PPT16 (Child Meningitis, ADHD)

Meningitis

• spinal meningitis

• an inflammation of the meninges (the membranes that line the brain & spinal cord)-- (“__” )

• usually caused either by a virus or by bacteria that travel through the bloodstream from an infection in another part of the body

• can occur at all ages but it is commonest in infancy

• more common males than females

1. person-to-person; respiratory droplets

2. close & prolonged contact

3. 2-10 days

Transmission: (Meningitis)

1. bacterial transmission from __ thru __

2. __ & __ (e.g. sneezing & coughing on someone, living in close quarters, sharing eating or drinking utensils, etc.)

3. incubation period: __ days

1. skipping vaccinations

2. age; 5; 20

3. living in a community setting; meningococcal meningitis

4. pregnancy; listeria bacteria

5. weakened immune system; spleen

Risk factors (Meningitis)

1. __ (Risk rises for anyone who hasn't completed the recommended childhood or adult vaccination schedule).

2. __ (Most cases of viral meningitis occur in children younger than age __ years. Bacterial meningitis is common in those under age __).

3. __ (College students living in dormitories, personnel on military bases, and children in boarding schools and child care facilities are at greater risk of __ meningitis). This is probably because the bacterium is spread through the respiratory route, and spreads quickly through large groups.

4. __ (It increases the risk of an infection caused by __ bacteria, which also may cause meningitis). The infection increases the risk of miscarriage, stillbirth and premature delivery.

5. __ (AIDS, alcohol use disorder, diabetes, use of immunosuppressant drugs and other factors that affect your immune system increase the risk of meningitis). Having a __ removed also increases risk. People without this organ should get vaccinated to lower the risk.

1. altered consciousness

2. bulging fontanelles

3. photophobia

4. Opisthotonos

5. Brudzinski’s sign

6. Kernig’s sign

S/Sx (NB): (Meningitis)

1. __/ apnea

2. severe headache/ __

3. __ (intolerance to light)

4. __(spasm of the muscles causing backward arching of the head, neck & spine) (sev. Stiffneck)

5. __ (flexing the pt’ s. neck causes flexion of the hips & knees)

6. __(flexing the pt’ s. hip 90 degrees then extending the pt’ s. knee causes pain)

SEE:

• Sudden high fever.

• Confusion or trouble concentrating.

• Sleepiness or trouble waking.

• Skin rash in some cases, such as in meningococcal meningitis.

S/Sx (>2y.o.): (Meningitis)

(Early meningitis symptoms may be similar to the flu. Symptoms may develop over several hours or over a few days).

(SCSS)

• Bacterial meningitis

• Viral meningitis

• Chronic meningitis

• Fungal meningitis

• Parasitic meningitis

CAUSES (Meningitis)

(BVCFP)

Bacterial Meningitis

caused by an ear or sinus infection, a skull fracture, or — rarely — some surgeries

streptococcus pneumoniae

(the most common cause of bacterial meningitis in infants, young children and adults) more commonly causes pneumonia or ear or sinus infections. A vaccine can help prevent this infection.

Neisseria meningitidis (Meningococcus)

(This bacterium causes a bacterial meningitis called meningococcal meningitis). It commonly cause an upper respiratory infection but can cause meningococcal meningitis when they enter the bloodstream. This is a highly contagious infection that affects mainly teenagers and young adults. It may cause local epidemics in college dormitories, boarding schools and military bases.

Haemophilus influenzae; Haemophilus influenzae type b (Hib)

this bacterium was once the leading cause of bacterial meningitis in children. But new Hib vaccines have greatly reduced the number of cases of this type of meningitis.

Listeria monocytogenes

(These bacteria can be found in unpasteurized cheeses, hot dogs and lunchmeats). People who are pregnant, newborns, older adults and people with weakened immune systems are most susceptible. During pregnancy, listeria can cross the placenta. Infections in late pregnancy may be fatal to the baby.

Viral meningitis

1. enteroviruses

2. herpes simplex virus (HSV), HIV, mumps virus, west nile virus

is usually mild and often clears on its own. Most cases are caused by a group of viruses known as (1)__ (shed in respiratory secretions and stool and sometimes are present in the blood and cerebrospinal fluid of infected patients). Viruses such as (2)__, __, __, __ and others also can cause this type of meningitis.

chronic meningitis

1. mycobacterium tuberculosis

2. 2 weeks

• long-lasting — can be caused by slow-growing organisms such as fungi and (1)__. They invade the membranes and fluid surrounding the brain.

• develops over (2)__ weeks or more. Symptoms are similar to acute meningitis, which is a sudden, new case. They include headache, fever, vomiting and mental cloudiness.

fungal meningitis

1. fungal spores

2. cryptococcal meningitis

• It may mimic acute bacterial meningitis. It's often contracted by breathing in (1)__ that may be found in soil, decaying wood and bird droppings.

• isn't spread from person to person. (2)__ is a common fungal form of the disease. It affects people with weakened immune systems, such as from AIDS. It can cause death if not treated with an antifungal medicine. Even with treatment, this type of meningitis may come back.

parasitic meningitis

1. eosinophilic meningitis

2. amoebic meningitis

• Parasites can cause a rare type of meningitis called (1)__. Parasitic meningitis also can be caused by a tapeworm infection in the brain or cerebral malaria. (2)__ is a rare type that is sometimes contracted through swimming in fresh water and can quickly become life-threatening.

• The main parasites that cause meningitis typically infect animals. People are usually infected by eating foods contaminated with these parasites. This type of meningitis isn't spread between people.

bacterial meningitis

1. GBS & gram

2. purulent

3. CHON

4. <70 mg/dl

5. >1000cells/microL

6. +

• More dangerous

• Fatal if not treated quickly with antibiotic (AB)

  1. __ – bacilli (found in intestines, vagina or rectum)

  2. CSF clear to __

  3. Elev. __

  4. Dec. glucose: __

  5. WBC ct. __

  6. CSF gram stain & culture: often __ for a sp. organism

viral meningitis

1. 7-10

2. polio, MMR, HSV, rabies, HIV

3. cloudy

4. CHON

5. glucose

6. <500 cells/microL

7. no organism

• More common

1. Less serious (usually clears up on its own in __ days)

2. Enterovirus (__, __, __, __, __)

3. CSF clear to __

4. Elev. __

5. Normal __

6. WBC ct. __

7. CSF gram stain & culture: __ identified

SEE:

1. CSF study

2. blood culture; 80-90%; ESR

3. CT scan

Diagnosis: (Meningitis)

1. __ (Lumbar puncture is done to collect __)(analysis of __, typically reveals microorganisms on gram stain & culture)

2. __ (reveals up to __ of responsible bacteria) (elevation of C-reactive protein, __ differentiate bacterial from viral causes)

3. __ (show slit-like lateral ventricle & areas of low attenuation)

Treatment:

1. 3 rd gen. Cephalosporins (Cefotaxime; Ceftriaxone)

   1. Penicillin G or Meropenem

   2. Ampicillin

2. Acyclovir (anti-viral)

   1. Oseltamivir

3. Corticosteroids (Dexamethasone)

Prevention:

1. Practice good hygiene

2. Vaccination

   1. H. influenza

   2. S. pneumoniae

3. Antibiotic prophylaxis

Complication:

1. Sensori-neural hearing loss (SNHL)

(MENINGITIS)

Treatment:

1. __ (__; __)- for Bacterial M.

   1. __ - alternate to Ceftriaxone

   2. __ - for Listeria M.

2. __ (anti-viral)- for Viral Meningitis-- HSV (herpes simplex virus)

   1. __ - for influenza

3. __ (__)- for children > 6wks. Old

Prevention:

1. __ (hand washing; Don't share drinks, foods, straws, eating utensils, lip balms or toothbrushes with anyone else; avoid cheeses made from unpasteurized milk, choose cheeses that are clearly labeled as being made with pasteurized milk )

2. __

   1. (__ @ 2 months of age)

   2. (__ @ 2 months (initial)

3. __ of susceptible at-risk contacts

Complication:

1. __- inner ear is affected

• Opisthotonos

• Kernig’s Sign

• Brudzinski’s neck sign

Signs of Meningeal Irritation (OKB) / Triad Sign

ADHD (Attention-Deficit Hyperactivity Disorder)

1. 5%

2. frontal, parietal, temporal, occipital LOBES

3. 7

• a developmental delay (has (1)__ smaller brain); these type of brains have low levels of a neurotransmitter called norepinephrine.

• smaller, less active, less developed brain regions (impaired activity in four functional regions of the brain--(2) __, __, __ and __ lobe)

• abnormal cognitive, behavioral, and motivational functioning (affect the regulation of moods, emotions, and brain cell connections)

• a disorder that appears in early childhood

• signs & symptoms typically appear before the age of (3)__

• symptoms are typically at most prominent during elementary grades

• usually continues into adulthood

• Inattentive ADHD

• Hyperactive-Impulsive ADHD

• Combined ADHD

types of ADHD (IHC)

Inattention

S/Sx (ADHD):

>daydreams, has a hard time paying attention

>trouble listening to what’s being said

>easily distracted from tasks & play

>doesn’t follow through on obeying instructions

>disorganized

>loses important things

>forget things

>doesn’t want to do things that require ongoing mental

effort

>has trouble understanding information quickly &

accurately

Hyperactivity

S/Sx (ADHD):

> fidgets or squirms

> talks too much

> has trouble playing quietly

> often runs about or climbs in situations where it’s inappropriate

Impulsivity

S/Sx (ADHD):

> blurts out inappropriate comments or answers before the entire question has been asked

> can’t wait for things

> trouble taking turns or standing in line

> acts without thinking

> can’t control emotions

> interrupts others

1. neurotransmitters; Nor-epi, Dopamine

2. genetic; 20-25%

3. preservatives & artificial food coloring; red dye 40-; sodium benzoate

4. cigarette, alcohol

Contributing Factors: (ADHD)

1. a deficiency in the __ (__ & __) in the brain

2. __(if 1 child has ADHD, the chances of a sibling having it are __)

3. __ (__ a synthetic food dye made from petroleum; preservative __)

4. __ & __ use of mother during pregnancy

1. developmental pediatrician

2. medical and social history

3. vision. hearing

4. memory, problem-solving, listening

Evaluation: (ADHD)

1. evaluated by a __

2. ___ (about pregnancy, family members with ADHD, emotional difficulties)

3. __ & __ test

4. __, __ & __ skills

1. family therapy (parent training)

2. behavioral therapy

3. cognitive behavioral therapy

4. medication; Ritalin/ Dexedrine

Treatment:

1. __ (__) -best way to deal with ADHD, by learning how to handle own frustration with child’s behavior, to parent consistently & positively

2. __ -structuring situations at home & school so a child doesn’t become unnecessarily stimulated or distracted

   • helping a child to develop coping strategies for particular situations

3. __ -The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks

4. __ -stimulants (__/ __) (it helps to regulate levels of neurotransmitters in the brain)

1.)Change the scene

2.)Reward instead of punish

3.) Being clear and consistent.

4.) Keeping a routine and a schedule.

5.) Organizing everyday items.

Prevention: (ADHD)

FOR KIDS

1.)__ (eliminate sources of overstimulation & distraction in the child’s environment)

2.)__ (praise good behavior immediately/ giving a little token that pleases a child)(reward should be something enjoyable right away because ADHD kids don’t like to wait)

3.) __. Children with ADHD need consistent rules they can understand and follow.

4.) __. Keep the same routine everyday, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or a bulletin board. Write changes on the schedule as far in advance as possible.

5.) __. Have a place for everything, (such as clothing, backpacks, and toys), and keep everything in its place. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home necessary books.

• Keeping routines.

• Making lists for different tasks and activities.

• Using a calendar for scheduling events.

• Using reminder notes.

Prevention: (ADHD)

For Adults

A professional counselor or therapist can help an adult with ADHD learn how to organize their life with tools such as:

(KMUU)

Human sources:

·       Streptococcus pneumoniae

·       Neisseria meningitidis (Meningococcus)

·       Haemophilus influenzae (Haemophilus influenzae type b (Hib) bacterium

Animal sources:

·       Listeria monocytogenes

Human sources:

·      

·      

·     

Animal sources:

·      

1. Cerebrospinal fever

2. Pia Mater, Arachnoid Mater, Dura Mater

3. CSF

1. Meningitis is also referred to as

2. parts of meninges (PAD)

3. substance that carries the meninges; will appear yellowish and purulent if bacteria is present; affected if there is a hematogenous spread

1. subarachnoid space (between the arachnoid and pia mater)

2. wear PPE, mask in particular

3. 3 feet away

4. 1 nurse (will not cater any pt)

1. the location of where CSF is situated and circulated

2. nursing intervention for meningitis

3. how many feet away should a pt. with meningitis be distanced from other patients

4. how many nurse must be assigned to a pt. with meningitis

1. Pentavalent, PCV

2. Flu vaccine (Hib vaccine or Haemophilus influenzae type b vaccine)

vaccines for meningitis:

1. pedia:

2. adult:

1. viral meningitis

2. bacterial meningitis

a type of meningitis is common in this age:

1. under 5 yrs old -

2. under 20 yrs old -

1. crowded places

2. pregnant/ pregnancy

3. CNS

4. humans

5. dormant

1. meningitis will spread faster in this type of setting

2. no raw & unpasteurized food must be served when __

3. bacteria can easily infiltrate the __

4. are the sources of bacteria

5. bacteria may appear __ in some factors/ cases

1. fresh water (swamps)

2. lethargy (pathologic sleepiness)

3. severe headache & bulging fontanelles

1. parasites are common in these areas

2. early sign of meningitis

3. late signs of meningitis

1. hypothalamus (regulation center)

2. increase in Intracranial Pressure (ICP)

3. trigeminal nerve

4. increase in ICP

5. hypothalamus (thermoregulation center)

reasons for S/Sx manifestation:

1. fevers and chills & poor feeding will manifest because the __ is affected

2. irritability because __

3. photophobia the __ is affected

4. Seizure because __

5. Shivering because __ is affected

pin-prick rash and cold hands & feet

severe S/Sx of meningitis if there is a systemic sepsis and there will be a constriction of blood vessels so it will result to little or to no supply of oxygen

1. ↑ of ICP

2. 4 vials

3. pedia: 1 ml/vial

   adult: 8-40 ml/vial

4. Sims position/ side-lying

5. G16

1. HCP must check the ICP first before inserting the spinal manometer because there might be a possibility that there is an __ — dangerous, potentially leading to brain herniation

2. how many vials should be obtained for the CSF study

3. Vial (quantity/ age group):

   pedia-

   adult-

4. position for CSF study

5. gauge size

3-way stopcock

• used during lumbar puncture to control the flow of cerebrospinal fluid (CSF) and allow for different procedures like measuring opening pressure, collecting CSF samples, and, if necessary, therapeutic injections.

• It's essentially a valve that allows you to divert fluid flow between the patient, the manometer (for measuring pressure), and a collection tube.

1. neutrophils (WBC)

2. Erythrocyte Sedimentation Rate (ESR)

3. CSF study

4. 0-3 mg/L

5. pedia: <10 mm/hr

   adult: <20 mm/hr

6. Sensorineural hearing loss

1. ↑ ICP because of the release of __

2. presence of erythrocyte (RBC)

   • test to differentiate bacterial from viral causes

3. definitive test for meningitis

4. CRP NV

5. ESR NV for pedia & adult

6. is manifested because the trigeminal nerve is affected

• Ma’am: neck, spine, back

• Google: neck, back, and lower extremities (legs)

opisthotonos sign affected areas

overstimulation

in persons who has ADHD, __ is not allowed (activity)

1. norepinephrine

2. dopamine

3. neuropsychologist

4. newborn screening

1. fight-or-flight hormone; for memory

2. feel-good hormone

3. doctors for adults (ADHD)

4. test for infants (ADHD)

1. Occupational Therapist

2. Ritalin

1. partner of a developmental pediatrician for ADHD

2. DOC that can/will increase Norepinephrine & Dopamine

1. direct spread

2. hematogenous spread

modes of transmission for Meningitis:

1. - skin, nose, anatomical defect (s. bifida, skull fx)

2. - blood stream

spinal manometer

CSF pressure is typically measured during a lumbar puncture using a __

1. Eosinophilic meningitis; Angiostrongylus cantonensis

2. amoebic meningitis; Naegleria Fowleri

1. __ high levels of eosinophils (WBC) in the CSF. the most common cause globally is infection with the__

2. also known as primary amoebic meningoencephalitis (PAM), is a rare type but almost always fatal caused by __

   • is a rare type that is sometimes contracted through swimming in fresh water and can quickly become life-threatening.

1. rifampin

2. ciprofloxacin

3. ceftriaxone

4. azithromycin

• 24 hrs

antibiotic prophylaxis:

1. a common and effective option, especially for infants (4 oral doses for 48 hrs)

2. widely used (single oral dose)

3. preferred for pregnant women and sometimes used as an alternative to rifampin or ciprofloxacin (single injection)

4. single oral dose (if resistant to ciprofloxacin)

• prophylaxis should be initiated ideally within __ hrs of identifying the index patient (the person with the disease)

1. <15

2. >15

1. normal pressure during CSF study

2. abnormal pressure during CSF study

1. Meningococcal vaccine

2. Pneumococcal vaccine

3. Haemophilus influenzae type b (Hib) vaccine

Vaccines:

1. protects against the bacteria Neisseria meningitidis — common cause of meningitis

2. protects against Streptococcus pneumoniae — another common cause of meningitis

3. protects against Haemophilus influenzae type B (Hib) — bacteria that used to be a common cause of meningitis in children but is now less common due to widespread vaccination