al-zaytoonah private university of jordan

8/8/2019 Al-Zaytoonah Private University of Jordan

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Al-zaytoonah private university of Jordanfaculty of nursing

maternal and child health departmentpediatric health coarse (clinical 301348).

Case presentation about meningitis .Prepared by: heba al-khozae.

Student no. : 200711008 .Clinical area : albasheer hospital .

Group no.: 1.Dr. nehad qasem.

cl. inst. : miss. Amneh.


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Childs name:

Sex: male.

Age:2, 5 months. Date of birth:14\2\2010.

Body weight: 4, 1 kg.

Height:56 cm.

Head circumference: 40 cm.

Open and mild plugging anterior fontanel.Temp.:38, 5 c.

Resp.:55 breath\min.

Pulse:160 beat\min.


3/20

Condition on arrival: holding by his father.

Date of admission:21\4\2010. Via: emergency.

Floor: medical. Room no.: 8.Source of data: childs parents, patient file and medical healthteam.

Confirmed medical diagnosis: bacterial meningitis.

Complains upon admission:fever, hypo activity, tachycardia

and poor feeding from 5 days.Past medical and surgical history: history of neonatal jaundicetreated at home , upper respiratory infection and no any pastsurgical history.


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Perinatal history:

Gestational period:39 weeks.

Type of delivery: c\s due to previous c\s.

Birth weight:3,2 kg.

Without any complications immediately after delivery , and notadmitted to NICU .

Immunization status: BCG only.

No any family history of hereditary or chronic diseases , and no anyhistory of abortion , stillbirth , or congenital anomalies.

Nutrition and metabolic pattern:

Loss of 1 kg, anorexia, breast feeding 2-3 times\day , low amounts.

Other body systems appear normal without any complications.


5/20

A,W A,W

Meningitis A,W

28years

30years

2,5month

s

3years


6/20


7/20

According to text book: in my patient:

Poor feeding Poor feedingLethargy IrritabilityIrritability Fever

Apnea hypoac

Apathy Bulging fontanelSeizures, Convulsions Anorexia Jaundice tachycardiBulging fontanel tachypneaPallor increased sleepinessShockHypotonia

Shrill cryHypoglycemiaNuchal rigidity, stiff neck

Anorexia, nausea and vomiting.PhotophobiaFever (generally present, although some severely ill children present with hypothermia)


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Specific signs that indicate meningeal

irritation:1- Positivekernigs sign:when the

patient Is lyingwith the thigh

flexed on theabdomen, theleg cant becompletelyextended.


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Specific signs that indicate

meningealirritation cont:2- Positive brudziniskis

sign: when the patientsneck is flexed ( after ruling

out cervical trauma orinjury), flexion of the kneesand hips is produced; whenthe lower extremity of oneside is passively flexed, a

similar movement is seen inthe opposite extremity. It isthe more sensitive indicatorof meningeal irritationthan kerings sign.


10/20

Specific signs that indicate

meningealirritation cont:3- Nuchal rigidity (stiff neck):

this is an early sign. Anyattempts at flexion of thehead are difficult because ofspasms in the muscles of theneck . forceful flexion causessevere pain.

4- Photophobia (extensivesensitivity to light) : thisfinding is common, although

the cause is unclear.5- Rash.6- Disorientation and

memory impairment.7-Seizures


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CBC test: normal range:HB: 9,8 g\dl. 9,0-14,0 g\dl

WBC: 19,6 *10^3 cells\l 5.0-19,5 *10^3 cells\l

RBC: 3.1 *10^12 CELLS\L 2,7-4,9 *10^12 CELLS\L

Blood chemistry:

Glucose: 6,0 mmol\l 3.3-5,5 mmol\l

Urea: 1,4 mmol urea\l 1,1-4,3 mmol urea\lCreatinine: 18, 26 mol\l 18-35 mol\l

Ca: 2,3 mmol\l 2,2-2,7 mmol\l

Na: 133 mmol\l 139-146 mmol\l

K: 4,8 mmol\l 3,5-5,0 mmol\l

Cl: 101,0 mmol\l 98-106 mmol\l

CSF analysis:

WBC: 1,5*10^6\l 0-5*10^6\l

RBC: not present not present

PROTIEN: 45,8 mg\dl 15-45 mg\dl

Glucose: 48,2 mg\dl 50-80 mg\dl

CSF culture: growth of Homophiles influenza type b (Hib).


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1- Seizures.

2- inappropriate antidiuretic hormone secretion (SIADH)

3- subdural effusions, and brain abscesses.

4- muscular hypertonia

5- complex seizure disorders

6- mental motor retardation

7- learning disabilities

8- obstructive hydrocephalus9- cerebral atrophy

10- Hearing impairment


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Prolonged or difficult-to-control seizures, especiallyafter the fourth hospital day, are predictors of acomplicated hospital course with serious sequelae. On

the other hand, seizures that occur during the first 3days of illness usually have little prognosticsignificance.

Approximately 6% of affected infants and children show

signs of disseminated intravascular coagulopathy andendotoxic shock. These signs are indicative of a poorprognosis.


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Nursing management:

Nursingdiagnosis

Goal Nursingintervention

Nursingimplementation

Evaluation

Hyperthermiarelated todisease

process.

Relieveof fever.

1-apply coldcompresses.

2- Closelymonitoring

for vital

signs.3- Givemedication as

prescribed.

1-apply coldcompresses.

2-Closelymonitoring for

vital signs.3-Give

medication asprescribed.

Control offever.


16/20

Nursing management cont:Nursingdiagnosis



Evaluation

Activity

intolerancerelated todisease

process.

1- improve rest

and comfort.2- Prevent anycomplications.

1- Teaching

the mothersome of finemassagetechnique.2- Prevent

positioninjury.3- Providerest toconserveenergy.

1- do fine

massage toimprovemuscles and

preventhypotonia.

2- closelymonitoring

forneurologicstatus to

prevent anycomplications.

No any

complicationhappened.


17/20

Nursing management cont:Nursingdiagnosis



Evaluation

Risk for fluid

volume deficitrelated to poorfeeding andfever

Improve

fluidvolume.

1-promoting

fluid andelectrolytesintake via i.vroot.

2- encouragebreast

feeding.

1-Administer

fluid asprescribed.2- monitoring forintake and outputto preventcomplications.

Maintain

adequatehydration.


18/20

Nursing management cont:

Nursingdiagnosis



Evaluation

Altered

nutrition lessthan bodyrequirementsrelated to lossof appetite and

poor feeding.

Improve

nutritionalstatus.

1-promoting

calorie intakevia i.v root.2- encouragebreast feeding

1- administer i.v

fluids asprescribed.2-encouragebreast feeding asthe childstolerate.

Maintain

adequatenutritionalstatus.


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1-Swartz MN. Bacterial meningitis--a view of the past 90 years. N Engl JMed. Oct 28 2004;351(18):1826-8.

2-Taylor HG, Mills EL, Ciampi A, et al. The sequelae of Haemophilusinfluenzae meningitis in school-age children. N Engl J Med. Dec

13 1990;323(24):1657-63.

3-Yogev R, Guzman-Cottrill J. Bacterial meningitis in children: criticalreview of current concepts. Drugs. 2005;65(8):1097-

4-Tauber MG, Moser B. Cytokines and chemokines in meningealinflammation: biology and clinical implications. Clin Infect

Dis. Jan 1999;28(1):1-11; quiz 12

5-Prasad K, Karlupia N. Prevention of bacterial meningitis: an overviewof Cochrane systematic reviews. Respir Med. Oct 2007;101(10):2037-43.


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Thank you

al-zaytoonah private university of jordan

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