SlideShare una empresa de Scribd logo
1 de 23
MUHIMBILI UNIVERSITY OF
HEALTH AND ALLIED
SCIENCESNURSING
   SCHOOL OF
  DEPARTMENT OF CLINICAL NURSING
  PEDIATRIC NURSING
  TOPIC:MANAGEMENT OF CHILD WITH
  MENINGITIS
  PRESENTER:SONGOMA JOHN
INTRODUCTION
Meningitis is an inflammation of the meninges
 , the protective membranes that surround the
 brain and spinal cord.
Common causes of meningitis may include:
 Bacteria, Virus, Fungi and Parasites.

 Most episodes of meningitis result from
  hematogenous seeding of infection from
  other sites to the meninges.
1. Bacterial causes
Varies with age:
1. Newborn to 3 months of age:
     E. coli and other coliforms, group B Streptococci,
     Listeria monocytogenes, Strep pneumoniae,
     H. influenza type b, Neisseria meningitidis

2.   Age 3 months to adolescence:
     N. meningitidis, S pneumoniae, H influenza type b
     (in young children)

     Mycobacterium tuberculosis is most common in
      young children, but can affect children of any
      age.
. Fungal Causes
   Common in immunocompromised patients.
    May include:Histoplasma , Coccidioides
    ,Paracoccidiodes ,Candida , Aspergilus
    Cryptococcus neoformans
   Viral Causes (aseptic meningitis) include:-
         Mumps
        Enterovirus (coxackie, polio)
        Adenovirus and
        Herpes simplex
Classification of meningitis
1. Based on duration, meningitis is classified as:
     Acute: symptoms present within a period of 0 –
      24 hrs
     Sub acute: symptoms lasting from 1-7 days.
     Chronic: symptoms lasting over 7 days


2. Based on aetiology:
     Bacterial meningitis
     Viral (aseptic) meningitis
     Fungal meningitis
Clinical Presentation: Symptoms
and signs
1. Young infants < 3 months: The signs and
  symptoms are non specific and may include:
   Fever or hypothermia
   Bulging fontanelle or acute increase in head
    circumference
   Convulsions / seizures
   High-pitched cry, irritability
   Lethargy, altered mental state
   Apnoea
   Poor feeding, vomiting.
2. Children > 3 months to adolescents:
   Fever   is present in about ~ 50% of patients.
    Headache,   photophobia, stiff neck, irritability or
     lethargy, vomiting and altered level of consciousness.
    Kerning’s sign in older children (inability to completely
     extend the leg).
 Brudzinski’s sign in older children (flexion at the
  knee in response to forward flexion of the neck).
 Convulsions in 20 – 30% of cases.

 Focal neurological deficits due to vasculitis or
  thrombosis of blood vessels.
 Papilledema (Swelling of the optic disc (where the
  optic nerve enters the eyeball); usually associated
  with an increase in intraocular pressure) is
  uncommon unless in advanced cases. This
  suggests increased intracranial pressure.
Laboratory Investigations
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
Laboratory Investigations cont.
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.
Investigations cont
6.Other examinations
   Electroencephalogram (EEG) if seizures are
    prominent.
   Head imaging (CT). Indications for CT are:
     Focal neurological examination findings,
     Seizures,
     Increasing head circumference,
     Lack of improvement despite appropriate treatment
      and
     Suspected brain abscess.
   CTshould only be done when the patient is
   stable.
Medical Treatment of Meningitis
pediatric
1. Triage and ensure the ABCDs.
2. IV line for IV medication and rehydration
3. Drug therapy.
Treatment of Bacterial meningitis 1

        Give antibiotic treatment as soon as
         possible:
         1. Infants < 3 month old:
              Ampicillin 200 mg/kg/day IV div q6hr,
               PLUS
              Cefotaxime 200 mg/kg/day IV div q6hr for
               10 to 14 days
Treatment of bacterial meningitis 2

      2. Age 3 months to < 18 years; choose on
        of the following regimens:

        1) Chloramphenicol 25 mg/kg IV (or IM) 6
         hourly, plus Ampicillin 50 mg/kg IV (or IM) 6
         hourly

        2) Chloramphenicol 25 mg/kg IV (or IM) 6
         hourly, plus Benzyl penicillin 6o mg/kg
         (100,000 IU /kg) IV or IM 6 hourly.
Treatment of bacterial meningitis 2

      2. Age 3 months to < 18 years; choose on
        of the following regimens:

        1) Chloramphenicol 25 mg/kg IV (or IM) 6
         hourly, plus Ampicillin 50 mg/kg IV (or IM) 6
         hourly

        2) Chloramphenicol 25 mg/kg IV (or IM) 6
         hourly, plus Benzyl penicillin 6o mg/kg
         (100,000 IU /kg) IV or IM 6 hourly.
Treatment of bacterial meningitis 3

   Alternative treatment:
       If Haemophilus influenza or Pneumococcus is
        common;
        1) Ceftriaxone 50 mg/kg IV or IM 12 hourly or 100
           mg/kg IV od for up to 10 – 14 days, or
        2) Cefotaxime 50 mg/kg every 6 hrs for 3 weeks.
Supportive Treatment
       Give paracetamol 15 mg/kg 6 – 8 hrly for
        fever (>38.50 C)
       IV fluids: isotonic fluids at maintenance
        rate (250 ml/24hrs).
       Feeding according to age requirement (75
        – 100 kcal/kg/day).
       Give anticonvulsant if convulsing
       Correct hypoglycemia if present
       NGT for feeding
       Physiotherapy
Nursing management
  Monitor vital signs 2-4 hrly (Temperature, Pulse
   rate, Oxygen saturation, BP, and Respiratory
   Rate)
 Monitor Input/output

 Give treatment as prescribed.

 Maintain a clear airway

• Turn the patient every 2 hours.
• Do not allow the child to lie in a wet bed.
• Pay attention to pressure points
 Monitor IV fluids very carefully and examine
   frequently for signs of fluid overload
   Nurses should monitor the child’s state of
    consciousness, respiratory rate and pupil size
    every 3 hours during the first 24 hours (thereafter,
    every 6 hours).
   On discharge, assess all children for neurological
    problems, especially hearing loss.
   Measure and record the head circumference of
    infants.
    If there is neurological damage, refer the child for
    physiotherapy, if possible, and give simple
    suggestions to the mother for passive exercises
Nursing management at
emergency
   Step one
   Triage according to clinical indicators.
   Step two
   Prioritise care. The nurse’s role is to prioritise
   Airway, Breathing and Circulation,
    accompanied by a rapid assessment of
    conscious level using the AVPU# scale.
 Step three
Follow with specific nursing assessments. These should
  include the following:
■ Assess for decreased cerebral tissue perfusion related to
  increased ICP:
– neurological observations, including blood pressure
  should be performed at intervals determined by the
  child’s clinical state
– assess for increased ICP
– monitor fluid and electrolyte status.
■ Assess for ineffective breathing pattern related to
  increased ICP:
Assess for potential for injury related to seizures:
– document characteristics of seizure activity-duration,
   characteristics of motor behaviour and post-ictal phase
– assess the patient’s environment for potential hazards.
■ Assess for alteration in fluid and electrolytes related to SIADH,
   DI, diuretics, fluid restrictions:
– monitor haemodynamic parameters
– monitor urine output
– monitor SG, urine electrolytes and osmolality.
■ Assess for alterations in comfort related to meningeal
   irritation, headache, photophobia, fever
– monitor temperature and assess effectiveness of comfort
   measures.
Reference

NSW HEALTH( 2010) Management of acute
 bacterial meningitis in infants and children
 Clinical Practice Guidelines
WHO (2005) POCKET BOOKOF Hospital care
 for children GUIDELINES FOR THE
 MANAGEMENT OF COMMON ILLNESSES
 WITH LIMITED RESOURCES

Más contenido relacionado

La actualidad más candente (20)

Meningitis
MeningitisMeningitis
Meningitis
 
Head injury and nursing management
Head injury and nursing managementHead injury and nursing management
Head injury and nursing management
 
BPAD
BPADBPAD
BPAD
 
Hydrocephalus disease
Hydrocephalus diseaseHydrocephalus disease
Hydrocephalus disease
 
Seizure and nursing care.
Seizure and nursing care.Seizure and nursing care.
Seizure and nursing care.
 
Pneumonia in children
Pneumonia in childrenPneumonia in children
Pneumonia in children
 
Meningitis
MeningitisMeningitis
Meningitis
 
Management For Meningitis
Management For MeningitisManagement For Meningitis
Management For Meningitis
 
Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT)
 
KANGAROO MOTHER CARE
KANGAROO MOTHER CAREKANGAROO MOTHER CARE
KANGAROO MOTHER CARE
 
Convulsive disorder
Convulsive disorderConvulsive disorder
Convulsive disorder
 
Meningitis In Children
Meningitis  In ChildrenMeningitis  In Children
Meningitis In Children
 
Hydrocephalus
HydrocephalusHydrocephalus
Hydrocephalus
 
Tef ppt copy
Tef ppt   copyTef ppt   copy
Tef ppt copy
 
Hydrocephalus
HydrocephalusHydrocephalus
Hydrocephalus
 
Encephalitis
EncephalitisEncephalitis
Encephalitis
 
Nephrotic syndrome in children
Nephrotic syndrome in childrenNephrotic syndrome in children
Nephrotic syndrome in children
 
NURSING CARE OF CHILDREN WITH AIDS/HIV
NURSING CARE OF CHILDREN WITH AIDS/HIVNURSING CARE OF CHILDREN WITH AIDS/HIV
NURSING CARE OF CHILDREN WITH AIDS/HIV
 
PAEDIATRICS HIV
PAEDIATRICS HIVPAEDIATRICS HIV
PAEDIATRICS HIV
 
cerebrovascular accident
cerebrovascular accidentcerebrovascular accident
cerebrovascular accident
 

Destacado (20)

Meningitis
MeningitisMeningitis
Meningitis
 
Meningitis
MeningitisMeningitis
Meningitis
 
Meningitis
MeningitisMeningitis
Meningitis
 
Meningitis ppt
Meningitis pptMeningitis ppt
Meningitis ppt
 
Meningitis
MeningitisMeningitis
Meningitis
 
Meningitis
MeningitisMeningitis
Meningitis
 
Meningitis Powerpoint
Meningitis PowerpointMeningitis Powerpoint
Meningitis Powerpoint
 
Meningitis clase
Meningitis claseMeningitis clase
Meningitis clase
 
Meningitis
MeningitisMeningitis
Meningitis
 
Tubercular meningitis
Tubercular meningitisTubercular meningitis
Tubercular meningitis
 
Tuberculous meningitis
Tuberculous meningitisTuberculous meningitis
Tuberculous meningitis
 
Meningococcal meningitis
Meningococcal meningitisMeningococcal meningitis
Meningococcal meningitis
 
Tuberculous meningitis
Tuberculous meningitisTuberculous meningitis
Tuberculous meningitis
 
Meninges
MeningesMeninges
Meninges
 
TB Meningitis
TB MeningitisTB Meningitis
TB Meningitis
 
Meningococcal meningitis
Meningococcal  meningitisMeningococcal  meningitis
Meningococcal meningitis
 
4 Meningococcal Meningitis
4 Meningococcal Meningitis4 Meningococcal Meningitis
4 Meningococcal Meningitis
 
meningitis
meningitismeningitis
meningitis
 
Chronic Pain syndromes
Chronic Pain syndromesChronic Pain syndromes
Chronic Pain syndromes
 
Postural control and Dynamics Presentation
Postural control and Dynamics PresentationPostural control and Dynamics Presentation
Postural control and Dynamics Presentation
 

Similar a Meningitis presentation

Meningitis in children
Meningitis in childrenMeningitis in children
Meningitis in childrendhanyav54
 
Convulsion and neonatal hyperthermia
Convulsion and neonatal hyperthermiaConvulsion and neonatal hyperthermia
Convulsion and neonatal hyperthermiaTheShraddha
 
Febrile seizures in emergency department
Febrile seizures in emergency departmentFebrile seizures in emergency department
Febrile seizures in emergency departmentTarek Kotb
 
Session 37_Neonatal Pneumonia.pptx
Session 37_Neonatal Pneumonia.pptxSession 37_Neonatal Pneumonia.pptx
Session 37_Neonatal Pneumonia.pptxAugustusCaesar7
 
Tuberculous Meningitis (TBM)
Tuberculous Meningitis (TBM)  Tuberculous Meningitis (TBM)
Tuberculous Meningitis (TBM) Ashok Rangi
 
National guidelines on pediatric TB
National guidelines on pediatric TBNational guidelines on pediatric TB
National guidelines on pediatric TBAbhijeet Deshmukh
 
meningitis-170320103315.pdf
meningitis-170320103315.pdfmeningitis-170320103315.pdf
meningitis-170320103315.pdfHajiDrammeh
 
Learning points emergency resuscitation
Learning points emergency resuscitationLearning points emergency resuscitation
Learning points emergency resuscitationAltaf Bhat
 
Convulsion and neonatal hyperthermia
Convulsion and neonatal hyperthermiaConvulsion and neonatal hyperthermia
Convulsion and neonatal hyperthermiaTheShraddha
 
Bacterial and bacterial-like sepsis in children - Susanna Esposito
Bacterial and bacterial-like sepsis in children - Susanna Esposito   Bacterial and bacterial-like sepsis in children - Susanna Esposito
Bacterial and bacterial-like sepsis in children - Susanna Esposito WAidid
 
acute flaccid paralysis and surveillance
acute flaccid paralysis and surveillanceacute flaccid paralysis and surveillance
acute flaccid paralysis and surveillanceapoorvaerukulla
 
Febrile convulsion 2019
Febrile convulsion    2019Febrile convulsion    2019
Febrile convulsion 2019nancygalaly
 
Febrile convulsions 2013
Febrile convulsions 2013Febrile convulsions 2013
Febrile convulsions 2013zahid mehmood
 

Similar a Meningitis presentation (20)

Meningitis in children
Meningitis in childrenMeningitis in children
Meningitis in children
 
Meningitis
MeningitisMeningitis
Meningitis
 
Convulsion and neonatal hyperthermia
Convulsion and neonatal hyperthermiaConvulsion and neonatal hyperthermia
Convulsion and neonatal hyperthermia
 
Neonatal sepsis
Neonatal sepsisNeonatal sepsis
Neonatal sepsis
 
CNS disorders in pediatrics
CNS disorders in pediatricsCNS disorders in pediatrics
CNS disorders in pediatrics
 
Neonatal sepsis
Neonatal sepsisNeonatal sepsis
Neonatal sepsis
 
Febrile seizures in emergency department
Febrile seizures in emergency departmentFebrile seizures in emergency department
Febrile seizures in emergency department
 
Session 37_Neonatal Pneumonia.pptx
Session 37_Neonatal Pneumonia.pptxSession 37_Neonatal Pneumonia.pptx
Session 37_Neonatal Pneumonia.pptx
 
Tuberculous Meningitis (TBM)
Tuberculous Meningitis (TBM)  Tuberculous Meningitis (TBM)
Tuberculous Meningitis (TBM)
 
National guidelines on pediatric TB
National guidelines on pediatric TBNational guidelines on pediatric TB
National guidelines on pediatric TB
 
Meningitis
MeningitisMeningitis
Meningitis
 
meningitis-170320103315.pdf
meningitis-170320103315.pdfmeningitis-170320103315.pdf
meningitis-170320103315.pdf
 
Learning points emergency resuscitation
Learning points emergency resuscitationLearning points emergency resuscitation
Learning points emergency resuscitation
 
MENINGITIS.pptx
MENINGITIS.pptxMENINGITIS.pptx
MENINGITIS.pptx
 
Convulsion and neonatal hyperthermia
Convulsion and neonatal hyperthermiaConvulsion and neonatal hyperthermia
Convulsion and neonatal hyperthermia
 
Bacterial and bacterial-like sepsis in children - Susanna Esposito
Bacterial and bacterial-like sepsis in children - Susanna Esposito   Bacterial and bacterial-like sepsis in children - Susanna Esposito
Bacterial and bacterial-like sepsis in children - Susanna Esposito
 
PROTOCOLS FOR NEONATES
PROTOCOLS FOR NEONATESPROTOCOLS FOR NEONATES
PROTOCOLS FOR NEONATES
 
acute flaccid paralysis and surveillance
acute flaccid paralysis and surveillanceacute flaccid paralysis and surveillance
acute flaccid paralysis and surveillance
 
Febrile convulsion 2019
Febrile convulsion    2019Febrile convulsion    2019
Febrile convulsion 2019
 
Febrile convulsions 2013
Febrile convulsions 2013Febrile convulsions 2013
Febrile convulsions 2013
 

Más de Songoma John

VENTILATION AND PERFUSION FOR NURSING ANATOMY
VENTILATION AND PERFUSION FOR NURSING ANATOMYVENTILATION AND PERFUSION FOR NURSING ANATOMY
VENTILATION AND PERFUSION FOR NURSING ANATOMYSongoma John
 
malnutrition case presentation
malnutrition case presentationmalnutrition case presentation
malnutrition case presentationSongoma John
 
Changes to maternal
Changes to maternalChanges to maternal
Changes to maternalSongoma John
 
CHILD SHOULD NOT BE TREATED AS MIN ADULT
CHILD SHOULD NOT BE TREATED AS MIN ADULTCHILD SHOULD NOT BE TREATED AS MIN ADULT
CHILD SHOULD NOT BE TREATED AS MIN ADULTSongoma John
 
DIABETIC PRESENTATION
DIABETIC PRESENTATIONDIABETIC PRESENTATION
DIABETIC PRESENTATIONSongoma John
 

Más de Songoma John (6)

VENTILATION AND PERFUSION FOR NURSING ANATOMY
VENTILATION AND PERFUSION FOR NURSING ANATOMYVENTILATION AND PERFUSION FOR NURSING ANATOMY
VENTILATION AND PERFUSION FOR NURSING ANATOMY
 
malnutrition case presentation
malnutrition case presentationmalnutrition case presentation
malnutrition case presentation
 
Changes to maternal
Changes to maternalChanges to maternal
Changes to maternal
 
CHILD SHOULD NOT BE TREATED AS MIN ADULT
CHILD SHOULD NOT BE TREATED AS MIN ADULTCHILD SHOULD NOT BE TREATED AS MIN ADULT
CHILD SHOULD NOT BE TREATED AS MIN ADULT
 
DIABETIC PRESENTATION
DIABETIC PRESENTATIONDIABETIC PRESENTATION
DIABETIC PRESENTATION
 
Trancheosophagial
TrancheosophagialTrancheosophagial
Trancheosophagial
 

Último

VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service LucknowVIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknownarwatsonia7
 
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy GirlsCall Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girlsnehamumbai
 
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Call Girls Service Noida Maya 9711199012 Independent Escort Service Noida
Call Girls Service Noida Maya 9711199012 Independent Escort Service NoidaCall Girls Service Noida Maya 9711199012 Independent Escort Service Noida
Call Girls Service Noida Maya 9711199012 Independent Escort Service NoidaPooja Gupta
 
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...saminamagar
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls ServiceCall Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Servicesonalikaur4
 
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...narwatsonia7
 
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Miss joya
 
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000aliya bhat
 
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort ServiceCall Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Serviceparulsinha
 
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Glomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxGlomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxDr.Nusrat Tariq
 
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...rajnisinghkjn
 
Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptxDr.Nusrat Tariq
 
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...narwatsonia7
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipurparulsinha
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceNehru place Escorts
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformKweku Zurek
 

Último (20)

VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service LucknowVIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
 
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy GirlsCall Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
 
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Call Girls Service Noida Maya 9711199012 Independent Escort Service Noida
Call Girls Service Noida Maya 9711199012 Independent Escort Service NoidaCall Girls Service Noida Maya 9711199012 Independent Escort Service Noida
Call Girls Service Noida Maya 9711199012 Independent Escort Service Noida
 
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...call girls in Connaught Place  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
call girls in Connaught Place DELHI 🔝 >༒9540349809 🔝 genuine Escort Service ...
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
 
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls ServiceCall Girls Thane Just Call 9910780858 Get High Class Call Girls Service
Call Girls Thane Just Call 9910780858 Get High Class Call Girls Service
 
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
 
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
 
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000Ahmedabad Call Girls CG Road 🔝9907093804  Short 1500  💋 Night 6000
Ahmedabad Call Girls CG Road 🔝9907093804 Short 1500 💋 Night 6000
 
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort ServiceCall Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
 
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
 
Glomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxGlomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptx
 
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
 
Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptx
 
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
Russian Call Girls Chickpet - 7001305949 Booking and charges genuine rate for...
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
 
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy Platform
 

Meningitis presentation

  • 1. MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCESNURSING SCHOOL OF DEPARTMENT OF CLINICAL NURSING PEDIATRIC NURSING TOPIC:MANAGEMENT OF CHILD WITH MENINGITIS PRESENTER:SONGOMA JOHN
  • 2. INTRODUCTION Meningitis is an inflammation of the meninges , the protective membranes that surround the brain and spinal cord. Common causes of meningitis may include:  Bacteria, Virus, Fungi and Parasites.  Most episodes of meningitis result from hematogenous seeding of infection from other sites to the meninges.
  • 3. 1. Bacterial causes Varies with age: 1. Newborn to 3 months of age: E. coli and other coliforms, group B Streptococci, Listeria monocytogenes, Strep pneumoniae, H. influenza type b, Neisseria meningitidis 2. Age 3 months to adolescence: N. meningitidis, S pneumoniae, H influenza type b (in young children) Mycobacterium tuberculosis is most common in young children, but can affect children of any age.
  • 4. . Fungal Causes  Common in immunocompromised patients. May include:Histoplasma , Coccidioides ,Paracoccidiodes ,Candida , Aspergilus Cryptococcus neoformans  Viral Causes (aseptic meningitis) include:- Mumps Enterovirus (coxackie, polio) Adenovirus and Herpes simplex
  • 5. Classification of meningitis 1. Based on duration, meningitis is classified as:  Acute: symptoms present within a period of 0 – 24 hrs  Sub acute: symptoms lasting from 1-7 days.  Chronic: symptoms lasting over 7 days 2. Based on aetiology:  Bacterial meningitis  Viral (aseptic) meningitis  Fungal meningitis
  • 6. Clinical Presentation: Symptoms and signs 1. Young infants < 3 months: The signs and symptoms are non specific and may include:  Fever or hypothermia  Bulging fontanelle or acute increase in head circumference  Convulsions / seizures  High-pitched cry, irritability  Lethargy, altered mental state  Apnoea  Poor feeding, vomiting.
  • 7. 2. Children > 3 months to adolescents:  Fever is present in about ~ 50% of patients.  Headache, photophobia, stiff neck, irritability or lethargy, vomiting and altered level of consciousness.  Kerning’s sign in older children (inability to completely extend the leg).
  • 8.  Brudzinski’s sign in older children (flexion at the knee in response to forward flexion of the neck).  Convulsions in 20 – 30% of cases.  Focal neurological deficits due to vasculitis or thrombosis of blood vessels.  Papilledema (Swelling of the optic disc (where the optic nerve enters the eyeball); usually associated with an increase in intraocular pressure) is uncommon unless in advanced cases. This suggests increased intracranial pressure.
  • 9. Laboratory Investigations 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
  • 10. Laboratory Investigations cont. 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.
  • 11. Investigations cont 6.Other examinations  Electroencephalogram (EEG) if seizures are prominent.  Head imaging (CT). Indications for CT are:  Focal neurological examination findings,  Seizures,  Increasing head circumference,  Lack of improvement despite appropriate treatment and  Suspected brain abscess.  CTshould only be done when the patient is stable.
  • 12. Medical Treatment of Meningitis pediatric 1. Triage and ensure the ABCDs. 2. IV line for IV medication and rehydration 3. Drug therapy.
  • 13. Treatment of Bacterial meningitis 1  Give antibiotic treatment as soon as possible: 1. Infants < 3 month old:  Ampicillin 200 mg/kg/day IV div q6hr, PLUS  Cefotaxime 200 mg/kg/day IV div q6hr for 10 to 14 days
  • 14. Treatment of bacterial meningitis 2 2. Age 3 months to < 18 years; choose on of the following regimens: 1) Chloramphenicol 25 mg/kg IV (or IM) 6 hourly, plus Ampicillin 50 mg/kg IV (or IM) 6 hourly 2) Chloramphenicol 25 mg/kg IV (or IM) 6 hourly, plus Benzyl penicillin 6o mg/kg (100,000 IU /kg) IV or IM 6 hourly.
  • 15. Treatment of bacterial meningitis 2 2. Age 3 months to < 18 years; choose on of the following regimens: 1) Chloramphenicol 25 mg/kg IV (or IM) 6 hourly, plus Ampicillin 50 mg/kg IV (or IM) 6 hourly 2) Chloramphenicol 25 mg/kg IV (or IM) 6 hourly, plus Benzyl penicillin 6o mg/kg (100,000 IU /kg) IV or IM 6 hourly.
  • 16. Treatment of bacterial meningitis 3  Alternative treatment:  If Haemophilus influenza or Pneumococcus is common; 1) Ceftriaxone 50 mg/kg IV or IM 12 hourly or 100 mg/kg IV od for up to 10 – 14 days, or 2) Cefotaxime 50 mg/kg every 6 hrs for 3 weeks.
  • 17. Supportive Treatment  Give paracetamol 15 mg/kg 6 – 8 hrly for fever (>38.50 C)  IV fluids: isotonic fluids at maintenance rate (250 ml/24hrs).  Feeding according to age requirement (75 – 100 kcal/kg/day).  Give anticonvulsant if convulsing  Correct hypoglycemia if present  NGT for feeding  Physiotherapy
  • 18. Nursing management  Monitor vital signs 2-4 hrly (Temperature, Pulse rate, Oxygen saturation, BP, and Respiratory Rate)  Monitor Input/output  Give treatment as prescribed.  Maintain a clear airway • Turn the patient every 2 hours. • Do not allow the child to lie in a wet bed. • Pay attention to pressure points  Monitor IV fluids very carefully and examine frequently for signs of fluid overload
  • 19. Nurses should monitor the child’s state of consciousness, respiratory rate and pupil size every 3 hours during the first 24 hours (thereafter, every 6 hours).  On discharge, assess all children for neurological problems, especially hearing loss.  Measure and record the head circumference of infants.  If there is neurological damage, refer the child for physiotherapy, if possible, and give simple suggestions to the mother for passive exercises
  • 20. Nursing management at emergency  Step one  Triage according to clinical indicators.  Step two  Prioritise care. The nurse’s role is to prioritise  Airway, Breathing and Circulation, accompanied by a rapid assessment of conscious level using the AVPU# scale.
  • 21.  Step three Follow with specific nursing assessments. These should include the following: ■ Assess for decreased cerebral tissue perfusion related to increased ICP: – neurological observations, including blood pressure should be performed at intervals determined by the child’s clinical state – assess for increased ICP – monitor fluid and electrolyte status. ■ Assess for ineffective breathing pattern related to increased ICP:
  • 22. Assess for potential for injury related to seizures: – document characteristics of seizure activity-duration, characteristics of motor behaviour and post-ictal phase – assess the patient’s environment for potential hazards. ■ Assess for alteration in fluid and electrolytes related to SIADH, DI, diuretics, fluid restrictions: – monitor haemodynamic parameters – monitor urine output – monitor SG, urine electrolytes and osmolality. ■ Assess for alterations in comfort related to meningeal irritation, headache, photophobia, fever – monitor temperature and assess effectiveness of comfort measures.
  • 23. Reference NSW HEALTH( 2010) Management of acute bacterial meningitis in infants and children Clinical Practice Guidelines WHO (2005) POCKET BOOKOF Hospital care for children GUIDELINES FOR THE MANAGEMENT OF COMMON ILLNESSES WITH LIMITED RESOURCES