Scribd Logo
Upload

Welcome to Scribd!

  • Meningitis Case Presentation

    Uploaded by

    payel.das0607
    9 views21 pages

    Original Title

    meningitis case presentation

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    9 views21 pages

    Meningitis Case Presentation

    Uploaded by

    payel.das0607

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 21
    CASE PRESENTATION Sub: CHILD HEALTH NURSING Submitted to Submitted by Mrs.T.Mitra LIPI BARMA SAUD Faculty MSc Nursing 1* year student (2022-23) Govt. College of Nursing Govt. College Nursing Murshidabad medical college & Hospital Murshidabad medical college & Hospital INTRODUCTION The nervous system is subject to infection by the same organisms that affect other organs of the body. However, the nervous system is limited in the ways in which it responds to injury, needed to identify the causative agent, The inflammatory process can affect the meninges (meningitis) or brain (encephalitis). Meningitis is the inflammation of the meninges, the covering membrane of the brain and spinal cord. It is a major cause of hospitalization of children with high mortality rate. The term meningitis to be considered as a misnomer, because it is virtually impossible that inflammation is limited to the meninges only. Meningoencephalitis is a better nomenclature, as brain tissue is also inflamed along with meninges. Identification Data- * Name : Sarfarhaz Sk. © Age- :3 month © Sex- : Male + Registration number 20379 + Ward :Paediatric Medicine Ward. * Bed no :Room -I bed/no-16A Father name : Sahin Sk. + Mother name : Chumki Khatoon © Address :Vill+P.O- Hasaanpur ,P.S-Suti 2 © Dist -Murshidabad. © Religion : Muslim © Admission date- 08.01.2023 © Time of admission 210.20 AM © Under Doctor : Unit 11C(Dr. Bholanath Aich) © Diagnosis : Bacterial Meningitis, Health History © Chief Complains- This child has abnormal appearance and fever with convulsion from last 3 days. The child with diagnosis of meningitis is admitted at Paediatric Medicine Ward for getting treatment. Ps 95 emf history of illness Past Health history Medical History- The child has a history of pneumonia and ear infection at age of one month Child has intermittent fever prior one week of admission. © Surgical History- Nothing significant. Birth History Prenatal History: ‘© Mother's health condition : Good proper ; Mother visited antenatal clinic 4 times ‘TT I and TT2 immunization in pregnancy. Mother's antenatal care + Antenatal visit ee for antenatal checkup She get injection © Radiation exposure/other medications —_ : USG was done but no other radiation exposure and no harmful medications is taken. Folic acid was taken. Natal History: * Place of delivery :Beldanga BPHC © Mode of delivery + Normal vaginal delivery at 39 weeks of gestation + Birth weight 2.7Ke * Baby cried after birth 2 Yes * Any problem during delivery lothing significant * Post natal history :After birth the mother and baby's health condition was good. Baby was passed meconium after birth, and passed urine within 24 hours. And he gets BCG OPV-0 dose and Hep-B at birth. IMMUNIZATION HISTORY: © Atbirth : Hep-B & VIT-K ON-02.11.22 BCG &OPV -ON-03.11.22 * 6 weeks : OPV-1 Pentavalent-1 IPV-1,PCV-1 ON- 29.12.22. * PERSONAL HISTORY: © Hygiene : Good © Bath Per day :One time © Nails :Clean © Hair + Not Clean, No dandruff and pediculi * Elimination pattern + He did not passed stool regularly. * Sleep : He did not slept well Play : He did not move his hand and feet well DIET HISTORY: © Breastfeeding : Started % hour of after birth to till now he depend on exclusive breast feeding. FAMILY HISTORY © Type of family : Nuclear © No of family member 4 : © Health history No family history of diabetes, hypertension, hypothyroidisom, tuberculosis or any other hereditary disease like hemophilia, thalassemia etc. SOCIO ECONOMIC DATA: Housing Water supply Ventilation Head of family Occupation Income Sanitation Electricity PHYSICAL EXAMINATION © Date * Time Anthropometric Measurement: Weight * Height * Head Circumference © Chest Circumference © Mid upper arm Circumference vital signs: ‘© Temperature © Pulse © Respiration © P02 EMOTIONAL STATUS GENERAL APPERANCE: © Body built © Activity © Posture © Level of consciousness * Color © Skin turgor © Cleanliness © Texture © Sensation HEAD * Size © Shape : Pucca House ibe well Well ventilated : Father of the child : Motor-mechanic. : 7000/- per month Rs Sanitary Latrine Present + Present. :10/01/2023 1:00 AM Skg :58em. 38cm 30cm :144¢em :102°F :92 beats/min +32 breaths/ min 98% :He is irritable : Endomorphic : Lathergic :Normal : Unconscious : Pink : Good : Clean : Moist : Normal : Normal : Round © Fontanels closed. * Cephalohematoma — ; Not applicable. * caput succidenum —_: Not applicable HAIR: * Texture * Color FACE * Condition and looks MOUTH © Lips ‘© Cleft lip or palate * Tongue © Teeth Taste sensation © Odour of mouth * Mucus membrane and gums © Size of chin + Eyebrow © Eyelashes © Eyelids © Eyeball © Conjunetiva © Colour of sclera © Pupillary reaction * Vision «Discharge © Shape «Discharge © Tympanic membrane « Hearing that NOSE © Shape « Discharge + Anterior fontanel are not closed but posterior fontanels are Size — nie :baby is unconscious. : Moist and symmetrical : Absent : Clean : she has did not erupt teeth till now. : Present : Normal : Normal : Normal : Normal : Sticky eye lashes + Sticky eye lids Normal lormal : White : Abnormal : Normal : Absent : Normal : Absent : Normal + Baby pis unconseious(her mother said baby has no hearing difficulty) : Normal : Absent 2 ee ee © Septum : Undeviated * Smell sensation : Present NECK © Size : Normal * Tums Easily from side to side : Yes © Webbing of neck : Absent * Range of motion : Absent * Lymph node : Normal © Thyroid gland : Normal * Varicose vein : Absent. GENITALIA © Any abnormality : Nothing significant. ANUS * Anal opening : Present © Any abnormality : Nothing significant * Bowel Movement Normal * Worms bsent INSPECTION OF CHEST: © Respiratory rate 234 breath/min © Heart rate 86 beats/min © Heard sound 381 and S2 present $3 and $4 and murm is absent * Movement :Symmetrical a © Breast size :Greater than 5 mm Abnormality :Absent © Nipple ‘Raised Air entry in both lungs : Equal ABDOMEN Inspection: © Abdomen : Soft © Umbilical Cord : Not Applicable Auscultation: * Bowel Sound :Present Palpation: © Palpation of Liver :Not palpable or enlarged © Spleen : Not Palpable * Abnormal shape :Absent Percussion: © Gas/fluid/ mass :Absent NAILS: © Size :Ling till finger Cyanosis : Absent * Clubbing BACK: * Skin * Spine © Spinal curve UPPER LIMBS: © Symmetry © Congenital malformation * Full range of motion © Edema * Joints Reflexes LOWER LIMBS: © Symmetry * Congenital malformation © Full range of motion Edema © Joints © Reflexes DEVELOPMENTAL MILESTONE : Absent : No rash or lesion and redness : Normal curvature : Normal : Symmetrical Absent :Absent(due to unconscious) : Absent :Not Flexible(due to unconscious) : Absent(due to unconscious) : Symmetrical : Absent : Absent(due to unconscious) :Not Flexible(due to unconscious) :Absent(due to unconscious) AREA EXPECTED FINDINGS IN FINDINGS CHILD a. Vital signs: ¥ Temperature 36.5-37 degree C 37.4 degree C Y Pulse 90+ 15 beats/min 92 beats/min Y Respiration 32--34 breath/min 32 breath/min. b. Biological development: Y Height 60 om 58cm Y Weight 5.4-6 kg sk Y Head circumference 4lcm 38cm Y Chest circumference 32cm 30cm Y Mid arm circumference 11-12cm 14.4cm ¥ Abdominal circumference 40cm 28cm Y Anterior fontanels Close Close Y Control of sphincter no no C. Grossmotor development Able to lift the chin& hold head yes, yes, Y Able to tum head towards sound Yes Yes Y Able to regard bright coloured object | Yes Yes ¥_ Able to follow moving object Yes Yes AREA EXPECTED FINDING FINDING IN CHILD d. Fine motor Yes development: Yes Able to put hand into the Yes mouth Yes eSocial development Yes Y Able to smile back to | Completely depend on her mother or mother care giver. £. Psycho-soci Sense of trust vs mistrust g- Psycho-sexual-Oral Need for sucking pleasure. yes e. Sensory development: Y Ableto recognise | Yes Yes mother Yes yes Y Stop crying in yes yes response to music Y Looks in direction | yes yes made below ear f. Language development Y Able to produce Yes yes cooing sound. f. Reflexes Rooting- Touching stroking | }Jead tums and the simulation, mainly to | Present the cheek near the comer of | find the food the mouth Sucking-Touching the lips _| Sucking movement to take of food. Lieetae with the nipple of the breast. Swallowing-__Accompanies | Food reaching the posterior of the mouth present the sucking reflex is swallowed present Gagging- When more f004 | 1, mediate return of undigested food ig taken into the mouth that canbe _ successfully swallowed Sneezing & coughing-| Clearing of upper au passages PY 1 cont Foreign substance entering the upper and lower airways sneezing and lower air passage by coughing eS Blinking- Exposure of eyes to bright light Dolls eye-_Turn the neonate's head slowly to night or left side Palmer grasp-Object placed in neonate's palms Stepping and dancing- Hold neonate in a vertical position with feet touching a flat and firm surface Moro(startle)- The neonate is held in supine position supporting upper back and head with one hand and lower back with other The neonate's head is suddenly allowed to drop down backward for an inch Protection of eyes by rapid eyelid closure Normally eyes do not move -Grasping of object by closing fingers around it Rapid alternating flexion and extension of the legs an in stepping Generalized _ muscular activity. Symmetric abduction and extension of arms and legs with fanning of fingers .The thumb and index fingers form a (C) shaped in both hand. ‘The extremities then flex and adduct. The baby may cry. present Not present present Present. Present Disease Condition: Definition: Meningitis is the inflammation brain and spinal cord. of the meninges, the covering membrane of the It is a major cause of | hospitalization of children wi to be considered as a misnomer, to the meninges only. Meningo: inflamed along with meninges. ith high mortality rate, The term meningitis because itis virtually impossible that inflammation is limited encephalitis is a better nomenclature, as brain tissue is also Related anatomy & Physiology: Meninges are three layers of membranes that cover and Protect brain and spinal cord Central nervous system [CNS]). They're known Dura mater: This is the outer layer, closest to your skull. Arachnoid mater: This is the middle layer. Pia mater: This is the inner layer, closest to brain tissue. Together the arachnoid mater and pia mater are called leptomeninges. There are three spaces within the meninges: The epidural space is a space between skull and dura mater and the dura mater of spinal cord and the bones of vertebral column. Analgesics (pain medicine) and anesthesia are sometimes injected into this space along spine. The spinal cord ends between the first and second lumbar vertebra in the middle of back, at which point, only cerebrospinal fluid is present. This is the site where a lumbar puncture ("spinal tap") is performed. The subdural space is a space between dura mater and arachnoid mater.Under normal conditions, this space isn'ta space, but can be opened if there's trauma to brain (such as a brain bleed) or other medical condition. The subarachnoid space is a space between arachnoid mater and pia mater.It's filled with cerebrospinal fluid.Cerebrospinal fluid act as a cushions and protects our brain and spinal cord. The Meninges The meninges are layers of tissue that separate the skull and the brain. Skull Dura mater Arachnoid Layer Pia Mater Anatomy Menu Brain agar Rhores pATHOPHYSIOLOGY OF MENINGITIS: Bacteria ( causative organism) 2 J Colonisation and penetration of nasopharyngeal mucosal membranes by bacteria J Survival of bacteria in blood and transportation via circulation J Invasion of the central nervous system J Multiplication in subarachnoidal space 4 r—> Increased permeability of blood-brain barrier. | | _ stimulation by | | bacteria and | -transendothelial migration of <<— bacteria products | granulocytes and monocytes | 4 | r release of cytokines L__—_————_ and prostaglandins -leakage of plasma proteins JL — cerebral edema - increased intracranial pressure ~ impaired circulation. - irritability ~ restlessness Classification sording to b ‘According to book According to patient A, Accord i cording to etiology- ? Bacterial Meningitis. . Baby having a past ; health history of pneumonia Pyogenic or bacterial el Viral Tubercular Parasitic/Fungal, B. According to duration: © Acute<4 wks-Bacterial, Viral. ‘+ Chronic>4wks-Partially treated, ‘TB, Fungal. High Risk Group of meningities | According to book According to patient © Infancy Infancy ‘© History of ear infection. © Elderly © Immunocompromised + Tlymphocyte defect + Head trauma ‘© Splenic dysfunction or Asplenia neural surgery Ear infections # College students living in dormitory «Military recruits Route of infection jing to book ‘According to patient © Nasopharynx Nasopharynx(baby has history of a pneumonia.) © Blood stream * Direct spread (skull ‘meningo and encephalocele) Middle ear infection Infected Ventriculoperitoneal shunts. Congenital defects Sinusitis, fracture, « Ear infection. Etiology Aseptic Meningitis Herpes simplex virus bHIV, C. Mumps virus d. West nile viruses. e. Arbo virus £. Cytomegalovirus g. Adenovirus h, Enterovirus is most common cause of aseptic meningitis, Tuberculin Meningitis- tuberculosis. Mycobacterium ‘Sino | According to book According to patient i |_1 | Bacterial meningitis Bacterial_meningitis. Baby having a ~~ | a. streptococcus pneumoniae past health history of pneumonia. b. neisseria But causative organism is not found, c. Haemophilus influenzae d Listeria monocytogenes 2 Diagnostic evaluation According to book According to patient . History collection. Physical examination. Assessment and Diagnostic Findings, If the clinical presentation suggests meningitis, diagnostic testing is conducted to identify the causative organism. Computed tomography (CT) scan or magnetic resonance imaging (MRI) Scan to detect a shift in brain contents (which may lead to hemiation) prior toa lumbar puncture. Key diagnostic tests: bacterial culture and Gram staining of CSF and blood. Diagnosis is made by lumbar Puncture for CSF evaluation for Pressure, proteins, glucose and leucocytes. History collection. Physical examination done, ON-09.01.23, LDH-130ulit, CBG-136 mg/dl. MPDA-Non reactive, Scrub typhus-non reactive, Dengue NS-1-Non reactive, CSF study done-on 08.01.29 Glucose-65mg/dl Protein-25.9 mg /al Cell type-all lymphocytes cell count is lem3. k Rigidity. A stiff and painful neck can be an early sign and any attempts at flexion of the head are difficult. + Positive Kernig's sign. When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended. + Positive Brudzinski's sign. When the patient's neck is flexed, flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity, Photophobia. Extreme sensitivity to light is a.common finding. + Skin lesions. Skin lesions develop, ranging from a petechial rash with Purpuric lesions to large areas of eechymosis, Cognitive impairment. Disorientation and memory impairment are common early in the course of the illness, + Seizures, Seizures can occur and are the result of areas of irritability in the brain, Others 1.Fever Chills Marked irritability. 3.Frequent seizures (often accompanied by a nap 4.Bulging fontanel 5.Nuchal rigidity possible 6.Brudonsk and Kernig signs not helpful in diagnosis Difficult to elicit and evaluate in this age group 7.Subdural empyema IH influenzae infection) 8.Headache 9.Vomiting 10.Alterations in sensorium 11 Irritability 12.Agitation May develop Child well at birth but within a few days. | begins to look and behave poorly. | 14.Refuses feedings | 13.Poor sucking ability 16.Vomiting or diarrhea 17.Poor tone I d, ‘According to patient Seizures occurred two times on the day of admission. -fever for 3 days prior day of admission. - Headache -Vomiting -Alterations in sensorium -Hyperactivity but variable reflex responses. -Drowsiness -Respiratory irregularities or apnea. -Cyanosis -Weight loss. - sticky eye. (both). -Disorientation. -Lack of movement -Child well at birth but within a few days begins to look and behave poorly prior 10 days of admission, -Weak cry Full, tense, and bulging frontanale 19.Nuchal rigidity, 20.Weak cry Full, tense, and bulging frontanale. 21.Hyperactivity but variable reflex responses. 22.purpuric rashes Joint involvement (meningococcal and Haemophilus influenzae infection) 23.Chronically draining ear (pncumococeal meningitis. Nonspecific Signs That May Be Present Hypothermia or fever depending on the infant's Jaundice Irritability Drowsiness Respiratory irregularities or apnea, Cyanosis Weight loss Infants and Young Children Classic picture (above) rarely seen in children aged between 3 months and 2 years Management According to book. According to patient The specific antibiotic therapy . The commonly used drop are — inj penicillin 105 lace units/kg/day 4 hourly Inj.Cefotaxime 200 mg/ kg/day Hourly IV Inj Ceftriaxone 150 mg/kg/day BD. Inj.Ampicillin Inj-gentamicin Inj-amikacin, , Combination of two antibiotics can be administered. Antibiotics can be given intrathecal in neonatal meningitis and in advance cases. Inj.Corticosteroids, Dexamethasone0.15 mg/kg — every 6 hrly iv to prevent neurological complications. : Osmotic diuretic therapy is given with mannitol (20%) 0.5 mg/kg every 4 to 6 hours IV, for maximum 6 doses to Tuberculous reduce the increased intracranial pressure. Anticonvulsive drugs, diazepam 0.3 mg/kg . Other anticonvulsives like of childhood phenoberbitone or phenytoin can also be used. On the day of 08.01.22 IVF- ISOLYTE-P 150 ML 8 hrly Inj- Meropenum200 mg IV stat& TDS. Inj- Amoxyclavunate 50 mg TV STAT. Inj- phenitoin 15mg IV OD. Inf- Paracitamol 50 mg IV SOS. Inj-Lorazepalm 0.5 mg IV SOS. i Continue all. “wont 1 Adesoup uoBKxQ- ‘aatsodsasun, “Tuniwioa ‘oysepeay, suoddns 105 mojtid ‘syoo] Ayredy Suysey Aquq aunssasd Irews apraoid ‘uorysod ounjprut Wop eansTTO oo|g pasvaiou Uw you 40 peay urewurePY OL, - Jo UBS 304 payaaujg- ‘uonwanyes UaBAxo s0y1UOU O]- -ssoutsmoup £q ysiaiq p¢-dsoy “aunssaid jejuessenut | -uoyssryzod | poouaptaa se uorsnysod uot asuodso “uuu /S1g 06-25INd | __pasvazou Jo UIs Auv aAsasqo OL: anssit ‘anssny paseauaut ou pip Aqug 194 -panosdut 0} payoadxo 460 1-dwa “smyeis worojounau | anosduuy ey up[dwwod 19410. si uojstyiod anssty | _“payoyo ua uv uBis joa souuow of OL ansshy 2An22} UL ep aMDsTTNS “Aqug ay 01 usard afuods pido'9 suvioiskyd Aq poquiosoud sv [wi OZ “s8uupu uod Jur saisunupy °s | snsouteyp pur Crowsoquy somuoyy 19AI@ 0} apts aU “Surpaay ysvaiq soy aTesnosu poy winy pt suvioissyd ¥20UD- “2o,Ape 40190 TEP OMTTTIO. “@unyuon ‘eysepvay sod se sonaukdque Suyavy 494 q paouapixa | — ynoqu potsiom sey ays Tey UAUIAAUIED Lao 0} paivjar Ayarxuy wep aansatqng, “uoysjnauoo Sump ypRU 1sv9Iq AIT ploav 0} soYJOU! JonsIsu- -aposida uo}s]nauwoa {Jo wonwanp paasasqo~ “SN Jo [tu QOL wy Bur gz MOHU>Hd 1 a01ape 40}90p Jad sv Fup juvsjnauoo -1ue apoaistuswupe - “Xquq ay 0} pag poo [ey atp) apyaodd= “uoysjnatioo Suunp ypur seoq aat8 yu op saypoUt oF aD1ApL Oo] - “oposida uuotsjnauoo Jo uoneanp ax19sq0 O]- -a91ape sojoop sod se Srp juesjnauos 4 01 pag A ssoussayisaa AMpIBU YON yup aanaafdo sssajysa pu “ssoussayisou Uuorsynauos Buisuy -ssoooid asvasip ynoge aSpajmouy, JOHOVT eyep aapaafqo -ssaooid aseasip yoge puvysiopun you pip ays yey 1o]du09 191, squayxa oulos “auop soquiaut A]! JO on aaoudutt 28papaiouy -atlop aq oF Jaquious oplAosg- se uoneziedsot, Suyuonsonb quaaaud “auop “auop “uonoayt ‘uy Buo] 04 parejar J9i]}0 on payoadxa, uomipuos Kquq jo mawssassy | aq 0} wortpuos

    You might also like