Peds, part 35: Nervous Disorders - Meningitis
by Cathy Parkes January 07, 2022 Updated: January 17, 2022 4 min read
Hi, I'm Cathy with Level Up RN. In this video, I am going to talk about meningitis, and at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video, so definitely stay tuned for that. And if you have our Level Up RN Pediatric Nursing flashcards, definitely pay close attention to the bold red text on these cards because those are going to be particularly important facts for you to know. Meningitis is the inflammation of the meninges, which are the membranes that surround and protect the brain and the spinal cord. So the pathophysiology behind this disorder is that you have an infectious organism, which could be a bacteria or a virus that enters the central nervous system and the meninges either through the bloodstream or directly through trauma. So viral meningitis usually resolves without treatment. Bacterial meningitis is usually more severe and does require antibiotics and can be life-threatening. In terms of the risk factors associated with meningitis, this includes crowded conditions such as dorms or prisons, for example, immunosuppression and travel exposure. In terms of prevention, infants are given the HIB and the PCB vaccines, which helps to protect them from meningitis. Teenagers are given a meningitis vaccine, particularly before they go to college and live in a dorm, which is a crowded living condition. So I just sent my son up to college, and we definitely made sure that he had his meningitis A and his meningitis B vaccines prior to moving up there.
Signs and symptoms of meningitis include a fever, headache, nausea and vomiting, as well as nuchal rigidity, which means neck stiffness. And then the patient may also have photophobia, which is sensitivity to the light, and then they will also exhibit a positive Brudzinski sign as well as a positive Kernig sign. So I'm going to explain these two signs here. So a positive Brudzinski sign, if you want to test for that sign, you would have the patient kind of lay down flat on their back and you would place one hand on their chest and the other hand behind their head, and you attempt to pull up their head like this. And that will cause them pain such that they flex in their knees and hips. So the way I remember the sign, if you look at the word Brudzinski, it starts with brud. So if you try to pull up your patient's head, they'll be like, "Brah, that hurts." So that's how I remember that sign. And then with the Kernig sign, Kernig starts with K and knee, the word knee starts with K. So with this test, you would have the patient lay flat, you would have them bend their knee, and you would attempt to straighten out their leg. And I'm a little stiff. But if that really hurts and they're unable to do that, then that would be a positive Kernig sign. So hopefully that little demonstration helped you. Other signs of symptoms can include altered mental status, tachycardia, and seizures.
In terms of diagnosis, we are going to obtain a cerebral spinal fluid sample through a lumbar puncture. We're going to analyze this CSF. And depending on whether the patient has bacterial meningitis or viral meningitis, we will have different findings with the CSF. So if the patient has bacterial meningitis, that CSF will be cloudy, the glucose content will be decreased, the protein will be increased, and the white blood cell content will be increased. And then we will have a positive gram stain. If the patient has viral meningitis, that CSF will be clear, and the glucose level will typically be normal. We may see a slight increase in protein and white blood cells, and we will have a negative gram stain. So in terms of treatment, we would give antibiotics for bacterial meningitis. We can give analgesics for either type to help with the pain, and we can give anti-convulsants if seizures are a concern for the patient. Nursing care associated with meningitis includes the implementation of droplet precautions for any patient with suspected or confirmed bacterial meningitis, so they will need to stay on those droplet precautions for the first 24 hours with antibiotic therapy. So our little cool chicken hint for remembering this, if you happen to know the song It's Raining Men, which is by the Weathergirls, and it came out in the 80s. And I have to admit that I was around when the song was big. If you don't know it, you got to Google it, but it goes, "It's raining men." And so that will help you remember that with meningitis, you will have droplet precautions. So like rain drops. So it's raining men, meningitis requires droplet precautions.
The other thing you're going to want to do is implement seizure precautions. So that means patting the side rails of the bed, making sure you have oxygen equipment available. You want to monitor your patient's neurological status. You want to provide a quiet room with dim lights because of that photophobia and then you want to minimize your patient's intracranial pressure. So we want to maintain the head of the bed at 30 degrees. We're going to want to keep their head midline and minimize any suctioning.
All right, it's time for a quiz. I have three questions for you. First question, what is the difference in CSF appearance between viral and bacterial meningitis? The answer is with viral meningitis, the CSF will be clear, and with bacterial meningitis, the CSF will be cloudy. Second question. A patient with meningitis may have a positive Kernig sign and a positive Brudzinski sign. True or false? The answer is true. So those were the signs that I so eloquently demonstrated for you guys earlier in this video. Question number three, what type of precautions should the patient be put on for suspected bacterial meningitis? The answer is droplet precautions. Okay, that's it for this video. If you've enjoyed it, be sure to like this video. Leave me a comment. Take care and good luck with studying. They will need to be on droplet precautions for the first 24 hours with antibiotic therapy. And then they can be that the really-- the do, de, do. [laughter] Sorry. I'm going to try again.
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