aseptic meningitis—nonbacterial most commonly viral in etiology. associated with mumps, measles,...
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Aseptic meningitis—NONbacterialMost commonly viral in etiology. Associated with mumps, measles, herpes,
other viral syndromesSigns and Sx—generally gradual in onset,
but may be sudden. Headache Fever—low-grade, usually GI sx—nausea and vomiting may be R/T ICP General malaise Maculopapular rash Symptoms usually disappear in 3-10 days
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Acute inflammation of meninges & CSF caused by bacterial infectionHaemophilus influenzae type B (vaccine)Streptococcus pneumoniaeNeisseria meningitidis
Risk factors: immunosuppression, preexisting CNS anomalies, chronic diseases
Organisms may come from infections in teeth, sinuses, tonsils, lungs, skull fracture
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Etiology by age of incidence:Neonate-3 months: Group B Beta Strep
and E.Coli
3 months-3 years: Haemophilus Influenzae Type B Streptococcus pneumonieae Neisseria meningitidis (meningococcal) Staphylococcus aureus
School-age and beyond: Meningococcal due to high transmissibility through droplet form.
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Hx of URI or ear infection Irritabilitiy, restlessness Severe HA, fever, chills, vomiting Stiff neck (nuchal rigidity) can
progress to point of opisthotonos Alterations in sensorium High pitched cry in infants; bulging
fontanel May begin w/seizure or develop later Photophobia Kernig’s and Brudzinski’s sign
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Dx: Hx/physical and lumbar puncture CSF cloudy; culture done **KNOW CSF FLUID
RESULTS!! Management:
Begin IV antibiotics and fluids IMMEDIATELY Respiratory isolation till on meds for 24hrs if
bacterial, longer if viral NPO Freq VS & neuro checks I&O Assess for ↑ICP; Keep HOB elevated Assess for SIADH – may need to restrict fluids Keep room/environment quiet, darkened; ↓stimuli Pain meds as ordered; uninterrupted rest periods Seizure precautions Reportable to local Health Dept.
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Complications of meningitis: epilepsyneuro damage (brain damage to learning
disabilities) hearing or vision loss – hearing most
commonhydrocephalus10-15% mortality
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Acute toxic encephalopathy w/other organ involvement; fatty changes in liver
Sudden change in LOC, fever, vomiting Progresses rapidly; ↑ICP; death Risk factors: triggered by a mild viral
illness like chickenpox or flu and use of salicylates especially Aspirin
Children <18; most bet 4 – 14 yrs Liver Bx is final clinical Dx
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Quiet, lethargic, vomiting Confusion, combativeness, hyper-
reflexia Obtunded, seizures, decorticate rigidity Deepening coma, fixed pupils Coma, loss of deep tenden reflexes,
flaccid,respiratory arrest
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ICU – monitor for cerebral edema; ICP Assess resp status, CVP, arterial pressure Oxygen; intubation if needed Accurate and frequent I & O Tx: shock (fluids, electrolytes,
vasopressors) Tx: for ↑ICP –keep ↑HOB, airway support,
administer mannitol as ordered) Treat hyperthermia(cooling & meds) Supportive care & ongoing info for family
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Malfunction in the electrical system of the brain; alterations in the firing of the neurons by group of hyper-excitable cells
Epilepsy: chronic DO w/recurrent seizures Partial – begins local in one hemisphere
Simple partial or partial complex Generalized – both hemispheres
Immed loss of consciousnessTonic clonic and petit mal
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Simple partial: No loss of consciousness; alterations in motor function, autonomic signs, sensory symptoms
Partial complex: consciousness impaired; staring, lip smacking, chewing, unusual hand movements
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Petit mal or Absence: lack of awareness, unresponsive; lasts less than 15 secs; abrupt onset and cessation
Tonic clonic: Aura does NOT precede seizure. Postictal period after seizure: relaxation, confusion, amnesia, unresponsivenessTonic: sudden loss of consciousness, cry
out & muscles get rigid; jaw clenchedClonic: alternate contraction and
relaxation of extremities
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Prolonged seizures: > 20 min or recurrent
OR postictal period > 30 min Medical emergency → resp failure,
hypotension, hypoxic brain damage, hypoglycemia
ICU – need IV benzodiazepineDiazepam or Lorazepam If IV access is difficult, EBP has shown that
anti-convulsants administered rectally via a 5-8 French feeding tube with syringe is very effective.
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When to call 911 If no history of previous seizureNot breathingSeizure lasting > 5minutes
Turn child to side; put NOTHING in mouth
Do not restrict movement Protect head – maintain safe
environment Observe, record, and report seizure
activity Provide information/teaching to family
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Anticonvulsants:Phenobarbital Phenytoin (Dilantin): gum hyperplasia SECarbamazepine (Tegretol)Valproic acid (Depakene)Primidone (Mysoline)Ethosuximide (Zarontin)Clonazepam (Klonopin)