 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 oritis 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 hip, so hemophilus influenza type B. That's also the cause for epiglottitis in children, strep pneumonia, tuberculosis and hysteria meningitis. 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 and 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 head trauma, systemic infections can travel and affect the meninges as well as infections of the head, ears, eyes, nose, and throat. So the HEE and T system because they're so close to the brain so they can spread easily causing inflammation of the meninges. So signs and symptoms, I've delineated 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 white 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 increased intracranial pressure and as with any inflammation inflammatory markers are going to travel to the site and therefore in neonates when the fontanelle 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 nuclear rigidity which basically means neck stiffness and there are two signs that are named after Mr. Koernick and Mr. Brazinski that we can assess for here in terms of this neck stiffness. So Koernick'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 Brazinski's sign is passive neck flexion causes the hips and knees 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 nuclear rigidity or neck stiffness which is a telltale sign for meningitis. Patient clearly whenever there's inflammation or infection one might have a fever just like in neonates patients might have vomiting 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 petechiae 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 I exaggerated so there is multiple petechiae now 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 they need to be admitted to the intensive care and the likelihood that something bad is going to happen from their honor 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 send that central sorry cerebral spinal fluid to the lab for analyses now because the patient this is a significant infection we are 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 of 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 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 bacterial remember whenever there's 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 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 um spinal canal we will see that it's cloudy but also the lab report will 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 love to replicate there so they eat up all the glucose and in turn they produce proteins so that's why the glucose level and 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 um 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 a permanent or temporary vision or hearing loss so again because it's the lining of the brain or it might um the infection might have come from the ears or sinuses so that can be a complication as well as delayed growth so now there's a central nervous system infection in a very small child that can certainly lead to the delayed growth and development because of the irritation of the meninges 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 might affect any cranial nerves so whatever cranial nerve you can think of and its function it might not be functioning normally so this may 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 particularly a purpuror 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 the 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 bacterial infection and certainly they're 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 in 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 taken over the counter anti inflammatory 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 neural 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 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 the 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 feet of 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 vertebrae 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's a rebroad spinal fluid if there's an 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 by table which is basically very similar to opening that lumbar spine space we talked about sterile procedures certainly we need to send this 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 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 a wildly and walking around the room so keep in mind meningitis is very very serious any of these signs and symptoms can lead 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 understanding please follow me on youtube and subscribe and also check out my instagram page to get the latest posting of videos and any announcements thanks for watching see you next time