According to "Sheehy's Emergency Nursing Principles and Practice," meningitis is the inflammation of the meningeal layers, which is the protective covering that surrounds the brain and spinal cord; it is a neurological emergency and an infectious disease emergency. The infection may be caused by a virus or a bacteria. One sign of meningitis is abnormal spinal fluid.
History
Meningitis can be caused by many different organisms that gain access to the brain and spinal cord. Viral meningitis is usually less severe and has a gradual onset of the symptoms. Bacterial meningitis has a sudden onset of symptoms and can be fatal. Examples of risk factors that could lead to meningitis include respiratory tract infections, ear infections, head injuries or alcoholism. Patients who are immunosupressed are also at a higher risk of developing meningitis.
Symptoms
Patients with meningitis may have a fever, headache and sensitivity to light. They may also complain of pain or stiffness when putting their chin down to their chest, called nuchal rigidity. Vomiting, chills and seizures may also be seen with meningitis symptoms. Depending on the bacteria that is causing the infection, some patients will have small red or purple dots noted on their body. These are caused by broken blood vessels under the skin. If these symptoms are present, a doctor will likely order a test to check for abnormal spinal fluid, which can confirm a diagnosis of meningitis.
Identification
To test spinal fluid, a doctor will perform a lumbar puncture, also known as a spinal tap. The spinal tap will allow the physician to take a sample of the spinal fluid, called cerebral spinal fluid, or CSF, which will be sent to the laboratory to be analyzed. The fluid is analyzed for white blood cells, glucose, and protein. White blood cells are the body's defense against infection. A high white blood count is indicative of inflammation in the brain and spinal cord. Glucose can help identify what type of meningitis is present: glucose levels are more likely to be decreased with bacterial meningitis than in viral meningitis. Abnormal protein levels in the spinal fluid indicate an abnormal process is occurring in the brain and spinal cord. When the tap is initially performed, the physician will measure a pressure of the fluid.The pressure signifies the amount of pressure in the brain tissues and spinal fluid. A high pressure is a sign of meningitis.
Appearance of Fluid
Normal spinal fluid is clear and colorless. If the fluid appears cloudy, it may indicate a build-up of protein and white blood cells. If the fluid is red in color it may indicate bleeding. On occasion there may be a small amount of blood in the fluid, which is caused from the insertion of the needle into the spinal cord. In addition to the specific tests noted in Section 3, the spinal fluid is sent to the laboratory for a culture, which will identify the specific bacteria causing the infection. Cultures need time to grow the bacteria and it may be a couple days before the exact bacteria is confirmed.
Treatment
Patients with bacterial meningitis will be hospitalized, placed on isolation and started on antibiotics. Because the patient's immune system is being stressed from the infection, they are at risk of contacting other potential infections. The isolation helps protect the patient and visitors.
References
- "Sheeny's Emergency Nursing Principles and Practice;" Mosby Elsevier; 2010
- "Current Diagnosis & Treatmemt Emergency Medicine;" McGraw Hill; 2010
