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MENINGITIS Key signs and symptoms • Nuchal rigidity that may progress to opisthotonos • Positive

Brudzinski’s sign (the child flexes the knees and hips in response to passive neck flexion) • Positive
Kernig’s sign (inability to extend the leg when the hip and knee are flexed) Key test results • Lumbar
puncture shows increased CSF pressure, cloudy color, increased white blood cell count and protein level,
and decreased glucose level if meningitis is caused by bacteria. • Culture and sensitivity of CSF identifies
the causative organism. • Xpert EV test helps distinguish between viral and bacterial meningitis. Key
treatments • Analgesics to treat the pain of meningeal irritation • Corticosteroid: dexamethasone
(Decadron) • Droplet precautions (should be maintained until at least 24 hours of effective antibiotic
therapy have elapsed; continued isolation recommended for meningitis caused by Haemophilus
influenzae or Neisseria meningitidis) • Antibiotics (based on results of CSF culture and sensitivity):
ceftazidime (Fortaz), ceftriaxone (Rocephin) • Seizure precautions Key interventions • Monitor vital
signs and intake and output. • Assess the child’s neurologic status frequently. • Examine the young
infant for bulging fontanels, and measure head circumference.

Meningitis Meningitis is an inflammation of the brain and spinal cord meninges. It’s most common in
infants and toddlers but can occur in other age groups as well. The incidence of meningitis is greatly
reduced with routine Haemophilus influenzae type B vaccine. CAUSES • Viral or bacterial agents,
transmitted by the spread of droplets (organisms enter the blood from the nasopharynx or middle ear)

ASSESSMENT FINDINGS • Nuchal rigidity that may progress to opisthotonos (arching of the back) •
Headache • Fever • High-pitched cry • Irritability • Delirium • Coma • Petechial or purpuric lesions
possibly present in bacterial meningitis • Positive Brudzinski’s sign (the child flexes the knees and hips in
response to passive neck flexion) • Positive Kernig’s sign (inability to extend the leg when the hip and
knee are flexed) • Projectile vomiting • Seizures (may occur) DIAGNOSTIC TEST RESULTS • Lumbar
puncture shows increased CSF pressure, cloudy color, increased white blood cell count and protein level,
and decreased glucose level if the meningitis is caused by bacteria. • Culture and sensitivity of CSF
identifies the causative organism. • Xpert EV test helps distinguish between viral and bacterial
meningitis. NURSING DIAGNOSES • Decreased intracranial adaptive capacity • Ineffective breathing
pattern • Risk for injury TREATMENT • Droplet precautions (should be maintained until at least 24 hours
of effective antibiotic therapy have elapsed; continued precautions recommended for meningitis caused
by H. influenzae or Neisseria meningitidis) • Hypothermia blanket • Oxygen therapy may require
intubation and mechanical ventilation to induce hyperventilation to decrease ICP • Seizure precautions
• Treatment for coexisting conditions • Burr holes to evacuate subdural effusion, if present

Drug therapy • Analgesics to treat the pain of meningeal irritation • Corticosteroid: dexamethasone
(Decadron) • Antibiotics (based on results of CSF culture and sensitivity): ceftazidime (Fortaz),
ceftriaxone (Rocephin) INTERVENTIONS AND RATIONALES • Monitor vital signs and intake and output to
assess for excess fluid volume. • Assess the child’s neurologic status frequently to monitor for signs of
increased ICP. • Provide a dark and quiet environment. Environmental stimuli can increase ICP or
stimulate seizure activity. • Maintain seizure precautions to prevent injury. • Administer medications as
ordered to combat infection and decrease ICP. • Move the child gently to prevent a rise in ICP. •
Maintain isolation precautions as ordered to prevent the spread of infection. • Provide emotional
support for the family to decrease anxiety. • Examine the young infant for bulging fontanels, and
measure head circumference; hydrocephalus is a complication that can result from meningitis. Teaching
topics • Explanation of the disorder and treatment plan • Medication use and possible adverse effects •
Understanding the importance of isolation and sanitation

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