脑/脊膜炎meningitis

Meningitis

脑/脊膜炎

Definition

说明

Meningitis is an inflammation of the meninges, the thin tissue that surrounds the brain and spinal cord. There are several types of meningitis. The most common is viral meningitis, in which a virus enters the body through the nose or mouth and travels to the brain. The other is bacterial meningitis. It can be deadly, it is rare though. It usually starts with a cold-like infection. It can block blood vessels in the brain and lead to stroke and brain damage. It can also harm other organs.

脑/脊膜炎即脑脊膜的炎症，包裹大脑或脊髓的薄膜的发炎。脑/脊膜炎分几种，最常见有病毒性脑/脊膜炎，它是病毒经由口、鼻侵入人体，进入大脑所引起的。另一种是细菌性脑/脊膜炎。细菌性脑/脊炎虽然较为罕见，但它可以致命。它的初始症状为一感冒样感染。它可以阻断大脑血管，导致中风和大脑损伤。它也可以伤害其他器官。

Pathophysiology

病理生理学

A variety of organisms can produce an inflammation of the meninges, in neonates, the primary organisms responsible are gram-negative enteric bacilli, gram-negative rods, and group B streptococci. In children 3 months to 5 years of age, the primary organism responsible for meningitis is Haemophilus influenzae type B. Meningitis in older children is usually the result of a Neisseria meningitidis infection or a staphylococcal infection.

多种细菌可以引起脑/脊膜炎症。引起在新生儿脑/脊炎的有革兰氏阴性肠杆菌、革兰氏阴性杆菌、B型链球菌。引起3个月至5岁小孩感染的细菌以B型流感嗜血杆菌为主。年龄再大一点的儿童通常是由脑/脊膜炎萘瑟氏菌感染或葡萄球菌感染引起。

Aseptic meningitis is usually caused by a virus and affects young adults more often than children. Older children usually manifest a variety of nonspecific prodromal signs and flulike symptoms that last for 1 to 2 weeks. Although fatigue and weakness may last for a number of weeks, sequelae are uncommon.

无菌性脑/脊膜炎通常由病毒引起，幼儿患病率高于儿童。大小孩通常会出现一些非特异性前驱症状或感冒样症状，可持续1－2周。尽管疲乏无力可持续几周，但很少产生严重后果。

Otitis media, sinusitis, or respiratory tract infections may be the initial stage of infection. In addition, a predisposition resulting from an immune deficiency increases the likelihood of occurrence of this disorder. Once the meninges are infected, the organisms are spread through the CSF to the brain and adjacent tissues. Prognosis varies, depending on a variety of factors. Neonatal meningitis has a high mortality rate and an increased incidence of neurologic sequelae. Bacterial meningitis results in a large number of patients' having behavioral changes, motor dysfunction, and cognitive changes such as perceptual deficits.

中耳炎、鼻窦炎或呼吸道感染为感染初期症状。此外，免疫不足导致缺陷会增加发生这种疾病的机率。一旦脑/脊膜受到感染，细菌就会通过中枢神经系统传播到大脑及相邻组织。病情发展不定，取决于多种因素。新生儿脑/脊膜炎死亡率很高，造成神经损伤的后果也很常见。细菌性脑/脊膜炎造成大量患者行为变化、运动障碍及认知能力问题，如知觉缺陷。

Clinical Manifestations

临床表现

The symptoms of meningitis vary and depend both on the age of the child and on which bacterium or virus is causing the infection. The symptoms of viral meningitis are usually milder than those of bacterial meningitis. However, symptoms of bacterial and viral cases can be similar, particularly in the early stages of the disease.

脑/脊膜炎症状有很多种，它与儿童年龄有关，也与致病的细菌或病毒有关。病毒性脑/脊膜炎症状通常比细菌性脑/脊膜炎要轻。不过，两者很相似，尤其是在疾病之初。

Classic symptoms of meningitis include: high fever, severe headache, vomiting or nausea with headache, confusion or difficulty concentrating, seizures, sleepiness or difficulty waking up, stiff neck, sensitivity to light, lack of interest in drinking and eating, skin rash in some cases, although rashes caused by bacterial meningitis look different from those caused by viral meningitis.医学.全在.线www.med126.com

脑/脊膜炎的典型症状包括发烧、剧烈头痛、呕吐或恶心伴头痛、神志不清或难以集中注意力、癫痫发作、嗑睡或难以行走、颈强直、畏光、食欲不振及有时皮疹，但病毒性和细菌性脑/脊膜炎所引起的皮疹有所不同。

Diagnostic Tests

诊断检查

1. Lumbar puncture and culture of CSF with the following results

腰椎穿刺及脑脊液检查可提示下列结果：

a. White blood count (WBC)--increased

白细胞计数－增加

b. Glucose level--decreased (bacterial); normal (viral)

葡萄糖水平－下降（细菌性)；正常（病毒性)

c. Protein--high (bacterial); slightly elevated (viral)

蛋白－高（细菌性)，稍升（病毒性)

d. Pressure--increased

颅压－增加

e. Identification of causative organism -- meningococcal, gram-positive (streptococci, staphylococci, pneumococci, H. influenzae), or viral (Coxsackie virus, ECHO virus)

致病功确诊－脑/脊膜炎球菌、革兰氏阳性（链球菌、葡萄球菌、肺炎球菌、流感嗜血杆菌)、或病毒（柯萨奇病毒、艾柯病毒)

f. Lactic acid--elevated (bacterial)

乳酸－升高（细菌性)

g. Serum glucose--elevated

血清葡萄糖－升高

2. Blood culture--to identify causative organism

血液培养－确诊致病细菌

3. Urine culture--to identify causative organism

尿培养－确诊致病细菌

4. Nasopharyngeal culture--to identify causative organism

鼻咽培训－确诊致病细菌

5. Serum electrolytes--elevated if child dehydrated; increased serum sodium (Na+); decreased serum potassium (K+)

血清电解质－儿童脱水时升高；血清钠增加（Na+)；血清钾降低（K+)

6. Urine osmolarity--increased with increased secretion of ADH

尿渗透度－随ADH分泌增多而上升

Therapeutic Management

治疗

Meningitis is considered a medical emergency requiring early recognition and treatment to prevent neurologic damage. The child is placed in respiratory isolation for at least 24 hours after the initiation of intravenous (IV) antibiotics sensitive to the causative organism. Intravenous hydration therapy is instituted to correct electrolyte imbalances, in addition to providing hydration. This fluid administration requires frequent assessment of the infused volume to prevent fluid overload complications such as cerebral edema. Treatment is then directed toward the identification and management of complications of the disease process.

脑/脊膜炎属急诊，需要早识别早治疗，以防神经受损。在静脉注射致病菌敏感抗生素后，小孩至少要呼吸隔离24小时。除了补充液体外，静脉补液也可以纠正电解质紊乱。但在静脉补液时，应经常评估输注量，防止液体超负荷引起并发症，如脑水肿。在后续治疗中，应着重识别和处理疾病过程中出现的并发症。

Nursing Management

护理

Goals

目标

The child will return to normal or control central nervous system symptoms.

患儿恢复正常，中枢神经系统症状得到控制。

The child will not experience neck and/or head pain.

患儿无颈痛和/或头痛。

Nursing Diagnoses

护理诊断

Risk for infection transmission related to contagious nature of organism

有感染传播危险　与细菌传染性有关

Acute pain related to headache, fever, neck pain secondary to meningeal irritation

急性痛　与继发于脑/脊膜炎症的头痛、发烧、颈痛有关

Activity intolerance related to fatigue and malaise secondary to infection

活动无耐力　与继发于感染的疲乏和不舒服有关

Risk for impaired skin integrity related to immobility, dehydration, and diaphoresis

有皮肤完整性受损的危险　与固定、脱水和出汗有关

Risk for imbalanced nutrition: less than body requirements related to anorexia, fatigue, nausea, and vomiting

有营养失调危险：低于机体需要量　与厌食、疲劳、恶心和呕吐有关

Risk for injury related to restlessness and disorientation secondary to meningeal irritation

有受伤危险　秘继发于脑/脊膜炎症的不安和定向力障碍有关

Anxiety related to treatments, environment, and risk of death

焦虑　与治疗、环境和死亡危险有关

Risk for ineffective therapeutic regimen management related to insufficient knowledge of condition, treatments, pharmacologic therapy, rest/activity balance, signs and symptoms of complications, follow-up care, and prevention of recurrence

有治疗方案无效的危险　与对疾病、治疗、药物、休息/活动平衡、并发症症状、随访及预防复发等知识缺乏有关 医学全.在线提供

Nursing Interventions

护理措施

1. Monitor infant's or child's vital signs and neurologic status as often as every 2 hours.

监视婴儿或儿童生命体征与神经系统状况，每2　小时一次

a. Temperature, respiratory rate, apical pulse

体温、呼吸率、心尖搏动

b. Level of consciousness (LOC)

神志清醒程度

c. Pupils equal, react to light (PERL)

瞳孔等大、光反应

2. Monitor child's hydration status.

监视儿童水合状况

a. Skin turgor

皮肤肿胀

b. Urinary output

排尿量

c. Urinary osmolarity

尿渗透度

d. Signs and symptoms of hyponatremia

低钠血症状

e. Urine specific gravity

尿比重

f. Input and output

输入输出

g. Daily weights

日体重

3. Monitor child for seizure activity

监视儿童癫痫发作情况

4. Institute isolation procedures with respiratory precautions to protect others from infectious contact; keep child in isolation for 24 hours after antibiotics are started.

采取呼吸隔离措施，保护其他儿童不受感染接触，自开始服用抗生素起至少要隔离24小时

5. Monitor the IV infusion and the side effects of medications.

监视静脉轮流及药物副作用

a. Antibiotics

抗生素

b. Anticonvulsants

抗痉挛药

6. Provide comfort measures in an environment that is quiet and has minimal stressful stimuli.

保持环境安静，安慰患者，减少刺激

a. Avoid bright lights and noise.

避免亮光和噪音

b. Avoid excessive manipulation of the child.

避免过分管教儿童

7. Position child with head of bed slightly elevated to decrease cerebral edema; monitor administration of fluids.

卧床时，床头略微抬高，减少脑水肿，监视补液情况

8. Reduce temperature through the use of tepid sponge baths or hypothermia mattress.

通过温水擦浴或使用低温床垫降低体温

9. Provide emotional support when the child undergoes a lumbar puncture and other tests.

儿童行腰穿或其他检查时给予情感支持

a. Provide age-appropriate explanations before procedures.

操作前给予适当的与年龄相宜的解释

b. Restrain child to prevent occurrence of injury.

约束儿童，以免受伤

10. Provide emotional support to family.

给家人提供情感支持

a. Provide and reinforce information about condition and hospitalization.

提供并强化病情与住院信息

b. Encourage ventilation of feelings of guilt and self-blame.

鼓励内疚、自责等情感的宣泄

c. Encourage use of preexisting support.

鼓励接受帮助

d. Provide for physical comforts (e.g., sleeping arrangements, hygiene needs).

保持身体舒适（如睡眠安排、卫生需要)

11. Provide age-appropriate diversional activities.

提供相应活动，分散注意力

Patient Teaching

病人宣教

Instruct parents about administration of medications and monitoring for side effects.

指导家长如何给药与监视副作用

Instruct parents to monitor for long-term complications and their signs and symptoms.

指导家长监视并发症及其症状体征