Foundation University COLLEGE OF NURSING Dumaguete City

CASE STUDY ON CNS INFECTION WITH SEIZURE ARI WITH SEVERE DISEASE

In partial fulfilment of the requirements In Nursing Care Management (NCM) 101

Submitted to:
Mrs. Ivy Monteclaro - Cornelia, R.N.

Clinical Instructor Submitted by:
Catacutan, Rudyard Go, Teyfel Joline A. Palubon, Bjon Troy O.

BSN III – B5 Date Submitted:
October 04, 2008

TABLE OF CONTENTS
I. II. III. IV. V. VI. Introduction Central Objectives Specific Objectives Demographic Profile/ Biographical Information Erik Erikson’s Theory on Psychosocial Development Nursing History a. Chief Complaints b. Admitting Impression/ Diagnosis c. HPI d. Past Health History e. Family History with Genogram f. Psychosocial History g. Environmental History h. Spiritual History VII. Physical Assessment Findings VIII. Anatomy and Physiology of Systems/ involved in the disease condition IX. Review of Related Literature X. Pathophysiology XI. Medical Interventions a. treatment b. laboratory exams and Correlation c. Drug Study XII. Nursing Theory applicable to care of patient XIII. Gordon’s Functional Health Pattern XIV. List of Nursing Care Plan XV. Annotated Readings XVI. Conclusion XVII. Bibliography

INTRODUCTION
The central nervous system, or CNS, comprises the brain, the spinal cord, and associated membranes. Under some circumstances, bacteria may enter areas of the CNS. If this occurs, abscesses or empyemas may be established. The CNS is well defended against infection. The spine and brain are sheathed in tough, protective membranes. The outermost membrane, the dura mater, and the next layer, the arachnoid, entirely encase the brain and spinal cord. However, these defenses are not absolute. In rare cases, bacteria gain access to areas within the CNS. Bacterial infection of the CNS can result in abscesses and empyemas (accumulations of pus). Abscesses have fixed boundaries, but empyemas lack definable shape and size. CNS infections are classified according to the location where they occur. For example, a spinal epidural abscess is located above the dura mater, and a cranial subdural empyema occurs between the dura mater and the arachnoid. As pus and other material from an infection accumulate, pressure is exerted on the brain or spinal cord. This pressure can damage the nervous system tissue, possibly permanently. Without treatment, a CNS infection is fatal. A seizure complication of infection can consist of a single seizure or can go on to become a chronic epilepsy. Seizures can arise as an acute, subacute, or long- term consequence of an infectious state. The type of epileptic complication and when it arises from an infection depend on the nature of the infectious illness, its duration, and the type and extent of damage to the CNS. Quantitative data on seizure risk from infection would be extremely useful but there are few detailed studies. One reason is that retrospective analysis of seizure risk factors is complicated by the interdependence of the many multisystemic and iatrogenic events typically impacting patients during the course of their illness. A retrospective study of survivors of encephalitis or meningitis between 1935 and 1981 was conducted to assess the risk of unprovoked seizures after CNS infection. The 20-year risk of developing unprovoked seizures was 6.8%, and the ratio of observed to expected cases of unprovoked seizures was 6.9%. The increased incidence of unprovoked seizures was highest during the first 5 years after CNS infection but remained elevated over the next 15 years of follow-up.

Formulate an effective Nursing Care Plan relative and applicable to the client based on the conditions the client is subjective to. and toxicity of the following drugs: Paracetamol. Name the medical intervention or treatment given for the disease involved accurately. dose. Specific Objectives: Given the time and resources. Able to trace the pathophysiology of CNS Infection with Seizure. Dexamethasone. II. Develop priorities for the initial management of client with CNS Infection with Seizure. and Cimetidine. Evaluate the data in Gordon’s Functional Health Pattern intensively. DEMOGRAPHIC PROFILE . the learners shall: • • • • • • • • • • • Obtain information regarding the demographic profile and the history of the client completely. Review the anatomy and physiology of the organs involved and affected in CNS Infection with Seizure. Central Objective: At the end of two hours case presentation. Demonstrate an understanding of the pharmacologic action. indication. Diazepam. the learners shall acquire deeper knowledge. Assist client’s condition prior to beginning any treatment.OBJECTIVES OF THE STUDY I. Ceftriaxone. Demonstrate reassessment after each therapeutic intervention. Objectively evaluate the case study presentation through a socialized discussion. develop beginning skills and manifested desirable attitudes / values towards the management of client with CNS Infection with Seizure and ARI with Severe Disease.

Several hours PTA had rolling of eyeballs and stiffness of extremities for a few minutes. Bollos Name: Juniel Medina Lijarso Age: 3 months old Sex: Male Religion: Roman Catholic Birth date: May 31.Date of assessment: September 11. and ambroxol. 2008 Address: Bio – os. 2008 Room and Bed Number: ICU AND Bed # 07 Attending Physician: Dr. Amlan. CNS Infection ARI with several diseases . History of Present Illness: Patient’s condition started four days PTA. high grade fever. Patient had four days on and off fever. 2008 at 7:43 pm at pediatric ward Chief Complaints: • Non – productive cough. then this was followed by another at 5:00pm at the time of admission. three days cough. Lijarso Occupation: Farmer Occupation: House wife Date and Time of Admission: Admitted on September 09. Oriental Negros Parents – Father: Jose Lijarso Mother: Mary Ann M. klancid. on and off with convulsive episodes was noted four days PTA. 2 days PTA had sought and consult and was given paracetamol. Admitting Impression: • • • R/O.

redness and swelling noted at IV site. NPO with breastfed with strict aspiration precaution. with continuous O2 administration at 1 – 2 L/min.General Impression: • Received sleeping on bed with D5 0. Chief Complaints: . NURSING HISTORY A. no inflammation.3% NaCl at right metacarpal vein.

CNS Infection  ARI with severe disease C. General health in the past has been good despite minor illnesses such as coughs and colds. Environmental History: . 2 days PTA had sought and consult and was given paracetamol. B. Past Health History:  Mother delivered the baby by NSVD. Several hours PTA had rolling of eyeballs and stiffness of extremities for a few minutes. E. except his mother. Psychosocial History:  He is taking cared by his parents. History of Present Illness:  Patient’s condition started four days PTA. F. and ambroxol. three days cough. It is his first time to be admitted in the hospital and also he is the first child of his parents. D. on and off with convulsive episodes was noted four days PTA. Had not yet given any immunizations. and then this was followed by another at 5:00pm at the time of admission. he doesn’t want other people to carry him. high grade fever. Non – productive cough. Admitting Impression/Diagnosis:  R/O. And has no allergies. klaricid. Patient had four days on and off fever. Breast fed since birth up to present. At the age of 3 months.

G. They also go to church on Wednesday and pray the Rosary with the neighbourhood every Friday. H. Amlan. Their place is peaceful and they can breathe fresh air. He lives with his mother and father @ Bio-os. Family History with Genogram: Berto Lijarso (Grandfather)  *Father Side * Emetria Lijarso (Grandmother) Housewife  Lodrigo Medina (Grandfather) Farmer  * Mother Side* Norma Buenaflor Medina (Grandmother) Housewife    . where they live in a small house made of bamboo. Negros Oriental. Spiritual History:  The family is pure Roman Catholic and they go to church every Sunday.

Rosie Lijarso got the hereditary disease which is anemia. The mother side family of our client had hypertension. Lijarso 29 y.o Eldest Son  Mary Ann M.o Father Farmer Christophe r Miko Medina 35 y.Gorio Lijarso Eldest Son Rosie Lijarso Eldest Sister  Mario Lijarso Third Child Jose Lijarso 30 y. Lijarso Conclusion: 3 months   The father side family of our client had two genetic diseases these are cancer and anemia. They are five in the family and only Ms. Both of his grandfather and grandmother have hypertension. for the boys they don’t know if they got any of it.o Mother Housewife Junito Medin a 22 y. His grandfather died due to cancer and his grandmother is anemic. . They are four in the family and she is the only girl in the family.o Third Child Jovanni Medina 20 y.o Younges t Son Lijarso Younges t Son Juniel M. His elder brother has hypertension while the rest they don’t know if they got that disease.

Evaluation The objective of care as partially met as evidenced by: + Vital signs stabilized.Client  . Objectives Within our care the client will show maintain core temperature within normal range as evidenced by: + Demonstrate behaviours to monitor Interventions Independent: + Monitor client temperature note shaking. + Monitor environmental temperature.Anemic  .died because of cancer  . Rationale + To be able to administer medication in case of fever. + Room temperature or number of blankets should be altered to maintain near normal body temperature. chills/profuse diaphoresis. limit or add bed linens.decease  .Hypertension  .With CNS infection Cues / Evidences Subjective Cue: “ Gi hilantan akong anak upat na ka adlaw mu balik daun mawala iyang hilanat ug taas pud ” as verbalized by the mother. Nursing Diagnosis Hyperthermia related to excessive fluid loss as evidenced by increase in body temperature higher than normal range.LEGEND:  . + Freed from seizure acitivity. .

Enhancement of . + Auscultate breath sounds noting adventitious sounds such as rales. Relieves pain by inhibiting prostaglandin synthesis at the CNS but does not have anti – inflammatory action because of its minimal effect on peripheral prostaglandin synthesis. avoid using alcohol. - - - + Administer Diazepam 1. (nasal cannula) and promote normothermia. promote calmness and sleep. + Monitor heart rate and rhythm. + To reduce metabolic demands or oxygen consumption. This inhibition also suppresses the spread of seizure activity produce by epileptogenic foci in the cortex. + Review signs and symptoms of hyperthermia.Objective Cues: Vital Signs:  T = 38. Collaborative: + Administer Paracetamol 125 mg supp. + Absence of adventitious sounds : rales + Monitored input and output. + Be free of seizure activity. + Provide Supplemental oxygen.2 ̊ C  P = 142 bpm. + Administer medications as ordered. + May help reduce fever. unlabored Seizure and convulsion present Skin warm to touch \ Adventitious breath sound present : rales O2 therapy 1 – 2 L/ Min. + Monitor input and output. + Maintain bed rest. thalamus and limbic system. + Administered medications as ordered.2 mg IVTT Q 4 ̊ PRN for seizure + Facilitates/potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety. + Provide tepid sponge bath. +Reviewed signs and symptoms of hyperthermia. + Maintain Bed rest. ½ stick Q 4 ̊ PRN for T = 38 ̊ and up C + Decreases fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilation. weak and irregular  R = 38 cpm. + Maintained bed rest.

resulting to decreased gastric acid secretion by about 50 – 80 %. + Synthetic glucocorticoid with marked anti – inflammatory effect because of its ability to inhibit prostaglandin synthesis. To run for 24H + To support circulating volume and tissue perfusion. leukocytes and fibroblasts at sites of inflammation. + Competitively inhibits histamine at H2 . rendering cell wall osmotically unstable. + Administer Ceftriaxone 300 mg IVTT Q 12 ̊ + Inhibits bacterial cell wall synthesis. + Used to reduce fever.3% NaCl at 20 mgtts/min.GABA – mediated presympathetic inhibition at the spinal level and brain stem reticular formation results to skeletal muscle relaxation. It can also cause the reversal of increased capillary permeability.receptor site of gastric parietal cells . leading to cell death. + Provide cooling blanket + IVF: D5 0. phagocytosis and lysosomal enzyme release. inhibit migration of macrophages.5 mg IVTT Q 6 ̊ + Administer Cimetidine 30 mg IVTT Q 6 ̊ . + Administer Dexamethasone 0.

Treatments: Treatments  September 09.Medical Interventions A. Rationale . 2008 (7:45 pm) Please admit to Pedia – ICU TPR + In order to monitor his vital signs.

promoting osmotic instability. May relieve fever through central action in the hypothalamic heat-regulating center.2 mg IVTT every 4 hours prn.3% NaCl 500 mL at SR  (6:20 pm) . U/A. fat. and influences protein. Suction Secretions prn Padded tongue Depressor for access For close watch + Indicates more thorough assessment and replace fluid loss and electrolytes imbalance.Request FWB of patients type 250 mL and transfuse 75 cc as packed RBC  September 10.Blood typing stat .IVF to ff D5 0. + To support circulating volume and tissue perfusion. + Competitively inhibits action of histamine on the H2 receptor sites of parietal cells.May breastfeed with strict aspiration precaution . 2008 (12:20am) .Paracetamol 125 mg supp ½ stick for rectum then every 4 hours PRN for T=38 and above  (8:00 am) . depresses the CNS. stimulates bone marrow.D5 0. Ceftriaxone 600 mg IVTT now then 300 mg every 12 hours IVTT Dexamethasone 0. and suppresses the spread of seizure activity. + A benzodiazepine that probably potentiates the effects of GABA. + Decreases inflammation. Stool Exam start venoclysis 8:05 pm D50. usually bactericidal.3% NaCl at SR + indicates more thorough assessment + Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or of other substances that sensitize pain receptors to stimulation. + Inhibits cell-wall synthesis. mainly by stabilizing leukocyte lysosomal membranes. decreasing gastric acid secretion. suppresses immune response. . for seizure O2 inhalation 1 – 2 L/min.5 mg IVTT every 6 hours Cimetidine 30 mg IVTT every 6 hours Diazepam 1. + To support circulating volume and tissue perfusion.3 NaCl 500 mL to run at 30 mgtts/min. and carbohydrate metabolism.  (10:00 pm) .- - NPO CBC.

+ To support circulating volume and tissue perfusion.3 % NaCl 500 mL for 24 hours  September 12. 2008 .Repeat CBC in ARI  September 13.3 mL OD + To support circulating volume and tissue perfusion. September 11.D/C Dexamethasone . 2008 D5 IMB 500 mL at SR Consume Cimetidine Transfer to respi. + To support circulating volume and tissue perfusion.D5 0.D5 IMB 500 mL at SR .  September 14. + To support circulating volume and tissue perfusion.D5 IMB at SR September 16. 2008 . 2008 .  - .D5 IMB 500 mL at SR  September 15. + To support circulating volume and tissue perfusion. 2008 Consume IVTT meds and IVF MGH Immunize drops 0. 2008 .Follow up blood and transfuse when available .

Laboratory Exams and correlation: Laboratory Exams + Urinalysis: Color Transparency Specific Gravity Glucose Protein pH Yellow Hazy 1.0 Straw to dark yellow Clear 1.B.005 – 1.035 Negative Negative 4.8 Within normal range Within normal range Within normal range Glucosuria Protinuria Within normal range Result Normal Values Correlation U1 + Microscopic Examination: .5 .015 Negative Trace 6.

22 9. chronic renal failure .5 13 – 18 g/dL 40 .- Pus cells RBC Epith.26 + Complete Blood Count: Hemoglobin Hematocrit 11.Color . Urates Bacteria 0 -2/hpf None None Moderate Few 0-2/hpf 0 – 5/hpf Few negative Negative Within normal range Within normal range Within normal range Within normal range Within normal range + Fecalysis: .5 33.50 L% Malignancy of organs.Consistency F1 + Microscopic Examination: Ascaris Ring worm Hook worm Trienuns Troph Cyst Yellow Soft No ova None Parasites Seen None Seen Within normal range Within normal range + Cross – Matching: No. Cells Amorph. Blood Component Extraction Expiration 1 O+ 755441 PRBC 8. of Units Blood Type Serial No.

Diazepam 1. tissue necrosis.Eosinophil .00 26. Drug Study: 1.Lymphocyte .Basophil 51 37 7 4 1 40 – 75 20 – 45 0 – 20 0–6 0-1 C.900 150-400T/cumm 4 – 11 k/uL Within normal range Acute infection. depresses the CNS.- Platelet Count WBC 280.  Mechanism of Action:  Adverse Reactions: .Monocyte . parasitic disease Within normal range Within normal range Within normal range Within normal range Within normal range + Differential Count: .2 mg IVTT every 4 hours PRN for Seizure  Generic Name:  Brand Name:  Classification: Diazepam Diazepam Intensol Anticonvulasants A benzodiazepine that probably potentiates the effects of GABA.Neutrophil . and suppresses the spread of seizure activity.

urine retention. Hematologic: neutropenia Respiratory: respiratory depression. hallucinations. renal. paradoxical. dysarthria. apne SKIN: rash  Nursing Consideration: • 2. nystagmus GI: nausea. When using oral solution. headache. diarrhea with rectal form. usually bactericidal. promoting osmotic instability. dizziness CV: phlebitis . GU: incontinence. dilute dose just before giving. Ceftriaxone Sodium Rocephin Anti – infectives Inhibits cell-wall synthesis. tremor. constipation. anxiety. fatigue.• • • • • • • • CNS: drowsiness.  Mechanism of Action:  Adverse Reaction: • • CNS: fever. Ceftriaxone 600 mg IVTT now then 300 mg every 12 hours IVTT  Generic name:  Brand Name:  Classification: • • Use Diastat rectal gel to treat no more than five episodes per month and no more than one episode every 5 days because tolerance may develop. headache. blured vision. minor changes in EEG patterns. bradycardia. Monitor periodic hepatic. CV: CV collapse. transient amnesia. slurred speech. ataxia. hypotension EENT: diplopia. and hematopoietic function studies in patients receiving repeated or prolonged therapy. insomnia.

fat. seizures. hypertension.5 mg IVTT every 6 hours  Generic Name:  Brand Name:  Classification: Dexamethasone Cortastat Corticosteroids  Mechanism of Action: Decreases inflammation.  Adverse Effects: • • CNS: Insomnia. headache. and carbohydrate metabolism. rash. candidiasis HEMATOLOGIC: leukopenia SKIN: pain. suppresses immune response. Dexamethasone 0.• • • • GI: diarrhea GU: genital pruritis. vertigo. induration. thrombophlebitis . ask patient if he is allergic to penicillins Obtain specimen for culture and sensitivity tests before giving first dose. mainly by stabilizing leukocyte lysosomal membranes. and influences protein. depression CV: heart failure. tenderness at injection site. stimulates bone marrow. pruritis  Nursing Considerations: • • Before giving drugs. psychotic behaviour. 3. edema.

glaucoma GI: peptic ulceration. vomiting GU: menstrual irregularities. increased urine glucose and calcium levels  Nursing Diagnosis: • • • • Determine whether patient is sensitive to other corticosteroids. Always adjust to lowest effective dose. Dizziness. GI irritation. decreasing gastric acid secretion  Adverse Reactions: • • • CNS: confusion. increase appetite.• • • EENT: cataracts. Most adverse reactions to corticosteroids are dose – or duration – dependent. 4. Give oral dose with food when possible. nausea. Cimetidine 30 mg IVTT every 6 hours  Generic Name:  Barnd Name:  Classification: Cimetidine Tagamet Anti – ulcer  Mechanism of Action: Competitively inhibits action of histamine on the H2 receptor sites of parietal cells. hallucinations. headache GI: mild and transient diarrhea GU: impotence .

muscle pain  Nursing Considerations: • • • Assess patient for abdominal pain. Paracetamol 125 mg ½ stick every 4 hours PRN for T= 38 and above  Generic Name:  Brand Name:  Classification: Parctamol Tempra antipyretics  Mechanism of action: Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or of other substances that sensitize pain receptors to stimulation. Schedule dose at the end of hemodialysis treatment IM injection may be given undiluted.  Adverse Reaction: • Hematologic: haemolytic anemia. pancytopenia . 5.• MUSCULOSKELETAL: arthralgia. neutropenia. May relieve fever through central action in the hypothalamic heat-regulating center. leukopenia.

trauma  Nursing Considerations: • • • Many OTC and prescription products contain acetaminophen. be aware of this when calculating total daily dose. Use liquid form for children who have difficulty swallowing.• • • Hepatic: jaundice Metabolic: hypoglycemia Skin: rash. Erik Erikson’s Theory on . In children. don’t exceed five doses in 24 hours.

Psychosocial Development Functional Health Pattern And .

Nursing Care Plan Review of Related Literature .

ANATOMY AND PHYSIOLOGY OF THE .

INVOLVED SYSTEMS PHYSICAL ASSESSMENT FINDINGS .

Nursing Theory applicable to care of patient .

ANNOTATED READINGS .

CONCLUSIONS .

BIBLIOGRAPHY .

uk/search?&page=1&9=CNS.ORG  Smeltzer. Blackswell’s Nursing dictionary.Infection%20&site=2  Margolis. John Hopkins Symptoms Remedies. Dawn. . Al. Et.nhs. nursing and health profession. 5t edition. Al. Suzanne C. 11th edition. Joyce M.  Mosby’s pocket dictionary of medicine. Medical-surgical nursing (clinical management for positive outcome). S. (2003).(2006)  Freshwater. Et. WWW.library. Et.7th edition. Et. Al. Volume 2. (2005). Medical – surgical Nursing . Al.WIKIPEDIA.  Black.  http://cks. (2005). Volume 1.

2007 edition.  Lippincott.com “Physical Assessment “ I. Bollos . Malan Press. Comprehensive Health History: A. al. PPD’s Nursing Drug Guide. Williams & Wilkins. 28th edition. Nursing drug handbook.  www. Et. (2008). Patient’s History: Name: Juniel Medina Lijarso Room and Bed Number: ICU AND Bed # 07 Age: 3 months old Sex: Male Religion: Roman Catholic Attending Physician: Dr.mimsonline.

Birth date: May 31. Medications: + Paracetamol 125 mg supp. Amlan. 2008 at 7:43 pm at pediatric ward with the chief complaints of Non – productive cough.2 mg IVTT q 4 ̊ PRN for seizure + Ceftriaxone 300 mg IVTT Q 12 ̊ + Dexamethasone 0.5 IVTT Q 6 ̊ + Cimetidine 30 mg IVTT Q 6 ̊ D. high grade fever. C. Past Health History: . ½ stick Q 4 ̊ PRN for T = 38 ̊C and up + Diazepam 1. on and off with convulsive episodes was noted four days PTA. Lijarso Occupation: Farmer Occupation: House wife Date and Time of Admission: Admitted on September 09. History of Present Illness: • • Admitted on September 09. on and off with convulsive episodes was noted four days PTA. high grade fever. Chief Complaints: • Non – productive cough. 2008 at 7:43 pm at pediatric ward B. 2008 Address: Bio – os. Oriental Negros Parents – Father: Jose Lijarso Mother: Mary Ann M.

General Survey:  Received sleeping on bed with D5 0.2 ̊C. P = 142 bpm.• Mother delivered the baby by NSVD. II.  Mother Side: + The mother side family of our client had hypertension.3% NaCl at right metacarpal vein. weak and irregular. They are five in the family and only Ms. Both of his grandfather and grandmother have hypertension. .. for the boys they don’t know if they got any of it. with continuous O2 administration at 1 – 2 L/min. It is his first time to be admitted in the hospital and also he is the first child of his parents. Had not yet given any immunizations. Family History:  Father Side: + The father side family of our client had two genetic diseases these are cancer and anemia. redness and swelling noted at IV site. And has no allergies. Breast fed since birth up to present. E. and R = 38 cpm. His grandfather died due to cancer and his grandmother is anemic. NPO with breastfed with strict aspiration precaution. His elder brother has hypertension while the rest they don’t know if they got that disease. With the final vital signs T = 38. no inflammation. unlabored. They are four in the family and she is the only girl in the family. Rosie Lijarso got the hereditary disease which is anemia. General health in the past has been good despite minor illnesses such as coughs and colds.

Sign up to vote on this title
UsefulNot useful