Meningococcal meningitis and child nursing

Part A

Signs and Symptoms of Meningococcal meningitis

The ten year old child admitted with signs of Meningococcal meningitis must be suffering from an infection of bacteria Neisseria meningitidis, which is a gram negative diplococcus consisting of several serogroups that include A, B, C, 29E, H, I, K, L, W135, X, Y, and Z (Meningococcal disease). The pathogenicity and immunogenicity will depend on the serogroup responsible for the infection (Meningococcal meningitis). Since the infection has occurred in Australia, there is the strong possibility of the serogroups of A, B, and C being causative agents, as more than ninety percent of all the cases of meningococcal disease in Australia is caused by these serogroups. Meningococcal meningitis is not a frequently occurring infectious disease in a ten-year old child and the signs and symptoms have to be discerned appropriately for confirmation of meningococcal meningitis (Infectious Diseases 2003, p.146). In addition, it must be remembered that in only about 30-50% of invasive meningococcal disease causes Meningococcal meningitis, and in most of the other cases it could be Meningococcal septicemia. This is significant as treatment of patients with increased intracranial pressure as in the case of Meningococcal meningitis differs from the treatment of patients with shock, as in the case of septicemia (Faust, Cathie & Levin, 2007).

The 10-year child with Meningococcal meningitis is likely to present with vomiting, headache, fever, meningismus, with or without lowered cognition capabilities. There is also the likelihood of seizures, lateralizing deficits, and cerebral edema. Bacteremia is a frequent occurrence with Meningococcal meningitis that shows as a petechial and purpuric rash most often seen on the lower extremities and trunk. A non-specific symptom of lack of appetite may also be demonstrated (Chan et al, 2001, p.68). The presence of petechial and purpuric rash in the child is confirmation that the infection involves both the meninges as well as the blood stream. Infection of the blood stream is characterized by release of lipo-oligosaccharide (LOS)-associated membranes with growth of the bacteria. It is this release of (LOS)-associated endotoxin into the blood steam that causes thrombocytopenia shown in the purporic rash (Nath & Revankar, 2006, p.243).

The ten year old may show the classical signs and symptoms of Meningococcal meningitis consisting of vomiting, fever, headache, meningismus (nuchal rigidity), and confusion or delirium (Porter, 2004). This view is supported by Winn et al, 2005, p.581, but it is not necessary that all the classical signs and symptoms are seen in the ten year old child, as in about fifty percent of Meningococcal meningitis all the classical signs are not shown (Winn et al, 2005, p.581). These typical signs and symptoms of Meningococcal meningitis are because of the pathophysiology of the infection. The bacteria Neisseria meningitidis enters the subarachnoid space through the blood stream and directly reaches the meninges, which becomes the focus of the infection. The infection causes an intense host inflammatory response, which is the result of the presence of lipoteichoic acid and other cell wall products of Neisseria meningitidis, produced due to bacterial lysis. Mediation of this response is through the stimulation of brain cells with a similar action as macrophages that release cytokine and other mediators. The progress of the infection is such that this mediation is insufficient and edema in the brain occurs giving rise to the signs and symptoms of Meningococcal meningitis consisting of fever, headache, meningismus (nuchal rigidity), and confusion or delirium (Miller, Gaur & Kumar, 2008).

Part B

Important Considerations when Nursing the Child and Family

The initial nursing management of a child with suspected Meningococcal meningitis consists of assessing the condition of the airways, breathing, circulation, disabilities, and discomforts and then deciding on the initial management strategy. Once the initial management strategy has shown easing of the symptoms in the child, the next step is to assess any bio-chemical abnormalities and make the necessary attempts to set right the abnormalities. At the same time it is also necessary to confirm the diagnosis of Meningococcal meningitis, for which a lumbar puncture has to be done. However, a lumbar puncture may not be possible if the child has developed seizures, is heamodynamically unstable, has significant respiratory distress or there are signs of raised intracranial pressure. In such cases blood samples should be taken and sent for culturing (Kendrick & Morrison, 2006, p.627). Taking these steps in the initial management of the child with suspected Meningococcal meningitis ensures that nursing interventions are in keeping with the recognized standards of practice and fulfils the duty of care as required by the ANMC National Competency Standards for a Registered Nurse, 2005.

However prior to initiating then nursing intervention steps, it is necessary to explain these steps to the family and get their consent, identifying in the process any objections that might arise from cultural and moral reasons and sorting out these differences with the family. These measures by the nursing professional ensures that recognition and acceptance of the family members to be part of the intervention decision process and the practice of nursing in accordance with the nursing professions’ codes of ethics and conduct in keeping with the ANMC National Competency Standards for a Registered Nurse, 2005.

The ANMC National Competency Standards for a Registered Nurse, 2005, requires that nursing and health care knowledge, skills and attitudes are incorporated to give safe and effective care. This becomes meaningful in the case of assistance with the diagnosis. The diagnosis for Meningococcal meningitis may be impaired due to safety reasons (Branco, Amoretti & Tasker, 2007, P. S 46). Culturing the blood is an alternative, but could be impaired in case of treatment with antibiotics, prior to admission. A recent study in a pediatric hospital in Australia has revealed that real-time PCR assays are highly reliable in predicting positive and negative values for meningococcal diseases in children in clinical settings. It may be useful to consider PCR assays to assist in the diagnosis of for Meningococcal meningitis in the child, if lumbar puncture and blood culture are found unsuitable (Bryant et al, 2004, p.2919). Use of such research in the practice of nursing finds support from the ANMC National Competency Standards for a Registered Nurse, 2005, which recommends the identification of relevant research for improving the health outcomes of an individual and a group.

Identification of the serogroup of the bacteria Neisseria meningitidis involved in the in the infection of the child is useful in the treatment of the infection. Neisseria meninigitidis infections are normally spread within the community (Chavez & Gallardo, 2006, p. 51). This knowledge makes it imperative that in the collecting the history of the patient from the family members, attention is paid to collecting the relevant data, which in this case is the and in the right framework as required by the ANMC National Competency Standards for a Registered Nurse, 2005.

In fact the ANMC National Competency Standards for a Registered Nurse, 2005, recommends that the nursing assessment be comprehensive and systematic. This is relevant in the case of this child and understanding the possible progress of the disease in the child. Fuessel, 2006, p. 16, points out that use of penicillin in patients suspected with meningitis results in poor prognosis in children. This finding is supported by Harnden, et al 2006, p.1295 who report that mortality and morbidity in children with meningitis are increased in the case of children being administered parenteral penicillin by General Practitioners, prior to admission to the hospital. Incorporating relevant assessment data for the development of the care plan is a component in the role of the nursing professional in the eyes of the ANMC National Competency Standards for a Registered Nurse, 2005. The ANMC National Competency Standards for a Registered Nurse, 2005, looks upon the role of the nursing professional as not merely ending with the collection of data for the care plan, but involves analyzing and interpreting data accurately, particularly, when the there is a conflict in the information and data, as may the case in the development of the care plan for this child with suspected Meningococcal meningitis.

The family needs of the child are also the concern of the nurse. The primary need is assess and prevent the spread of the infection to other members of the family and educate them on the means to prevent the spread of the infections, which includes the use of vaccines (Estep, 2005, p.117). The ANMC National Competency Standards for a Registered Nurse, 2005, requires such a concern from the nursing professional by recommending the facilitation of physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security of which infection control is a component.

The outcome of the management of this child with suspected meningitis may not be successful and there is the possibility of the loss of the child (Porter, 2002). This means there is the possible need for support of the family and the nursing professional should be prepared and capable to provide such support as required through the ANMC National Competency Standards for a Registered Nurse, 2005, which calls for the implementation of support to individuals or groups in the face of emotional distress. Literary References

Branco, R. G., Amoretti, C. F. & Tasker, R. C. (2007). Meningococcal disease and meningitis. Jornal de pediatria, 83(Suppl 2), S-46-53.

Bryant, P. A. Li, H. Y., Zaia, A., Griffith, J., Hogg, G., Curtis, N. & Carapetis, J. R. Prospective study of a real-time PCR that is highly sensitive, specific, and clinically useful for diagnosis of meningococcal disease in children. Journal of clinical microbiology, 42(7), 2919-2925.

Chan, E.D., Terada, L. S., Kortbeek, J. & Winston, B. W. (2001). Bedside critical care manual. Oxford: Elsevier Health Sciences, pp.68.

Chavez, O. P. V. & Gallardo, S. P. (2006). Meningococcus meningitis nursing intervention from an epidemiological perspective, Revista de enfermeria, 29(5), 49-56

Estep, M. (2005). Meningococcal meningitis in critical care: an overview, new treatments/preventions, and a case study. Critical care nursing quarterly, 28(2), 111-121.

Fuessel, H. S. (2006). Meningitis: a worse prognosis with penicillin? MMW Fortschritte der Medizin, 148(31-32), 16

Faust, S., Cathy, K. & Levin, M. (2007). Meningococcal Infections. emedicine. Retrieved March 26, 2009, from, WebMD, Medscape Today Web Site: http://emedicine.medscape.com/article/966333-overview

Harnden, A., Ninis, N., Thompson, P., Perera, A., Levin, M., Mant, D. & Mayon-White, R. (2006). Parenteral penicillin for children with meningococcal disease before hospital admission: case-control study. BMJ, 332(7553), 1295-1298.

Infectious Diseases. (2003). Retrieved March 26, 2009, from, Australia’s Young People 2003 Web Site: http://www.aihw.gov.au/publications/phe/ayp03/ayp03-c10.pdf

Kendrick, T. & Morrison, A. (2006). Pediatric consideration in critical care. In Doug Elliot, Leanne Aitkin & Wendy Chaboyer (Eds.), ACCCN’s Critical Care Nursing (pp.605-642.). Chatswood, New South Wales: Elsevier Australia

Meningococcal disease. (2009). Retrieved March 26, 2009, from, Infectious Diseases, Epidemiology & Surveillance, Victorian Government Health Information Web Site: http://www.health.vic.gov.au/ideas/bluebook/meningococcal

Meningococcal meningitis. (2009). Retrieved March 26, 2009, from, World Health Organization Web Site: http://www.who.int/mediacentre/factsheets/fs141/en/

Miller, L. M. Gaur, A. H. & Kumar, A. (2008). Meningitis, Bacterial. emedicine. Retrieved March 26, 2009, from, WebMD, Medscape Today Web Site: http://emedicine.medscape.com/article/961497-overview

Nath, S. K. & Revankar, S. G. (2006). Problem-based microbiology. Oxford: Elsevier Health Sciences, pp.243.

National Competency Standards for the Registered Nurse. (2005). Retrieved March 26, 2009, from, Australian Nursing & Midwifery Council Web Site: http://www.anmc.org.au

Porter, V. (2002). Support for When Meningitis Strikes. Medscape Infectious Diseases, 4(1), Retrieved March 26, 2009, from, Medscape Today Web Site: http://www.medscape.com/viewarticle/430000

Porter, V. (2004). Bacterial Meningitis: A Deadly But Preventable Disease. Medscape Nurses 6(1) Retrieved March 26, 2009, from, Medscape Today Web Site: http://www.medscape.com/viewarticle/481019

Winn, W.C., Koneman, W. E., Allen, D. S., Janda, W. M., Schrecknbecker, P. C., Procop, G. W. & Woods, G. L. (2005). Koneman’s color atlas and textbook of diagnostic microbiology, Sixth Edition. Philadelphia: Lippincott Williams & Wilkins, pp.581