Meningitis.pdf

o The brain and spinal cord are covered by connective tissue layers collectively called the meninges which form the blood-brain barrier. 1-the pia mater (closest to the CNS) 2-the arachnoid mater 3-the dura mater (farthest from the CNS). The meninges contain cerebrospinal fluid (CSF). Men...

o The brain and spinal cord are covered by connective tissue layers collectively called the meninges which form the blood-brain barrier. 1-the pia mater (closest to the CNS) 2-the arachnoid mater 3-the dura mater (farthest from the CNS). The meninges contain cerebrospinal fluid (CSF). Meningitis is an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain  Meningitis can be caused by many different organisms including viruses and bacteria.   Meningitis, caused by a bacteria, is life threatening and requires urgent medical attention and treatment with antibiotics.  Meningitis caused by a virus is very rarely life threatening but can cause the body to become very weak.  When bacteria invade the body they can cause meningitis, septicaemia or meningitis and septicaemia together Etiology TABLE Common Causes of Meningitis in Different Age Groups Age Affected Causative Organism Causes of Meningitis Newborns and infants (birth–3 months) Escherichia coli; group B Streptococcus ; Listeria monocytogenes; Streptococcus pneumonia Infants and children (3 months–6 years) Streptococcus pneumonia; Neisseria meningitides (meningococcal meningitis); Haemophilus influenza type B; group B Streptococcus Older children and adolescents (6– Streptococcus pneumonia; Neisseria meningitides 16 years) (meningococcal meningitis) Maternal factors, such as premature rupture of fetal membranes and maternal infection during the last week of pregnancy, are major causes of neonatal meningitis. Pathophysiology Bacterial meningitis causes inflammation, swelling, purulent exudates, and tissue damage to the brain. It can occur as a secondary infection to upper respiratory infections, sinus infections, or ear infections, and can also be the result of direct introduction through ; skull fracture or severe head injury; neurosurgical intervention; congenital structural abnormalities, such as spina bifida; or the presence of foreign bodies, such as a ventricular shunt. Clinical Manifestations of Bacterial Meningitis Therapeutic Management Bacterial meningitis is a medical emergency and requires prompt hospitalization and treatment. Deterioration may be rapid and occur in less than 24 hours, leading to long-term neurologic damage and even death. Intravenous antibiotics will be started immediately after the LP and blood cultures have been obtained if bacterial meningitis is suspected. The length of therapy and specific antibiotic will be determined based on the analysis and the culture and sensitivity of the CSF. Corticosteroids may be ordered to help reduce the inflammatory process. Specific medical treatment varies based on the suspected causative organism and will be determined by the physician or nurse practitioner. Physical Examination Observe the general appearance of the child. The infant with bacterial meningitis may rest in the opisthotonic position (picture dowen), and the older child may complain of neck pain. In the infant a bulging fontanel may be present, which often is a late sign, and the infant may be consolable when lying still as opposed to being held. Presence of positive Kernig and Brudzinski signs can indicate irritation of the meninges. Inspect the child for presence of a rash; a petechial, vesicular, or macular rash may be seen. Infant in opisthotonic position: head and neck are hyperextended to relieve discomfort. Laboratory and Diagnostic Tests Common laboratory and diagnostic studies ordered for the assessment of bacterial meningitis include: LP—Fluid pressure will be measured and a sample is obtained for analysis and culture. CSF will be elevated and CSF will reveal increased white blood cells (WBCs) and protein and low glucose (the bacteria present feed on the glucose). Complete blood count (CBC)—WBCs will be elevated. Blood, urine, and nasopharyngeal culture—Performed to look for source of infection and to rule out sepsis. Blood culture will be positive in cases of septicemia. Nursing Management Administer prescribed antibiotics as soon as possible after obtaining cultures. Quickly initiate supportive measures to ensure proper ventilation, reduce the inflammatory response, and help prevent injury to the brain. Interventions are aimed at reducing ICP and maintaining cerebral perfusion along with treating fluid volume deficit, controlling seizures, and preventing injury that may result from altered LOC or seizure activity. Initiate appropriate isolation precautions. In addition to standard precautions, infants and children diagnosed with bacterial meningitis will be placed on droplet isolation until 24 hours of antibiotics have been received to help prevent transmission to others. . Reducing Fever  Increased body temperature; warm, flushed skin; and tachycardia may be present. Reducing fever is important to help maintain optimal cerebral perfusion by reducing the metabolic needs of the brain.  Administer antipyretics such as acetaminophen and nonsteroidal  anti-inflammatory drugs (NSAIDs) such as ibuprofen, per order.  Institute nonpharmacologic measures, if needed. Reduce environmental temperature and use cooling blankets, fans, cold compresses, and tepid baths to help reduce fever. Avoid measures that cause shivering because it increases heat production and is therefore counterproductive and uncomfortablefor the child.  Preventing Bacterial Meningitis  Bacterial meningitis is a serious illness and prevention is important. It is transmitted by direct close contact with respiratory droplets from the nose or throat. Most at risk are those living with the child or anyone with whom the child played or was in close contact.  Postexposure prophylaxis and postexposure immunization may be effective. Control measures should be initiated in environments where risk exists. Disinfect toys and other shared objects to decrease transmission of the micro-organisms to others.  To reduce group B streptococcus infection in neonates, screen pregnant women. If the screening results are positive, administer intrapartal antibiotics.   Vaccines are an important way to prevent bacterial meningitis and are available for some specific causative organisms, but complete vaccination prevention is not possible at this time. The Hib vaccine is routine starting at 2 months of age and all children should be immunized to continue the reduction of bacterial meningitis caused by H. influenzae type B. The pneumococcal vaccine is also routine for all children starting at 2 months of age.  Meningococcal vaccination is routine for all children 11 to 12 years of age with a booster at age 16. Adolescents 16 to 18 may be vaccinated with serogroup B meningococcal vaccines if they are part of certain at-risk groups..