1. MUHIMBILI UNIVERSITY OF
HEALTH AND ALLIED
SCIENCESNURSING
SCHOOL OF
DEPARTMENT OF CLINICAL NURSING
PEDIATRIC NURSING
TOPIC:MANAGEMENT OF CHILD WITH
MENINGITIS
PRESENTER:SONGOMA JOHN

2. INTRODUCTION
Meningitis is an inflammation of the meninges
, the protective membranes that surround the
brain and spinal cord.
Common causes of meningitis may include:
 Bacteria, Virus, Fungi and Parasites.
 Most episodes of meningitis result from
hematogenous seeding of infection from
other sites to the meninges.

3. 1. Bacterial causes
Varies with age:
1. Newborn to 3 months of age:
E. coli and other coliforms, group B Streptococci,
Listeria monocytogenes, Strep pneumoniae,
H. influenza type b, Neisseria meningitidis
2. Age 3 months to adolescence:
N. meningitidis, S pneumoniae, H influenza type b
(in young children)
Mycobacterium tuberculosis is most common in
young children, but can affect children of any
age.

4. . Fungal Causes
 Common in immunocompromised patients.
May include:Histoplasma , Coccidioides
,Paracoccidiodes ,Candida , Aspergilus
Cryptococcus neoformans
 Viral Causes (aseptic meningitis) include:-
Mumps
Enterovirus (coxackie, polio)
Adenovirus and
Herpes simplex

5. Classification of meningitis
1. Based on duration, meningitis is classified as:
 Acute: symptoms present within a period of 0 –
24 hrs
 Sub acute: symptoms lasting from 1-7 days.
 Chronic: symptoms lasting over 7 days
2. Based on aetiology:
 Bacterial meningitis
 Viral (aseptic) meningitis
 Fungal meningitis

6. Clinical Presentation: Symptoms
and signs
1. Young infants < 3 months: The signs and
symptoms are non specific and may include:
 Fever or hypothermia
 Bulging fontanelle or acute increase in head
circumference
 Convulsions / seizures
 High-pitched cry, irritability
 Lethargy, altered mental state
 Apnoea
 Poor feeding, vomiting.

7. 2. Children > 3 months to adolescents:
 Fever is present in about ~ 50% of patients.
 Headache, photophobia, stiff neck, irritability or
lethargy, vomiting and altered level of consciousness.
 Kerning’s sign in older children (inability to completely
extend the leg).

8.  Brudzinski’s sign in older children (flexion at the
knee in response to forward flexion of the neck).
 Convulsions in 20 – 30% of cases.
 Focal neurological deficits due to vasculitis or
thrombosis of blood vessels.
 Papilledema (Swelling of the optic disc (where the
optic nerve enters the eyeball); usually associated
with an increase in intraocular pressure) is
uncommon unless in advanced cases. This
suggests increased intracranial pressure.

9. Laboratory Investigations
1. CSF
 Lumbar puncture or a shunt tap is performed as
soon as the diagnosis of meningitis is
suspected.
 CSF should be examined for:
 Microbiology and
 Biochemistry

10. Laboratory Investigations cont.
2. C-Reactive protein (CRP).
3. Blood culture and other cultures
(urine, abscess, and middle ear).
4. Full Blood Picture (CBC) and ESR.
5. Serum electrolytes, BUN, Creatinine.

11. Investigations cont
6.Other examinations
 Electroencephalogram (EEG) if seizures are
prominent.
 Head imaging (CT). Indications for CT are:
 Focal neurological examination findings,
 Seizures,
 Increasing head circumference,
 Lack of improvement despite appropriate treatment
and
 Suspected brain abscess.
 CTshould only be done when the patient is
stable.

12. Medical Treatment of Meningitis
pediatric
1. Triage and ensure the ABCDs.
2. IV line for IV medication and rehydration
3. Drug therapy.

13. Treatment of Bacterial meningitis 1
 Give antibiotic treatment as soon as
possible:
1. Infants < 3 month old:
 Ampicillin 200 mg/kg/day IV div q6hr,
PLUS
 Cefotaxime 200 mg/kg/day IV div q6hr for
10 to 14 days

14. Treatment of bacterial meningitis 2
2. Age 3 months to < 18 years; choose on
of the following regimens:
1) Chloramphenicol 25 mg/kg IV (or IM) 6
hourly, plus Ampicillin 50 mg/kg IV (or IM) 6
hourly
2) Chloramphenicol 25 mg/kg IV (or IM) 6
hourly, plus Benzyl penicillin 6o mg/kg
(100,000 IU /kg) IV or IM 6 hourly.

15. Treatment of bacterial meningitis 2
2. Age 3 months to < 18 years; choose on
of the following regimens:
1) Chloramphenicol 25 mg/kg IV (or IM) 6
hourly, plus Ampicillin 50 mg/kg IV (or IM) 6
hourly
2) Chloramphenicol 25 mg/kg IV (or IM) 6
hourly, plus Benzyl penicillin 6o mg/kg
(100,000 IU /kg) IV or IM 6 hourly.

16. Treatment of bacterial meningitis 3
 Alternative treatment:
 If Haemophilus influenza or Pneumococcus is
common;
1) Ceftriaxone 50 mg/kg IV or IM 12 hourly or 100
mg/kg IV od for up to 10 – 14 days, or
2) Cefotaxime 50 mg/kg every 6 hrs for 3 weeks.

17. Supportive Treatment
 Give paracetamol 15 mg/kg 6 – 8 hrly for
fever (>38.50 C)
 IV fluids: isotonic fluids at maintenance
rate (250 ml/24hrs).
 Feeding according to age requirement (75
– 100 kcal/kg/day).
 Give anticonvulsant if convulsing
 Correct hypoglycemia if present
 NGT for feeding
 Physiotherapy

18. Nursing management
 Monitor vital signs 2-4 hrly (Temperature, Pulse
rate, Oxygen saturation, BP, and Respiratory
Rate)
 Monitor Input/output
 Give treatment as prescribed.
 Maintain a clear airway
• Turn the patient every 2 hours.
• Do not allow the child to lie in a wet bed.
• Pay attention to pressure points
 Monitor IV fluids very carefully and examine
frequently for signs of fluid overload

19.  Nurses should monitor the child’s state of
consciousness, respiratory rate and pupil size
every 3 hours during the first 24 hours (thereafter,
every 6 hours).
 On discharge, assess all children for neurological
problems, especially hearing loss.
 Measure and record the head circumference of
infants.
 If there is neurological damage, refer the child for
physiotherapy, if possible, and give simple
suggestions to the mother for passive exercises

20. Nursing management at
emergency
 Step one
 Triage according to clinical indicators.
 Step two
 Prioritise care. The nurse’s role is to prioritise
 Airway, Breathing and Circulation,
accompanied by a rapid assessment of
conscious level using the AVPU# scale.

21.  Step three
Follow with specific nursing assessments. These should
include the following:
■ Assess for decreased cerebral tissue perfusion related to
increased ICP:
– neurological observations, including blood pressure
should be performed at intervals determined by the
child’s clinical state
– assess for increased ICP
– monitor fluid and electrolyte status.
■ Assess for ineffective breathing pattern related to
increased ICP:

22. Assess for potential for injury related to seizures:
– document characteristics of seizure activity-duration,
characteristics of motor behaviour and post-ictal phase
– assess the patient’s environment for potential hazards.
■ Assess for alteration in fluid and electrolytes related to SIADH,
DI, diuretics, fluid restrictions:
– monitor haemodynamic parameters
– monitor urine output
– monitor SG, urine electrolytes and osmolality.
■ Assess for alterations in comfort related to meningeal
irritation, headache, photophobia, fever
– monitor temperature and assess effectiveness of comfort
measures.

23. Reference
NSW HEALTH( 2010) Management of acute
bacterial meningitis in infants and children
Clinical Practice Guidelines
WHO (2005) POCKET BOOKOF Hospital care
for children GUIDELINES FOR THE
MANAGEMENT OF COMMON ILLNESSES
WITH LIMITED RESOURCES