PHINMA UNIVERSITY OF ILOILO

COLLEGE OF ALLIED HEALTH SCIENCES

Nursing Department

CNS INFECTION

Grand Case Presentation

Prepared by:

GARBOSA, ANGEL KATE

GARCES, MARIA FATIMA

GEVERO, SUZYNE AIRA

GUILLEN, KIM KRISTINE DEE

LAZARITO, JESSAMINE

BSN 2-A

Adviser:
 IRENEO GRANT PILLA

General Objectives:

At the end of the study, the students will be able to improve not only the
knowledge in the disease process and clinical manifestations but also on how to give
necessary interventions indicated to the patient. By this, we will be able to hasten our
knowledge, skills, and attitude in giving appropriate nursing care for the patient.
Through thorough research and interview we can acquire concrete and necessary
information about CNS INFECTION.

Specific Objectives:

Knowledge:

1. To understand not only the knowledge in the disease process and clinical
manifestations but also in giving appropriate nursing intervention indicated to the
patient.

2. To explain about the overview of the disease and illustrate the pathophysiology
of the disease and how it affects laboratory results.

3. To distinguish the different modalities of treatment to control clinical

manifestations and prevent further complication.

Skills:

1. To demonstrate skills in giving nursing care to the patient.

2. To use techniques suitable for the care of the patient.

3. To show actions to reduce risk pose by the different factors in the environment.
Attitude:

1. To develop trust and rapport with the patient and his significant others to gain
good working relationship for the success of this case study.

2. To participate actively in the case presentation.

3. To cooperate actively in the working process in finishing the case study.

 GENERAL HISTORY

Biographical Data

This is a case study of G.H.S, 1 month and 2 days old, male, lives in Lopez
Jaena Street, Molo, Iloilo City, Roman Catholic, single, and a Filipino citizen born on
December 28, 2019 at Iloilo Doctors Hospital via Cesarean Section. The only child of
R.A.S (mother) 30 years old and R.J.S (father) 32 years old both working in a private
company.

R.A.S(mother) brought him to the hospital last January 19, 2020 at 8pm under
the supervision of Dr. De Ramos at The Medical City.

Reason for Seeking Care

- Patient experienced seizure.

Brief History and Pertinent Exam Findings

Mother is 30 years old primigravida who had cough and nasal catarrh at 2nd and
3rd trimester. She also had pre-eclampsia, given Methyldopa. Patient was delivered full
term via 1cs for pre-eclampsia at Iloilo Doctors Hospital. Patient was discharged well
after 4days.

15 days prior to admission, patient had postprandial vomiting. Consult was done
with attending physician, given Simethicone. Laboratory test done which revealed
normal results.

On the day of admission, patient had upward rolling of eyeball with stiffening of
extremities for approximately 1-2 minutes. Thus, this admission,

PPE:

 Afebrile

 Supple neck, soft, flat fontanels

 Clear breath sounds

 Flat abdomen, hyperactive bowel sounds

  Full pulses

Past Medical History

Patient experienced oral thrush last January 7, 2020. He never experienced

operations and injuries. He has no known allergies. His grandfather in his paternal side

has Diabetes Mellitus and Hypertension and his grandfather and grandmother in

maternal side both diagnosed with Hypertension. Patient was vaccinated with BCG and

Hepa B vaccinated at birth last December 18, 2019.

Overview of the Case

The central nervous system (CNS) is the part of the body’s nervous system that

includes the brain and spinal cord. It controls most functions of the bod and mind. An

infection of the central nervous system can be a life-threatening condition, especially for

children with weakened immune systems. These infections need quick diagnosis and

immediate treatment by an infectious disease specialist. Bacteria, fungi. and viruses are

the most common causes of CNS infection.

PHYSICAL ASSESSMENT

General Survey: Patient is awake and conscious.

Skin:

Is light brown, smooth and soft, uniform in color all throughout the body, skin is
moist and warm to touch. No rashes, masses and lesions noted upon inspection.
Temperature is 36.3°C.

Head and Scalp:

 Is round with prominence in the frontal and occipital area. No tenderness noted
upon palpation. Posterior fontanelle and anterior fontanelle are still open. Head
circumference of 36 cm.

Hair:

Is short and black, smooth to touch, no lice or nits noted upon inspection and is
unequally distributed.

Nails:

Are concave in shape, clean, well-trimmed, pink nail beds, smooth to touch.

Eyes:

Pupils are equal, reactive to light and accommodation. Sclera is white and clear.
Conjunctiva is pink. Eyebrows are symmetricaly aligned, eyelashes are evenly
distributed and curled outward. No discharges noted upon inspection.

Ears:

Are symmetrical on both sides, brown pinna and uniform in color, smooth to touch.
No lesions noted upon inspection. No impacted cerumen noted.

Nose and Sinuses:

Is midline and intact, patent airway, pink and moist mucous membrane, no nasal
flaring noted upon inspection. Nasal septum is at midline and not perforated. No nasal
discharges noted upon inspection.

Mouth:

Lips are pink in color, gums is pink and moist, no teeth present, tongue is in midline
and pink.

Chest and Heart:

Thorax is smooth to touch, skin is intact, light brown and uniform in color, clear
breath sounds upon auscultation, apical pulse auscultated. Respiratory rate of 34 bpm.
Cardiac rate of 129 bpm. Chest circumference of 36 cm.

Abdomen:
 Smooth to touch, brown and uniform in color, rounded abdomen. Abdominal
Circumference of 31 cm.

Extremities

Upper: Arms are symmetrical in size, equal muscle distribution, hairs are equally
distributed. No deformities noted upon inspection.

Lower: Legs are symmetrical in size, equal muscle distribution. No deformities

noted upon inspection.

PATHOPHYSIOLOGY OF CNS INFECTION:

CNS INFECTION

ETIOLOGY
PRECIPITATING FACTORS PREDISPOSING FACTORS
 Familial incidence  Altered integrity of the  Age
neuron.

CNS protein level of 82.1

mg/dl

Increased protein level is a

sign of nerve inflammation.

Blockage in the flow of spinal

fluid.

Seizure

Tonic phase – tonic cry,

extensions of arms, legs, and
or face, fingers clenched.
 Clonic phase – muscles
relaxed completely.

Laboratory Tests
Post-ictal phase – poor
Date: January 19, 2020 coordination

CBC / PLATELET

Exam Result Normal Values

Hemoglobin 120 120-170 g/l

Hematocrit 0.37 0.40-0.50

RBC 3.62 4.60-6.00× 10 12^/L

WBC 10.6 H 5.00 - 10.00 × 10^ g/ L

Differential Count

Myelocyte 0.00 0.00

Metamyelocytes 0.00 0.00 -0.01

Stabs 0.00 0.03 - 0.05

Segmenters 0.29 0.50 - 0.70

Eosonophils 0.00 0.00 - 0.05

Basonophils 0.00 0.00 - 0.01

Lymphocytes 0.71 0.20 - 0.40

Monocytes 0.00 0.00 - 0.07

Platelet count 439 150 - 450 × 10^ g/L

MCV 101 80 -100 cum m

MCHC 32.7 32- 36 g/L

MCH 33.1 27- 32 pg

RDW 13.0

REMARKS: DONE TWICE

Date: January 19, 2020

STAT SPECIMEN: SERUM

Examination Result Normal Value

Calcium 1.36 1.13- 1.31 mmol/ L

Sodium 135.2 135-148 mmol/ L

Potassium 4.81 3.50- 5.30 mmol/ L

FECALYSIS

PHYSICAL EXAM MICROSCOPIC EXAM

Color: Yellowish Ascaris Lumbricoids ova:

Consistency: Soft Hookworm:

Strongloids Sterioraus:

CELLULAR STRUCTURE Guardia Lambua:

Pus Cells: Trichiuris Trichiura:

RBC: Entamoeba Histolytica:

Fat Globules: Cyst:

Yeast Cells: Occasional Trophozoite:

Fungal Hyphae: Entamoeba Coli:

Bacteria: Cyst:

Trophozoite:

REMARKS: NO INTESTINAL PARASITE SEEN

 URINALYSIS 4SG

Date: January 20, 2020

PHYSICAL EXAMINATION CHEMICAL EXAMINATION

Color: Pale Straw Protein: Negative

Character: Slightly Hazy Sugar: Negative

Reaction: 6.0

Specific Gravity: 1.005

MICROSCOPIC EXAM

RBC: 0.2/ HPF (occasional) CRYSTAL :

PUS CELLS: 0. 2/ HPF (occasional) URIC ACID :

Epithelial Cells: Occasional Calcium Oxalate:

Mucus thread: Urates: occasional

Bacteria: Occasional

Others:

CULTURE AND SUSCEPTIBILITY TEST

Date: January 20, 2020

SPECIMEN: Blood with ARD (Right Arm)

Preliminary Result: No growth after 24 hours of incubation

ULTRASOUND

Type of Examination: CRANIAL

Date: 01/20/2020

CHIEF COMPLAINT: Upward rolling of eyeballs

FINDINGS / IMPRESSION
- Ultrasound through the anterior fontanelle shows intact cerebral sulci and gyri

- There is no abnormal extra- axial fluid collection

- The lateral, third and fourth ventricles are normal in size

- The right frontal horn measures 1.5 mm and the left frontal horn measures 1.5 mm

- The third ventricle measures 2.1 mm and fourth ventricle measures 3.3 mm

- There is no displacement of the midline structures

- The corpus callosum is intact. The posterior fossa is intact.

IMPRESSIONS: UNREMARKABLE CRANIAL ULTRASOUND

CULTURE AND SUSCEPTIBILITY TEST

Date: January 22, 2020

Specimen: Blood with ARD (Right Arm)

Result: No growth after 3 days of incubation

BACTERIOLOGY SECTION

Date: January 22, 2020

Specimen: KOH

Result: No fungal elements seen on smear

INDIA INK PREPARATION

Date: January 22, 2020

Specimen: Cerebrospinal Fluid

India Ink Preparation:

No encapsulated yeast cells seen on preparation

 CHEMISTRY

Examination Results Units Reference Value

CSF Sugar 41.46 mg/dl 40-70

CSF Protein 82.1 mg/dl 15-45

BODY FLUID SECRETIONS

Date: January 22, 2020

Body Fluid Cell CT/ Differential CT

Physical Appearance:

Color: Colorless

Volume: 1 ml

Transparency: Clear

Total cell count:

WBC: 1 cells/ cu. mm

RBC: 1 cells/ cu. mm

Differential Count:

Polymorphonuclear cells:

Lymphocytes:

REMARKS: Differential count not possible

CULTURE AND SENSITIVITY

Date: January 23, 2020

Specimen: CSF

Intermediate Result: No Growth after 24 hours of incubation.

CULTURE AND SENSITIVITY

Date: January 25, 2020

Specimen: CSF

Intermediate Result: No Growth after 72 hours of incubation.

CULTURE AND SENSITIVITY

Date: January 26, 2020

Specimen: Blood with ARD (Right Arm)

Intermediate Result: No Growth after 7 days of incubation.

CULTURE AND SENSITIVITY

Date: January 27, 2020

Specimen: CSF

Intermediate Result: No Growth after 5 days of incubation.

CRYPTOCOCCAL STUDIES

Date: January 28, 2020

Specimen Type: Cerebrospinal Fluid

Result: