2.  Aseptic meningitis—NONbacterial  Most commonly viral in etiology.  Associated with mumps, measles, herpes, other viral syndromes  Signs and Sx—generally gradual in onset, but may be sudden. Headache Fever—low-grade, usually GI sx—nausea and vomiting may be R/T  ICP General malaise Maculopapular rash Symptoms usually disappear in 3-10 days

3.  Acute inflammation of meninges & CSF caused by bacterial infection  Haemophilus influenzae type B (vaccine)  Streptococcus pneumoniae  Neisseria meningitidis  Risk factors: immunosuppression, preexisting CNS anomalies, chronic diseases  Organisms may come from infections in teeth, sinuses, tonsils, lungs, skull fracture

4.  Etiology by age of incidence:  Neonate-3 months: Group B Beta Strep and E.Coli  3 months-3 years: Haemophilus Influenzae Type B Streptococcus pneumonieae Neisseria meningitidis (meningococcal) Staphylococcus aureus  School-age and beyond: Meningococcal due to high transmissibility through droplet form.

5.  Hx of URI or ear infection  Irritabilitiy, restlessness  Severe HA, fever, chills, vomiting  Stiff neck (nuchal rigidity) can progress to point of opisthotonos  Alterations in sensorium  High pitched cry in infants; bulging fontanel  May begin w/seizure or develop later  Photophobia  Kernig’s and Brudzinski’s sign

6.  Dx: Hx/physical and lumbar puncture  CSF cloudy; culture done **KNOW CSF FLUID RESULTS!!  Management:  Begin IV antibiotics and fluids IMMEDIATELY  Respiratory isolation till on meds for 24hrs if bacterial, longer if viral  NPO  Freq VS & neuro checks  I&O  Assess for ↑ ICP; Keep HOB elevated  Assess for SIADH – may need to restrict fluids  Keep room/environment quiet, darkened; ↓ stimuli  Pain meds as ordered; uninterrupted rest periods  Seizure precautions  Reportable to local Health Dept.

7.  Complications of meningitis:  epilepsy  neuro damage (brain damage to learning disabilities)  hearing or vision loss – hearing most common  hydrocephalus  10-15% mortality

8.  Acute toxic encephalopathy w/other organ involvement; fatty changes in liver  Sudden change in LOC, fever, vomiting  Progresses rapidly; ↑ ICP; death  Risk factors: triggered by a mild viral illness like chickenpox or flu and use of salicylates especially Aspirin  Children <18; most bet 4 – 14 yrs  Liver Bx is final clinical Dx

9.  Quiet, lethargic, vomiting  Confusion, combativeness, hyper-reflexia  Obtunded, seizures, decorticate rigidity  Deepening coma, fixed pupils  Coma, loss of deep tenden reflexes, flaccid, respiratory arrest

10.  ICU – monitor for cerebral edema;  ICP  Assess resp status, CVP, arterial pressure  Oxygen; intubation if needed  Accurate and frequent I & O  Tx: shock (fluids, electrolytes, vasopressors)  Tx: for ↑ ICP –keep ↑ HOB, airway support, administer mannitol as ordered)  Treat hyperthermia(cooling & meds)  Supportive care & ongoing info for family

11.  Malfunction in the electrical system of the brain; alterations in the firing of the neurons by group of hyper-excitable cells  Epilepsy: chronic DO w/recurrent seizures  Partial – begins local in one hemisphere  Simple partial or partial complex  Generalized – both hemispheres  Immed loss of consciousness  Tonic clonic and petit mal

12.  Simple partial: No loss of consciousness; alterations in motor function, autonomic signs, sensory symptoms  Partial complex: consciousness impaired; staring, lip smacking, chewing, unusual hand movements

13.  Petit mal or Absence: lack of awareness, unresponsive; lasts less than 15 secs; abrupt onset and cessation  Tonic clonic: Aura does NOT precede seizure. Postictal period after seizure: relaxation, confusion, amnesia, unresponsiveness  Tonic: sudden loss of consciousness, cry out & muscles get rigid; jaw clenched  Clonic: alternate contraction and relaxation of extremities

14.  Prolonged seizures: > 20 min or recurrent  OR postictal period > 30 min  Medical emergency → resp failure, hypotension, hypoxic brain damage, hypoglycemia  ICU – need IV benzodiazepine  Diazepam or Lorazepam  If IV access is difficult, EBP has shown that anti- convulsants administered rectally via a 5-8 French feeding tube with syringe is very effective.

15.  When to call 911  If no history of previous seizure  Not breathing  Seizure lasting > 5minutes  Turn child to side; put NOTHING in mouth  Do not restrict movement  Protect head – maintain safe environment  Observe, record, and report seizure activity  Provide information/teaching to family

16.  Anticonvulsants:  Phenobarbital  Phenytoin (Dilantin): gum hyperplasia SE  Carbamazepine (Tegretol)  Valproic acid (Depakene)  Primidone (Mysoline)  Ethosuximide (Zarontin)  Clonazepam (Klonopin)