Meningitis is a rapidly progressive infectious disease of the central nervous system, usually with no focal neurologic signs but severe systemic manifestations. What are the signs and symptoms that are the most typical characteristics of acute bacterial meningitis and nursing considerations when prioritizing care for the patient. 

1)Acute bacterial meningitis is rapidly progressive bacterial infection of the meninges and subarachnoid space. Bacterial type is the second most common type viral meningitis, but it is more serious.

2)Early signs include a fever and stiff neck, headache, nausea, vomiting, confusion, and increased sensitivity to light. Immediate medical attention is essential.

Nursing care:

• Admission Assessment: Assess and record baseline vital signs such as heart rate, blood pressure, respiratory rate, oxygen saturation, temperature, pain.
• Neurological assessment: Assess and record level of consciousness, GCS, and seizure acitivity
• Assess the fontanel for fullness or bulging. 
• Renal Assessment: Check for hydration status.
• Skin Assessment: Inspect skin for rash. A non-blanching, petechial/pupuric rash is indicative of acute meningococcal disease.

Management

• Treat seizures in the setting of meningitis immediately. (Afebrile Seizures or Seizure Management in NICU.)
• Fluid resuscitation may be required.  (Fluid Management in Meningitis)
• Administer antibiotics.
• Antibiotics must not be delayed for more than 30 minutes once the decision to treat has been made. 
• A delay to antibiotics is associated with poorer outcomes.
• Blood tests.
• Blood cultures.
• Full blood count.
• Glucose, urea and electrolytes.
• Bare weight - place order in Epic.
• Lumbar Puncture.
• Delay to LP should not delay antibiotic administration.
• LP may be delayed due to the severity of the child's condition.
• Monitor site for swelling and signs of infection ½ hourly for 4 hours.
• If steroids are ordered, administer 15 minutes prior to parenteral antibiotics or, if this is not possible, within one hour of receiving their first dose of IV antibiotics. 
• Steroids may be ordered and given at the time of lumbar puncture if the clinical suspicion of meningitis is high.
• Current evidence suggests that steroids may reduce the risk of hearing loss in bacterial meningitis.
• Steroids are not recommended in neonates due to concern regarding effects on neurodevelopment.
• Measure head circumference of infants - place order in Epic.
• If encephalitis is suspected, IV acyclovir will be ordered.
• Bacterial Meningitis (excluding meningococcal meningitis) does not require isolation. Staff should don appropriate PPE when performing procedures such as blood sampling. 
• If Meningococcal Meningitis is suspected patients should be isolated and droplet precautions continued for 24 hours after administration of appropriate antibiotics. Order isolation status in Epic.

Meningitis can be fatal. Nursing staff need to prioritise antibiotic treatment, as delays are associated with poorer outcomes. 

Testing the urine specific gravity to assess fluid status can be useful, especially in infants and children with a labile fluid status, and those on full maintenance intravenous fluids. This can be ordered in Epic and performed at the clinician's discretion. 

Step-by-step explanation

According to the Centers for Disease Control and Prevention (CDC), the symptoms of meningitis can appear either suddenly or over a few days. They normally emerge in 3 to 7 days after infection.

Early symptoms of meningitis include:

• nausea and vomiting
• fever
• headache and a stiff neck
• muscle pain
• sensitivity to light
• confusion
• cold hands or feet and mottled skin
• in some cases, a rash that does not fade under pressure

Later symptoms include seizures and coma.

Infants may:

• breathe quickly
• refuse feeds and be irritable
• cry excessively, or give a high-pitched moan
• be stiff, with jerky movements, or listless and floppy