peds exam 4 meningitis
4
A child is being admitted with a diagnosis of bacterial meningitis. selcet the procedure the nurse should do first? 1. administer IV antibiotics 2. admin maintence IV fluids 3. placement of a foley 4. send the spinal fluid and blood levels to the lab
1- brudzinski sign
The nurse is caring for a 6 month old infant diagnosed with meningitis. when the chil dis placed in the supine position and flexes his neck, the nurse notes he flexes his hips and knees. this is referred to as: 1. Brudzinski sign 2. kernig sign
clear
Whar color should CSF be?
4 ( normla for them is 30-60/minute
Which clinical assesment of a neonate with bacterial meningitis would warrant immediate intervention? 1. irritability 2. rectal temp of 100.6 3. quieter than usual 4. resp rate of 24/minutes
teaching
be sure parent knows patient will go on po abt after completion of iv abt
polyuria and polydipsia.. first sign may be enuresis
cardinal signs of diabetes insipidus are"
bacterial meningitis
caused by pus forming bacteria meningococci, pneumococci, and hameophilu organisms
high fever headache stuff neck( nuchal rigidity) vomiting with HA seizure photophobia change in LOC
children over 2 years old clinical manefestations:
well at birth refuses to feed vomiting diarrhea " not doing well"
clinincal manifestations of neonate with meningitis:
bacterial viral or aseptic tuberculous
3 main types of meningitis
cloudy
CSF will be ____ with meningitis
cloudy, decreased glucose,ELEVATED protein,
CSF with bacterial meningitis would have what?
poor feeeding fever vomiting seizures hihg pitched cry bulging fontanel irritability
Clinical manefestations under 2 years of age:
Diabetes insipidus
If a child has a shrilly cry and you give them water instead of milk and it satisfies them they may have?
2. IV fluids
In which order would a nurse question for a child just admitted with the diagnosis of bacterial meningitis? 1. maintian isolation until 24 hours after iv abt 2. iv fluids at 1.5 times reg maintencece 3. neuro checks every hour 4. admin tylenlol for temp higher than 38c( 100.4)
1
Which is/are the most common no lethal complications occurring from meningitis? 1. cranial nerve deficits 2. epilepsy 3. bleeding intracranial 4. cerebral palsy
diabetes insipidus
deficent secretion of ADH that produces a state of uncontrolled diuresis
SIADH
fluid retention and hypotonicity are clinical manefestations of
iv abt for 7-10 days and IV steroids , viral= no abt
for bacterial meningitis what needs to be done?
decreased
glucose levels in CSF for bacterial meningitis will be______
spinal tap
how is meningitis diagnosed
vasopressin, IM,SC, or nasal spray( not in the infant though)
hwo would we treat the child with diabetes insipidus?
opisthotonus
late sign that involves a spasm with extreme hyperextension of the body over age 2
true
only 10% of meningitis cases are fatal True/false
impending vascuar collapse( DO SOMETHING FAST OR CHILD WILL DIE)
petechal or purpruic rash( meningococcal) is hallmark sign of what
SIADH
results from oversecretion of ADH
3
select the best room assignment for a newly admitted child with bacterial meningitis: 1. semiprivate with a roommate who also has bacterial meningitis 2. semiprivate room with a roommate who has bacterial meningitis but has rec'd iv abts for more than 24 hours 3. private room that is dark and quiet with minimal stimulation 4. private room that is bright and colorful and has developmentally appropriae activities available
kernig- pain in hamstring when attempting to extend the leg after flexing your thigh against your body brudzinski sign- involuntary hip and knee flexion when the childs head bends towards the chest when supine
these test are only done in children older than 2
cepalosporin
usually on what kind of abt?
maintain HOB 15-30 avoid flexion of the neck may be on side( most comfortable) QUIET ENVIRONMENT may give tylenol with codeine for pain prevent constipation( bedrest) maintainn IV fluids as prescribed
what are some measures to maintain a stable ICP
mental retardation
what can happen if bacterial memningits is not treated properly?
spinal tap!!!!!!!!!!!!!!!!!!!!!!
what diagnostic test is done to diagnose meningitis?
hearing loss seizures mental retardation visual impairment behavioral problems
what is neurologic sequela?
can develop SIADH and DI( diabetes insipidus)
what is two comps than can occur with bacterial meningits?
isolation precaustions( droplet and contact)
what precasutions need to be taken with bacterial meningitis?
pupillary edema optic disc swelling
what some signs of increased ICP?
droplet for at least 24 hours after the first dose of antibiotics
what type of precautions need to be implemented for the patient with bacterial meningigtis? and fro how long
HIb 2,4,6 12-15 prevnar 2,4,6,12-15 maenactra high risk 9 months
what vaccines can protect against this?
3
which should the nurse teach the parent of a child with suspected meningitis? 1. abt are not intiated until the CSF cultures are definitive for specificity to prevent resistance 2. abt are useless against viral infections so they are not used for meningitis 3. atibiotics should be started before the CSF cultures are definitve culture results may take up to 3 days 4. abt initiation is based on the age, signs, and symptoms of the child not on the causative agent
elevated
white blood cells will be ____ with meningitis?
holding on to it
with SIADH are they pissing alot or holding onto water?
true
with SIADH fluids are restriced to 1/2-/14 the niormal true/false
decreased
would serum sodium be increased or decreased with SIADH?