meningitis-1

Meningitis is an acute inflammation of the duramater, pia mater and arachnoid membrane in the brain and spinal cord (meninges).It is always a CSF infection. The bacteria often enter the CSF through the upper respiratory tract or penetrating wounds to the skull.

Streptococcus pneumoniae and Nesseria meningitidus are the common causes of meningitis.

If untreated, 100% of patients will die from the infection.

In bacterial meningitis, CSF production is increased which has the potential to lead to increasing ICP. Bacterial toxins spread to other areas of the brain leading to oedema. As a result of the dura mater swelling, increased production of CSF and oedema, ICP in patients must be carefully monitored.

Signs and symptoms

 

Meningism  is the triad of nuchal rigidity (neck stiffness), photophobia (intolerance of bright light) and headache. It is a sign of irritation of the meninges.

Paediatric signs and symptoms

  • fever
  • nausea/vomiting
  • irritability
  • refusal to feed
  • restlessness: as a result of sore muscles and joints
  • bulging fontenalle (indicative of increased ICP in infants)

More information can be found here: http://www.pharmaceutical-journal.com/files/rps-pjonline/pdf/cp200907_meningitis_clinical-307.pdf

Petechae rash: small red or purple spots (purpura) that do not disappear when pressure is applied to the skin. This occurs in 50-75% of cases.

petechiae-purpura

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The Meningitis Foundation of New Zealand symptom chart can be found here: http://www.meningitis.org.nz/vdb/document/67

Nursing Management

Meningitis is a medical emergency. A blood culture and lumbar puncture will be taken and analyzed for the diagnosis of meningitis. Antibiotic therapy will be initiated before the before the diagnosis is confirmed.

  • Antibiotics
  • Vital signs and GSC
  • Monitor ICP
  • Fever management
  • Pain management
  • Fluid balance
  • Respiratory assessment
  • Vaccinations discussed with parents

Following the acute period, patients will need several weeks of care.

  • High protein, high calorie diet
  • Range of movement exercises and warm baths for continuing muscle rigidity
  • Encourage rest
  • Support parents and family

Vision, hearing, cognitive skills, and motor and sensory abilities should be assessed after recovery as there is a possibility of long-term complications with meningitis.

 

Retrieved from https://www.youtube.com/watch?v=k3mV0ln4yHw

 

 

 

Reference:

Elliot, M., Laskowski-Jones, L., & Baker, J. (2008). Nursing management: Acute intracranial problems. In D. Brown & H. Edwards (Eds.), Lewis’s medical-surgical nursing: Assessment and management of clinical problems (2nd ed., pp. 1570–1603). Sydney, Australia: Mosby Elsevier.

Mann, K., & Jackson, M. A. (2008). Meningitis. Pediatrics in Review, 29(12), 417–430. doi: 10.1542/pir.29-12-417.

Putz, K., Hayani, K., & Zar, F. A. (2013). Meningitis. Primary Care: Clinics in Office Practice, 40(3), 707–726. doi: 10.1016/j.pop.2013.06.001.

Starship Child Health (2016). Meningitis. Retrieved from https://www.starship.org.nz/for-health-professionals/starship-clinical-guidelines/m/meningitis/

 

 

 

 

 

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