Meningitis

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 the bacterial

o Viral or Aseptic  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

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Petachial or purpuric rashes with meninococcal infection – Large areas of ecchymosis • Rash with meninococcal is common in school age children and highly contagious

COMPLICATIONS

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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

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Cannot always be made on the basis of S/S CSF exam provides a definitive Dx

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Lumbar Puncture – CSF culture – Blood culture

NURSING MANAGEMENT • • • • • •

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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