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Course: Pediatric Nursing

Topic: Nursing Care of Child with Neurological Disorders (III)

The Nurses International Community

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Module Goals

Learners will be able to:

Identify factors associated with meningitis and encephalitis in children
Identify common signs and symptoms
Identify risk factors associated with these disorders
Explain the role of the nurse in caring for children with meningitis and encephalitis

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Meningitis

An infection causing inflammation of the meninges

(the thin lining of the brain and spinal cord)

Causes:

Bacteria or
Viruses

Very serious and needs immediate medical attention.

Queensland Government, Children’s Health Queensland Hospital and Health Service,2022

Better Health, 2019

Contact info: info@nursesinternational.org

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Types of Meningitis

Bacterial Meningitis:

A serious and sometimes fatal condition that can progress quickly
May lead to permanent disabilities including deafness and brain injury
The most common types include:

Haemophilus influenzae type b (Hib)
Neisseria meningitidis (meningococcus)
Streptococcus agalactiae (group B streptococcus)
Streptococcus pneumoniae (pneumococcus)

Queensland Government, Children’s Health Queensland Hospital and Health Service,2022

Cafasso,2022

Contact info: info@nursesinternational.org

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Types of Meningitis

Viral Meningitis:

More common than bacterial meningitis

Viruses that may cause meningitis include:

non polio enteroviruses
flu virus
polioviruses
paramyxovirus (mumps)
varicella (chickenpox)

Most cases are mild and children usually make a full recovery although some may be hospitalized for a short time

Queensland Government, Children’s Health Queensland Hospital and Health Service,2022

Cafasso,2022

Contact info: info@nursesinternational.org

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Risk Factors

An infection present with:

A number of viruses, bacteria, or fungi
Viruses: polioviruses, the mumps virus (paramyxovirus), the flu virus, and West Nile virus
Bacteria: Group B streptococcus, E. coli, Haemophilus influenzae type b (Hib), and a strep bacteria

Weakened immune system

Stanford Children’s Health,2022

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Critical Thinking Question

What factors put children at risk for meningitis? (Select all that apply)

Infection with virus
Infection with bacterias
A child with weakened immune system
A child who is dehydrated
A child with a head injury

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Sign and Symptoms

Headache, Fever
Nausea or vomiting
Seizures
Bulging fontanelle (the soft spot on a baby’s head)
Irritability and high pitched cry (in young babies)
Arching of the body or neck (Opisthotonus)
Stiff neck (nuchal rigidity) in older children
Sensitivity to bright lights
Joint and muscle aches and pains
Drowsiness or confusion
A rash looks like red/purplish spots (does not turn white with pressure)

Queensland Government, Children’s Health Queensland Hospital and Health Service,2022

Contact info: info@nursesinternational.org

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Physical Signs

Hockenberry & Wilson, 2012

Adcox, 2018

Positive Kernig and Brudzinski signs

(Children and Adolescents)

To look for Kernig’s sign:

Have child in supine position
Flex the knee and hip in a 90˚ angle

If there is resistance or pain, consult a doctor right away

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Physical Signs

Hockenberry & Wilson, 2012

Adcox, 2018

Brudzinski signs

To check for the Brudzinski sign:

Have the child in supine position
Place one hand behind the head, and another on chest to prevent from rising
Then lift the head, bringing child’s chin to the chest

A positive Brudzinski sign causes flexion of the hips

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Critical Thinking Question

A young child is suspected of having meningitis

What symptoms would the nurse expect to see in the child?

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Diagnosis of Meningitis

A detailed history of signs and symptoms
Clinical examination
Blood tests
A lumbar puncture: (Definitive diagnostic test)

The pressure in the spinal canal and brain is measured
Samples for culture, blood cell count, glucose, protein
Elevated while blood cell,
Elevated protein above 100 mg/dl
Glucose level reduces (50% of blood sugar or below 40 mg/dl

Better Health, 2019

Paul & Bagga, 2013

Contact info: info@nursesinternational.org

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Management

Antibiotics (often given intravenously)
Hospital care
Anticonvulsant, cortisone and sedative medications, which may be used to treat complications
Most infants, children, and teens with mild viral meningitis get better on their own within 1 week to 10 days

Better Health, 2019

Healthline

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Prevention of Bacterial Meningitis

Some forms of meningitis can be prevented by immunization:

Hemophilus influenzae type b prevented with Hib immunization

The National Immunization Program schedule provides a free meningococcal ACWY vaccine for:

Children at 12 months of age
Under 20 years of age who did not have their meningococcal C vaccine at 12 months of age

Pneumococcal can be prevented with two types of pneumococcal vaccine and are available free of cost

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Critical Thinking Question

For a definitive test of meningitis (Lumbar puncture). What changes can be seeb in the Cerebrospinal fluid?

Elevated protein above 100 mg/dl
Decreased level of protein level
Glucose level reduces (50% of blood sugar or below 40 mg/dl)
Increased level of glucose

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Nursing Care Management

Assessment of:

Vital signs
Neurological signs
Level of consciousness
Fontanel for fullness or bulging
Inspect skin for rash
Intake and output
Pain evaluation
Observe for the sign of complication (Increased cranial pressure, shock)

The Royal Children’s Hospital Melbourne, 2019

Hockenberry and Wilson,2007

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Nursing Intervention

Necessary precautions to protect child from possible infection
Keep room quiet
Low stimulus environment:

Reduce tactile handling of the child
A quiet, dimly lit room reduces agitation, especially in children and young people experiencing photophobia

Where possible, raise the head of the bed greater than 30 degrees and maintain a neutral alignment

The Royal Children’s Hospital Melbourne, 2019

Hockenberry and Wilson,2007

Contact info: info@nursesinternational.org

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Nursing Intervention

Avoid actions that increase pain and discomfort such as lifting head
Ensure safety because the child is often restless and prone to seizure (side rails up, padded bed)
Administration of medications
Fluid management
Pain management
Family support:

Encourage ventilation of feelings
Inform about progress and all procedures and treatments

The Royal Children’s Hospital Melbourne, 2019

Hockenberry and Wilson,2007

Contact info: info@nursesinternational.org

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What Would the Nurse Do?

What are the nursing interventions while taking care of a child with meningitis?

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Red Flags

Any Ill child who develops a purpuric or petechial rash must receive medical attention immediately as it may be a sign of a serious clotting disorder

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Encephalitis

Encephalitis is an inflammation of the brain tissue
Most common cause is viral infections
In rare cases caused by bacteria or fungi

(Johnson, 2018)

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Causes

Viruses that cause encephalitis:

Enteroviruses – such as coxsackievirus, poliovirus and echovirus
Herpes simplex virus
Varicella zoster virus
Epstein-Barr virus
Cytomegalovirus
Adenovirus
Rubella
Measles
Japanese encephalitis virus

(Better Health, 2017)

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Symptoms

Fever, headache
Bulging of the fontanelles
Sensitivity to light
Neck stiffness
Lethargy
Irritability
Seizures
Skin rash
Confusion or hallucinations
Nausea and vomiting
Loss of consciousness (coma)

(University of Rochester Medical Center, 2022)

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Critical Thinking Question

What is the most common causes of meningitis in children?

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Risk Factors

A child is more at risk if they have any of these diseases:

Upper respiratory infection
Measles, Mumps, Rubella
Chickenpox
Herpes simplex virus
West Nile virus
Rabies
Lyme disease
Tuberculosis
Syphilis
An autoimmune reaction

(University of Rochester Medical Center, 2022)

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Diagnosis

Physical examination
Blood tests
Laboratory examination of cerebrospinal fluid
Computed tomography (CT) scan
Electroencephalography (EEG) to measure brain waves
Magnetic resonance imaging (MRI)

(Better Health, 2017)

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Treatment

Treatment depends on the underlying cause, may include:

Antiviral medicines
Steroid injections
Treatments to help control the immune system
Antibiotics or antifungal medicines
Painkillers to reduce discomfort or a high temperature
Medicine to control seizures
Support with breathing: oxygen face mask or a breathing machine (ventilator)

(NHS, 2019)

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Prevention

Not always possible to prevent encephalitis
Some of the infections that can be prevented with vaccinations include:

Measles, mumps and rubella (MMR) vaccine
Japanese encephalitis vaccine
Tick-borne encephalitis vaccine
Rabies vaccination

(NHS, 2019)

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Nursing Management

Nursing care of a child with encephalitis is same as for the meningitis
Other intervention include:

Neurologic monitoring
Observation of consciousness
Assessing and managing increasing ICP
Medication as prescribed
Support of family and child

(Hockenberry & Wilson, 2007)

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Critical Thinking Question

What vaccines help prevent encephalitis in the children?

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur
Health customs: In some cultures family members play a large role in health care decision-making
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

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References

Adcox, M. (2018). How to Recognize Kernig’s Sign. [ Review of the article How to Recognize Kernig’s Sign by, S. Han]. Healthline. Retrieved from: https://www.healthline.com/health/kernig-sign

Better Health. (2019). Meningitis. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/meningitis

Cafasso, J. (2022 January 31). Pediatric Meningitis: Symptoms, Causes, and Prevention. [ Review of the article Pediatric Meningitis: Symptoms, Causes, and Prevention, by, C. Stephens]. Healthline. Retrieved from: https://www.healthline.com/health/meningitis-in-pediatrics

CDC. (2021). Viral Meningitis. https://www.cdc.gov/meningitis/viral.html

Contact info: info@nursesinternational.org

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References

Hersi, K., Gonzalez, F.J., & Kondamudi, N.P., et al. (2021 Nov 7). Meningitis (Nursing).StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568762/

Hockenberry, M. J. & Wilson, D. (2007). WONG’S Nursing Care of Infants and Children. 8th edi. Mosby

Paul, V. K. & Bagga, A. (2013). Central Nervous System. GHAI Essentials Pediatrics. 8th edi. CBC Publishers.

Queensland Government, Children’s Health Queensland Hospital and Health Service. (2022). Children Health Fact Sheets:Meningitis. https://www.childrens.health.qld.gov.au/chq/information-for-families/fact-sheets/

Contact info: info@nursesinternational.org

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References

Stanford Children’s Health. (2022). Meningitis in Children. https://www.stanfordchildrens.org/en/topic/default?id=meningitis-in-children-90-P02528#:~:text=Meningitis%20is%20most%20often%20caused,with%20a%20weak%20immune%20system

The Royal Children’s Hospital Melbourne. (2019). Nursing Management of Meningitis. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Nursing_Management_of_Meningitis/

Better Health. (2017). Viral Encephalitis. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/viral-encephalitis

Contact info: info@nursesinternational.org

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References

Johnson, S. (2018 September 29). Encephalitis. [ Review of the article Encephalitis, by T. Walker]. Healthline. Retrieved from: https://www.healthline.com/health/encephalitis

Hockenberry, M. J. & Wilson, D. (2007). WONG’S Nursing Care of Infants and Children. 8th edi. Mosby

NHS. (2019). Encephalitis. https://www.nhs.uk/conditions/encephalitis/

University of Rochester Medical Center. (2022). Encephalitis in Children. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02600#:~:text=What%20is%20encephalitis%20in%20children,changes%20in%20alertness%2C%20and%20seizures

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