Meningitis

usefull for BSc nursing students

1. MENINGITIS: DEFINITION: Meningitis is defined as an inflammation of the meninges covering the brain and spinal cord. 1

2. CLASSIFICATION: Depending upon the etiological agent, meningitis is of three types: Bacterial or pyogenic meningitis Aseptic meningitis Tubercular meningitis 2

3. ETIOLOGY: In infant, acute bacterial meningitis may be caused by variety of bacteria like E.coli Pseudomonas Klebsiella Streptococcus Staphylococcus β hemolytic streptococcus. In infants younger than 2months, group B Streptococci & E.coli account for 70% cases. 3

4. PATHOPHYSIOLOGY: Infection from any part of the body like nasopharynx Organisms invade surrounding blood vessels Through blood, organisms enter cerebrospinal fluid Infection spread through subarachnoid space Inflammatory process begins 4

5. Increase in CSF exudation in ventricles CSF flow through ventricular aqueduct Thrombophlebitis of cerebral vessels Infection of cerebral cortex, cerebral damage 5 Co n t…..

6. CLINICAL FEATURES: Clinical features in neonates include: Poor feeding Vomiting Diarrhea Lethargy Weak cry Sleepiness 6

7. Clinical feature of infant older than 3 months include: Fever Irritability Poor feeding Vomiting High pitch cry Seizures Nuchal rigidity 7

8. Clinical features in children older than 3 years include: Fever, chills and malaise Headache, vomiting, papilledema There are signs of meningeal irritation like: Nuchal rigidity Positive Brudzinski’s sign Positive kernig’s sign Photophobia Delirium, deep coma or stupor 8

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10. DIAGNOSTIC EVALUATION: Lumbar puncture CSF examination Blood examination Computed tomography & MRI 10

11. MANAGEMENT: Treatment of meningitis include: 11 Specific treatment: Treatment is started with antibiotic, commonly used antibiotics are (Cephalosporins, Vancomycin, Cefotaxine) for 7-14 days & 3 weeks for gram negative bacteria. Symptomatic treatment: Seizure management: phenobarbitone, Dilantin & Diazepam Management of intracranial pressure: Mannitol, Frusemide Fever and headache: Aspirin or acetaminophen

12. c) Supportive care: I/V fluids to maintain fluid- electrolyte balance, monitor neurological status, in shock condition requires vasoactive drugs like epinephrine and dopamine. 12

13. NURSING MANAGEMENT: Isolate the child Administration of drugs Control seizures and protect the child from injury Maintain fluid intake and nutrition Provide comfort and rest Monitor the child’s condition Parental guidance and support 13

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