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Bacterial Meningitis Kayla F, Precious S, Christian R,, Sabrea Ewing,…
Bacterial Meningitis
Kayla F, Precious S, Christian R,, Sabrea Ewing, Cristina Tobias, Loan Tran
Pathophysiology
Bacterial Meningitis is acute inflammation of the meninges and CSF. Bacteria enters into the CSF and bacterial growth occurs within that compartment of the body leading to the inflammation and within the CSF and the adjacent brain tissue. Enters into the body by TBI, microrganisms within the nasopharynx (most common).
Clinical Manifestations are different for each age group are different
Children and Adolescents: Fever, Chills, headache, and vomiting
Infants and young children: Fever, hypothermia, poor feeding, vomiting, marked irritability, restlessness, seizures, bulging or tense fontanel, marked by hight pitch crying.
Pharmacology
*Antibiotics are the main therapy
Dexamethasone
(corticosteroid)
controversial use in reducing long term complications of bacterial meningitis when given with the first dose of antibiotics
Ceftriaxone
(cephalosporin)
superior treatment
sterilizes the CSF
reduced incidence of hearing impairment
Vancomycin
(glycopeptide)
given until antibiotic susceptibility test results are available
Prevention Strategy
Meningococcal Vaccination
Recommended age 11-12 + booster at 16
High risk children can receive vaccine as early as 2 months
Additional Measures
IV Hydration
Labs and Diagnostic Tests
Lumbar puncture
-
most definitive Dx test
; fluid pressure measured and samples obtained for gram stain cultures of cerebrospinal fluid
Nursing considerations:
Sedation with fentanyl and midazolam can help alleviate pain and prevent crying (crying can affect accurate interpretation of spinal fluid pressure)
Can apply topical anesthetics (LMX (4% lidocaine) or EMLA cream (mix of lidocaine and prilocaine)) to reduce pain during lumbar puncture
Dx typically positive if:
Increased spinal fluid pressure
Increased WBC count
Decreased glucose levels
Increased protein concentration
Serum glucose sample
- usually taken half an hour before lumbar puncture
Blood culture
- can help further identify bacterial organism; may occasionally be positive when CSF bacterial culture is negative
Patient Safety Considerations
Initiating seizure precautions (padded bed rails)
Fall risk
Place patient on droplet precautions
Maintenance of ventilation
Quality Patient Outcomes
Patient is able to tolerate fluids and foods appropriate for their age group
Patient and family are able to recognize early S&S of meningitis
Antibiotics given as soon as definitive diagnosis is established
Cerebral edema is prevented
Early isolation to prevent further exposure
Side effects are adequately managed
Neurological complications prevented
Nursing Interventions/ Nursing Care
Teach parents proper hand washing
Reduce stimuli (patients more sensitive to light)
Use pillows alongside child in side-lying position & btwn knees for comfort in cases of nuchal rigidity (neck stiffness)
Evaluate pain & implement relief measures, e.g. elevating HOB 30 degrees, & fall prevention
Monitor intake, urine output, LOC, VS, pertinent labs, and open fontanels (for infants)
Maintain IV infusion (10 days of abx, typically intermittent) and adequate hydration status
Observe for complications of increased ICP, shock, and/or respiratory distress (administer oxygen as needed)
Prevention through vaccination
The evidence strongly suggests that all children should be immunized against the
most common organisms responsible for bacterial meningitis (i.e., H. influenzae
The evidence strongly suggests that all children should be immunized against the
most common organisms responsible for bacterial meningitis (i.e., H. influenzae
type b, S. pneumoniae, and Neisseria meningitidis) as prevention to decrease the
type b, S. pneumoniae, and Neisseria meningitidis) as prevention to decrease the
incidence of bacterial meningitis. Nurses should stress to the parents, children,
adolescents, and young adults the importance of adhering to the immunization
schedule to protect against serious childhood diseases
Nurses should stress to the parents, children,
adolescents, and young adults the importance of adhering to the immunization
schedule to protect against serious childhood diseases.