CHILD HEALTH NURSING

Meningitis (lectures) - by Mrs Sunita Bhandari (Shah)

Meningitis
Meningitis is an inflammation of the meninges, the membranes that cover the brain and spinal cord. It is usually caused by bacteria or viruses, but it can also be caused by certain medications or illnesses.
 
Causes

Bacteria
—Group B streptococcus,
—Escherichia coli, and listeria monocytogenesare the most common causes of meningitis in newborns and premature babies
—Streptococcus pneumoniae (pneumococcus) and neisseria meningitidis (meningococcus is more frequent in children older than 2 months of age.
—Tuberculous meningitis,

—Aseptic
—Viral
—Parasitic
—Non-infectious
 
Clinical features

Children younger than 2 years old do not display the characteristic signs of meningitis, instead they may exhibit
—Poor feeding
—Irritability and lethargy
—High pitched cry
—Bulging fontanel
—Fever or low temperature
—Opisthotonos
—Resistance to beingheld

 
 
Older children may exhibit
—Respiratory or GI problem
—Headache
—Neck stiff
—Kernigsign
—Brudinskisign
—Petechial rash
—Photophobia
—Phonophobia
—Seizure during onset or during course.
 
Diagnosis
—CSF analysis by LP.
—CBC: increase WBC
—Blood culture
 
 
Therapeutic management

Bacterial meningitis

Antibiotics
—Empiric antibiotics must be started immediately, even before the results of the lumbar puncture and CSF analysis are known.

Steroids
—corticosteroids (usually dexamethasone) reduces rates of mortality, severe hearing loss and neurological damage in adolescents and adults

 
Viral and fungal meningitis

—Viral meningitis typically requires supportive therapy only;
—Herpes simplex virus and varicella zoster virus may respond to treatment with antiviral drugs such as aciclovir,
—Mild cases of viral meningitis can be treated at home with conservative measures such as fluid, bedrest, and analgesics.
—Fungal meningitis, such as cryptococcal meningitis, is treated with long courses of highly dosed antifungals, such as amphotericin B and flucytosine
 
Nursing management

—Careful observation to note clinical characteristic
—Monitor temperature and vital sign frequently
—Mechanical ventilation may be needed if the level of consciousness is very low, or if there is evidence of respiratory failure
—Monitor I/O and fluid and electrolyte balance(—If child is unconscious, keep NPO, then liquids progression as tolerated —Fluid restriction prevents cerebral edema)
—check for neurological signs and monitor the level of consciousness
—Assess for sign of ICP
—Glasgow coma scale.
—Measure head circumference
—Administration prescribed medicine
—provide supportive intervention(body temperature, bowel, bladder, skin)
—decrease environmental stimuli
 
Complication
—CNS complication: Hydrocephalus, empyma, Ventriculitis, brain abscess.
—Long term neurological deficit: hemiplegia, aphasia, ocular palsies, hemianopsia, blindness, deafness, sensorineural auditary impairment, mental retardation.
—Systemic complication: shock, myocarditis, seizure disorder including ipilapticus.