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