neurosensory and musculoskeletal disorder: meningitis Flashcards
acute neurological disorders
meningitis
reye syndrome
meningitis
inflammation of the cerebrospinal fluid (csF) and meninges.
reye syndrome
life-threatening disorder that involves acute encephalopathy and fatty changes of the liver.
viral meningitis care required?
usually requires
only supportive care for recovery.
bacterial meningitis contagious or not
contagious
viral meningits risk factors
- Cytomegalovirus (CMV)
- adenovirus, mumps, herpes simplex virus
- arbovirus
bacterial meningitis risk factors
- Neisseria meningitidis (meningococcal)
- Streptococcus pneumoniae (pneumococcal)
- Haemophilus influenzae type B (Hib)
Escherichia coli
meningits risk factors
- 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
meningitis expected findings
- Photophobia
● Nausea
● Irritability
● Headache
meningitis newborn expected findings
- 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
meningitis expected findings 3m to 2 y
- 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
meningitis expected findings 2y through adolescence
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
deliberate flexion
flexion of extremities occurring with deliberate flexion of the child’s neck
brudzinki sign
severe neck stiffness causes hips and knees to flex when neck is flexed upwards
kernig sign
unable to striaghten leg greater than 135 degrees without pain
diagnosing meningitis
Send Blood cultures, CBC
CSF analysis indicative of meningitis
meningitis bacterial analysis of csf
- Cloudy color
- Elevated WBC count, elevated protein
- Decreased glucose content
- Positive Gram stain
- high protein
meningitis viral analysis of csf
- Clear color
- Slightly elevated WBC count
- Normal or slightly elevated protein content
- Normal glucose content
- Negative Gram stain
meningitis lumbar puncture how is it done
- 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.
prepping & procedure a lumbar puncture
- 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.
ct or mri
Performed to identify increased (ICP) or
abscess.
- Assist with positioning.
Administer sedatives as prescribed.
what requires immediate attention for meningitis
petechiae or purple rash
isolate precautions for meningitis
- 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.
nursing care for meningitis
- 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.
antibiotics
- 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
corticosteroids: dexamethasone
- 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
analgesics
- 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
complications of meningitis increased intracranial pressure newborns
- 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).
increased intracranial pressure children
- 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).
s/s of increased icp in newborns and infants
bulging fontanels, increased head circumference, high-pitched cry, distended scalp veins, irritability, bradycardia, and respiratory change.
s/s for increased icp children
- 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).
