Bacterial meningitis

Bacterial meningitis is a severe infectious disease of the central nervous system, an inflammation of the meninges, which is caused by the bacterial infection. Neisseria meningitides and Streptococcus pneumoniae are the pathogens in response for the most cases of this disease, though meningitis in patients older than 50 years may be caused by Listeria monocytogenes, and in patients that suffer from immunodeficiency or alcoholism Haemophilus influenzae (type b) caused bacterial meningitis may occur.

Bacterial meningitis is not a widespread disease, its general occurrence is about 3 to 10 cases for the every 100 000 people all over the world, particularly 2.2 per 100 000 in the USA. [3] But the clinical course of the disease is grave and deceptive, and in an early stage of the disease patient may display only minor symptoms of cold, that’s why early diagnostics of the bacterial meningitis is highly important and patients affected require adequate and timely treatment and attentive, careful nursing.

In the case listed in the assignment patient displays the symptoms of the early stage bacterial meningitis. The disease had started in about 24 hours and manifested itself with mood changes (irritability), headache and neck stiffness, drowsiness and nausea, accompanied by vomiting, photophobia, hyperthermia and moderate tachycardia. These pathologic changes in the organism of the patient are caused by the presence of the pathogenic microorganisms and by the intoxication with the metabolic wastes of the bacteria. These substances serve as pyrogens and stimulate the receptors of the appropriate white blood cells.

These WBC start to release pyrogenic cytokines into the blood flow, and mentioned cytokines are transported to the anterior hypothalamus and trigger the mechanisms of thermoregulation in a way that leads to the elevation of the thermoregulatory set point. As a result of these changes and subsequent neurohumoral commands of the hypothalamus heat production and heat conservation in the organism are increased. Heat production is increased by the means of involuntary muscular contractions (so called “chills”), and recently produced heat is conserved because of the constriction of the peripheral blood vessels and of the appropriate behavioral changes. Tachycardia arises as a result of the sympathetic vegetative system activation by the cytokines and subsequent release of the additional portions of adrenaline into the blood flow.

Headache is the results of elevated intracranial pressure which causes tension of the dura mater and irritation of nerve endings of the trigeminal nerve. The mechanism of ICP elevation, in a few words, comprises the following steps: invasion of the bacterial cells into the central nervous system, their propagation in the liquor, production of proinflammatory cytokines, and increase of BBB (blood – brain barrier) permeability and infiltration of inflammatory neutrophils. (Tsao N. et al. 1999)

This also increases liquor volume because of absorbance and circulation failure and, finally, results in elevation of ICP. Nausea and vomiting arise as the result of the nervus vagus endings irritation, and the cause of photophobia is general hyperesthesia and aggravation of headache in the presence of bright light. Irritability and subsequent drowsiness are the result of intoxication of the cortical neurons by the bacterial exotoxins. Neck stiffness originate from muscular pain (myalgia) – muscles of the neck and back contract uncontrollably and that makes body and neck bend backward, thus dampening the pain.

The first days of the disease are critical for the patient’s survival and recovery, and, as it was said before, timely treatment and careful nursing are the matters of high importance. Leaving the questions of treatment aside, let’s touch upon the question of nursing care for the patient like Mr. Scott. The care of the patient with the early stage of bacterial meningitis is supportive, according to Shearer-Cooper L. A. and Frey R. (1996) Adequate and attentive nursing must include measures of several types: administration of prescribed strain-specific antibiotic treatment, providing comfort and care for the patient, assessing of the patient’s condition and prevention of aggravations, isolation of the patient if necessary to avert dissemination of the infection.

Working this division out in details, it is necessary to mention administration of antibiotics and other medications as ordered by the physician, analgesics, anticonvulsants, oxygen and fluids if necessary. (Springhouse 2003; Comer S. 2003) These measures are the parts of the treatment aimed to maintain therapeutic concentrations of medicines in the bloodstream and though to guarantee maximum efficacy of the treatment. (Ahrens T. S., Prentice D. 1997)

In order to provide comfort and care to the patient nurse should take steps to compensate patient’s temporary decreased ability to care for himself, among them are provision of skin and hair care, bathing, sufficient nutrition and hydration, (Sheppard M. 2000) maintenance of comforting environmental conditions i.e. temperature control, quiet and dim light (this will decrease the load on hyperirritable sensory organs and thus reduce pain of the patient) minimization of seizure and trauma risks by padding side rails of the bed (Comer S. 2003; Springhouse. 2003)

Assessing the present condition include monitoring body temperature, blood pressure and respiratory rate, general neurological, cardiovascular and respiratory status, (Springhouse. 2003) level of conscience and other vital signs. (Shearer-Cooper L. A., Frey R. 1996) Prevention of aggravations includes control of pyrexia, rehydration of the patient, administration of anticonvulsants, if necessary, mechanical lung ventilation, and control of the patient’s position in bed to avert the bedsores development. Respiratory isolation should be performed at first 24-48 hours to protect the staff and visitors and to prevent dissemination of the infection. (Ahrens T. S., Prentice D. 1997)

Reference list

1. Ahrens S., Prentice D. 1997. Critical Care Certification. McGraw-Hill Professional
2. Comer 2003. Delmar’s Critical Care Nursing Care Plans. Thomson Delmar Learning
3. 2006. [online] [Accessed 17^th November 2006]. Available from World Wide Web: http://www.indiana.edu/~health/hot/meningitis.shtml
4. Shearer-Cooper L. A., Frey R. 1996. An Introduction to Nursing Assisting: Building Language Skills. Thomson Delmar Learning
5. Sheppard A., Wright M., Sheppard M. 2000. Principles And Practice of High Dependency Nursing. Elsevier Health Sciences
6. 2003. Straight A’s Medical-Surgical Nursing. Lippincott Williams & Wilkins
7. Tsao N., Puthuparampil P. Kanakamma, Tien-Yau Luh, Chen-Kung Chou, and Huan-Yao Lei. 1999. Inhibition of Escherichia coli-Induced Meningitis by Carboxyfullerence. Antimicrobial Agents and Chemotherapy. 43 (9), p. 2274