Meningitis

Nuchal rigidity, fever, and headache might look like the flu — but missing meningitis can kill the client in hours. Knowing which signs demand immediate action separates safe practice from catastrophe.

Meningitis is inflammation of the meninges caused by bacterial, viral, or fungal organisms. Bacterial meningitis (most commonly Neisseria meningitidis or Streptococcus pneumoniae) is a medical emergency with mortality rates of 15–30% even with treatment. Viral meningitis is typically self-limiting. The hallmark triad is fever, nuchal rigidity (stiff neck), and altered mental status. Two classic assessment findings confirm meningeal irritation: Kernig's sign (pain and resistance when extending the knee with hip flexed at 90°) and Brudzinski's sign (involuntary hip and knee flexion when the neck is passively flexed). A petechial or purpuric rash suggests meningococcal infection and signals potential septicemia. Lumbar puncture confirms diagnosis — bacterial CSF shows cloudy appearance, elevated protein, decreased glucose, and elevated WBCs with neutrophil predominance. Viral CSF is clear with normal glucose and lymphocyte predominance. Nursing priorities include droplet precautions for bacterial meningitis (maintained for 24 hours after effective antibiotic therapy begins), rapid IV antibiotic administration, neurological checks every 1–2 hours, monitoring for increased intracranial pressure, seizure precautions, and keeping the environment dim and quiet to reduce photophobia-related agitation. Close contacts of meningococcal meningitis require prophylactic antibiotics (rifampin, ciprofloxacin, or ceftriaxone).

Key Distinctions

Don't confuse Kernig's sign (leg extension resistance) with Brudzinski's sign (neck flexion causes hip flexion) — students constantly swap them. Bacterial CSF is cloudy with low glucose; viral CSF is clear with normal glucose — mixing these up leads to wrong answers. Droplet precautions apply to bacterial meningitis, not viral — and only for the first 24 hours of antibiotics, not the entire hospitalization.

Clinical Pearl

"Kernig = Knee (can't straighten it), Brudzinski = Brain-to-knee (flex the neck, the knees follow)." Engrave this — it shows up on every NCLEX form.