Ch. 12: Meningitis Flashcards by Melissa Johnson

What is meningitis?

An inflammation of the CSF and meninges

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What are meninges?

CT that cover the brain and spinal cord

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Meningitis and _____ have similar manifestation and are both sometimes preceded by _______. Testing is necessary to differentiate between the two

Reye’s Syndrome—preceded by viral infections

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What kind of meningitis usually requires only supportive care for recovery?

Viral (or aseptic)

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What kind of meningitis is a contagious infection?

Bacterial (septic)

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Bacterial meningitis: What does the prognosis depend on?

How quickly care is initiated

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What are some viral illnesses that could precede viral meningitis?

Cytomegalovirus
Adenovirus
Mumps
Herpes simplex virus
Arbovirus

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What are some bacterial infections that could lead/cause bacterial meningitis?

Neisseria meningitidis {meningococcal]
Streptococcus pneumoniae [pneumococcal]
Haem. flu type B [Hib]
E. Coli

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Bacterial meningitis can be caused by what type of injuries?

Injuries that provide direct access to CSF

EX: Skull fracture, penetrating head wound

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What meningitis does crowded living conditions cause?

Bacterial

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Are manifestations of viral and bacterial meningitis similar or different?

Similar

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Newborns: Is illness present at birth?

No illness is present at birth, but it progresses within a few days

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Newborns: What are clinical manifestations of meningitis in a newborn?

Vague and difficult to diagnose but

poor muscle tone
weak cry
poor suck
refuses feegind
V/D
Possible fever or hypothermia

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Newborns: What is a late sign of meningitis?

Bulging fontanels

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3m-2y: What are the clinical manifestations (6)

Seizures with a HIGH pitched cry
Fever, irritability
Bulging fontanels
Possible nuchal rigidity
Poor feeding
Vomiting

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3m-2y: Is the Brudzinski’s sign reliable for diagnosis for this age?

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3m-2y: Is Kerning’s sign a reliable for diagnosis for this age?

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2year-adolescents: What is often the initial sign?

Seizures

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2y-adolescents: What kind of rigidity?

Nuchal rigidity

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2y-adolescents: Positive Brudzinski’s sign. What does this mean?

Flexion of extremities occurring with deliberate flexion of the child’s neck

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2y-adolescnets: Positive Kernig’s sign. What does this mean?

Resistance to extension of the child’s leg from a flexed position

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2y-adolescents: What are some other signs of meningitis?

Fever, chills
Headache
Irritability and restlessness that may progrss to drowsiness, delirium, stupor, and coma

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2 year-adolescents: What is seen specifically with meningococcal infection?

Petechia or purpuric type rash

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2y-adolesecents: What may be seen specifically with meningococcal and Hib infection?

Involvement of joints

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2y-adolescents: What may be seen specifically with pneumococcal infection?

Chronic draining ear

Lab tests: What cultures are positive sometimes when CSF is negative?

Blood cultures are sometimes positive when the CSF culture is negative

Lab tests: Do we need to do a CBC?

Yes

How does the CSF analysis look for bacterial?

- CLOUDY color - Elevated WBC & protein - Decreased glucose - POSITVE gram stain

How does the CSF analysis look for viral?

- CLEAR color - Slightly elevated WBC - Normal or slightly elevated protein - Normal glucose - NEGATIVE gram stain

CSF analysis: bacterial or viral Elevated WBC and protein

Bacterial

CSF analysis: bacterial or viral Clear color

Viral

CSF analysis: bacterial or viral Normal glucose

Viral

CSF analysis: bacterial or viral Decreased glucose

Bacterial

CSF analysis: bacterial or viral +gram stain

Bacterial

CSF analysis: bacterial or viral -gram stain

Viral

CSF analysis: bacterial or viral Slightly elevated WBC

Viral

CSF analysis: bacterial or viral Normal or slightly elevated protein

Viral

CSF analysis: bacterial or viral Cloudy color

Bacterial

CSF analysis: bacterial or viral Clear color

Viral

What diagnostic procedure is the definitive diagnostic test for meningitis?

Lumbar puncture

Where do you insert the spinal needle for the lumbar puncture?

The subarachnoid space between L3 and L4 OR between L4 and L5

For the lumbar procedure, is it okay if the child doesn't have an empty bladder?

Have the child empty their bladder

What may be applied over the biopsy area before the lumbar puncture? How far in advance is this done?

EMLA cream 45 min-1 hr prior to procedure

How should child be for lumbar procedure..what position?

SIDE LYING with the head FLEXED and knees DRAWN UP toward chest *assist in maintaining this position; distraction may need to be used

Is it okay for the child to be sedated for the lumbar procedure?

Yes, they can with fentanyl and midazolam

How many test tubes of CSF are taken from lumbar procedure?

3-5

Lumbar procedure: Instruct the client to remain in bed _____ in a ____ position to prevent leakage and a resulting spinal headache. This may not be possible for infant, toddler, or preschooler

Remain in bed 4-8 hours in a FLAT position

Why may a CT or MRI be done?

To idetify increased ICP and/or an abscess

What type of rash requires immediate medical attention?

Petechia or purpuric type rashI

If meningitis is suspected, does the client require isolation?

YES

If meningitis is suspected what precautions are needed?

DROPLET

What does droplet precautions require?

- Private room or room with other clients who have same infection (make sure each client has separate equip) - Masks for providers and visitors

Monitor VS, urine output, fluid status, pain level, neurologic status for patients. For infants, all that was just stated is done and one more thing. What is that other thing?

Monitor head circumference

Correct fluid volume deficits and then restrict fluids until no evidence of increased ICP and serum ____ levels are in the expected range

Serum sodium

Maintain ___ if the client has a decreased level of consciousness. As clients condition improves, how should nutritional status change?

NPO if decreased LOC As condition improves advance to clear liquid then to diet client can tolerate

How should clients room be temp wise?

Cool

How should clients positioning be?

Without a pillow and slightly elevate HOB Can also be positioned side lying to reduce neck discomfort

What meningitis should antibiotics be given for: bacterial or viral?

Bacterial

Are corticosteroids such as dexamethasone indicated for viral infections?

Corticosteroids such as dexamethasone assists with the management of increased ICP initially. Do they still work for long term complications?

May not be effective for long term complications

What are corticosteroids (dexamethasone for example) most effective for?

Reducing neurologic complications in children with infections caused by Hib

What may be given to relieve discomfort ?

Acetaminophen with codeine

Why should we assess the clients temp prior to administering acetaminophen or ibuprofen?

Because these medications can mask a fever

Encourage parents to maintain appropriate immunizations for the client. When should children receive the Hib and PCV vaccines?

2 m, 4 m, 6 m--then again between 12 and 15 months

What is a complication of meningitis?

Increased ICP--which can lead to neurological dysfunction

What are signs of increased ICP in infants?

- Bulging or tense fontanels - Increased head circumference - HIGH pitched cry - DISTENDED scalp veins - Irritability - BRADYcardia - Resp changes

What are signs of increased ICP in children?

- Increased irritability - Headache - N/V - Diplopia - Seizures - BRADYcardia - Resp. changes

A nurse is caring for a client who has suspected meningitis and a decreased LOC. Which of the following actions by the nurse is appropriate? A. Place client on NPO B. Prepare client for liver biopsy C. Position client dorsal recumbent D. Put client in protective environment

A B. Liver= used to diagnose Reyes C. Client should be positioned without a pillow and slightly elevated HOB D. Meningitis=droplet precautions

A nurse is caring for a 4m infant who has meningitis. Which of the following findings is associated with this diagnosis? A. Depressed anterior fontanel B. Constipation C. Presence of rooting reflex D. High pitched cry

A nurse is reviewing CSF fluid analysis for a client who has suspected meningitis. Which of the following results indicates viral meningitis (SATA) ``` A. Negative gram stain B. Normal glucose content C. Cloudy color D. Decreased WBC E. Normal protein ```

A, B, E

A nurse is developing an in-service about viral and bacterial meningitis. The nurse should include that the introduction of which of the following immunizations decreased the incidence of bacterial meningitis in children? (SATA) A. Inactivated polio vaccine (IPV) B. Pneumococcal conjugate vaccine (PCV) C. Diptheria and tetanus tozoids and acellular pertussis vaccine (DTaP) D. Hamophilus influenzae type B (Hib) vaccine E. Trivalent inactivated influenze vaccine (TIV)

B, D