Nursing care plan of Meningitis

image

Definition:

– It is an inflammation of the meninges.

– it is the most common infection in children

 

Causes of Meningitis

1- Bacteria : e.g., meningococcus, pneumococcus, influenza bacillus, tubercle baccilus.

2- Viral: A wide variety of viruses.

pathophysiology of Meningitis

– Meningitis occurs as a result of the extension of a body infection or directly from wound into skin, skull fracture or through surgical procedures, lumber puncture.

– Once the organism implanted, it spreads into the CSF then to subarachnoid space.

– As any bacterial infection, the infection process is inflammation, exudation, accumulation of the white blood cells and varying degree of tissue damage.

– The brain becomes edemetous and the brain entire surface is covered with purulent exudates.

– If infection extends to brain ventricles, thick pus and adhesion will obstruct the CSF flow.

 

Manifestations of Meningitis

In Neonates: (extremely difficult to diagnose).

► Manifestations are vague and non-specific.

► Refuses feedings and poor sucking ability.

► Vomiting and diarrhea.

► Poor tone and lack of movement and poor crying.

► Hypothermia or fever (depending on infant’s maturity) , jaundice, irritability, drowsiness, seizures, apnea, cyanosis, and weight loss are non-specific signs that may be present.

► The full, tense, bulging fontanel may or may not be present until late in the disease.

► Untreated neonate will develop cardiovascular collapse, seizure, and apnea.

 

In infants and young children:

► Children between 3 months and 2 yrs are rarely developing the classical picture of meningitis.

► Fever, poor feeding and vomiting.

► Marked irritability, restlessness, and seizures which is accompanied with high pitch cry.

► Bulging fontanel is the significant finding.

► The young child may have nuchal rigidity and positive Brudzinski and Kernig signs.

– In Kernig signs the child easily extends the leg when in supine position.

– When the thigh is flexed toward the abdomen, pain prevents complete extension of the leg.

– In Brudzinski sign, while the child in supine position, he bends his head toward his chest.

– In younger child the nurse can bend the child’s head.

– This action usually produces involuntary hip and knee flexion in the child with meningitis.

 

Manifestations in children and adolescents:

► Fever, chills, headache, vomiting.

► The initial sign is usually seizure, which may recur as the disease progress.

► Extreme irritability, agitation.

► The child may develop photophobia, delirium, hallucinations, drowsiness and coma.

► Neck rigidity (nuchal rigidity) which may progress to opistotonous.

► Positive Kering and Brudzinski signs.

► Skin may be cold and cyanotic.

 

Diagnostic tests of Meningitis

► Lumber puncture is the diagnostic test. Elevated spinal fluid pressure, turbid CSF, culture of CSF is recommended.

► White blood count (usually WBC count is elevated).

► Blood glucose is reduced.

► Blood culture.

 

Therapeutic management of Meningitis

The initial therapeutic management includes:

► Isolation precautions.

► Initiation of antimicrobial therapy, usually through IV infusion and in large doses.

► Maintenance of optimum hydration through IV infusion.

► Reduction of increased ICP.

► Control of seizures.

► Maintenance of ventilation.

► Control of hypothermia or fever.

► Correction of anemia.

► Treatment of complications.

 

Nursing care plan of Meningitis

Nursing diagnosis I :

– Altered tissues perfusion (cerebral) related to cerebral edema, increased ICP, seizures.

Nurse Goal (1):

– The child will have normal neurologic status.

– Intervention: the nurse must

► Establish neurologic baseline assessment and vital signs on admission.

► Monitor factors that may further increase cerebral edema and ICP (fever, seizures, hypercapnia).

To decrease or prevent increasing the ICP :

– organise nursing activities around periods of low ICP to prevent increasing ICP.

– Monitor pupil size and reactivity / hour, when necessary or as ordered as sign of increased ICP.

–  Measure head circumference daily and document it in growth chart.

– palpate the anterior fontanel and cranial suture every shift if age appropriate.

– Monitor intake and output hourly. Notify physician if output is below 1 ml/kg/hr or 2 ml/kg/hr.

– Assess the infant for irritability, lethargy and feeding intolerance.

– place emergency equipment (such as oxygen, suction, ..) near the child’s room or at bedside table.

– Check urine specific gravity / 4-6 hrs or when necessary.

– Notify physician if it is above 1.030 or less than 1.010.

 

Expected outcome of Meningitis

The child has :

– improved cerebral perfusion

– normal level of consciousness

– vital signs in baseline

– Glascow Coma Scale within normal limits and appropriate behaviour.

 

Nursing diagnosis II :

– Altered nutrition: less than body requirements related to restricted intake; nausea, and vomiting, swallowing and chewing difficulty.

Nurse Goal (1):

– The child’s weight will be stable and appropriate for age, normal serum protein, moist mucous membrane and adequate urine output.

– Nausea and vomiting controlled.

Nursing Intervention

► Weight the child daily on the same scale and record on growth chart.

► Monitor skin turgor, mucous membrane and urine output.

► Position the infant or child upright after feeding.

► Provide a flexible feeding schedule with small feedings of favourite foods.

► Minimise handling around feeding times.

► Assist the child with chewing with the child’s chin and jaw in the nurse’s hand, if swallowing is impaired & if so feed by NG Tube.

► Consult dietician.

► Assess level of consciousness before giving liquids.

Expected outcome

The child shows normal growth and development, has nausea and vomiting under control, has adequate daily caloric intake and proper hydration.

Related posts:

Posted in Neurology, Nursing Care Plans, Nursing Intervention Tagged with: , , , , ,

FaceBook Page