腦/脊膜炎meningitis

Meningitis

腦/脊膜炎

Definition

說明

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.

腦/脊膜炎即腦脊膜的炎癥，包裹大腦或脊髓的薄膜的發(fā)炎。腦/脊膜炎分幾種，最常見有病毒性腦/脊膜炎，它是病毒經(jīng)由口、鼻侵入人體，進(jìn)入大腦所引起的。另一種是細(xì)菌性腦/脊膜炎。細(xì)菌性腦/脊炎雖然較為罕見，但它可以致命。它的初始癥狀為一感冒樣感染。它可以阻斷大腦血管，導(dǎo)致中風(fēng)和大腦損傷。它也可以傷害其他器官。

Pathophysiology

病理生理學(xué)

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.

多種細(xì)菌可以引起腦/脊膜炎癥。引起在新生兒腦/脊炎的有革蘭氏陰性腸桿菌、革蘭氏陰性桿菌、B型鏈球菌。引起3個月至5歲小孩感染的細(xì)菌以B型流感嗜血桿菌為主。年齡再大一點的兒童通常是由腦/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.

無菌性腦/脊膜炎通常由病毒引起，幼兒患病率高于兒童。大小孩通常會出現(xiàn)一些非特異性前驅(qū)癥狀或感冒樣癥狀，可持續(xù)1－2周。盡管疲乏無力可持續(xù)幾周，但很少產(chǎn)生嚴(yán)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、鼻竇炎或呼吸道感染為感染初期癥狀。此外，免疫不足導(dǎo)致缺陷會增加發(fā)生這種疾病的機率。一旦腦/脊膜受到感染，細(xì)菌就會通過中樞神經(jīng)系統(tǒng)傳播到大腦及相鄰組織。病情發(fā)展不定，取決于多種因素。新生兒腦/脊膜炎死亡率很高，造成神經(jīng)損傷的后果也很常見。細(xì)菌性腦/脊膜炎造成大量患者行為變化、運動障礙及認(rèn)知能力問題，如知覺缺陷。

Clinical Manifestations

臨床表現(xiàn)

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.

腦/脊膜炎癥狀有很多種，它與兒童年齡有關(guān)，也與致病的細(xì)菌或病毒有關(guān)。病毒性腦/脊膜炎癥狀通常比細(xì)菌性腦/脊膜炎要輕。不過，兩者很相似，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.醫(yī)學(xué).全在.線www.med126.com

腦/脊膜炎的典型癥狀包括發(fā)燒、劇烈頭痛、嘔吐或惡心伴頭痛、神志不清或難以集中注意力、癲癇發(fā)作、嗑睡或難以行走、頸強直、畏光、食欲不振及有時皮疹，但病毒性和細(xì)菌性腦/脊膜炎所引起的皮疹有所不同。

Diagnostic Tests

診斷檢查

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

腰椎穿刺及腦脊液檢查可提示下列結(jié)果：

a. White blood count (WBC)--increased

白細(xì)胞計數(shù)－增加

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

葡萄糖水平－下降（細(xì)菌性)；正常（病毒性)

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

蛋白－高（細(xì)菌性)，稍升（病毒性)

d. Pressure--increased

顱壓－增加

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

致病功確診－腦/脊膜炎球菌、革蘭氏陽性（鏈球菌、葡萄球菌、肺炎球菌、流感嗜血桿菌)、或病毒（柯薩奇病毒、艾柯病毒)

f. Lactic acid--elevated (bacterial)

乳酸－升高（細(xì)菌性)

g. Serum glucose--elevated

血清葡萄糖－升高

2. Blood culture--to identify causative organism

血液培養(yǎng)－確診致病細(xì)菌

3. Urine culture--to identify causative organism

尿培養(yǎng)－確診致病細(xì)菌

4. Nasopharyngeal culture--to identify causative organism

鼻咽培訓(xùn)－確診致病細(xì)菌

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

血清電解質(zhì)－兒童脫水時升高；血清鈉增加（Na+)；血清鉀降低（K+)

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

尿滲透度－隨ADH分泌增多而上升

Therapeutic Management

治療

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.

腦/脊膜炎屬急診，需要早識別早治療，以防神經(jīng)受損。在靜脈注射致病菌敏感抗生素后，小孩至少要呼吸隔離24小時。除了補充液體外，靜脈補液也可以糾正電解質(zhì)紊亂。但在靜脈補液時，應(yīng)經(jīng)常評估輸注量，防止液體超負(fù)荷引起并發(fā)癥，如腦水腫。在后續(xù)治療中，應(yīng)著重識別和處理疾病過程中出現(xiàn)的并發(fā)癥。

Nursing Management

護理

Goals

目標(biāo)

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

患兒恢復(fù)正常，中樞神經(jīng)系統(tǒng)癥狀得到控制。

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

患兒無頸痛和/或頭痛。

Nursing Diagnoses

護理診斷

Risk for infection transmission related to contagious nature of organism

有感染傳播危險　與細(xì)菌傳染性有關(guān)

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

急性痛　與繼發(fā)于腦/脊膜炎癥的頭痛、發(fā)燒、頸痛有關(guān)

Activity intolerance related to fatigue and malaise secondary to infection

活動無耐力　與繼發(fā)于感染的疲乏和不舒服有關(guān)

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

有皮膚完整性受損的危險　與固定、脫水和出汗有關(guān)

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

有營養(yǎng)失調(diào)危險：低于機體需要量　與厭食、疲勞、惡心和嘔吐有關(guān)

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

有受傷危險　秘繼發(fā)于腦/脊膜炎癥的不安和定向力障礙有關(guān)

Anxiety related to treatments, environment, and risk of death

焦慮　與治療、環(huán)境和死亡危險有關(guān)

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

有治療方案無效的危險　與對疾病、治療、藥物、休息/活動平衡、并發(fā)癥癥狀、隨訪及預(yù)防復(fù)發(fā)等知識缺乏有關(guān) 醫(yī)學(xué)全.在線提供

Nursing Interventions

護理措施

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

監(jiān)視嬰兒或兒童生命體征與神經(jīng)系統(tǒng)狀況，每2　小時一次

a. Temperature, respiratory rate, apical pulse

體溫、呼吸率、心尖搏動

b. Level of consciousness (LOC)

神志清醒程度

c. Pupils equal, react to light (PERL)

瞳孔等大、光反應(yīng)

2. Monitor child's hydration status.

監(jiān)視兒童水合狀況

a. Skin turgor

皮膚腫脹

b. Urinary output

排尿量

c. Urinary osmolarity

尿滲透度

d. Signs and symptoms of hyponatremia

低鈉血癥狀

e. Urine specific gravity

尿比重

f. Input and output

輸入輸出

g. Daily weights

日體重

3. Monitor child for seizure activity

監(jiān)視兒童癲癇發(fā)作情況

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

采取呼吸隔離措施，保護其他兒童不受感染接觸，自開始服用抗生素起至少要隔離24小時

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

監(jiān)視靜脈輪流及藥物副作用

a. Antibiotics

抗生素

b. Anticonvulsants

抗痙攣藥

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

保持環(huán)境安靜，安慰患者，減少刺激

a. Avoid bright lights and noise.

避免亮光和噪音

b. Avoid excessive manipulation of the child.

避免過分管教兒童

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

臥床時，床頭略微抬高，減少腦水腫，監(jiān)視補液情況

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

通過溫水擦浴或使用低溫床墊降低體溫

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

兒童行腰穿或其他檢查時給予情感支持

a. Provide age-appropriate explanations before procedures.

操作前給予適當(dāng)?shù)呐c年齡相宜的解釋

b. Restrain child to prevent occurrence of injury.

約束兒童，以免受傷

10. Provide emotional support to family.

給家人提供情感支持

a. Provide and reinforce information about condition and hospitalization.

提供并強化病情與住院信息

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

鼓勵內(nèi)疚、自責(zé)等情感的宣泄

c. Encourage use of preexisting support.

鼓勵接受幫助

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

保持身體舒適（如睡眠安排、衛(wèi)生需要)

11. Provide age-appropriate diversional activities.

提供相應(yīng)活動，分散注意力

Patient Teaching

病人宣教

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

指導(dǎo)家長如何給藥與監(jiān)視副作用

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

指導(dǎo)家長監(jiān)視并發(fā)癥及其癥狀體征