SL SPECIFIC TEACHIN LEARNIN AV

NO. TIM OBJECTIVE CONTENT G G AID EVALUATIO

E S ACTIVITY ACTIVITY S N
1 1 min to introduce MENINGITIS
the topic
L
E
A
R W
N H
I I
N T
G L E
I
INTRODUCTION C S B
Meningitis is an infection of the protective U T O
M E A
membranes that surround the brain and N R
spinal cord (meninges).It can affect anyone, D I D
I N
but is most common in babies, young S G &
children, teenagers and young adults. C
U P
Meningitis is classified as septic or aseptic. S P
The aseptic form may be viral or secondary S T
I
to lymphoma, leukemia, or human O
immunodeficiency virus (HIV). The septic N

form is caused by bacteria such as

 Streptococcus pneumoniae and Neisseria
meningitidis.

Meningitis can be very serious if not treated L

E
quickly. It can cause life-threatening blood A
poisoning (septicaemia) and result in R
1 min N W define the term
2 to define the permanent damage to the brain or nerves. I H
term meningitis
N I
meningitis DEFINITION G T
Meningitis is an inflammation of the E
C L
meninges. The meninges are the three U I B
membranes that cover the brain and spinal M S O
T A
cord. Meningitis can occur when fluid D E R
2 min I N D describe the
3 surrounding the meninges becomes
S I incidence of
to state the
infected. C N & meningitis
incidence of
meningitis U G
INCIDENCE AND PREVALENCE S P
 Although meningitis is a notifiable S P
I T
disease in many countries, the exact O
incidence rate is unknown. N
 In 2013 meningitis resulted in 303,000
deaths – down from 464,000 deaths in
 1990.
 In 2010 it was estimated that meningitis
resulted in 420,000 deaths, excluding
L
cryptococcal meningitis. E
 Bacterial meningitis occurs in about 3 A
R W
people per 100,000 annually in Western N H
countries. Population-wide studies have I I
N T
shown that viral meningitis is more G L E
common, at 10.9 per 100,000, and occurs I
C S B
more often in the summer. U T O
 Sub-Saharan Africa has been plagued by M E A
N R
large epidemics of meningococcal D I D
meningitis for over a century, leading to it I N
S G &
being labeled the "meningitis belt". C
4 2 min state the
to explain the Epidemics typically occur in the dry U P anatomy and
anatomy and S P physiology of
season (December to June), and an S T
physiology of meninges
meninges epidemic wave can last two to three years, I
O
dying out during the intervening rainy N
seasons.
ANATOMY AND PHYSIOLOGY
 L
E
A
R
N W
Structure
I H
 The meninges is a layered kunit of N I
G T
membranous connective tissue that L E
covers the brain and spinal cord. These C I
U S B
coverings encase central nervous system M T O
structures so that they are not in direct E A
D N R
contact with the bones of the spinal I I D
column or skull. S N
C G &
 The meninges are composed of three U
membrane layers. The outer layer is the S P
S P
toughest and thickest. It is called the I T
dura mater .The middle layer is the O
N
arachnoid .The inner-most layer lays
directly on the nervous tissue of the brain
 or spinal cord, and is called the pia
mater.
 There is subarachnoid space between the
inner-most pia mater and the arachnoid L
mater. The space is filled with E
A
cerebrospinal fluid. Each layer of the R W
meninges serves a vital role in the proper N H
I I
maintenance and function of the central N T
nervous system. G L E
I
Functions of Meninges. C S B
 The meninges functions primarily to U T O
M E A
protect and support the central nervous N R
system (CNS). D I D
I N
 It connects the brain and spinal cord to S G &
the skull and spinal canal. C
U P
 The meninges forms a protective barrier S P
that safeguards the sensitive organs of S T
I
the CNS against trauma. It also contains O
an ample supply of blood vessels that N

deliver blood to CNS tissue.

 Another important function of the
meninges is that it produces
cerebrospinal fluid. This clear fluid fills
the cavities of the cerebral ventricles and L
surrounds the brain and spinal cord. E
A
 Cerebrospinal fluid protects and R W
nourishes CNS tissue by acting as a N H
I I
shock absorber, by circulating nutrients, N T
and by getting rid of waste products. G L E
I
Layers of meninges. C S B
U T O
M E A
N R
D I D
I N
S G &
C
U P
S P
S T
I
Dura Mater O
N
 The dura mater is the outermost layer of
the meninges, lying directly underneath
 the bones of the skull and vertebral
column. It is thick, tough and
inextensible.
 Within the cranial cavity, the dura L
contains two connective tissue sheets: E
A
 Periosteal layer – lines the inner surface R
of the bones of the cranium. N W
I H
 Meningeal layer – deep to the periosteal N I
layer inside the cranial cavity. It is the G T
L E
only layer present in the vertebral column. C I
 Between these two layers, the dural U S B
M T O
venous sinuses are located. They are E A
responsible for the venous vasculature of D N R
I I D
the cranium, draining into the internal S N
jugular veins. C G &
U
 In some areas within the skull, the S P
meningeal layer of the dura mater folds S P
I T
inwards as dural reflections. They O
partition the brain, and divide the cranial N

cavity into several compartments. For

 example, the tentorium cerebelli divides
the cranial cavity into supratentorial and
infratentorial compartments.
 The dura mater receives its own L
vasculature; primarily from the middle E
A
meningeal artery and vein. It is innervated R
by the trigeminal nerve. N W
I H
Arachnoid Mater N I
 The arachnoid mater is the middle layer of G L T
I E
the meninges, lying directly underneath the C S
dura mater. U T B
M E O
 It consists of layers of connective tissue, is N A
avascular, and does not receive any D I R
I N D
innervation. S G
 Underneath the arachnoid is a space C &
U
known as the sub-arachnoid space. It S P
contains cerebrospinal fluid, which acts to S P
I T
cushion the brain. Small projections of O
arachnoid mater into the dura (known as N

arachnoid granulations) allow CSF to re-

5 enter the circulation via the dural venous
3 min to describe the list out the risk
sinuses.
risk factors of factors of
meningitis Pia Mater meningitis
 The pia mater is located underneath the
sub-arachnoid space. It is very thin, and L
E
tightly adhered to the surface of the brain A
and spinal cord. It is the only covering to R W
N H
follow the contours of the brain (the gyri I I
and fissures). N L T
G I E
 Like the dura mater, it is highly S
vascularised, with blood vessels C T B
U E O
perforating through the membrane to M N A
supply the underlying neural tissue. I R
D N D
RISK FACTORS I G
S &
Risk factors for meningitis include:
C
Skipping vaccinations. Risk rises for U P
S P
anyone who hasn't completed the
S T
recommended childhood or adult I
O
vaccination schedule.
N
Age. Most cases of viral meningitis occur
 in children younger than age 5. Bacterial
meningitis is common in those under age
20.
Living in a community setting. College
L
students living in dormitories, personnel on E
A
military bases, and children in boarding
R W
schools and child care facilities are at N H
I I
greater risk of meningococcal meningitis.
N T
This is probably because the bacterium is G L E
6 I
spread by the respiratory route, and spreads
3 min to enlist the C S B state the causes
causes of quickly through large groups. U T O of meningitis
meningitis M E A
Pregnancy. Pregnancy increases the risk of
N R
listeriosis — an infection caused by listeria D I D
I N
bacteria, which may also cause meningitis.
S G &
Listeriosis increases the risk of miscarriage, C
U P
stillbirth and premature delivery.
S P
Compromised immune system. AIDS, S T
I
alcoholism, diabetes, use of
O
immunosuppressant drugs and other factors N
that affect your immune system also make
you more susceptible to meningitis. Having
your spleen removed also increases your
risk, and anyone without a spleen should
get vaccinated to minimize that risk.
L
CAUSES E
A
Viral infections are the most common cause
R W
of meningitis, followed by bacterial N H
I I
infections and, rarely, fungal infections.
N T
Because bacterial infections can be life- G E
L
threatening, identifying the cause is
C I B
essential. U S O
M T A
 Bacterial meningitis
E R
Bacteria that enter the bloodstream and D N D
I I
travel to the brain and spinal cord cause
S N &
acute bacterial meningitis. But it can also C G
U P
occur when bacteria directly invade the
S P
meninges. This may be caused by an ear or S T
I
sinus infection, a skull fracture, or, rarely,
O
after some surgeries. N
Several strains of bacteria can cause acute
bacterial meningitis, most commonly:
Streptococcus pneumoniae
(pneumococcus). This bacterium is the
L
most common cause of bacterial meningitis
E
in infants, young children and adults in the A
R
United States. It more commonly causes
N W
pneumonia or ear or sinus infections. A I H
N L I
vaccine can help prevent this infection.
G I T
Neisseria meningitidis (meningococcus). S E
C T
This bacterium is another leading cause of
U E B
bacterial meningitis. These bacteria M N O
I A
commonly cause an upper respiratory
D N R
infection but can cause meningococcal I G D
S
meningitis when they enter the
C &
bloodstream. This is a highly contagious U
S P
infection that affects mainly teenagers and
S P
young adults. It may cause local epidemics I T
O
in college dormitories, boarding schools
N
and military bases. A vaccine can help
prevent infection.
Haemophilus influenzae (haemophilus).
Haemophilus influenzae type b (Hib)
bacterium was once the leading cause of
bacterial meningitis in children. But new
L
Hib vaccines have greatly reduced the E
A
number of cases of this type of meningitis.
R W
Listeria monocytogenes (listeria). These N H
I I
bacteria can be found in unpasteurized
N T
cheeses, hot dogs and lunchmeats. Pregnant G L E
I
women, newborns, older adults and people
C S B
with weakened immune systems are most U T O
M E A
susceptible. Listeria can cross the placental
N R
barrier, and infections in late pregnancy D I D
I N
may be fatal to the baby.
S G &
 Viral meningitis C
U P
Viral meningitis is usually mild and often
S P
clears on its own. Most cases in the United S T
I
States are caused by a group of viruses
O
known as enteroviruses, which are most N
common in late summer and early fall.
 Viruses such as herpes simplex virus, HIV,
mumps, West Nile virus and others also can
cause viral meningitis.
 Chronic meningitis
Slow-growing organisms (such as fungi and L
E
Mycobacterium tuberculosis) that invade
A
the membranes and fluid surrounding your R W
N H
brain cause chronic meningitis. Chronic
I L I
7 meningitis develops over two weeks or N I T
3 min to list out the G S E describe the
more. The signs and symptoms of chronic
sign and T sign and
symptoms of meningitis — headaches, fever, vomiting C E B symptoms of
meningitis U N O meningitis
and mental cloudiness — are similar to
M I A
those of acute meningitis. N R
D G D
 Fungal meningitis
I
Fungal meningitis is relatively uncommon S &
C
and causes chronic meningitis. It may
U P
mimic acute bacterial meningitis. Fungal S P
S T
meningitis isn't contagious from person to
I
person. Cryptococcal meningitis is a O
N
common fungal form of the disease that
affects people with immune deficiencies,
such as AIDS. It's life-threatening if not
treated with an antifungal medication.
 Other meningitis causes
Meningitis can also result from L
E
noninfectious causes, such as chemical
A
reactions, drug allergies, some types of R W
N H
cancer and inflammatory diseases such as
I I
sarcoidosis. N L T
G I E
SIGNS AND SYMPTOMS
S
Headache and fever are frequently the C T B
U E O
initial symptoms; fever tends to remain high
M N A
throughout the course of the illness; the I R
D N D
headache is usually either steady or
I G
throbbing and very severe as a result of S &
C
meningeal irritation.
U P
• Meningeal irritation results in a number of S P
S T
other well recognized signs common to all
I
types of meningitis: O
N
• Nuchal rigidity (stiff neck) is an early
 sign.
• Positive Kernig’s sign: When lying with
thigh flexed on abdomen, patient cannot
completely extend leg.
• Positive Brudzinski’s sign: Flexing L
E
patient’s neck produces flexion of the
A W
knees and hips; passive flexion of lower R H
N I
extremity of one side produces similar
I L T
movement for opposite extremity. N I E
G S
• Photophobia (extreme sensitivity to
T B
light) is common. C E O
U N A
8 • Rash (N. meningitidis): ranges from
to explain the M I R
4 min petechial rash with purpuric lesions to large N D
types of state the types
meningitis D G of meningitis
areas of ecchymosis.
I &
• Disorientation and memory impairment; S
C P
behavioral manifestations are also common.
U P
As the illness progresses, lethargy, S T
S
unresponsiveness, and coma may develop.
I
• Seizures can occur and are the result of O
N
areas of irritability in the brain; ICP
increases secondary to diffuse brain
swelling or hydrocephalus; initial signs of
increased ICP include decreased level of
consciousness and focal motor deficits.
• An acute fulminant infection occurs in L
E
about 10% of patients with meningococcal
A
meningitis, producing signs of R W
N H
overwhelming septicemia: an abrupt onset
I I
of high fever, extensive purpuric lesions N T
G L E
(over the face and extremities), shock, and
I
signs of disseminated intravascular C S B
U T O
coagulation (DIC); death may occur within
M E A
a few hours after onset of the infection. N R
D I D
TYPES OF MENINGITIS
I N
Meningitis can be divided into two types S G &
C
based on its causing agents. They are
U P
- Septic Meningitis and S P
S T
- Aseptic meningitis
I
Septic meningitis is the type of meningitis O
N
caused by bacteria. It can lead to significant
brain damage. Swelling of the meninges can
result in paralysis or a debilitating stroke. In
some cases, bacterial meningitis is fatal.
Bacterial meningitis can be caused by many
different types of bacteria, including L
E
Streptococcus pneumoniae, Neisseria
A
meningitides, and Haemophilus influenzae, R W
N H
and vaccines are available that target many
I I
of them. N L T
G I E
Children now routinely get a meningitis
S
vaccine around ages 11 to 12, followed by a C T B
U E O
booster vaccine at age 16.
M N A
Bacterial meningitis is usually more I R
D N D
common in infants under 1 year of age and
I G
people ages 16 to 21. College students S &
C
living in dorms or other close quarters are at
U P
increased risk, as are adults with certain S P
S T
medical problems, including those without
I
a spleen. O
N
Aseptic meningitis is the inflammation of
9 the meninges, a membrane covering the
to describe the
brain and spinal cord in patients whose
3 min pathophysiolo explain the
gy of cerebral spinal fluid test result is negative pathophysiolog
meningitis y of meningitis
with routine bacterial cultures.
Aseptic meningitis is caused by viruses, L
E
mycobacteria, spirochetes, fungi,
A
medications, and cancer malignancies R W
N H
The most common cause of aseptic
I I
meningitis is by viral infection specifically N T
G L E
by enteroviruses. Other causes may include
I
side-effects from drugs and connective C S B
U T O
tissue disorders.
M E A
Although it is usually caused by certain N R
D I D
viruses, it has a number of other etiologies
I N
as well, both infectious and noninfectious. S G &
C
Hence, the term aseptic meningitis is no
U P
longer synonymous with viral meningitis, S P
S T
although the two are still often used
I
interchangeably. O
N
Aseptic meningitis is more common than
 bacterial meningitis. But its symptoms are
usually less severe. Serious complications
are rare. Most people recover within two
weeks after the onset of symptoms.
L
E
PATHOPHYSIOLOGY
A W
R H
N I
I T
N L E
G I
S B
C T O
U E A
M N R
I D
D N
 Meningeal infections generally originate I G &
10 S
in one of two ways: either through the C P
4 min state the blood stream from other infections U P enlist the
diagnostic S T diagnostic
evaluation of (cellulitis) or by direct extension (after a S evaluation of
meningitis traumatic injury to the facial bones). I meningitis
O
 The causative organism enters the N
bloodstream, crosses the blood–brain
 barrier, and triggers an inflammatory
reaction in the meninges. Independent of
the causative agent, inflammation of the
subarachnoid and pia mater occurs,
increasing intracranial pressure (ICP) L
E
results.
A
 Bacterial or meningococcal meningitis R W
N H
also occurs as an opportunistic infection in I I
patients with acquired immunodeficiency N L T
G I E
syndrome (AIDS) and as a complication S
of Lyme disease. C T B
U E O
 Bacterial meningitis is the most significant M N A
form. The common bacterial pathogens I R
D N D
are N. meningitidis (meningococcal I G
meningitis) and S. pneumoniae, S &
C
accounting for 80% of cases of meningitis U P
in adults. Haemophilus influenzae was S P
S T
once a common cause of meningitis in I
children, but, because of vaccination, O
N
infection with this organism is now rare in
 developed countries.
DIAGNOSTIC EVALUATION
Doctor or pediatrician can diagnose
meningitis based on a medical history, a
physical exam and certain diagnostic tests. L
E
During the exam, doctor may check for
A
signs of infection around the head, ears, R W
N H
throat and the skin along the spine.
I I
Following diagnostic evaluation tests are N T
G L E
usually done for meningitis treatment:
I
Blood cultures. C S B
U T O
Blood
M E A
samples are N R
D I D
placed in a
I N
special dish S G &
C
to see if it grows
U P
microorganisms, S P
S T
particularly bacteria.
I
A sample may also be placed on a slide and O
N
stained (Gram's stain), then studied under a
11 microscope for bacteria.
Computerized tomography (CT) or
3 min to explain the describe the
treatment of Magnetic Resonance Imaging (MRI). treatment of
meningitis meningitis

L
E
A W
R H
N I
I T
N L E
G I
S B
C T O
U E A
M N R
I D
D N
I G &
S
Scans of the head may show swelling or C P
U P
inflammation. S T
X-rays or CT scans of the chest or sinuses S
I
also may show infection in other areas that O
may be associated with meningitis. N
Spinal tap (lumbar puncture).
For a
definitive
diagnosis of
meningitis, L
E
you'll need a
A
spinal tap to collect R W
N H
cerebrospinal fluid
I I
(CSF). N L T
G I E
In people with meningitis, the CSF often
S
shows a low sugar (glucose) level along C T B
U E O
with an increased white blood cell count and
M N A
increased protein. I R
D N D
CSF analysis may also help doctor identify
I G
which bacterium caused the meningitis. S &
C
If the doctor suspects viral meningitis, he or
U P
she may order a DNA-based test known as a S P
S T
polymerase chain reaction (PCR)
I
amplification or a test to check for O
N
antibodies against certain viruses to
 determine the specific cause and determine
proper treatment.
TREATMENT
The treatment depends on the type of
L
meningitis the person has. E
A W
Bacterial meningitis:
R H
Acute bacterial meningitis must be treated N I
I T
immediately with intravenous antibiotics
N L E
and sometimes corticosteroids. This helps G I
S B
to ensure recovery and reduce the risk of
C T O
12 complications, such as brain swelling and U E A
M N R
state the seizures. explain the
4 min I D
management The antibiotic or combination of antibiotics D N management of
of meningitis I G & meningitis
depends on the type of bacteria causing the
S
infection. Doctor may recommend a broad- C P
U P
spectrum antibiotic until he or she can
S T
determine the exact cause of the meningitis. S
I
Doctor may drain any infected sinuses or
O
mastoids — the bones behind the outer ear N
that connect to the middle ear.
Viral meningitis:
Antibiotics can't cure viral meningitis, and
most cases improve on their own in several L
E
weeks. Treatment of mild cases of viral
A
meningitis usually includes: R W
N H
- Bed rest
I I
- Plenty of fluids N T
G L E
- Over-the-counter pain medications to
I
help reduce fever and relieve body aches C S B
U T O
Doctor may prescribe corticosteroids to
M E A
reduce swelling in the brain, and an N R
D I D
anticonvulsant medication to control
I N
seizures. If a herpes virus caused S G &
C
meningitis, an antiviral medication is
U P
available. S P
S T
Other types of meningitis
I
If the cause of your meningitis is unclear, O
N
doctor may start antiviral and antibiotic
treatment while the cause is determined.
Treatment for chronic meningitis is based
on the underlying cause. Antifungal
medications treat fungal meningitis, and a
combination of specific antibiotics can treat
tuberculous meningitis. However, these
medications can have serious side effects,
so treatment may be deferred until a
laboratory can confirm that the cause is
fungal.
Non-infectious meningitis due to allergic
reaction or autoimmune disease may be
treated with corticosteroids. In some cases,
no treatment may be required because the
condition can resolve on its own. Cancer-
related meningitis requires therapy for the
specific cancer.
MANAGEMENT
Medical Management
• Vancomycin hydrochloride in
combination with one of the
cephalosporins (eg, ceftriaxone sodium,
 cefotaxime sodium) is administered by
intravenous (IV) injection.
13 • Dexamethasone (Decadron) has been
shown to be beneficial as adjunct therapy explain the
2 min list out the complications
complications in the treatment of acute bacterial of meningitis
of meningitis
meningitis and in pneumococcal
meningitis.
• Dehydration and shock are treated with
fluid volume expanders.
• Seizures, which may occur early in the
course of the disease, are controlled with
phenytoin (Dilantin).
• Increased ICP is treated as necessary.
Nursing Management
• Prognosis depends largely on the
supportive care provided. Related nursing
interventions include the following:
• Assess neurologic status and vital signs
constantly. Determine oxygenation from
arterial blood gas values and pulse
 oximetry.
• Insert cuffed endotracheal tube (or
tracheostomy), and position patient on
mechanical ventilation as prescribed.
• Assess blood pressure (usually monitored
using an arterial line) for incipient shock,
which precedes cardiac or respiratory
failure.
• Rapid IV fluid replacement may be
prescribed, but take care not to
overhydrate patient because of risk of
cerebral edema.
• Reduce high fever to decrease load on
heart and brain from oxygen demands.
• Protect the patient from injury secondary
to seizure activity or altered level of
consciousness (LOC).
• Monitor daily body weight; serum
electrolytes; and urine volume, specific
gravity, and osmolality, especially if
 syndrome of inappropriate antidiuretic
hormone (SIADH) is suspected.
• Prevent complications associated with
immobility, such as pressure ulcers and
pneumonia.
• Institute infection control precautions
until 24 hours after initiation of antibiotic
therapy (oral and nasal discharge is
considered infectious).
• Inform family about patient’s condition
and permit family to see patient at
appropriate intervals.
COMPLICATIONS

Meningitis complications can be severe.

The longer the has the disease without
treatment, the greater the risk of seizures
and permanent neurological damage,
including:

- seizures
- hearing loss
- vision loss
- memory problems
- arthritis
- migraine headaches
- brain damage
- kidney failure
- hydrocephalus
- a subdural empyema, or a buildup of
fluid between the brain and the skull
 A meningitis infection may produce
bacteria in the bloodstream. These
bacteria multiply and some release
toxins. That can cause blood vessel
damage and leaking of blood into the
skin and organs.
 A serious form of this blood infection
can be life-threatening. Gangrene may
damage skin and tissue. In rare cases,
amputation may be necessary. Several
 other serious complications may occur in
people with meningitis.

SUMMARY

In this document, the focus area of the study

are laid down in details on the introduction,
definition, incidence, anatomy and
physiology ,risk factors, causes, types,
pathophysiology, symptoms, diagnostic
evaluation, treatment, management,
complications and preventive measures of
meningitis.
CONCLUSION
Meningitis is an inflammatory condition
involving the membranes (meninges)
covering the brain and spinal cord. It can
have infectious causes, such as bacteria,
mycobacteria, viruses, fungi, or parasites, or
be associated with autoimmunity, cancer, or
reactions to medication. Most deaths due to
meningitis have infectious causes, but the
clinical severity of disease varies with the
causative organism. Bacterial meningitis
can rapidly become fatal and lead to severe
disability in those who survive. Both
bacterial and viral meningitides can place a
substantial burden upon families,
communities, and societies. Although
bacterial meningitis has often been
associated with persistent intellectual
impairment, some viral pathogens, such as
parechovirus, have also been associated
with impaired developmental attainment.