Running Head: BACTERIAL MENINGITS

Essential Knowledge of Bacterial Meningitis

LeAnna Ceglia
California State University, Stanislaus

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Essential Knowledge of Bacterial Meningitis

For a registered nurse, it is not uncommon to treat a patient with flu-like symptoms such
as headaches, fever, and vomiting. On a critical floor, these symptoms along with increased
intracranial pressure are seen on a regular basis. However, if these symptoms are put together
along with nuchal rigidity, the situation changes drastically. These symptoms are commonly
corresponded with bacterial meningitis. According to Lewis, Dirksen, Heitkemper, Bucher, and
Camera (2011), bacterial meningitis is an acute inflammation of the meningeal tissues that
surround the spinal cord and the brain. This is a life threatening condition that is often fatal and
requires immediate attention and interventions from an entire medical team. By the end of this
paper, the reader will be knowledgeable of the pathophysiology of this particular meningitis as
well as understand the causes and potential risk factors of this disease process. Furthermore, the
reader will have a better understanding of the collaborative care provided including treatment,
nursing diagnoses, and patient teaching related to the individual diagnoses.
Etiology and Pathogenesis
Meningitis is an infection of the cerebral spinal fluid and arachnoid mater (Lewis, et al.,
2011). Initially, the brain is protected from bacteria from outside the body by different body
components such as the skull, the arachnoid membrane, the pia, the dura, and glia limitans
(Agamanolis, 2014). Therefore, if a bacterial infection occurs, such as bacterial meningitis, it is
due to the bacteria gaining access to the central nervous system. This can be accomplished
through the upper respiratory tract or through the bloodstream (Lewis, et al., 2011). According
to Agamanolis (2014), the organisms that cause bacterial meningitis colonize in the nasopharynx.
From here, the bacteria are able to enter into the bloodstream and gain access to the subarachnoid
space through complex interactions with endothelial cells (Agamanolis, 2014). Bacteria can also

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access the bloodstream either by penetrating wounds to the skull by fractured sinuses in basal
skull fractures (Lewis, et al., 2011).
Once entered in the body, the bacteria releases toxins that cause cell wall
lipopolysaccharide and neuronal apoptosis (Agamtoanolis, 2014). These processes damage the
blood brain barrier and cause an inflammatory response (Lewis, et al., 2011). The inflammatory
response caused by the infection leads to an increased production of cerebral spinal fluid as well
as an increase in intracranial pressure. This increased production of cerebral spinal fluid spreads
rapidly to other parts of the brain, covering cranial nerves as well as other intracranial structures.
This causes neurological dysfunctions, mainly effecting cranial nerves III, IV, VI, VII, and VIII
(Lewis, el al., 2011). Intracranial pressure, on the other hand, is a multifactorial process when it
comes to bacterial meningitis (Scheld, Koede, Nathan, & Pfister, 2015). This condition is
responsible for vasogenic edema as well as cytotoxic edema, which results from the leukocyte
infiltration. Interstitial edema also occurs as a result from blockade of normal cerebral spinal
fluid (CSF) pathways, and increased blood volume is expected in the brain (Scheld, Koede,
Nathan, & Pfister, 2015). Other complications, due to the blood brain barrier damage, include
increased vascular permeability. This causes the increased intracranial pressure, as well as
cerebral edema, decreased cerebral perfusion, hypoxia, and neuronal necrosis (Agamanolis,
2014).
Now that it is understood how this disease process works, it is important to understand
what causes this infection, what are the common symptoms, and who is most susceptible. The
leading causes of bacterial meningitis are Streptococcus pneumoniae and Neisseria menigitidis
(Lewis, et al., 2011). Haemophilus influenzae used to be the most common cause. However,
due to the Haemophilus influenzae conjugate vaccine, invasive H. influenzae infections in the

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United States and western Europe has decreased by over 90% since 1992 (Scheld, Koede,
Nathan, & Pfister, 2015). However, for the small percentage of the population that will be
infected, they are more likely to contract this infection in the fall, winter, or early spring (Lewis,
et al., 2011). This is because this disease process is often secondary to a viral respiratory
disease, therefore, it is more likely to occur during the flu season. Older adults and individuals
who are debilitated are also more susceptible as a result of their weakened immune systems.
Due to bacterial meningitis being spread through the upper respiratory tract, people who live in
close-quarter living conditions such as college dorms, prison, etc. are also at high risk for
contracting this infection. The most common clinical manifestations of this disease process
include flu-like symptoms such as nausea, vomiting, fever, and headache along with nuchal
rigidity. Due to the increased intracranial pressure, the patient may be experiencing decreased
level of consciousness and photophobia (Lewis, et.al, 2011).
Clinical Significance and Medical Management
As earlier stated, bacterial meningitis is a life-threatening infection that has a mortality
rate of 100% if left untreated (Lewis, et. al, 2011). According to the National Institute of
Neurological Disorders and Stroke (2015), a total of approximately 8,600 cases of bacterial
meningitis are reported in the United States each year. Of those 8,600 cases, 6,000 are caused by
Streptococcus pneumoniae. The other 2,600 cases are caused by Neisseria menigitidis. A total
of 10 to 15 percent of these reported cases are usually fatal with an additional 10 to 15 percent of
affected individuals left with permanent brain damage (National Institute of Neurological
Disorders and Stroke, 2015).
Treatment for bacterial meningitis is aggressive and requires immediate attention. When
a patient is suspected of having bacterial meningitis, they are put on isolation with droplet

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precautions per hospital policy (Knippa, et al., 2012). In addition, to properly diagnosis an
individual with bacterial meningitis, numerous tests and procedures take place. First, a urine,
throat, nose, and blood culture/sensitivity test is obtained. This will uncover which bacteria the
patient is infected with in order to treat with the proper antibiotics. Next, a complete blood count
will be conducted. A patient positive for bacterial meningitis will have increased white blood
cells, elevated protein levels, and decreased glucose. A computer tomography (CT) scan and
magnetic resonance imaging (MRI) may be conducted in order to identify increased intracranial
pressure. However, the most definitive diagnostic test to identify this specific disease process is
a cerebral spinal fluid analysis. This procedure is conducted by collecting cerebrospinal fluid
during a lumbar puncture. If the patient is positive for bacterial meningitis, the cerebrospinal
fluid will appear cloudy (Knippa, et al., 2012).
After a patient is diagnosed with bacterial meningitis, they will continue to be on droplet
precautions and isolated until they have had antibiotics for 24 hours (Knippa, et al., 2012). Fever
reductions will also be implemented as well as providing a quiet environment with minimal light.
It is important to keep the patient on bed rest with the head of the bed elevated at least to 30
degrees. This will help with the increased intracranial pressure. Seizure precautions and fluid
and electrolyte replacement will be maintained depending on the patients laboratory values
(Knippa, et al., 2012).
When it comes to medication treatment for bacterial meningitis, patients will receive
antibiotics Ceftriaxone or Cefotaxime until the culture and sensitivity test results are available
(Knippa, et al., 2012). Once the patient is diagnosed with this specific disease process, they will
be treated with ampicillin or penicillin (Lewis, et. al, 2011). Along with fever reduction
measures, acetaminophen or aspirin will be ordered to help decrease the patients increased body

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temperature. Dilantin, an anti-epileptic agent, will be ordered in case the patients intracranial
pressure increases or they experience a seizure due to the disease process complications.
Mannitol, a diuretic, will also be administered via intravenous to help decrease intracranial
pressure (Lewis, et al., 2011). Lastly, Ciprofloxacin or rifampin will be administered as a
prophylactic antibiotic to individuals who have had close contact with the patient (Knippa, et al.,
2012).
Nursing Diagnoses and Patient Teaching
There are several possible nursing diagnoses for patients who suffer from bacterial
meningitis. While an individual may qualify for numerous diagnoses, it also depends on other
various factors such as the individuals condition, their potential risk factors, and recovery
expectations. Although there are several nursing diagnoses that rate equally, if not more,
important, the diagnoses that will be discussed allow for the most patient teaching. These
diagnoses include: (1) ineffective airway clearance r/t seizure activity; (2) risk for fall r/t
neuromuscular dysfunction; (3) impaired mobility r/t neuromuscular or central nervous system
insult; and (4) impaired comfort r/t altered health status (Ackley & Ladwig, 2014). Not only are
these diagnoses numbered in order of importance, but, it is also important to consider that these
diagnoses can be adjusted depending on the individual patient and their situation.
Since patient teaching is endless, a few significant teaching points will be briefly touched
on for each diagnosis. Although the first diagnosis talks about ineffective airway clearance
related to potential seizures, the patient, unfortunately, has no control over their airway when
experiencing a seizure. With that being said, the appropriate teaching would be helping the
patient recognize when they are about to experience a seizure. For example, some individuals
experience certain feelings or get a certain smell right before it happens. By teaching them how

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to recognize the start of a seizure, the patient can make sure they let the person they are with
know what is about to happen and can prepare accordingly. It is also important to teach the
patients family and loved ones how to maintain the patients airway when experiencing a
seizure. For example, make sure they turn the patient on their side, loosen clothing around the
neck, and do not put anything in the patients mouth. For the second diagnosis, risk for falls, it is
important to teach both the patient and their family about fall reduction measures (Ackley &
Ladwig, 2014). For example, providing proper lighting in the house, making sure the floor is
clear of objects, having the patients bed low to the ground, etc. Another important factor is
teaching the patient how to safely ambulate in the home such as using hand rails or not carrying
objects when walking. Regular exercise is also crucial for the patient to help build strength and
improve balance (Ackley & Ladwig, 2014).
For the diagnosis regarding impaired mobility, it is important to teach the patient about
client progressive mobilization such as getting out of bed slowly when transferring or dangling
the legs first before standing (Ackley & Ladwig, 2014). The patient should also be taught
relaxation techniques during any activity. These techniques include stretching and/or deep
breathing. It is also crucial that family members work with the patient during self-care activities
by using a restorative care philosophy in order to maximize the patients independence and
function. For the last diagnosis of impaired comfort, it is important to teach the patient
relaxation techniques such as guided imagery, hypnosis, music therapy or even using the
television as a distraction. The patient should be made aware that they should talk with their
doctor if the discomfort continues. If relaxation techniques do not soothe the patient, the patient
and their family should be made aware that therapy and medication can be prescribed in order to
improve comfort (Ackley & Ladwig, 2014). Although this is a lot of information for a patient

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and their family to take in, with some guidance and reinforcement, the patient will be able to live
a happier and more autonomous life.
References
Ackley, B. & Ladwig, G. (2014). Nursing Diagnosis Handbook: An evidence-based guide to
planning care. Maryland Heights, MI. Mosby Elsevier.
Agamanolis, D. (2014). Chapter 5: infections of the nervous system. Retrieved from
http://neuropathology-web.org/chapter5/chapter5asuppurative.html
Knippa, A., Sommer, S., Ball, B., Churchill, L., Elkins, C., Janowski, M. J, Roberts, K, &
Wright, M. (2012). RN adult medical surgical nursing edition 8.0. Meningitis (pp.59-63).
Assessment Technologies Institute, LLC.
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2011). Medical-surgical
nursing: assessment and management of clinical problems. Acute Intracranial Problems
(pp.1425-1458). St. Louis, MI: Elsevier Mosby
National Institute of Neurological Disorders and Stroke

(2014). Meningitis and encephalitis

fact sheet. Retrieved from http://www.ninds.nih.gov/disorders/encephalitis_

meningitis/detail_encephalitis_meningitis.htm
Scheld, M. W., Koedel, U., Nathan, B., & Pfister, H.W. (2015). Pathophysiology of bacterial
meningitis: mechanism(s) of neuronal injury. The Journal of Infectious Diseases. 186,
225-233. Retrieved from
http://jid.oxfordjournals.org/content/186/Supplement_2/S225.full

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