11.03 Meningitis

Hey everybody, in this lesson we are going to be talking about the diagnosis meningitis.

The meninges are the membranes that cover and help protect the skull, the brain and the spinal cord. Meningitis is when these become inflamed because of some kind of infection (it could be bacterial, viral, fungal or a protozoan infection). If untreated, this results in swelling, increased intracranial pressure and neurological damage.

Meningitis is a life threatening illness and it can also cause long term complications like seizure disorders, hearing loss, and learning disabilities.

Diagnosing meningitis requires doing a lumbar puncture so that the cerebral spinal fluid can be analyzed for signs of infection. You can see in the photo here the position a baby needs to be in for the LP. I’ve gotten more used to it over the years, but I still find doing LP’s on little babies pretty awful. Because symptoms are nonspecific a blood culture and urine culture should also be done for infants and an IV needs to be placed as well- so lots of poking and prodding here!

A lot of times these babies just have, what seems like minor symptoms, like a slight fever and one episode of vomiting, so parents often need to be reminded of how severe meningitis is and of the long term complications to help them cope with seeing their baby go through all of this.

These kids are going to be admitted for antibiotics for 48 hours while waiting on the results of the cultures.

The classic symptoms for meningitis are fever, headache and meningeal signs, like nuchal rigidity (which basically means a stiff neck), and positive Kernig’s and Brudzinski's signs. A positive Kernig’s sign is when a patient has pain when the leg is extended while the hip is flexed at 90 degrees. A positive Brudzinski’s sign is when a patient’s neck is flexed forward and it’s painful so they draw their knees up to relieve the pain.

Vomiting is pretty common for kids as well.

The classical symptoms are pretty rare in infants and young kids. They can’t tell you if they have a headache or photophobia, and you can’t do a Kernig’s or Brudzinski's test on them. I mentioned on the diagnostic slide that for younger kids, and especially infants symptoms are non-specific. So things that you are looking for in this patient group are high-pitched, inconsolable crying, poor feeding, lethargy and bulging fontanelles.

Remember to always do a head to toe check for rashes. If you see a rash, press on it with your finger to see if it is a non-blanching rash- this just means that when you remove your finger the skin beneath isn’t white from the pressure, it stays purple. The photo here is an extreme example of this kind of rash. This can of rash, is a sign of Meningococcal disease. Meningococcal disease is super scary and progresses so quickly, within a matter of hours the child can go from well to dying. If meningococcal disease is suspected antibiotics should be given immediately, not waiting for diagnostic tests to be done.

Management is all about giving the right medication to treat the cause. So usually a broad spectrum antibiotic is given until the culture results are back.

Keep in mind that if the baby is less than 8 weeks old we have an even lower threshold for treating with antibiotics and antivirals because they are more likely to have problems if the meningitis goes untreated.

As soon as you suspect meningitis the child needs to be placed on droplet precautions.

And long term monitoring is important. Often a hearing test will be done 6 mo after the infection to check for any hearing loss.

From a nursing point of view one of the biggest challenges with these patients is trying to keep a working IV in place. Some kids end up needing a PICC line.

Your priority nursing concepts are intracranial regulation, infection control, and health Promotion.
Let’s go over the key points for this lesson. Meningitis is when the membranes in the central nervous system become inflamed from an infection of some kind. The classic symptoms for this are fever, headache and meningeal symptoms like stiff neck and positive Kernig and Brudzinski's signs. Infants and young kids won’t have these classic symptoms so be on the lookout for things like high pitched crying, bulging fontanels and poor feeding- all of which are signs if increased ICP. More often than not though, in infants, the symptoms are going to be very non-specific.

Meningitis is diagnosed by doing a lumbar puncture and analyzing and culturing the cerebral spinal fluid. A blood culture and urine culture are also likely to be done. While waiting on the results of the culture, the patient will be admitted for 48 hours of antibiotics.

Management is about treating the cause, monitoring for the neuro status and fluid status of the patient. Long-term complications, like learning disabilities, hearing loss and seizures can happen so it’s important to educate parents on this for future management.

That's it for our lesson on meningitis in pediatric patients. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!