The document provides information on nursing care for clients with meningitis. It discusses causes of meningitis including bacteria, viruses and fungi. The clinical presentation of acute and chronic meningitis is outlined. Physical exam findings, lab tests and treatment approaches are also reviewed. Prevention through immunization and chemoprophylaxis is mentioned. Nursing assessments, diagnoses and interventions for a case study of a 7-year old boy with meningitis are presented.
The document provides information on nursing care for clients with meningitis. It discusses causes of meningitis including bacteria, viruses and fungi. The clinical presentation of acute and chronic meningitis is outlined. Physical exam findings, lab tests and treatment approaches are also reviewed. Prevention through immunization and chemoprophylaxis is mentioned. Nursing assessments, diagnoses and interventions for a case study of a 7-year old boy with meningitis are presented.
The document provides information on nursing care for clients with meningitis. It discusses causes of meningitis including bacteria, viruses and fungi. The clinical presentation of acute and chronic meningitis is outlined. Physical exam findings, lab tests and treatment approaches are also reviewed. Prevention through immunization and chemoprophylaxis is mentioned. Nursing assessments, diagnoses and interventions for a case study of a 7-year old boy with meningitis are presented.
The document provides information on nursing care for clients with meningitis. It discusses causes of meningitis including bacteria, viruses and fungi. The clinical presentation of acute and chronic meningitis is outlined. Physical exam findings, lab tests and treatment approaches are also reviewed. Prevention through immunization and chemoprophylaxis is mentioned. Nursing assessments, diagnoses and interventions for a case study of a 7-year old boy with meningitis are presented.
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Asuhan keperawatan pada
klien dengan meningitis
Retno Lestari
Setelah menyelesaikan topik 8 ini, peserta
didik diharapkan mampu:
Melakukan pengkajian pada klien dengan
meningitis. Menetapkan diagnose keperawatan pada klien dengan meningitis. Merencanakan intervensi pada klien dengan meningitis Melakukan evaluasi pada klien dengan meningitis
Causes of Meningitis Bacteria Community-acquired - S. pneumoniae, N.
meningitidis, gp B streptococcus Post-op or hospital acquired MRSA, Ps. Aeruginosa In the very young and very old Listeria monocytogenes
Clinical Presentation Chronic meningitis Insidious, gradual onset Weeks of headache Low grade fever Sweats, chills Weight loss
Acute Meningitis
Physical Exam Brudzinskis sign uncommon Nucal rigidity common Photophobia common Rash - uncommon
Lab CT head r/o cerebritis, brain abscess, brain
edema Lumbar puncture High protein Low glucose (CSF:serum glucose < 50%) Bacterial antigens more sensitive in children Gram stain and culture
Treatment Ceftriaxone 2 gm IV Q 12, or Cefotaxime 2 gm
IV Q 4, plus Vancomycin 1.5 gm IV Q 12 In the very young or very old add Ampicillin 2 gm IV Q 4 If pcn allergic, ask for details: Rash : use cephalosporin Anaphylactic : use Aztreonam 2 gm IV Q 8
IN The ER 1st step Give antibiotics ASAP 2nd step draw labs 3rd step CT head 4th step - LP
Prevention Vaccines Pneumovax Meningicoccal vaccine Both should be administered to any asplenic
patient
Exposure to meningococcus Rifampin 600 mg PO BID x 4 doses Only for intimate contacts: spouse,
boyfriend/girlfriend, household contacts
Not needed for: classmates, co-workers, HCWs (ER personnel, EMTs, etc)
Other viruses HSV2 (HSV1 causes encephalitis) HIV Lymphocytic choriomeningitis virus Mumps Varicella Zoster
Viral Meningitis Cannot distinguish initially from bacterial meningitis Severe headache, photophobia, nucal rigidity, fever May be preceded by a few weeks by viral
gastroenteritis
Ask pt is he/she had the stomach flu some time in the past
couple weeks
Almost never involves brain (meningoencephalitis)
Pt never obtunded, no Hx of seizure
Disease is self-limited, resolves after 7 to 10 days
without treatment No serious sequelae
Chronic Meningitis
Causes Cryptococcus Coccidioides immitis Mycobacterium tuberculosis Other fungal histoplasmasma, blastomyces,
Presentation Insidious onset Low grade fever if any Persistant, worsening headache Photophobia and nucal rigidty usually absent Symptoms have usually lasted several weeks
by the time diagnosis is made
Diagnosis History Exposure to bird droppings (crypto) Travel to Arizona, Central Valley California, Desert Southwest (cocci) Contacts with TB pts CSF Glucose may be normal, but protein usually high (very high if coccidioma causes CSF obstruction)
Diagnosis TB CSF AFB smear usually negative AFB culture takes 6 weeks Positive PPD or quantiFERON may suggest diagnosis CSF PCR not standardized yet, but may be helpful; Cryptococcus India ink Cryptococcal Ag in CSF
Diagnosis Coccidioidomycosis Difficult diagnosis to make CSF fungal smear and cultures usually negative Titers have high false negativity rate even from CSF Cocci CF titer from serum may give clue. Any pt with history of pulmonary cocci who develops HA with pleocytosis should be treated for cocci meningitis
Treatment TB Treat like pulmonary TB: INH, Rif, Eth, PZA for two
Crytpococcus Amphotericin plus flucytosine for 6 weeks followed by
fluconazole to complete 6 months
High toxicity rate (renal failure, pancytopenia)
High dose fluconazole (400 to 800 mg QD) if cant
tolerate ampho + 5FC
Serial LPs to reduce CSF pressure and assure clearing of infection In AIDS pts continue Fluconazole until CD4 >100
Treatment Coccidioidomycosis Intrathecal amphotericin now rarely used
Chemical arachnoiditis
High dose fluconazole (800 to 1200 mg QD)
Serial LPs to assure improvement of infection Incurable symptoms may resolve, but patient
can never stop fluconazole
Taper down to no lower than 400 to 600 mg QD
Recurrent meningitis Mollarets meningitis Most common cause is HSV2 Many other poorly defined causes as well Leaking arachnoid cyst Cryptogenic May respond to acyclovir
Conclusion Acute bacterial meningitis is most commonly
caused by viruses, then bacteria
Chronic meningitis can be caused by fungi and TB Recurrent meningitis Mallorets Call ID when pt has meningitis
Kasus Seorang anak laki-laki berusia 7 tahun, dibawa ke rumah sakit
karena panas tinggi sejak 4 hari yang lalu dan mengeluh sakit kepala, kejang sebanyak 1 kali di rumah. Keluarga mengatakan leher anaknya terasa kaku. Dari hasil anamnesa perawat dengan ibu klien didapatkan bahwa anaknya pernah mengalami otitis media 1 bulan yang lalu, riwayat anoreksia. Hasil pemeriksaan perawat, anak tampak letargi, tanda-tanda vital: Suhu 39,5oC, nadi 120x/menit, pernapasan 22x/menit, brudzinski (+), kernig (+), mukosa kulit kering, turgor kembali 3 detik, GCS 345, badan teraba hangat. Hasil pemeriksaan lab: leukosit 15.000, LED 20mm/jam, pemeriksaan Analisis LCS dari Pungsi Lumbal: Sifat : keruh, Tekanan : 300 mmhg, Protein : 75 mg/dl, Leukosit total : 10/ml, Glukosa : 100 mg/dl, CT scan terdapat penumpukan cairan pada selaput meningen. Klien mendapatkan Fenitoin 5 mg/kg/24 jam, 3 kali sehari, asam salisilat 10 mg/kg/dosis, kloramfenikol 50mg/kgBB/24jam/IV 4x sehari.
Three protective membranes - meninges - cover the brain
and the spinal cord.Between the middle
membrane(Arachnoid) and the soft inner membrane (Pia) is the cerebrospinal fluid(light blue).In meningitis the infection will typically spread fromthe cerebrospinal fluid to the membranes and therefore this fluid is examined by lumbar punture when meningitis is suspected.
Pengkajian
Anamnesis
- keluhan utama Riwayat penyakit sekarang - aktifitas - sirkulasi - eliminasi - makanan/ cairan - hiegiene - neurosensorik - nyeri/ keamanan Riwayat penyakit dahulu - pernahkah mengalami infeksi jalan napas,dll - riwayat sakit TB paru
Pemeriksaan fisik
- tingkat kesadaran - fungsi serebri - pemeriksaan saraf kranial - sistem motorik - pemeriksaan refleks - gerakan involunter - sistem sensorik Pemeriksaan diagnostik Pengkajian psikososial (pada anak perlu dikaji dampak hospitalisasi)
DIAGNOSA dan INTERVENSI
Risk for ineffective cerebral
perfusion Related factors: - Infeksi - regulasi suhu abnormal o/hipotalamus
S= 39,5oC Sakit karena panas tinggi sejak 4 hari yang lalu Pernah mengalami otitis media 1 bulan yang lalu Badan teraba hangat Leukosit 15.000 Pungsi lumbal: keruh Sakit kepala
peradangan dan edema pada otak dan selaput otak Tujuan : dalam waktu 3 x 24 jam setelah
diberikan intervensi perfusi jaringan otak
meningkat. Kriteria hasil : tingkat kesadaran meningkat menjadi sadar disorientasi negatif, konsentrasi baik, perfusi jaringan dan oksigenasi baik, tanda-tanda vital dalam batas normal, dan syok dapat dihindari.
INTERVENSI
RASIONAL
Anjurkan klian berbaring min. 4-6
jam setelah lumbal pungsi
Untuk mencegah nyeri kepala yang
menyertai perubahan TIK
Monitor tanda2 peningkatan TIK
selama perjalanan penyakit
Untuk mendeteksi tanda2 syok
Monitor tanda2 vital dan neurologis
tiap 5-30 menit
Perubahan menandakan ada
perubahan TIK untuk intervensi awal
Hindari posisi tungkai
ditekuk/gerakan2 klien, anjurkan tirah baring
Untuk mencegah peningkatan TIK
Tinggikan sedikit kepala dgn hatihati, hindari fleksi leher
PENCEGAHAN Imunisasi HbOC, dimana protein carrier berasal dari non toksigenik mutant dari toksin diphteria. PRP-OMP, conjugate vaksin yang berisi outer membrane proteins dari N. Meningitidis/OMP PRP-D, berisi toksoid diphteria yang berikatan dengan rantai sedang PRP polymer. Meningococcal conjugate vaccine (MCV4) Chemoprophylaxis Pada kasus dengan penderita, secepatnya harus diberikan chemoprophylaxis.
Meningitis yang disebabkan oleh virus dapat
ditularkan melalui batuk, bersin, ciuman,
sharing makan 1 sendok, pemakaian sikat gigi bersama dan merokok bergantian dalam satu batangnya. Mancuci tangan yang bersih sebelum makan dan setelah ketoilet umum, memegang hewan peliharaan. Menjaga stamina (daya tahan) tubuh dengan makan bergizi dan berolahraga yang teratur adalah sangat baik menghindari berbagai macam penyakit.
