING, PHOTOPHOBIA(SENSITIVITY TO LIGHTS) * IRRITABILITYALTERED LEVEL OF CONSCIOUSNESS * POSITIVE KERNIG’S AND BRUDZINKI’S SIGN * NUCHAL RIGIDITY

BRUDZINKI’S SIGN: WHEN THE EXAMINER FLEXES THE PATIENT’S NECK, THE KNEES ND HIPS FLEX AT THE SAME TIME.
KERNIG’S SIGN: INABILITY TO STRAIGHTEN THE LEG WHEN THE HIP IS FLEXED AT A 90 DEGREE ANGLE. THE HAMSTRING MUSCLES BECOME VERY STIFF
Predisposing/Precipitating Factors of Bacterial meningitis
Incidence of meningitis is high among Blacks and Native American. Male infants have a high incidence of gram-negative neonatal meningitis.
Children under age 5, young people ages 18 to 24 and older adults are more likely to develop meningitis than the rest of the population. Black, Eskimo and American Indian children are especially at risk of meningitis caused by the bacteria H. influenzae and Streptococcus pneumoniae. People with weakened or suppressed immune systems also are at higher risk.
People who work with domestic animals (e.g., dairy farmers, ranchers) and pregnant women are at increased risk for meningitis associated with listeriosis (disease transmitted from animals to humans via soil). Listeriosis can be transmitted from mother to fetus through the placenta, causing spontaneous abortion. The disease is usually fatal in newborns.
Signs & Symptoms of Bacterial Meningitis
The classic manifestations of meningitis are nuchal rigidity (rigidity of the neck), Brudzinski’s sign and Kernig’s sign, and photophobia.
Other general manifestations related to infection may also be present, such as headache, fever, tachycardia, prostration, chills, fever, nausea, and vomiting. The client may be irritable at first, but, as the infection progresses, the client appears acutely ill and confused, stuporous, or comatose. Seizures may occur. A petechial or hemorrhagic rash may develop. Diagnosis is made by lumbar puncture. The CSF is cloudy. Gram stain of the CSF reveals organisms in 70% to 80% of all cases. When the organisms cannot be identified, bacterial antigens can be determined. H. influenza is frequently detected with this technique. Clients with bacterial meningitis demonstrate the following: * Moderately elevated CSF pressures * Elevated CSF protein level (normal, 15 to 45 mg/dl) * Decreased CSF glucose level (normal, 60 to 80 mg/dl, or two thirds of the serum glucose value) * Elevated white blood cell count, usually increased (100 to 10, 000/cm3), with predominantly polymorphonuclear leukocytes.
Nursing Considerations for Bacterial Meningitis 1. Assess neurologic function often. Observer level of consciousness (LOC) and signs of increased ICP (plucking at the bedcovers, vomiting, seizures, and a change in motor function and vital signs). Watch for signs for cranial nerve involvement (ptosis, strabismus, and diplopia). 2. Be especially alert for a temperature increase up to 38. 9o Celsius (102 F), deteriorating LOC, onset of seizures, and altered respirations, all of which may signal an impending crisis. 3. Monitor fluid balance. Maintain adequate fluid intake to avoid dehydration, but avoid fluid overload because of the danger of cerebral edema. Measure central venous pressure and intake and output accurately. 4. Watch for adverse effects of I.V. antibiotics and other drugs. To avoid infiltration and phlebitis, check I.V. site often and change the sites according to hospital policy. 5. Position the patient carefully to prevent joint stiffness and neck pain. Turn him often, according to planned positioning schedule. Assist with range-of-motion exercises. 6. Maintain adequate nutrition and elimination. It may be necessary to provide small, frequent meals or to supplement meals with nasogastric tube or parenteral feedings. To prevent constipation and minimize the risk of increased ICP resulting from straining at stool, give the patient a mild laxative or stool softener. 7. Ensure the patient’s comfort. Provide mouth care regularly. Maintain a quiet environment. Darkening the room may decrease photophobia. Relieve headache with a nonopioid analgesic, such as aspirin or acetaminophen as ordered. 8. Provide reassurance and support. The patient may be frightened by his illness and frequent lumbar punctures. If he’s deliberious or confused, attempt to reorient him often. Reassure his family that the delirium and behavior changes caused by meningitis usually disappear. However, fi a severe neurologic deficit appears permanent; refer the patient o a rehabilitation program as soon as the acute phase of this illness has passed. 9. To help prevent development of meningitis, teach patients with chronic sinusitis or other chronic infections and the importance of proper medical treatment. Follow strict sterile technique when treating patients with head wounds or skull fractures. 10. Prevention: 11. Give haemophilus influenza type B and pneumococcal vaccins to children. 12. Give meningocococcal vaccine to college students. 13. Give prophylactic antibiotics to those who have been exposed to a patient with meningitis 14. Patients who have symptoms of meningitis becomes irritable because of the palin and sensitivity to light. Try to create a quiet environment and encourage the family members to let the pt rest