Meningitis is an inflammation of the meninges, the protective membranes that surround the brain and spinal cord

1. MANAGEMENT OF CHILD
WITH MENINGITIS
PRESENTED BY
SYED JINIA JESMIN
M.SC. NURSING PART – 1 STUDENT
CON, NRSMCH
PRACTICE TEACHING

2. MENINGES
The meninges is the system of membranes which envelops the central nervous system.
It has 3 layers:
1. Dura mater
2. Arachnoid mater
3. Pia mater 2

3. DEFINITION
Meningitis is an
inflammation of the
meninges, the protective
membranes that surround
the brain and spinal cord
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• Meningitis can occur at all ages but it is commonest in infancy.
While 95% of the cases take place between 1 month- 5 years of
age.
• It is more common in males than females
INCIDENCE

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MENINGITIS
Bacterial or
Pyogenic
Meningitis
Aseptic
Meningitis
Tubercular
Meningitis
CLASSIFICATION

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Bacterial or Pyogenic
Meningitis
• It is caused by a wide variety of
pyogenic bacteria like
Haemophilus influenza,
Meningoccocus, Peumococus,
Steptococus etc.
• Haemophilus influenza and
Meingococus together account
for 70% of all cases of bacterial
meningitis.
• In infants younger than 2
months, Group B Streptococci
and E.coli account for 70%
cases of meningitis.
Aseptic Meningitis
• It is caused by virus, fungi or
protozoa. It is relatively
common and less serious.
• Its symptoms are similar to
common flu.
• In infants above the age of 3
months, infection is mainly
caused by Hemophilus
influenza, Pneumococcal,
Meningococcal and certain
virus, fungi and protozoa.
Tubercular Meningitis
• It is caused by Mycobacterium
tuberculosis.
ETIOLOGY OF MENINGITIS

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• Children on immunosuppressive drugs.
• Patients with diabetes mellitus and malignancies
• Immuno-compromised patients like babies of HIV positive mothers
• Meningitis may follow trauma, invasive procedures, lumbar puncture and penetrating
head wounds.
• Meningitis is common in infants and young children because their immune mechanism is
immature.
PEDISPOSING FACTORS

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PATHOPHYSIOLOGY

9. CLINICAL MANIFESTATION
Signs and symptoms are variable, depending on the patient's age, the etiologic agent, and the
duration of the illness when diagnosed. Onset may be insidious or fulminant.
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 Irritability
 Lethargy
 Vomiting
 Lack of appetite
 Seizures
 High-pitched cry
 Fever or hypothermia
Infants younger than age 2 months usually display

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Altered sleep patterns
Fever
Tenseness of the fontanelle
Nuchal rigidity
Positive kernig's sign’s
Brudzinski's signs
Infants up to age 2 manifest symptoms similar to those of the young infant
and may have

12. KERNIG’S &
BRUDZINSKI’S SIGN
Kernig’s Sign
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Brudzinski Sign

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• Vomiting
• Headache
• Mental confusion
• Lethargy, and Photophobia.
• Later symptoms include nuchal rigidity within 12 to 24 hours after onset.
• Positive kernig's or brudzinski's sign
• Seizures
• Progressive decline in responsiveness
Children older than age 2 initially have

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• Petechiae or purpura may develop.
• Characteristic skin lesions are most commonly observed in cases of meningococcal or
Pseudomonas infection.
• Hemorrhagic rashes may occur in any child with overwhelming bacterial sepsis
because of disseminated intravascular coagulation (DIC).
• Septic arthritis suggests either meningococcal or H. influenzae infection

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• Diagnosis is usually established by performance of a
lumbar puncture and examination of the CSF
• Cloudy or turbid appearance.
• Elevated CSF pressure.
• High cell count with mostly polymorph nuclear cells.
• Low glucose level.
• Elevated protein level (also may be normal).
• Positive Gram stain and cultures (identifies the causative
organism).
DIAGNOSTIC INVESTIGATION

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• Complete blood count (CBC) total white blood cell count usually increased, with a preponderance of
young neutrophils in the differential blood.
• Blood, urine, and nasopharyngeal cultures to look for source of infection.
• Platelet count, serum electrolytes, glucose, blood urea nitrogen and creatinine, and urinalysis usually done
to monitor critically ill patient.
Additional laboratory studies include the following:

17. MANAGEMENT
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• Treatment is started with antibiotic on the basis of culture and sensitivity
report of CSF
• The commonly used antibiotics are:
• Penicillin with third generation cephalosporin's.
• Vancomycin with third generation Cephalosporin, if penicillin resistance suspected.
• Cefotaxine/Ceftriaxone with Aminoglycosides.
SPECIFIC TREATMENT

19. DURATION OF
ANTIBIOTIC THERAPY
 7-14 days depending upon the type of
organism
 3 weeks in case of gram negative
bacteria.
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• Seizure management
• For controlling seizures, Phenobarbitone 10
mg is given intravenously.
• Dilantin can also be given in a dose of 7
mg/kg body weight.
• Diazepam 2.5 mg may be give reduce
restlessness.
SYAMPTOMATIC TREATMENT

21. MANAGEMENT OF INCREASED
INTRA CRANIAL PRESSURE
• Mannitol -0.5 mg/kg body weight as
20% solution is administered
• Frusemide 1mg/kg body weight
may be given.
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22. FEVER AND HEADACHE
Aspirin or acetaminophen may
be used to manage fever and
headache
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• IV fluids to maintain fluid-electrolyte balance.
• Monitoring of neurological status.
• Patents with septic shock require Vasoactive drugs like epinephrine and
dopamine.
SUPPORTIVE CARE

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ACUTE COMPLICATION
seizures
Cerebral edema
Increased ICP
Shock
SIADH
LONG-TERM COMPLICATION
“Sensorineural hearing loss”
Hydrocephalus
Blindness
Learning disabilities
Developmental delays
COMPLICATIONS

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• Obtain a history from the parents about recent upper respiratory or other infection.
• Assess LOC and neurologic status.
• Evaluate for Kernig's sign with the child in the supine position and knees flexed, flex the leg at the hip so the
thigh is brought to a position perpendicular to the trunk.
• Attempt to extend the knee.
• If meningeal irritation is present, this cannot be done, and attempts to extend the knee result in pain.
• Evaluate for Brudzinski's sign
• flex the patient's neck.
• Spontaneous flexion of the lower extremities indicates meningeal irritation.
• Monitor breathing pattern and circulatory status
NURSING ASSESSMENT

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• Ineffective Tissue Perfusion: Cerebral related to endotoxin release into the CSF
• Hyperthermia related to infectious process
• Acute Pain related to neurologic effects from the disease process
• Risk for Infection transmission related to bacterial agents
• Ineffective Tissue Perfusion: Cerebral related to complications of infectious process
• Anxiety of parents related to severity of illness and hospitalization
NURSING DIAGNOSES

27. NURSING INTERVENTIONS
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• Administer antimicrobial agents at specified time intervals to obtain optimal serum levels.
• Maintain patent I.V. line for medication administration.
• observe for signs of infiltration and phlebitis.
• Monitor closely for signs of complications affecting cerebral perfusion.
• Monitor vital signs, LOC, and neurologic status at frequent intervals.
• Monitor intake and output, weight, and head circumference daily to assess for hydrocephalus.
• Be especially alert for lethargy or subtle changes in condition, which may indicate cerebral edema.
• Accurately chart child's behaviour and clinical signs
Maintaining Cerebral Tissue Perfusion

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• Reduce the general noise level around the child, and prevent sudden loud noises.
• Organize nursing care to provide for periods of uninterrupted rest.
• Keep general handling of the child at a minimum. When necessary, approach the child slowly
and gently.
• Maintain subdued lighting as much as possible.
• Speak in a low, well-modulated tone of voice.
• Medicate for pain as ordered, avoiding opioids that cause CNS and respiratory depression.
Relieving Pain and Irritability

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• Use precautions until at least 24 hours after initiation of appropriate antibiotic therapy.
• Practice careful hand-washing technique.
• Make sure that personnel with colds or other infections avoid contact with infants with
meningitis, and wear a mask when it is necessary to enter the nursery.
• Teach parents and other visitors proper hand-washing and gown techniques.
• Maintain sterile technique for procedures when indicated.
Preventing Transmission of Infection

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• Monitor for and report any of the following:
• Decreased respirations, decreased pulse rate, increased systolic BP, pupillary changes, or decreased
responsiveness, which may indicate increased ICP.
• Decreased urine volume and increased body weight, which may indicate SIADH.
• Sudden appearance of a skin rash and bleeding from other sites, which may indicate DIC.
• Persistent or recurring fever, bulging fontanelle, signs of increased ICP, focal neurologic signs,
seizures, or increased head circumference, which may indicate subdural effusion.
• Hearing disturbances and apparent deafness, indicating cranial nerve involvement.
Avoiding Complications

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• Observe for episodes ofapnea, and initiate measures to stimulate respiration.
• Institute respiratory monitoring.
• Stimulate the infant when apnea does occur.
• Pinch feet and provide more vigorous stimulation if necessary.
• When spontaneous respiration does not occur within 15 to 20 seconds, provide bag or mask ventilation.
• Report any periods of apnea.
• Record length of apnea episode and response to stimulation
Avoiding Complications

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• Encourage the parents to engage in quiet activities with their child, such as reading or
listening to soft music.
• Provide the parents with an opportunity to express their concerns and answer questions
they may have regarding the child's progress and care.
• Engage the parents in the supportive care of the child so they may feel some control over
the situation.
Allaying Parental Anxiety

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• Provide parents with appropriate information if they and other family members are to receive
antibiotic prophylaxis, usually one dose of rifampin (Rifadin).
• Discuss symptoms for which the parents should watch as signs of possible latent complications,
especially hydrocephalus
• Give specific instructions about medications tobe administered at home.
• Encourage regular health maintenance visits to chart growth and development and assess for any
delays.
• Parents can obtain more information about meningitis at the Centers for Disease Control
FAMILY EDUCATION AND HEALTH MAINTENANCE

35. PREVENTION
• These steps can help prevent
meningitis:
• Wash your hands.
• Practice good hygiene.
• Stay healthy.
• Cover your mouth
• Some forms of bacterial
meningitis are preventable
with the vaccinations
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36. THANK YOU
Syed.jinia92@gmail.com