Running head: BACTERIAL MENINGITIS

Nursing Intervention: Bacterial Meningitis

BACTERIAL MENINGITIS

2
Bacterial Meningitis

Bacterial Meningitis is an acute infection in which the meninges, the brain parenchyma
are involved in inflammatory reaction. Thick pus formed due to infection obstructs flow of
cerebrospinal fluid which leads to increased intracranial pressure (ICP). Haemophilus influenza
Type b, Streptococcus pneumoniae, Neisseria meningitidis are the causative agents for bacterial
meningitis in 95 percent of children older than two month (Perry et al., 2013). Approximately 10
percent of cases of bacterial meningitis are fatal (Perry et al., 2013). In Canada, mainly
meningococcal outbreaks are due to Serogroup C Neisseria meningitides. This disease is
characterized by fever, severe headache, frequent seizures, poor feeding, vomiting, high pitched
cry, bulging fontanel and nuchal rigidity. A lumber puncher is a definite diagnostic test. Best way
to protect children from bacterial meningitis is to get immunization done for the disease
recommended by provincial immunization schedule (Perry et al., 2013).
Nursing interventions
Acute bacterial meningitis is a medical emergency which requires early recognition and
measures to reduce intracranial pressure to prevent death or residual disabilities for nursing
diagnosis which is ineffective tissue perfusion related to increased intracranial pressure (Perry et
al., 2013). The child suffering with bacterial meningitis should be on total bed rest in supine
position with strict fluid administration to avoid intracranial hypertension. Child is isolated from
other children usually in critical care unit for close observation because it occurs in an epidemic
form and is transmitted by droplet infection from nasopharyngeal secretions (Perry et al., 2013).
As most children are sensitive to noise, bright lights and external stimuli, the isolated room can
provide the required environmental atmosphere. To avoid seizures in the first few hours of the

BACTERIAL MENINGITIS

disease, appropriate measures for safety and intensive care can only be provided in an isolated
critical care unit (Perry et al., 2013). If supine position and total bed rest without a pillow and
slight head elevation are not given there is an increased risk of brain herniation due to increased
ICP (Oppenheimer & Rosman, 1976).
If the child is not isolated from other children there is an increased risk of spreading
infection by sharing their toys which may contain their saliva (Peel Public Health, 2015). The
consequences of not addressing the intervention can be fatal which can lead to serious
complications such as hearing loss, brain damage, learning disability because of an increase in
ICP (Perry et al., 2013). In support of my priority intervention chosen, according to Canadian
Pediatric Society, the prognosis of meningitis depends on monitoring of early complications in
isolation, posturing child appropriately and treating infection with timely antimicrobial therapy
(Nicole, 2014).
Collaborative Care Providers
Firstly, a pediatrician is the most important in collaborative care for early thorough
assessments, ordering strict fluid administration with antimicrobial therapy, and for doing lumbar
puncture which is required for diagnostic confirmation of the suspected cases of meningitis (Saez
& McCracken, 2003). Pediatrician will order pain reduction measures to avoid increase in ICP.
Observation of vital signs, neurological signs, loss of consciousness, urine output and other
pertinent data should to be carried out at frequent intervals, which is possible only in the
intensive care ordered by pediatrician (Perry et al., 2013). The pediatrician will advise antibiotics
to the people in close contact for protection (Peel Public Health, 2015). Pediatrician may order
enteral therapy if the child is not feeding.

BACTERIAL MENINGITIS

Secondly, an infection control official is the collaborative care provider who identifies
and determines risk of close contact and will guide about the precautions to be taken to avoid
infection spread. Infection can lead to considerable mortality and morbidity if not treated and
infection control measures are not followed (Nicole, 2014). The infection control person will
provide guidelines for hand washing techniques and measures to stop spread of droplet infection
to the staff and family members. She will notify the case to Peel Public Health to prevent further
risk of spread (Peel Public Health, 2015).
Inflammation of cochlear aqueduct and the auditory nerve can lead to reversible or
permanent deafness in 5 to 30 percent of patients suffering from meningitis (Saez &
McCracken, 2003). As mentioned earlier hearing loss can occur due to increase ICP if the child
is not given total bed rest in a quiet atmosphere with comfortable positioning of neck in the
isolated room and if therapy is delayed. In that case an Otologist is called in for auditory
assessments to avoid long term complications. The Otologist will do evaluation of the eighth
cranial nerve, and this is needed for at least for six months follow up period to assess for possible
hearing loss (Perry et al., 2013). In a study done by Canadian researchers it was found that one
month after they had meningitis, 37 percent had neurological problems and out of that 10 percent
had hearing loss (Child Health Alert, 1991)
Community Resources
Meningitis Relief Canada is a nonprofit organization. Their vision is to improve the lives
of individuals and families affected by complications of meningitis by providing means to
recover and return to their normal level. Free counseling services are provided and they educate
the public about the signs and symptoms of meningitis to reduce death and disability from the

BACTERIAL MENINGITIS

disease. They also, provide grief and bereavement counseling, financial assistance and support
service to patients suffering from meningitis. Immunization schedule for meningitis and the
vaccination is knowledge is also provided (Meningitis Relief, 2015).
Peel Public Health provides services that focus on health protection and disease
prevention. It is the role of their department to determine risk of spreading the infection after
getting notified by the hospital. They provide information about immunization schedule,
locations to get immunized and keep immunization record up to date for all children and review
them before children go to school (Peel Public Health, 2015). The department also gives
information about the meningitis disease, routes of transmission, risk factors, its reoccurrence
and treatment. Two publicly funded vaccines are available to protect against meningococcal
disease. The first is Haemophilus influenza type b-Hib vaccine which is given at 2, 4, 6 and 18
months of age. The second one is Menigococcal C conjugate for protection against some types of
meningococcal disease at 12 months of age (Peel Public Health, 2015).The client is benefited by
getting advice on contact precautions and support system.
Meningitis Research Foundation of Canada is a dedicated body in prevention of
meningitis (cite). They improve survival rates and outcomes and provide support to the families
who suffered from the disease. They do awareness programs to prevent the spread of this disease.
Clients visit their website and having a live chatting session with a medical advisor or can visit
their locations for more queries about the disease.
Conclusion
In conclusion, a child suffering from bacterial meningitis needs intensive care, should be
kept in isolation in a supine position to alleviate discomfort postures and environmental stimuli

BACTERIAL MENINGITIS

to avoid serious complications. Infection control measures should be followed to prevent spread
of meningitis.

BACTERIAL MENINGITIS