Meningitis call the Meninges (Better Health Channel,

Meningitis is a condition that causes inflammation of fluid and membranes surrounding the brain and spinal cord, these membranes are call the Meninges (Better Health Channel, 2014). There are 3 forms of meningitis, Bacterial, viral and fungal, we will be focusing on bacterial meningitis throughout this paper. Every year Bacterial Meningitis causes 170,000 deaths globally (Confederation of meningitis organisations, 2018) even though Meningitis is currently regularly vaccinated against worldwide. We will be examining the pathophysiology of the condition along with signs and symptoms patients may be experiencing and how to manage them. We will also examine medical treatment in relation to bacterial Meningitis and the nursing role with regards to this treatment and patient care.
Bacterial meningitis is caused by bacteria entering the cerebrospinal fluid (CSF) and reaching the subarachnoid space or Meninges directly. The host reacts to the components of bacteria causing an intense inflammatory response (Tunkel, 2018), stimulating macrophage equivalent brain cells to produce a number of inflammatory mediators. The result of these processes cause damage in the subarachnoid space ultimately leaving neurological injury and apoptosis. The development of further brain oedema, due to increased secretion of the antidiuretic hormone (ADH), effects circulation and ultimately can result in increased intracranial pressure (ICP) increasing the risk of uncal herniation (Muller, 2017).
Bacterial meningitis is a medical emergency, if left untreated there is a 100% death rate. In infants younger than 3 months of age the symptoms appear not specific and may include abnormal temperature, hypothermic or hyperthermic, irritability, vomiting, decreased feeding, lethargy, high pitched crying, Petechiae or purpura and sometimes a bulging fontanelle. As children get older the symptoms become more meningitis relatable with fever, Petechiae or purpura , vomiting, changes in behaviour, stiff neck, reduced appetite, photophobia and headaches (when they are able to verbalise) and possibly seizures (Muller, 2017a).
As stated previously bacterial meningitis is a medical emergency therefor medical treatment must be initiated immediately. On presentation to emergency department (ED), if bacterial meningitis is suspected, the medical team will perform a lumber puncture in an attempt to diagnose the bacteria causing the disease and a set of full blood cultures will be carried out at the same time as inserting intravenous access. It is also important to obtain bloods to assess electrolytes in a full blood picture as this will assist in recognising any related complications caused by the bacteria. Supportive fluid therapy will also be commenced at this stage to treat any septic shock and manage hydration. The patient will be nursed at 30 degrees and regular neurological observations should be carried out along with continuous monitoring and in children less than 18 months old a head circumference should be taken and observed (Kaplan, 2017).
Usually antimicrobial medications will commence immediately, even prior to the lumber puncture results returning, in an attempt to prevent the worsening of the infection. When referring to the bacterial meningitis treatment algorithm, Dexamethasone, Vancomycin and Cefotaxime are used in the initial stages of treatment as empiric antibiotics (Up to date. 2018) then once the CSF results are back, and the pathogen identified, antibiotics will be adjusted accordingly. All antibiotics used in treatment of bacterial meningitis must be able to pass the blood brain barrier to enable sufficient concentration in the CSF (Kaplan, 2017).
The length of treatment can vary anywhere from 5 days to 3 weeks depending on the pathogen that has caused the meningitis. A repeat lumber puncture and blood cultures are taken after 3 – 4 days of treatment to ascertain if the treatment is effective and also just prior to the end of treatment to ensure that the pathogen has been eradicated (Kaplan, 2017).
The severity of the disease on presentation to hospital, the patient’s age and the type of pathogen are all indicators of the patient outcome and the severity of disease associated complications. Currently the average mortality rate is around 4 – 5% even with treatment. The complications of bacterial meningitis can be divided into systematic and neurological. The systematic complications include septic shock, acute respiratory distress and arthritis (which may or may not resolve after eradication of the disease). The neurological complications associated with bacterial meningitis can include seizures, increased ICP, cerebral oedema, ataxia, hydrocephalus, impaired mental awareness and mental disability. These complications can arise at any time during the disease and even after the disease has been treated. In up one half of children who have suffered bacterial meningitis there will be some form of neurological deficit some of those being hearing loss, intellectual disability and deficits, and some form of neurological deficit (Kaplan, 2017).
From a nursing perspective it is important to always keep the parent and child informed about what is happening at all times. The patient will be isolated with precautions in place and depending on the severity and progression of the disease the patient will be transferred either to PICU or to a ward. Throughout the patients time on the ward they will be observed closely especially for any neurological changes as these changes can occur at any time during the presentation. The patient will be hemodynamically supported and be monitored at all times for any variations in vital signs. It is predictable that the parents will be feeling very anxious and as nurses is important to offer support to both the patient and the child. Giving parents up to date information is a good idea as this enables them to become informed in relation to the condition.
We have seen that bacterial meningitis can vary greatly in severity depending on how long the disease has been progressing, the age of the patient (more severe the younger the child) and the type of bacteria involved. Not matter how the presentation of the disease bacterial meningitis is a medical emergency as the neurological effects can be devastating and even deadly to a child so urgent medical treatment is essential. Even though bacterial meningitis is treatable, prevention is always better than cure. Vaccinations against the 5 main strains of meningitis are part of the national vaccination program within Australia and are free (Meningococcal Australia. 2018). Although vaccinating does not guarantee not contracting another strain meningitis, it definitely minimizes the chances and is recommended by health professionals worldwide.

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