Nursing care plan of Meningitis



– 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.

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