CHILD HEALTH NURSING

Care Plan on:

VIRAL MENIGO ENCEPHALITIS,
PYOGENIC MENINGITIS

SUBMITTED TO
Ms.Grace Mane madam
HOD of Pediatric Nursing
INE, Mumbai.
SUBMITTED BY
Yashoda Pawar
I Yr M.Sc. Nursing
INE, Mumbai.

SUBMITTED ON: 14/9/2020.

 VIRAL MENIGO ENCEPHALITIS,
PYOGENIC MENINGITIS

INTRODUCTION
As a part of our clinical experience in Pediatric nursing, we were posted to PICU JJ
Hospital Mumbai. When I was posted to PICU, I came across the patient by name Baby Sangita
Maurya, diagnosed as a viral meningo-encephalitis. I have selected this case for my care plan
and theory application on 25/02/2020 in order to use this knowledge in my day to day clinical
practice.

I. BIOGRAPHICAL INFORMATION

Name : Baby Sangeeta Maurya

Age : 5years

Sex : Female

Address :A/P Sundarm,Tal Palghar,Dist Palghar

Religion : Hindu

IP No. :2808279

Admission unit : 30 B

Date of admission : 24/02/2020

Date of history taking : 25/02/2020

Informant : Mother

II. DIAGNOSIS : Viral Menigo Encephalitis, Pyogenic Meningitis

III. PRESENT HISTORY

Chief Complaints with Duration
Baby Sangeeta was admitted with the complaint of
  Altered sensorium since 3 days
 Fever since 2 days,
 Convulsion 2 episode since 2 days

History of Present Illness

Baby was admitted , with the complaint of altered sensorium since 3 days,
fever since 2 days and convulsion 2 episodes since 2 days. The child was apparently
well before, when the child developed fever which was intermittent in nature. On the
same day child developed 1 episode of convulsion generalized tonic clonic along with
uprolling of eyeball and drooling of saliva. Then the child was taken to Local hospital
and treated there with which convulsion was under control.

IV. PAST MEDICAL HISTORY

Past illness, hospitalizations : There is no history of past illness, surgeries or
major illness.

Allergies : No allergies to any medications or food items

Medications : There is no history of previous medications

V. BIRTH HISTORY
Antenatal : Uneventful

Natal – Place of Birth : Hospital

Mode of Delivery : Normal vaginal
Gestational Age : Full term
Birth Weight : 2.5kg

Postnatal : No injuries

VI. FAMILY HISTORY

33 years 27years
 7years 5years
Has no family history of hypertension, diabetes, communicable disease,
cardiovascular disease or congenital anomaly. All of her family members are healthy.

VII. GROWTH AND DEVELOPMENT

Growth and development of Baby Sangeeta is appropriate to the age.

VIII. IMMUNIZATION
Baby Sangeeta has received all the immunization vaccines as per schedule.

IX. ELIMINATION PATTERN

Bowel : Has regular bowel movements.
Bladder : Bladder pattern is regular. Voids 5-6 times a day

X. NUTRITIONAL PATTERN
Recent Weight : 17 kg Expected Weight: 18 kg
Appetite : Normal

24 Hours Diet Recall:

Time Diet items
1. 7.30 AM 1Glass of milk
2. 9 AM 1 glass of juice
3. 1.30 PM 1 ½ cup of ragi
4. 4.PM 1 Glass of milk.
5. 8 PM 1 ½ cup of ragi

XI. SLEEPING PATTERN

Sleeping pattern is normal.

PHYSICAL EXAMINATION
1. General Observation
Baby Sangeeta is moderately built, nourished, 5 year old female child, conscious and
oriented to time, place and person.
2. Vital Signs
Temperature : 99 o F
Respiration : 30/mt.
Pulse rate : 100/mt.
BP : 90/60 mmHg

3. Anthropometric Measurements
Height : 104 cms
Weight : 17 kg

4. Skin And Mucus Membrane

Color : Fair
Edema : No
Moisture : Moist
Temperature : Warm to touch
Turgor : Good
Texture : Good
Any Abnormal Discharges : Nil

5. Hair
Changes in Texture : No changes
Characteristics : Equally distributed and black in color.
Lice : Absent

6. Nails
Changes in Appearance : No changes
Cyanosis : Absent
Texture : Normal
7. Head
Skull/Cranium Size, Shape : Normal
Movements : Normal
 Forehead : No scars

8. Face
Appearance : Normal
Color : Fair
Symmetry : Symmetrical
Movements : Normal

9. Eyes
Expression : Appears dull
Eye Lids : Eye lashes equally distributed
Lacrimation : Clear fluid expressed
Eyebrows : Equal, evenly distributed.
Conjunctiva : Clear
Sclera : White and moist
Cornea : Smooth, moist and round
Pupil : Pupils are equally reactive and accommodates light.

10. Ears
Appearance : No abnormal masses
Discharges : No abnormal discharges
Lesions : No lesions
Any Abnormalities : Nil

11. Nose
Appearance : No septal deviation
Discharges : Nil
Patency : Good
Sense of Smell : Good
Mouth And Throat
Lips : Normal, moist
Tongue : Not coated
 Teeth : Intact in upper and lower jaw
Gums : Normal color
Buccal Mucosa : Normal
Palate : No cleft palate
Tonsils : No inflammations
Taste : Normal

12. Neck
General Appearance : No scars, Normal range of movements
Trachea : Centrally located, No abnormal masses
Lymph Nodes : Not enlarged
Thyroid Glands : Smooth, firm and non tender
Salivary Glands : No inflammation
Cysts and Tumors : Nil

13. Chest And Respiratory System

Inspection : Size and shape is normal & symmetrical. RR: 30 breaths/min
Palpation : No tenderness
Percussion : No fluid collection
Auscultation : Normal lung sounds heard

14. Cardio Vascular System

Inspection : Size and shape of the chest is within normal limits
Palpation : No pericardial rub or palpable sounds
Percussion : Cardiac borders well within normal limits, no cardiac or
supracardiac dullness

Auscultation : S1 S2 heard well

15. Abdomen
Inspection : Size and shape of the abdomen is within normal Limits
 Palpation : No lumps present, mild tenderness present,

Percussion : No fluid spaces could be found

Auscultation : peristaltic sounds heard.

16. Back
Spine, Curvature : Normal
Symmetry : Symmetrical
Tenderness : No tenderness

17. Genitalia
Normal female genitalia

18. Extremities
Deformities : No
Swelling/ Edema : No
Muscles : Normal strength
Lymph Nodes : Not enlarged
Joints : Normal ROM
Fingers and Toes : Normal
Nails : Normal

19. Central Nervous System

Birth Injuries : Absent
Seizures : Two episodes of seizure present
Speech : Normal
Sensory Motor Changes : Respond to touch and other stimuli
Gait Changes : Normal
Cognitive Changes : Well oriented and conscious
Reflexes : Normal
20. Urinary System
Urinary Tract Infections : No
 Any Abnormalities : Nil

21. Gastro-Intestinal System

Diarrhea : Absent
Constipation : Absent
Bleeding : No
Worm Infestation : No

22. Psychosocial History

General Status of the Family
The child’s father is working as a Farmer with an annual income of Rs. 30000/-
and her mother is a housewife. Her father is the bread of the family. They are staying at a
rented house which has a living room, 1 bed room, kitchen and attached bathroom and
toilet. They have a low socio economic status. A lavatory facility is not available.

Relationship with the friends & family: Have good relationship with the friends and
family.

Activities of Daily Living : The child is not able to perform his activities of daily
living as she is having seizure.

Play Activities : Unable to play due to her condition.

School Performance : The child is studying UKG. Good performances in the

school.

Hobbies : Drawing and painting, playing with toys

23. Laboratory investigations
Sl. Investigation Results Normal values Remarks
No.
1. Haemoglobin 9.3gm/dL 12-16gm/dL Normal
2. TC 10,500cells/cmm 4500-11000cells/cmm Normal
3. DC:
Prothombin 70%
Lymphocyte 26%
Erythrocyte 4%
4. Glucose 60mg/dL 60-100 mg/dL Normal
5. Creatinine 0.3mg/dL 0.6-1.4 mg/dL Low
6. Sodium 139meq/L 135-148 meq/dL Normal
7. Potassium 3.5meq/L 3.5-5.2 meq/dL Normal
8. Chloride 107meq/L 95-106 meq/dL Elevated
9. Urea 20.5mg/dL 10-50 mg/dL Normal
10. Alkaline phosphate 416.5mg/dl
11. SGOT 128mg.dl
12. SGPT 39mg/dl
13. Platelet 1,25,000
14. CRP Positive
15. CSF
Glucose 37mg/dl
Protein 65mg/dl

24. Special investigations

CT scan of Brain: Mild diffuse cerebral edema
 MEDICATIONS
Medication name Dosage Frequency Route Actions Side effects Nursing responsibilities
1. Inj. Augmentin 300mg Bd IV Antibiotic Allergic reaction, Monitor ECG, check vital signs,
nausea, vomiting, and check for other side effects
increased salivation,
fever and chills

2. Inj. Hydrocortisone 30mg
Q 6H IV Corticosteroid Agranulosis, aplastic, Monitor the vital sign and BP.
anaemia, wide spread Check for other signs and
exfoliative dermatitis, symptoms of the patient.
confusion and
headache.

3. Syp. Paracetamol 5ml SOS Oral Antipyretic Allergic reaction, fever, Monitor the vital sign and BP.
nausea, vomiting Check for other signs and
symptoms of the patient.
 ASSESSMENT OF BABY SANGEETA USING JOHNSON BEHAVIOURAL SYSTEM MODEL

The focus on assessment process is to obtain knowledge regarding the client through interviews and observation of the patient
and family. The purpose is to evaluate the present behaviour in terms of past patterns to determine the impact of the present illness or
perceived health threat and /or hospitalization on behavioural patterns and to establish the maximum possible level of health towards
which an individual can strive. The behavioural system analysis approach provides a comprehensive framework in which various
types of data can be organised into a cohesive structure.

The assessment gathers specific knowledge regarding the structure and function of the eight subsystem (behavioural assessment and
those general and specific factor s that supply the subsystem functional requirements/ sustenal imperatives (environmental assessment)

FRAMEWORK ELEMENTS:

BEHAVIOURAL ASSESSMENT

ACHIEVEMENT : Baby Sangeeta is a 5 years old girl, studying in primary who live with parent and elder brother
in a rented house. She was good hardworking student.

AFFLIATIVE : Baby Sangeeta lives with her parents with love and guidance. She is loved and Cared by her
family members.

AGGRESSIVE/PROTECTIVE : Baby Sangeeta is having fever, seizure and altered sensorium since 3 days. She is not protective
of herself, as she is not ready to take medications.

DEPENDENCY : Baby Sangeeta education depends on her father and emotionally and physically all her needs
depend on her mother due to her condition. Income Rs 1500/month.

ELIMINATIVE : She has regular bowel and bladder movement.

INGESTIVE : She is adjusting with soft diet. Her mother is providing feeding through NG tube. She has no
vomiting and nausea.

RESTORATIVE : Baby Sangeeta is admitted with the complaints of fever, convulsion and altered sensorium since
3 days. She was taken to a Local hospital. Now she is experiencing fatigue, weakness, fever and
convulsion. She also feels anxious and depressed due to disease and environment.

SEXUAL : Baby is 5years old girl and he is very cooperative with other child.

ENVIRONMENTAL ASSESSMENT

FAMILIAL : Baby Sangeeta lived with her parents and brother. There were four members in their family.
Her father is the bread earner in her family. Mother looks after them with love and affection. Her
uncle gives financial support for their education as father income is not affordable.

SOCIOCULTURAL : Baby Sangeeta is from Hindu middle class family. They believe in god and do prayers. They
maintain good social relationship with friends, relatives and neighbours. They Celebrate all the
Hindu festival regularly.

ECOLOGICAL : They lived in a rented house, which consist of 1 bed rooms and one kitchen and attached
bathroom and toilet. The drainage is open drainage. They have poor public transportation
facility.

DEVELOPMENTAL : Baby Sangeeta is 5 years old girl. She enjoy with her friends in school. She is the mastermind
in her group

NURSING CARE GIVEN:

According to NANDA’s format of nursing diagnosis the following diagnosis are formulated:

1. Hyperthermia related to the disease condition.

2. Risk for injury related to seizure activity.

3. Risk for injury, hypoxia, and aspiration related to motor activity and loss of consciousness (tonic- clonic seizure).

4. Interrupted family processes related to a child with a chronic illness.

5. Parental knowledge deficit related to disease condition, treatment and follow up care.
NURSING CARE PLAN
NURSING NURSING PLANNING
ASSESSMENT IMPLEMENTATION EVALUATION
THEORY DIAGNOSIS OBJECTIVE INTERVENTIONS
It is identified Subjective data: Hyperthermia Child will be -Assess the condition -Child body Child’s fever
that due to the The mother related to able to of the child by temperature reduced to some
mode of complaint that increased body maintain monitoring the vital increased to 100.2oF extents.
intervention, she my child is temperature. normal body sign. Monitored the
is allowed to stay having fever temperature. -Avoid tight -Advised mother to vital 4th hourly.
in bed and her since 3 days. clothing. avoid tight clothing Changed the
ADL has to be -Maintain proper -Provided proper position
met in the bed. Objective data: ventilation in the ventilation. frequently and
Nurses also Temp: 99o F room her mother
identifies Resp: 30/mt -Maintain aseptic -Followed aseptic provided tepid
potential Pulse: 100/mt technique while precautions during sponge
problems of her BP: 90/60mmHg doing procedures. the procedures.
condition and -Monitor vital signs -Continuously
assesses her The child is at regular intervals. monitored vital
everyday and having fever and signs
take action to crying. -Administer -Administered
prevent antibiotics as antibiotics as per
complication prescribed by doctor. prescription.
 NURSING NURSING PLANNING
ASSESSMENT IMPLEMENTATION EVALUATION
THEORY DIAGNOSIS OBJECTIVE INTERVENTIONS
Johnson’s Subjective data: Risk for injury Child will be -Assess the - Child has repeated Baby Priya
behavioral The mother related to type free from condition of the seizure activity. remains free of
system model. complaint that of seizure. injuries of child. seizure activity
It is identified the child is seizure. -Encourage the - Encouraged mother
that she has having seizure. mother to be with to be with child
seizure. Nurses Objective data: the child always. always.
set mutual goals, Temp; 99o F -Administer anti - Administered
identifies the Resp: epileptic antiepileptic drugs as
focus of 30breaths/min medication as per per prescription.
intervention, Pulse: ordered.
identify 100bts/min -Avoid sharp - Advised mother to
techniques of BP: 90/60mmHg objects near to the remove all the sharp
treating during The mother is client and maintain objects out of reach
her planning. worrying and safe environment. to the child.
crying. -Avoid situations - Advised parents to
that are known to avoid situations that
precipitate a are known to
seizure like precipitate a seizure
blinking light, like blinking light,
fatigue. fatigue.
 NURSING NURSING PLANNING
ASSESSMENT IMPLEMENTATION EVALUATION
THEORY DIAGNOSIS OBJECTIVE INTERVENTIONS
Johnson’s Subjective data: Risk for injury, The client -Assess the factors - Child is small and Child feel relax
behavioral The mother hypoxia, and will not which cause having seizure and exhibits no
system model. complaint that aspiration experience injury to the child. activities. sign of physical
Nurse identifies whether my related to injury, -Do not use - Educated parents not or mental injury
that the client daughter will motor activity respiratory restrains and use any restrains or or aspiration.
has respiratory have injury. She and loss of distress or physical force to physical force to
distress and says that my consciousness. hypoxia. control the child control seizure
aspiration and its daughter mouth movements. activity.
affecting the is full of saliva -Place blanket -Instructed mother to
restorating sub- when she is on under the child’s place blanket under
system of the seizure. head to prevent the child’s head to
client. While injury. prevent injury.
planning Objective data: -Loosen clothing. -Loosen the cloths to
intervention she The mother facilitate breathing.
sets mutual goals looks anxious -Keep side rails -Kept side rails in
with clients, and depressed. raised when child position.
identifies focus is sleeping, resting
of intervention, or having seizure. -Advised parents to
techniques of -Allow seizure to allow seizure to end
intervention. end without without inference.
interference.
 NURSING NURSING PLANNING
ASSESSMENT IMPLEMENTATION EVALUATION
THEORY DIAGNOSIS OBJECTIVE INTERVENTIONS
Johnson’s Subjective data: Parental The parent -Assess the - Understanding level Parent got
Behavioral The client’s knowledge will maintain knowledge level of parents is poor. adequate
system model. parent says that deficit related the of the parent. knowledge.
Nurses identifies they don’t know to disease knowledge -Maintain good - Maintained good IPR They follow up
that the client’s anything about condition, level interpersonal with the client & his the ordered..
parent has lack of
the child treatment and regarding the relationship with family members.
knowledge
conditions. follow up care. child’s the parent.
regarding the
condition. -Explain about the - Explained regarding
child’s
Objective data: causes, symptoms the causes, symptoms
conditions,
The client’s and the prevention and preventive and
treatment and
follow up care. parents look of further treatment measures of

Nurses set mutual anxious and complications. the condition.

goals with client, asked many -Clarify the doubts - Clarified the doubts
identifies focus of doubts. of the parent. of the parents.
intervention, -Explain the - Educated the parents
technique of parents regarding regarding the follow
intervention the follow up and up and home care of
evaluation is home care of the child.
done according to child.
the established -
goal