Al-zaytoonah private university of Jordan

faculty of nursing
maternal and child health department
pediatric health coarse (clinical 301348).
Case presentation about meningitis .
Prepared by: heba al-khozae.
Student no. : 200711008 .
Clinical area : al ‫ـ‬basheer hospital .
Group no.: 1.
Dr. nehad qasem.
cl. inst. : miss. Amneh.
Child’s name:‫ي نا لف ايز محمد علوش‬
Sex: male.
Age: 2, 5 months. Date of birth: 14\2\2010.
Body weight: 4, 1 kg.
Height: 56 cm.
Head circumference: 40 cm.
Open and mild plugging anterior fontanel.
Temp.: 38, 5 c.
Resp.: 55 breath\min.
Pulse: 160 beat\min.
Condition on arrival: holding by his father.
Date of admission: 21\4\2010. Via: emergency.
Floor: medical. Room no.: 8.
Source of data: child’s parent’s, patient file and medical health
team.
Confirmed medical diagnosis: bacterial meningitis.
Complains upon admission: fever, hypo activity, tachycardia
and poor feeding from 5 days.
Past medical and surgical history: history of neonatal jaundice
treated at home , upper respiratory infection and no any past
surgical history.
Perinatal history:
Gestational period: 39 weeks.
Type of delivery: c\s due to previous c\s.
Birth weight: 3,2 kg.
Without any complications immediately after delivery , and not
admitted to NICU .
Immunization status: BCG only.
No any family history of hereditary or chronic diseases , and no any
history of abortion , stillbirth , or congenital anomalies.
Nutrition and metabolic pattern:
Loss of 1 kg, anorexia, breast feeding 2-3 times\day , low amounts.
Other body systems appear normal without any complications.
 30
28
years
years
A,W A,W

2,5 3
month years
s

Meningitis A,W
Bacterial meningitis is a life-threatening illness that results
from bacterial infection of the meninges. Beyond the
neonatal period, the 3 most common organisms that cause
acute bacterial meningitis are Streptococcus pneumoniae,
Neisseria meningitidis, and Haemophilus influenzae type b
(Hib).
Inflammation of the meninges and ventricles produces a
polymorphonuclear response, an increase in cerebrospinal fluid
(CSF) protein content, and utilization of glucose in CSF.
Inflammatory changes and tissue destruction in the form of
empyema and abscesses are more pronounced in gram-negative
meningitis. Thick inflammatory exudate causes blockage of the
aqueduct of Sylvius and other CSF pathways, resulting in both
obstructive and communicating hydrocephalus.
According to text book: in my patient:
Poor feeding Poor feeding
Lethargy Irritability
Irritability Fever
Apnea hypoactive

Apathy Bulging fontanel

Seizures, Convulsions Anorexia
Jaundice tachycardia
Bulging fontanel tachypnea
Pallor increased sleepiness
Shock
Hypotonia
Shrill cry
Hypoglycemia
Nuchal rigidity, stiff neck
Anorexia, nausea and vomiting.
Photophobia
Fever (generally present, although some severely ill children present with hypothermia)
Specific signs that indicate meningeal
irritation:
1- Positive
kernig’s sign:
when the
patient Is lying
with the thigh
flexed on the
abdomen, the
leg can’t be
completely
extended.
Specific signs that indicate
meningeal irritation con’t:
2- Positive brudziniski’s
sign: when the patient’s
neck is flexed ( after ruling
out cervical trauma or
injury), flexion of the knees
and hips is produced; when
the lower extremity of one
side is passively flexed, a
similar movement is seen in
the opposite extremity. It is
the more sensitive indicator
of meningeal irritation
than kering’s sign.
Specific signs that indicate
meningeal irritation con’t:
3- Nuchal rigidity (stiff neck):
this is an early sign. Any
attempts at flexion of the
head are difficult because of
spasms in the muscles of the
neck . forceful flexion causes
severe pain.
4- Photophobia (extensive
sensitivity to light) : this
finding is common, although
the cause is unclear.
5- Rash.
6- Disorientation and
memory impairment.
7-Seizures
CBC test: normal range:
HB: 9,8 g\dl. 9,0-14,0 g\dl
WBC: 19,6 *10^3 cells\l 5.0-19,5 *10^3 cells\l
RBC: 3.1 *10^12 CELLS\L 2,7-4,9 *10^12 CELLS\L
Blood chemistry:
Glucose: 6,0 mmol\l 3.3-5,5 mmol\l
Urea: 1,4 mmol urea\l 1,1-4,3 mmol urea\l
Creatinine: 18, 26 mol\l 18-35 mol\l
Ca: 2,3 mmol\l 2,2-2,7 mmol\l
Na: 133 mmol\l 139-146 mmol\l
K: 4,8 mmol\l 3,5-5,0 mmol\l
Cl: 101,0 mmol\l 98-106 mmol\l
CSF analysis:
WBC: 1,5*10^6\l 0-5*10^6\l
RBC: not present not present
PROTIEN: 45,8 mg\dl 15-45 mg\dl
Glucose: 48,2 mg\dl 50-80 mg\dl
CSF culture: growth of Homophiles influenza type b (Hib).
Medication:
Ampicillin 250 mg Q 8 hr’s I.V :
Action: antibiotic.
Side effect: allergic reactions.
Nursing role: note any allergic reactions.
Rpcephin 250 mg Q 12 hr’s I.V
Action: cephalosporin antibiotics.
Side effects: allergic reactions.
Nursing role: note any allergic reactions.
I.V fluids:
5% G\S 150cc I.V Q 8 hr’s + KCL 1,5 meq.
1- Seizures.
2- inappropriate antidiuretic hormone secretion (SIADH)
3- subdural effusions, and brain abscesses.
4- muscular hypertonia
5- complex seizure disorders
6- mental motor retardation
7- learning disabilities
8- obstructive hydrocephalus
9- cerebral atrophy
10- Hearing impairment
Prolonged or difficult-to-control seizures, especially
after the fourth hospital day, are predictors of a
complicated hospital course with serious sequelae. On
the other hand, seizures that occur during the first 3
days of illness usually have little prognostic
significance.
Approximately 6% of affected infants and children show
signs of disseminated intravascular coagulopathy and
endotoxic shock. These signs are indicative of a poor
prognosis.
Nursing management:
Nursing Goal Nursing Nursing Evaluation
diagnosis intervention implementation
Hyperthermia Relieve 1-apply cold 1-apply cold Control of
related to of compresses compresses. fever.
disease fever. . 2-Closely
process. 2- Closely monitoring for
monitoring vital signs.
for vital 3-Give
signs. medication as
3- Give prescribed.
medication as
prescribed.
Nursing management con’t:
Nursing Goal Nursing Nursing Evaluation
diagnosis intervention implementati
on
Activity 1- improve rest 1- Teaching 1- do fine No any
intolerance and comfort. the mother massage to complication
related to 2- Prevent any some of fine improve happened.
disease complications. massage muscles and
process. technique. prevent
2- Prevent hypotonia.
position 2- closely
injury. monitoring
3- Provide for
rest to neurologic
conserve status to
energy. prevent any
complication
s.
Nursing management con’t:
Nursing Goal Nursing Nursing Evaluation
diagnosis intervention implementation
Risk for fluid Improve 1- promoting 1-Administer fluid Maintain
volume deficit fluid fluid and as prescribed. adequate
related to poor volume. electrolytes 2- monitoring for hydration.
feeding and intake via i.v intake and output
fever root. to prevent
2- encourage complications.
breast
feeding.
Nursing management con’t:
Nursing Goal Nursing Nursing Evaluation
diagnosis intervention implementation
Altered Improve 1- promoting 1- administer i.v Maintain
nutrition less nutritional calorie intake fluids as adequate
than body status. via i.v root. prescribed. nutritional
requirements 2- encourage 2-encourage status.
related to loss breast feeding breast feeding as
of appetite and the child’s
poor feeding. tolerate.
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Med. Oct 28 2004;351(18):1826-8. 

2-Taylor HG, Mills EL, Ciampi A, et al. The sequelae of Haemophilus

influenzae meningitis in school-age children. N Engl J Med. Dec
13 1990;323(24):1657-63.

3-Yogev R, Guzman-Cottrill J. Bacterial meningitis in children: critical

review of current concepts. Drugs. 2005;65(8):1097-

4-Tauber MG, Moser B. Cytokines and chemokines in meningeal

inflammation: biology and clinical implications. Clin Infect
Dis. Jan 1999;28(1):1-11; quiz 12

5-Prasad K, Karlupia N. Prevention of bacterial meningitis: an overview

of Cochrane systematic reviews. Respir Med. Oct 2007;101(10):2037-43. 
Thank you