Question

System Disorder Template: Newborn Menigitis

Answer 1

Alteration in health (Diagnosis) - Newborn Meningitis

Pathophysiology - Bacterial or viral inflammation of meninges and cerebrospinal fluid. The meninges are the covering of the brain and spinal cord.

Health promotion and disease prevention: Vaccination

Vaccine against Neisseria meningitis disease

• Children between the age group - 2 months to 2 years if they suffer from
  1. Complement component deficiency
  2. A patient is taking medication that inhibits complement factors (sirolimus)
  3. A patient who has had his/her spleen removed
  4. Concomitant human immunodeficiency virus.
  5. Traveling to a country where the disease is common
• All children between the age group of 11 - 12 years and a booster at 16 years of age.

Vaccine against Haemophilus influenza infection: The vaccine needs to be given at

1. 2 months
2. 4 months
3. 6 months
4. Booster at
   1. 12 - 15 months
5. If the child has received the first vaccine at 15 yrs of age, a single dose is enough
6. Children between 1 - 5 years may need a booster vaccine if they are suffering from
   1. HIV infection
   2. Have had their spleen removed
   3. The patient is on chemotherapy or radiotherapy
   4. Stems cell transplant.

Risk factors:

1. Prematurity
2. Intrauterine infection
3. Fever during delivery
4. Head trauma leading to a skull fracture and CSF leak
5. Infection of a contiguous structure
   1. Sinusitis
   2. Mastoiditis
   3. Osteomyelitis of the skull
   4. Facial cellulitis
   5. Periorbital cellulitis
   6. Bacterial arthritis
6. Open neural tube defects -
   1. Spina bifida
   2. Anencephaly
   3. Encephalocele
7. Neurosurgical procedure (Ventriculoperitoneal shunts)
8. Sickle cell anemia and immuno-compromised conditions like HIV, complement deficiency

Expected finding

Neonates and infants:

Symptoms

1. Irritable
2. Change in feeding and sleeping habits
3. High pitched crying
4. Seizures
5. Vomiting
6. Fever

At 2 - 3 years of age:

1. Headache
2. Irritability
3. Anorexia
4. Photophobia
5. Confusion
6. Coma

Signs

Neonates and infants:

1. Febrile or hypothermia
2. Bulging fontanelle
3. Suture diastasis (widening of the suture)
4. Nuchal rigidity

Older children

1. Neck stiffness
2. Kernig sign - Hamstring stiffness which makes it difficult to straighten the leg when the hip is flexed at 90 degrees.
3. Brudzinski sign - The hip and knee get flexed when the neck is flexed.
4. Ptosis
5. Quint due to involvement of the sixth nerve
6. Loss of vision
7. Bradycardia, hypertension and apnea - brain herniation
8. Seizures, altered sensorium, and coma

Investigations:

1. Complete blood count
2. Blood culture
3. Serum electrolytes
4. HIV test

Diagnostic test

1. Lumbar puncture and cerebrospinal fluid analysis
2. Imaging studies like CT brain and MRI brain

Patient-centered care:

Medication:

1. Antibiotics
2. Steroid - to reduce the inflammation (dexamethasone)
3. Antipyretics
4. Anticonvulsants
5. Osmotic diuretics to reduce the intracranial pressure

Nursing care:

1. Assess for signs of neurological deterioration
2. Avoid turning the head sideways as it would compress the neck veins and increase the intracranial pressure.
3. Avoid bending the neck and or pushing the heel against the mattress as it increases the intrathoracic and intraabdominal pressure. This could lead to an increase in ICP.
4. Reduce external stimuli like loud noises, excessive touching the patient
5. Elevate the head at 30 degrees this will promote cerebral venous drainage
6. Give oxygen if the patient is hypoxic
7. Give the patient his/her medication as per the physician's advice.

Client education -

• Regular vaccination to prevent meningitis
• To take a balanced diet

Complication:

• Epilepsy
• Hydrocephalus
• Cranial nerve palsy (3 -6)
• Subdural effusions
• Brain abscess
• Loss of vision and hearing sense
• Syndrome of inappropriate Anti-diuretic hormone secretion
• Cerebral palsy

Safety precautions:

• Isolate the patient for at least 24- 48 hour after antibiotic initiation
• The health care workers should were personal protective gear
• Mask wearing should be compulsory for caregivers
• Regular hand washing
• Ensure regular air exchanges in the room in which the patient is admitted.