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ATI Pediatrics-MJ > Ch. 12: Meningitis > Flashcards

Ch. 12: Meningitis Flashcards

1
Q

What is meningitis?

A

An inflammation of the CSF and meninges

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2
Q

What are meninges?

A

CT that cover the brain and spinal cord

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3
Q

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

A

Reye’s Syndrome—preceded by viral infections

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4
Q

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

A

Viral (or aseptic)

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5
Q

What kind of meningitis is a contagious infection?

A

Bacterial (septic)

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6
Q

Bacterial meningitis: What does the prognosis depend on?

A

How quickly care is initiated

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7
Q

What are some viral illnesses that could precede viral meningitis?

A 
Cytomegalovirus
Adenovirus
Mumps
Herpes simplex virus
Arbovirus
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8
Q

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

A

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

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9
Q

Bacterial meningitis can be caused by what type of injuries?

A

Injuries that provide direct access to CSF

EX: Skull fracture, penetrating head wound

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10
Q

What meningitis does crowded living conditions cause?

A

Bacterial

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11
Q

Are manifestations of viral and bacterial meningitis similar or different?

A

Similar

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12
Q

Newborns: Is illness present at birth?

A

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

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13
Q

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

A

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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14
Q

Newborns: What is a late sign of meningitis?

A

Bulging fontanels

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15
Q

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

A
  • Seizures with a HIGH pitched cry
  • Fever, irritability
  • Bulging fontanels
  • Possible nuchal rigidity
  • Poor feeding
  • Vomiting
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16
Q

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

A

No

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17
Q

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

A

No

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18
Q

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

A

Seizures

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19
Q

2y-adolescents: What kind of rigidity?

A

Nuchal rigidity

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20
Q

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

A

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

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21
Q

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

A

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

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22
Q

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

A
  • Fever, chills
  • Headache
  • Irritability and restlessness that may progrss to drowsiness, delirium, stupor, and coma
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23
Q

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

A

Petechia or purpuric type rash

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24
Q

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

A

Involvement of joints

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25
Q

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

A

Chronic draining ear

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26
Q

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

A

Blood cultures are sometimes positive when the CSF culture is negative

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27
Q

Lab tests: Do we need to do a CBC?

A

Yes

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28
Q

How does the CSF analysis look for bacterial?

A
  • CLOUDY color
  • Elevated WBC & protein
  • Decreased glucose
  • POSITVE gram stain
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29
Q

How does the CSF analysis look for viral?

A
  • CLEAR color
  • Slightly elevated WBC
  • Normal or slightly elevated protein
  • Normal glucose
  • NEGATIVE gram stain
30
Q

CSF analysis: bacterial or viral

Elevated WBC and protein

A

Bacterial

31
Q

CSF analysis: bacterial or viral

Clear color

A

Viral

32
Q

CSF analysis: bacterial or viral

Normal glucose

A

Viral

33
Q

CSF analysis: bacterial or viral

Decreased glucose

A

Bacterial

34
Q

CSF analysis: bacterial or viral

+gram stain

A

Bacterial

35
Q

CSF analysis: bacterial or viral

-gram stain

A

Viral

36
Q

CSF analysis: bacterial or viral

Slightly elevated WBC

A

Viral

37
Q

CSF analysis: bacterial or viral

Normal or slightly elevated protein

A

Viral

38
Q

CSF analysis: bacterial or viral

Cloudy color

A

Bacterial

39
Q

CSF analysis: bacterial or viral

Clear color

A

Viral

40
Q

What diagnostic procedure is the definitive diagnostic test for meningitis?

A

Lumbar puncture

41
Q

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

A

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

42
Q

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

A

Have the child empty their bladder

43
Q

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

A

EMLA cream 45 min-1 hr prior to procedure

44
Q

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

A

SIDE LYING with the head FLEXED and knees DRAWN UP toward chest

*assist in maintaining this position; distraction may need to be used

45
Q

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

A

Yes, they can with fentanyl and midazolam

46
Q

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

A

3-5

47
Q

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

A

Remain in bed 4-8 hours in a FLAT position

48
Q

Why may a CT or MRI be done?

A

To idetify increased ICP and/or an abscess

49
Q

What type of rash requires immediate medical attention?

A

Petechia or purpuric type rashI

50
Q

If meningitis is suspected, does the client require isolation?

A

YES

51
Q

If meningitis is suspected what precautions are needed?

A

DROPLET

52
Q

What does droplet precautions require?

A
  • Private room or room with other clients who have same infection (make sure each client has separate equip)
  • Masks for providers and visitors
53
Q

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?

A

Monitor head circumference

54
Q

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

A

Serum sodium

55
Q

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

A

NPO if decreased LOC

As condition improves advance to clear liquid then to diet client can tolerate

56
Q

How should clients room be temp wise?

A

Cool

57
Q

How should clients positioning be?

A

Without a pillow and slightly elevate HOB

Can also be positioned side lying to reduce neck discomfort

58
Q

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

A

Bacterial

59
Q

Are corticosteroids such as dexamethasone indicated for viral infections?

A

NO

60
Q

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

A

May not be effective for long term complications

61
Q

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

A

Reducing neurologic complications in children with infections caused by Hib

62
Q

What may be given to relieve discomfort ?

A

Acetaminophen with codeine

63
Q

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

A

Because these medications can mask a fever

64
Q

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

A

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

65
Q

What is a complication of meningitis?

A

Increased ICP–which can lead to neurological dysfunction

66
Q

What are signs of increased ICP in infants?

A
  • Bulging or tense fontanels
  • Increased head circumference
  • HIGH pitched cry
  • DISTENDED scalp veins
  • Irritability
  • BRADYcardia
  • Resp changes
67
Q

What are signs of increased ICP in children?

A
  • Increased irritability
  • Headache
  • N/V
  • Diplopia
  • Seizures
  • BRADYcardia
  • Resp. changes
68
Q

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

A

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

69
Q

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

D

70
Q

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

A, B, E

71
Q

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)

A

B, D

ATI Pediatrics-MJ (41 decks)

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