full case presentation

1. MENINGITIS Case Presentation Aquino, Sheila Mae B. Austria, Tiffany M. Cabigao, Marc Andrew

3. The CNS consists of the brain, the spinal cord and the surrounding membranes or meninges that protect the delicate tissues from normal trauma. These tissues are also protected by the skull, the vertebral column, and the cerebrospinal fluid (CSF), the fluid in the subarachnoid space which serves as a cushion.

4. The dendrites transmits impulses to the cell nucleus; the axon transmits impulses away from the cell nucleus to body organs. These cells vary in size ranging from a few inches to several feet long, reaching from distant body sites such as feet, through the spinal cord, and to the brain.

9. Transmission Meningitis is spread by direct contact with a carrier’s secretions, especially by respiratory droplets. People may be carrier’s only, without having he actual disease.

13. (+) Brudzinski's sign (+) Kernig's sign

17. Lab and Diagnostic Exams Meningitis is diagnosed by analysis of the spinal fluid. Spinal fluid is obtained by a procedure called the lumbar puncture or spinal tap in which a needle is introduced into the space between vertebraeL-3 and L-4, because the spinal cord ends at L-2. Spinal fluis is withdrawn from the subarachnoid space.

19. Pathophysiology Enters the bloodstream & Crosses the blood-brain barrier BACTERIA Invasion of the nasopharynx Proliferates the CSF Inflammation of the subarachnoid & pia mater Increased ICP

21. CASE STUDY

28. Immunization

29. Developmental Milestones

31. Systems Review A review of all health problems of body systems: General: Fever EENT: Eye redness, ear discharge Skin: Warm and flushed Respiratory: Cough & cold GIT: diarrhea GUT: dysuria

34. Pharmacologic Intervention Ch

36. Me Pen

39. Nursing Care Plan CUES NURSING DIAGNOSIS GOAL NURSING INTERVENTION EVALUATION SUBJECTIVE: “ Mataas pa din ang lagnat nya hanggang ngayon” as verbalized by the patient’s mother. OBJECTIVE: -flushed skin -skin warm to touch -38.2 ºC -PR 109 -RR 34 -BP 90/60 Hyperthermia related to positive bacterial infection as manifested by flushed and warm to touch skin Short term: Within 1 hour of nursing intervention, the patient’s elevated temperature of 38.2 o C will lessen to 37.4 o C. Long term: Within 3 consecutive days of nursing intervention, the patient’s body temperature will return to its normal range. Establish rapport to mother to gain trust and cooperation Promote surface cooling by means of undressing ( heat loss by radiation and conduction) Demonstrate on ways on how to do proper Tepid Sponge Bath using wet and dry cloth Provide nutritious diet to meet increased metabolic demands Administer antipyretics as ordered . After 1 hour of nursing intervention, the goal is partially achieved as manifested by temperature of 37.7 o C.

40. CUES NURSING DIAGNOSIS GOAL NURSING INTERVENTION EVALUATION Subjective: “ Umiiyak yan kapag nagagalaw yung batok niya tska nung may ginawa si doctor sa kanya” Objective: - facial grimace - irritable - ( + ) Brudzinski’s sign - ( + ) Kernig’s sign Acute pain related to meningeal irritation with spasm of extensor muscles (neck, shoulders and back) as manifested by positive kernig’s and brudzinski’s sign. Within 2 hours of nursing intervention, the patient’s pain from 8 will reduce to 4 using the facial pain rating scale. Use pain rating scale appropriate to it’s age. Assess for neurologic status and vital signs. Position on the side with head gently supported in extension. Promote rest by keeping stimulation in the room to a minimum. Institute respiratory isolation. Monitor and record carefully intake and output. Administer mediation as ordered. After 2 hours of nursing intervention, there is no sign of facial grimace and irritability from the patient.

41. CUES NURSING DIAGNOSIS GOAL NURSING INTERVENTION EVALUATION Objective: - lethargic - change in motor responses - changes in papillary reaction Risk for ineffective cerebral tissue perfusion related to increased intracranial pressure Within an hour of nursing intervention, the nurse will be able to educate the patient’s mother about the causes and symptoms of ineffective cerebral tissue perfusion Educate patient’s mother about the causes of ineffective cerebral tissue perfusion. Observe carefully for signs of increased intracranial pressure such as; lethargy, shrill cry, hyperactive reflexes, decreased pulse and respiratory rate, increased blood pressure and temperature Carefully monitor the rate of all IV infusions to prevent overhydration Check for the urine’s specific gravity to detect oversecretion or undersecretion of ADH due to pituitary pressure Measure head circumference and weight Monitor vital signs After an hour of nursing intervention, the patient’s mother is educated about the causes and symptoms of ineffective cerebral tissue perfusion.