neurosensory and musculoskeletal disorder: meningitis

Question 1

acute neurological disorders

Answer 1

meningitis

reye syndrome

Question 2

meningitis

Answer 2

inflammation of the cerebrospinal fluid (csF) and meninges.

Question 3

reye syndrome

Answer 3

life-threatening disorder that involves acute encephalopathy and fatty changes of the liver.

Question 4

viral meningitis care required?

Answer 4

usually requires

only supportive care for recovery.

Question 5

bacterial meningitis contagious or not

Answer 5

contagious

Question 6

viral meningits risk factors

Answer 6

• Cytomegalovirus (CMV)
• adenovirus, mumps, herpes simplex virus
• arbovirus

Question 7

bacterial meningitis risk factors

Answer 7

• Neisseria meningitidis (meningococcal)
• Streptococcus pneumoniae (pneumococcal)
• Haemophilus influenzae type B (Hib)
  Escherichia coli

Question 8

meningits risk factors

Answer 8

• 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

Question 9

meningitis expected findings

Answer 9

• Photophobia
  ● Nausea
  ● Irritability
  ● Headache

Question 10

meningitis newborn expected findings

Answer 10

• 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

Question 11

meningitis expected findings 3m to 2 y

Answer 11

• 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

Question 12

meningitis expected findings 2y through adolescence

Answer 12

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

Question 13

deliberate flexion

Answer 13

flexion of extremities occurring with deliberate flexion of the child’s neck

Question 14

brudzinki sign

Answer 14

severe neck stiffness causes hips and knees to flex when neck is flexed upwards

Question 15

kernig sign

Answer 15

unable to striaghten leg greater than 135 degrees without pain

Question 16

diagnosing meningitis

Answer 16

Send Blood cultures, CBC

CSF analysis indicative of meningitis

Question 17

meningitis bacterial analysis of csf

Answer 17

• Cloudy color
• Elevated WBC count, elevated protein
• Decreased glucose content
• Positive Gram stain
• high protein

Question 18

meningitis viral analysis of csf

Answer 18

• Clear color
• Slightly elevated WBC count
• Normal or slightly elevated protein content
• Normal glucose content
• Negative Gram stain

Question 19

meningitis lumbar puncture how is it done

Answer 19

• 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.

Question 20

prepping & procedure a lumbar puncture

Answer 20

• 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.

Question 21

ct or mri

Answer 21

Performed to identify increased (ICP) or
abscess.

• Assist with positioning.
  Administer sedatives as prescribed.

Question 22

what requires immediate attention for meningitis

Answer 22

petechiae or purple rash

Question 23

isolate precautions for meningitis

Answer 23

• 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.

Question 24

nursing care for meningitis

Answer 24

• 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.

Question 25

antibiotics

Answer 25

- 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

Question 26

corticosteroids: dexamethasone

Answer 26

- 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

Question 27

analgesics

Answer 27

- 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

Question 28

complications of meningitis increased intracranial pressure newborns

Answer 28

- 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).

Question 29

increased intracranial pressure children

Answer 29

- 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).

Question 30

s/s of increased icp in newborns and infants

Answer 30

bulging fontanels, increased head circumference, high-pitched cry, distended scalp veins, irritability, bradycardia, and respiratory change.

Question 31

s/s for increased icp children

Answer 31

- 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).