neurosensory and musculoskeletal disorder: meningitis Flashcards

1
Q

acute neurological disorders

A

meningitis

reye syndrome

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2
Q

meningitis

A

inflammation of the cerebrospinal fluid (csF) and meninges.

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3
Q

reye syndrome

A

life-threatening disorder that involves acute encephalopathy and fatty changes of the liver.

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4
Q

viral meningitis care required?

A

usually requires

only supportive care for recovery.

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5
Q

bacterial meningitis contagious or not

A

contagious

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6
Q

viral meningits risk factors

A
  • Cytomegalovirus (CMV)
  • adenovirus, mumps, herpes simplex virus
  • arbovirus
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7
Q

bacterial meningitis risk factors

A
  • Neisseria meningitidis (meningococcal)
  • Streptococcus pneumoniae (pneumococcal)
  • Haemophilus influenzae type B (Hib)
    Escherichia coli
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8
Q

meningits risk factors

A
  • Incidence of bacterial meningitis has decreased in all age groups except infants under the age of 2 months since the introduction of the Hib and pneumococcal conjugate vaccines
    (PCV).
  • Injuries that provide direct access to CSF (skull fracture, penetrating head wound)
  • Crowded living conditions
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9
Q

meningitis expected findings

A
  • Photophobia
    ● Nausea
    ● Irritability
    ● Headache
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10
Q

meningitis newborn expected findings

A
  • No illness is present at birth, but it
    progresses within a few days.
  • Poor muscle tone, weak cry, poor suck,
    refuses feeding, and vomiting or diarrhea.
  • Possible fever or hypothermia.
  • Neck is supple without nuchal rigidity.
  • Bulging fontanels are a late sign.
  • rigid neck
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11
Q

meningitis expected findings 3m to 2 y

A
  • Seizures with a high-pitched cry
  • Fever and irritability
  • Bulging fontanels
  • Possible nuchal rigidity
  • Poor feeding
  • Vomiting
  • Brudzinski’s (flexion of neck and extension of legs) and Kernig’s signs not reliable
    for diagnosis
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12
Q

meningitis expected findings 2y through adolescence

A
Seizures (often initial sign)
- Nuchal rigidity
- Positive Brudzinski’s  and Kernig’s sign 
- Fever and chills, Headache
- Vomiting
- Irritability and restlessness 
- Petechiae or purpuric-type rash
- Involvement of joints (with meningococcal and Hib)
Chronic draining ear
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13
Q

deliberate flexion

A

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

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14
Q

brudzinki sign

A

severe neck stiffness causes hips and knees to flex when neck is flexed upwards

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15
Q

kernig sign

A

unable to striaghten leg greater than 135 degrees without pain

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16
Q

diagnosing meningitis

A

Send Blood cultures, CBC

CSF analysis indicative of meningitis

17
Q

meningitis bacterial analysis of csf

A
  • Cloudy color
  • Elevated WBC count, elevated protein
  • Decreased glucose content
  • Positive Gram stain
  • high protein
18
Q

meningitis viral analysis of csf

A
  • Clear color
  • Slightly elevated WBC count
  • Normal or slightly elevated protein content
  • Normal glucose content
  • Negative Gram stain
19
Q

meningitis lumbar puncture how is it done

A
  • This is the definitive diagnostic test
  • The provider inserts a spinal needle into the
    subarachnoid space between L3 and L4, and L5 vertebral spaces.
  • Measures spinal fluid pressure and collects
    CSF for analysis.
20
Q

prepping & procedure a lumbar puncture

A
  • Have the child empty their bladder.
  • Assist the provider with the procedure.
  • Apply (EMLA cream) 45 min to 1 hr prior to the procedure.
  • Place the child in fetal side lying position.
  • Use distraction methods as necessary.
  • The child can be sedated with fentanyl and\midazolam
    -Label specimens appropriately, and deliver them to the laboratory.
  • Monitor the site for bleeding, hematoma, or infection.
  • Instruct the client to remain in bed in a flat position to prevent leakage and spinal headache.
  • This might not be possible for an infant, toddler or preschooler.
    -Time required for bed rest depends on
    facility protocol and amount of fluid collected.
21
Q

ct or mri

A

Performed to identify increased (ICP) or
abscess.

  • Assist with positioning.
    Administer sedatives as prescribed.
22
Q

what requires immediate attention for meningitis

A

petechiae or purple rash

23
Q

isolate precautions for meningitis

A
  • Isolate the client as soon as meningitis is suspected, and maintain droplet precautions per facility protocol.
  • Providers and visitors should wear a mask.
  • Maintain respiratory isolation for a minimum of 24 hr after initiation of antibiotic therapy.
    Monitor vital signs, urine output, fluid status, pain level, and neurologic status.
24
Q

nursing care for meningitis

A
  • For newborns and infants, monitor head circumference and fontanels for changes and bulging.
  • Correct fluid volume deficits and then restrict fluids until no evidence of increased ICP and serum sodium levels are within the expected range.
  • Maintain NPO status if the client has a decreased level of consciousness.
  • As the client’s condition improves, advance to clear liquids and then a diet the client can tolerate.
  • Monitor vital signs, urine output, fluid status, pain level, and neurologic status.
25
Q

antibiotics

A
  • Administer IV antibiotics.
  • Length of therapy is determined by the client’s condition and CSF results.
  • Therapy can last up to 10 days.
  • Educate the family about the need to complete the entire course of medication.
  • get blood, collect specimen, antibiotics
26
Q

corticosteroids: dexamethasone

A
  • Not indicated for viral meningitis.
  • Assists with initial management of increased ICP, but might not be effective for long-term complications.
  • Most effective for infections caused by Hib.
    Educate on administration and possible adverse effects of the medication.
  • decrease swelling of brain
  • wean off of get cushin syndrome
  • hypertensive and hyperglycemic
27
Q

analgesics

A
  • Acetaminophen with codeine can be used to relieve discomfort.
  • Assess temperature prior to administering acetaminophen or ibuprofen, which can mask a fever.
  • Monitor respiratory status.
  • Monitor level of consciousness.
  • Provide support for the client and family
28
Q

complications of meningitis increased intracranial pressure newborns

A
  • less than 20
    Could lead to neurological dysfunction
  • Monitor for signs of increased ICP.
  • Newborns and infants: bulging or tense fontanels, increased head circumference, high-pitched cry, distended scalp veins, irritability, bradycardia, and respiratory changes
  • increase pressure = less perfusion
  • Provide interventions to reduce ICP (positioning; avoidance of coughing, straining, and bright lights; minimizing environmental stimuli).
29
Q

increased intracranial pressure children

A
  • Children: increased irritability, headache, nausea, vomiting, diplopia, seizures, bradycardia, and respiratory changes
    Provide interventions to reduce ICP (positioning; avoidance of coughing, straining, and bright lights; minimizing environmental stimuli).
30
Q

s/s of increased icp in newborns and infants

A

bulging fontanels, increased head circumference, high-pitched cry, distended scalp veins, irritability, bradycardia, and respiratory change.

31
Q

s/s for increased icp children

A
  • increased irritability, headache, nausea, vomiting, diplopia, seizures, bradycardia, and respiratory changes.
  • Provide interventions to reduce ICP (positioning; avoidance of coughing, straining, and bright light, minimizing environmental stimuli).