meningitis final

8/10/2019 Meningitis Final

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MENINGITIS

Galvez, Cindel Paulen Feliz

Go, Shiela May

Lamzon, Mary Pauline


2/22

Meningitisis an inflammation of the

membranes (meninges) surrounding yourbrain and spinal cord.

Common causes of meningitis may include: Bacteria, Virus, Fungi and Parasites.

Most episodes of meningitis result from

hematogenous seeding of infection fromother sites to the meninges.


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Causative Agents

Type Pathogen (most Common)

Bacterial Strep pneumoniae,Neisseriameningitis

Viral infection Coxsackie Virus, Echovirus, Arbovirus,

HIV,

TB meningitis M. Tuberculosis

Protozoal Infection Toxoplasma Gondii (toxoplasmosis)

Fungal infection Cryptococcus neoformans (cryptococcalmeningitis)


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Signs and Symptoms

Fever Severe, persistent

headache

Neck stiffness and pain

that makes it difficult totouch your chin to yourchest

Nausea and vomiting

Confusion anddisorientation

Drowsiness orsluggishness

Sensitivity to bright light Poor appetite

More severe symptomsinclude seizure and coma

In infants, symptoms mayinclude fever, irritability,poor feeding, andlethargy.

Skin rashRapid breathing


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DIAGNOSTIC EXAM

1. CSF

Lumbar puncture or a shunt tap is performed as

soon as the diagnosis of meningitis is suspected.

CSF should be examined for:

Microbiology and

Biochemistry


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2. C-Reactive protein (CRP).

3. Blood culture and other cultures (urine,

abscess, and middle ear).

4. Full Blood Picture (CBC) and ESR.

5. Serum electrolytes, BUN, Creatinine.

6. Urine test, to check for infection in theurinary tract.


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6.Other examinations

Electro encephalogram (EEG) if seizures areprominent.

Head imaging (CT). Indications for CT are:

(CT scan or MRI, to look for swelling of brain tissue or

for complications such as brain damage.)

Focal neurological examination findings, Seizures,

Increasing head circumference,

Lack of improvement despite appropriate treatment

and Suspected brain abscess.

CT should only be done when the patient is stable.


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CHAIN OF TRANSMISSION

HUMANNASAL AND

BUCCAL

SECRETION

DIRECTLY: touching,

kissing, coughing,

sneezing, etc

INDIRCTLY:

contaminating a formite

then handing it off

NOSE

AND

MOUTH

YOUNG CHILDREN ,

IMMUNOCOMPRO

MISED PERSON,

elderly people


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WHO ARE AT RISK?

Age -- Most cases of viral meningitis occur in childrenyounger than age 5. Bacterial meningitis commonlyaffects people under 20, especially those living incommunity settings.

Living in a community setting -- College students livingin dormitories, personnel on military bases, andchildren in boarding schools and child care facilities areat increased risk of meningococcal meningitis. This

increased risk likely occurs because the bacterium isspread by the respiratory route and tends to spreadquickly wherever large groups congregate.


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Skipping vaccinations --If you or your child

hasn't completed the recommended

childhood or adult vaccination schedule, therisk of meningitis is higher.

Pregnancy -- If you're pregnant, you're at

increased risk of contracting listeriosis aninfection caused by listeria bacteria, which

also may cause meningitis. If you have

listeriosis, your unborn baby is at risk, too.


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Compromised immune system -- Factors that

may compromise your immune system

including AIDS, alcoholism, diabetes and use

of immunosuppressant drugs also make

you more susceptible to meningitis. Removal

of your spleen, an important part of your

immune system, also may increase your risk


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PREVELANCE/INCIDENCE

Approximately 70 percent of meningitis cases occur inchildren under the age of 5 and in people over the age of 60. In

the United States, bacterial meningitis affects about 4,000

people each year, and viral meningitis affects about 10 people

in 100,000. Hib vaccine has reduced U.S. incidence of bacterial

meningitiscaused byHaemophilus influenzaetype b by

approximately 90 percent. The disease is more prevalent in

people between the ages of 15 and 24 who have not been

vaccinated.

Worldwide, bacterial resistance to penicillin and other

antibiotics and the lack of access to vaccines accounts for

rising rates of bacterial meningitis.


13/22

PREVELANCE/INCIDENCE

Childhood meningitis in the conjugate vaccine

era: a prospective cohort studyManish Sadarangani1, Louise Willis1, Seilesh Kadambari2, Stuart Gormley3, Zoe

Young1, Rebecca Beckley1, Katherine Gantlett1, Katharine Orf4, Sarah

Blakey4, Natalie G Martin1, Dominic F Kelly1, Paul T Heath2, Simon

Nadel3, Andrew J Pollard1
http://adc.bmj.com/search?author1=Manish+Sadarangani&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Louise+Willis&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Seilesh+Kadambari&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Zoe+Young&sortspec=date&submit=Submithttp://adc.bmj.com/search?author1=Zoe+Young&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Rebecca+Beckley&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Katherine+Gantlett&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Katharine+Orf&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Sarah+Blakey&sortspec=date&submit=Submithttp://adc.bmj.com/search?author1=Sarah+Blakey&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Natalie+G+Martin&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Dominic+F+Kelly&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Paul+T+Heath&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Simon+Nadel&sortspec=date&submit=Submithttp://adc.bmj.com/search?author1=Simon+Nadel&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Andrew+J+Pollard&sortspec=date&submit=Submithttp://adc.bmj.com/search?author1=Andrew+J+Pollard&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Simon+Nadel&sortspec=date&submit=Submithttp://adc.bmj.com/search?author1=Simon+Nadel&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Paul+T+Heath&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Dominic+F+Kelly&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Natalie+G+Martin&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Sarah+Blakey&sortspec=date&submit=Submithttp://adc.bmj.com/search?author1=Sarah+Blakey&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Katharine+Orf&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Katherine+Gantlett&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Rebecca+Beckley&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Zoe+Young&sortspec=date&submit=Submithttp://adc.bmj.com/search?author1=Zoe+Young&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Seilesh+Kadambari&sortspec=date&submit=Submithttp://adc.bmj.com/search?author1=Seilesh+Kadambari&sortspec=date&submit=Submithttp://adc.bmj.com/search?author1=Seilesh+Kadambari&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Louise+Willis&sortspec=date&submit=Submithttp://adc.bmj.com/content/early/2014/09/25/archdischild-2014-306813.abstracthttp://adc.bmj.com/search?author1=Manish+Sadarangani&sortspec=date&submit=Submit


14/22

Abstract

Bacterial conjugate vaccines have dramatically changed

the epidemiology of childhood meningitis; viral causes areincreasingly predominant, but the current UK epidemiology isunknown. This prospective study recruited children under16 years of age admitted to 3 UK hospitals with suspectedmeningitis. 70/388 children had meningitis13 bacterial, 26viral and 29 with no pathogen identified. Group BStreptococcus was the most common bacterial pathogen.Infants under 3 months of age with bacterial meningitis weremore likely to have a reduced Glasgow Coma Score andrespiratory distress than those with viral meningitis or otherinfections. There were no discriminatory clinical features in

older children. Cerebrospinal fluid (CSF) white blood cellcount and plasma C-reactive protein at all ages, and CSFprotein in infants


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PATHOPYSIOLOGY


16/22

Entry of basophils and

macrophages

Accumulation of fluid

and pus

InflamationFever

Entry of virus/bacteria to the

nasopharyngeal area

Non-Modifiable Risk Factors:

- Age

Modifiable Risk Factors:

Environment

Immune system

Poor hygiene

Invasion of virus/bacteria to the

respiratory tract: cough

Accumulates to blood stream goingto the brain and spine

Virus/bacteria colonize in the

Cerebro Spinal Fluid and Meninges

Release pyrogenic cytokines

Goes to blood vessle and signals the brain

Stimulates hypothalamus to

increase thermostats

Destruction of cells in the meninges

Release of chemical mediators: cytokin,

pyrogen

Menigeal irritabil ity

Pain: headache


17/22

Blank

Staring

Increased Intracrainal

pressure

Compression of brain and

Spine: Altered motor activity

Compression of Pons,

hypothalamus,

cerebrum

comaDrowziness

Compressed

Thoracic 6 (T6)

Stomach

upset:vomitting

Compressed

Cervical 2 (C2)

Stiff neck


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MEDICAL INTERVENTION

1)Give antibiotic treatment as soon as possible ( e.g.

Ampicillin plus Cefotaxime, Chloramphenicol plus

Ampicillin,Chloramphenicol plus Benzyl penicillin)

2)Give antipyretic drug if fever is present.

3)IV Fluids

4)Anticonvulsant if convulsing.

5)Medicines to treat pressure on the brain.(mannitol,

dexamethasone)


19/22

NURSING DIAGNOSIS

Deficient fluid volume related to increase

intracranial pressure as evidenced by

vomiting, altered level of consciousness, poor

skin turgor, dry lips, dry buccal mucosa.


20/22

Monitor vital signs(temp.,RR,PR)

Monitor Input/output

Monitor IV fluids very carefully and examinefrequently for signs of fluid overload

Increase fLuid intake

Oral care Observe standard precautions to prevent dse.

transmission.


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NURSING DIAGNOSIS

Hyperthermia related to inflammation of

meninges as evidenced by skin is warm to

touch, irritability, weak in appearance,

increase CSF WBC


22/22

NURSING INTERVENTION

Monitor vital signs(temperature)

Provide tepid sponge bath and cold compress

Increase fluid intake

Change clothing to loose and comfortable ones

after seizure roll pt. to side/semiprone-facilitate

gravity, drainage of secretions.

administer antibiotics with strict administration

schedule.

meningitis final

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