Viral Bacterial fungal
BY NAMAYANJA
MENINGITIS, is the acute inflammation of the meningeal
tissues surrounding the brain and the spinal cord (meninges)
Streptococcus pneumonia, Haemophilus
influenza, Neisseria meningitides (primary
cause), E. coli. Noninfectious meningitis
(drugs and vaccines
Invasion of microorganisms (usually in the
upper respiratory tract) leads to rapidly
increased blood supply to the meninges with
massive neutrophil migration. The neutrophils
then engulf the bacteria and disintegrate.
Exudate from tissue destruction contributes to
purulent material. The purulent material causes
the meninges to become inflamed and
increases ICP
History collection, physical examination, blood
culture, analysis of CSF, CBC, electrolyte levels,
RBS, CT Scan, MRI, PET scan, Skull x-ray (may
demonstrate infected sinuses)
Medical (pharmacological)
Antibiotics (ampicillin, penicillin, amoxicillin).
Antiviral(tenofovir). Antifungal (fluconazole).
Corticosteroid (dexamethasone). IV mannitol
for diuresis)
Surgical (Cochlear implantation
rehabilitation due to deafness)
DIAGNOSES
Ineffective tissue perfusion (cerebral) related to
infectious process and cerebral edema.
Hyperthermia related to the infectious process and
edema
Risk for imbalanced fluid volume related to fever and
decreased intake
Acute pain related to meningeal irritation
Impaired physical mobility related to prolonged
bedrest
NTERVENTIONS
Enhancing cerebral perfusion
Assess LOC, vital signs and neurologic parameters
frequently. Observe for signs and symptoms of ICP (eg
decreased LOC, dilated pupils, widening oulse
pressure
Maintain a quiet, calm environment to prevent
agitation which may cause an increased ICP.
Prepare patient for a lumbar puncture typically
precedes neuro imaging
parasitic
SUMAYIYAH
J210184205
Bacteria are transmitted from one person to another
Etiology through droplets of respiratory or throat secretions
from carriers, close and prolonged contact, (incubation
Transmission period is 4days but can range between 2 and 10days).
Pathophysiology
Skipping vaccinations, Age (viral meningitis occur in
Risk factors children younger than 5yrs.bacterial is common in those
under 20yrs), pregnancy, compromised immune system
(AIDS, alcoholism, diabetes, use of immunosuppressant
drugs), living in a community setting
Fever, Neck stiffness (Nuchal rigidity). Thigh flexion
upon flexion of the neck (Brudzinski’s sign),
resistance to the passive extension of the knee with
the hip flexed (Kernig’s sign), vomiting, photophobia,
Clinical manifestation
petechial rashes, Acute confusion
Diagnostic. E
Complications Hearing loss, memory difficulty, learning disabilities,
brain damage, gait problems, Seizures, kidney failure,
shock
management Medical (non pharmacological)
Maintenance of fluid electrolyte balance by IV therapy,
Nasogastric tube feeding vitamin supplementation,
head end elevation 30 to 45 degrees
Nursing Pathway ASSESSMENT
Obtain a history of recent infections and exposure to
causative agents
Assess neurologic status and vital signs
Evaluate for signs of meningeal irritation
Assess sensorineural hearing loss (vision and hearing),
cranial nerve damage ( eg facial nerve palsy) and
adminished cognitive function
Goals.
To enhance cerebral tissue perfusion
To reduce fever
To maintain fluid balance
To reduce pain
To return to optimal level of functioning (mobility)
Reducing fever Maintaining fluid balance
Administer antimicrobial agents on time to Prevent I.V fluid overload, which may worsen
maintain optimal blood vessels cerebral edema
Monitor temperature frequently or Monitor intake and output closely
continuously Monitor CVP frequency
Institute other cooling measures such as Administration of Osmotic diuretic (mannitol)
hypothermia blanket as indicated
Administer antipyretics as ordered

Reducing pain
Assess level, intensity, duration, and location of pain.
Promoting return to optimal level of Darken the room if photophobia is present
functioning Assist with position of comfort for neck stiffness, and turn
Implement rehabilitation interventions after patient slowly and carefully with head and neck in
admission eg turning and positioning alignment
Elevate the head of the bed to decrease ICP and reduced
pain
Administer analgesics as ordered. Monitor response and
adverse reactions. Avoid opioids which may mask a
decreasing LOC

HEALTH EDUCATION
Advise close contacts of the patient with
meningitis that prophylactic treatment maybe
indicated, they should check with their health
care providers or the local public health
department.
Encourage the patient to follow medication
regime as directed to fully eradicate the
infectious agent.
Encourage follow up and prompt attention to
infections in future

KEY AND REFRENCES.

LOC (Loss of consciousness)

ICP (Intracranial Pressure)

CSF (cerebrospinal fluid)

CBC (complete blood count)

PET Scan (Positron emission tomography)

References

(Mary, 2004)

(Al., 2000)

(Lippincott, 2001)

(Greenlee, 2019)
 Causes Is a break in the continuity of the
Direct blows, crushing forces,
FRACTURE
bone (defined according to its type
accident, trauma, bone tumor, and extent)
pathologic conditions

Types of fractures Patterns of fracture.

Complete (a break across the entire cross section of the bone,
Incomplete (the break occurs through only part of the cross
section of the bone,
Closed (simple fracture, one that doesn’t cause a break in the
skin)
Open (compound or complex fracture, is one in which the
skin is broken together with the broken bone,
Pathologic (it occurs through the area of the disease

Pathophysiology
Due to any etiology (crushing movement),
Fracture occurs, muscles that were attached to the bone
are disrupted causing spasm,
In addition, the blood periosteum and blood vessels in
the cortex and bone marrow are disrupted
Soft tissue damage occurs, leading to bleeding and
formation of hematoma between the fracture fragment
and beneath the periosteum
Release of chemical mediators histamines, prostaglandins
This results in vasodilation, edema, pain, loss of function,
leukocytes and infiltration of WBC

Complications Diagnostic evaluation

Bleeding, vascular injuries, nerve injuries, pulmonary X ray
embolism, fat embolism, compartment syndrome, infection Blood studies (decreased hemoglobin and hematocrit)
Long-term Arthroscopy (joint involvement)
Instability, Stiffness and impaired range of motion,
Nonunion or delayed union, Malunion, Osteonecrosis,
Osteoarthritis, Limb length discrepancy

Medical management NURSING PATHWAY

Principles include, ASSESSMENT
Reduction History
Open reduction A perceived snap or pop at the time of injury
Internal fixation may signal a fracture (or a ligament or tendon
injury)
External fixation
History of a fall or any bone disease
Closed reduction
Restlessness, anxiety and discomfort are controlled using
approaches like reassurance, position changes and pain relief
strategies.
Assessment.
Physical examination
Vascular and neurologic assessment distal to the injury
Inspection for open wounds, deformity, swelling, ecchymoses, and
decreased or abnormal range of motion
Palpation for tenderness, crepitation, and gross defects in bone or
tendon
Examination of the joints above and below the injured area (e.g., for the
shoulder joint, the cervical spine and elbow)
After fracture and dislocation are excluded (clinically or by
imaging), stress testing of the affected joints for pain and instability
Physical findings (pain, swelling, false motion, loss of function,
crepitus (cracked sound), tenderness
Neurovascular status (paresthesia, ischemia, pallor
Schock (fetal, the bone is vascular
Visible deformity
Bone healing
Hematoma forms between the end of the bone and in
surrounding soft tissue
Inflammation and accumulation of inflammatory exudates
Macrophages that phagocytes the hematoma and small
fragment of bone
Fibroblasts migrate to the site which unites the broken end
and is protected by an outer layer of the bone
The new bone deposits and cartilage are called callus
The callus matures and the cartilage is gradually replaced with
new bone
Medullary canal is reopened through the callus
Refrences
(Danielle Campagne, 2019)
(Hokanson)
(burnner)
Nursing diagnoses
Pain related to fracture, soft tissue damage, muscle
spasm and surgery
Impaired physical mobility related to fractured hip
Impaired skin integrity related to surgical incision
Risk for impaired urinary elimination related to
immobility
Risk for ineffective coping related to injury,
anticipated surgery and independence.
Nursing interventions (general)
Prevent infection, Cover any breaks in the skin with
clean or sterile dressing
Provide care during client transfer
Immobilize a fractured extremity with splint in the
position of the deformity before moving the client,
avoid strengthening the injured body part if a joint is
involved
Support the affected body part above and below
fracture site when moving the client
Provide client and family teaching
Explain prescribed activity restrictions and necessary
lifestyle modification because of impaired mobility
Teach the proper use of assistive devices, as indicated
Administer prescribed medications, which may include
opioid or nonge, restlessness, dyspnea, crackles, white
sputum opioid analgesics and prophylactic antibiotics
for an open fracture
Prevent and manage potential complications
Observe for symptoms of life threatening fat embolus
(personality changes, restlessness, dyspnea, white
sputum, crackles)
Observe for symptoms of compartment syndrome
Monitor closely for signs and symptoms of other
complications