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MENINGITIS

MENINGITIS
• An inflammatory process that affects the meaninges and spinal cord of the brain =  ICP
• Common interference with neurological functioning in children
• This is the most common infection of the CNS. It can be caused by a variety of
organisms, but the three main types are
Very Contagious – seen in
school and college age children
o Bacterial – Most Serious
 Pus forming bacteria especially meningococcus (most severe)Neisseria
meningitides, pneumosoccus, and influenza bacillus, Haemophilus (type B)
[now have vaccine].
• Fatal
• Significant cause of illness in the pediatric age group
• 90% of all cases appear before 5 years of age
• Could get septicemia and die from septic shock
• Meningococcal can die within hours, due to DIC, Shock,
overwhelming septiciemia,
o Hemorrhage or Septic shock

o Tuberculous
 Caused by tubercle bacuillus Not contagious and does not
invade the total body system like
o Viral or Aseptic the bacterial

 Caused by a wide variety of viral agents/benign

PATHOPHYSIOLOGY
• The common route of infection is by vascular dissemination from a focus of infection
elsewhere.
• Organisms also enter by direct implantation through various entries such as open
fractures, surgical procedures, lumbar puncture, anatomic abnormalities such as Spina
Bifida, Ear infections.
• The infectious process may extend to the ventricles with resulting adhesions causing
obstructive hydrocephalus and brain abscesses
• If infection in the brain – A purulent exudates covers the brain and may cause increased
ICP
• Most common route is through the blood stream from a focus of infection elsewhere
• Can occur as direct extension from invasive procedures or devices
• Meningococcal – direct contact – droplets and discharge from nose and throats of carriers

DIAGNOSIS
• Lumbar Puncture
o In children, may have vague symptoms so should do a lumbar puncture to be sure
that it is not bacteria
o Nuchal Rigidity
MANIFESTATIONS
• Nonbacterial, Aseptic, Viral
o Caused by a number of agents, principally viruses, and is frequently associated
with other diseases, such as measles, mumps, herpes, and leukemia
o Less severe, will resolve without specific treatment
o Onset is abrupt or gradual
o Initial manifestations
 Headache
 Fever
 Malaise
 GI Symptoms
 Signs of meningeal irritation (stiff neck,  LOC, irritable) that develops one or
two days after the onset of illness – usually specific to adults
o Onset is more insidious in infants and toddlers – there may be a maculopapular
rash
o The symptoms usually subside spontaneously and rapidly and the child is well in
three to ten days with treatment
TREATMENT
Primarily Symptomatic – Antibiotic agents may be administered and
isolation enforced until a definitive diagnosis is made. When patient comes
in will be automatically put on isolation until LP is done to determine if viral
or bacterial
• Tylenol for HA Position for comfort
• May be on antibiotics prophalictically
o Diagnosis
 Based on clinical features and CSF findings which include increased
lymphocytes, predominantly mononuclear cells

• Bacterial
o Illness is likely to be abrupt with:
 Fever – High – Initial symptom
 Chills
 Severe Headache – Initial symptom
 Vomiting assctd with/or quickly followed by alterations in sensorium r/t
ICP
 Irritability, even seizures, photophobia, delirium, hallucinations, aggressive
or maniacal behavior, drowsiness, stupor and coma – Increased ICP
 Occasionally the onset is slower, frequently preceded by several days of
respiratory or GI symptoms
 Stiff neck progressing to opisthotonos
• There neck is so stiff they are bowed on the bed and cannot lay flat
 Kernig Sign
• Painful to extend knee when lying flat
 Brudzinski Sign
• Neck up and ask to bend knees
o signs are positive for meningitis
 Petachial or purpuric rashes with meninococcal infection – Large areas of
ecchymosis
• Rash with meninococcal is common in school age children and highly
contagious
COMPLICATIONS
 Deafness
• May be given Decadron or Dexamethasone. This helps control the
deafness
 Seizures
 Paralysis
 Hydrocephalous
• May cause developmental delays
 Septic Shock

o Infants and Children


 Not the classic picture
 Fever – High
 Poor feeding
 Vomiting
 Cold hands and feet
 Dislike being handled
 Marked irritability
 Frequent seizures accompanied by high pitched cry “Meningeal Cry”
 Bulging fontanel the significant finding
 Nuchal rigidity may or may not be present
 No Brudzinski or Kernig Sign – not appropriate
 When changing diaper, baby may cry when lifting legs

o Neonates
 Extremely difficult to diagnose
 Vague and nonspecific signs such as:
• Poor feeding
• Poor sucking ability
• May vomit
• May have diarrhea
• Poor tone
• Lack of movement
• Poor cry
 Highest incidence between 6 months and 12 months
 Other symptoms may be present
• Hypothermia
• Fever
• Jaundice
• Irritability
• Drowsiness
• Seizures
• Resp irregularity or apnea
• Weight loss

DIAGNOSIS
 Cannot always be made on the basis of S/S
 CSF exam provides a definitive Dx
 Lumbar Puncture – CSF culture – Blood culture

NURSING MANAGEMENT
• FIRST thing you do as a nurse is ISOLATE the patient
o Respiratory isolation – Masks – Can transmit from mouth and nose
o For 24 hours or until you are sure it is not meningococcal Meningitis
• Lumbar Puncture
• Blood work is drawn
• Start Antibiotic Therapy
o Penicillin drug of choice, it crosses the blood brain barrier
• Close assessment for  ICP
• Maintenance of optimal hydration
o Due to high fever
o Careful not to overload
o May have to give volume expanders
• Maintenance of ventilation – ABG and O2 sat
• Decreasing of increased ICP – Mannitol
• Management of bacterial shock/Septic shock
• Control of seizures – Valium
• Give Decadron to decrease incidence of deafness
• Control of extreme temperature
• Correction of anemia
• Treatment of complications

Treatment of large doses of antibiotics for bacterial and treat other symptoms

Haemophilus B vaccine help to keep incidence of meningitis down

PREVENTION
• Prophylactic antibiotic to anyone who has been in contact or who has TB
• RIFAMPIN

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