KESTER GRANT COLLEGE, PHILIPPINES

BACTERIAL MENINGITIS
____________________________
A case presentation
Presented to:
Mr. Homer Lee, RN, MAN
_____________________________
In Partial Fulfillment
Of the Requirements for
Information on Nursing Management
_____________________________
Presented by:
Aquino, Sheila Mae B.
Austria, Tiffany M.
Cabigao, Marc Andrew G.
_____________________________
January 28, 2010

Introduction
Background
Meningitis is a clinical syndrome characterized by inflammation of the meninges.
Clinically, this medical condition manifests with meningeal symptoms (eg, headache,
nuchal rigidity, and photophobia) and an increased number of white blood cells in the
cerebrospinal fluid (CSF; pleocytosis). Depending on the duration of symptoms,
meningitis may be classified as acute or chronic. Acute meningitis denotes the evolution
of symptoms within hours to several days, while chronic meningitis has an onset and
duration of weeks to months. The duration of symptoms of chronic meningitis is
characteristically at least 4 weeks.
There are numerous infectious and noninfectious causes of meningitis. Examples
of common noninfectious causes include medications (eg, nonsteroidal anti-inflammatory
drugs, antibiotics) and carcinomatosis. The focus of this article is the infectious causes of
meningitis. Infectious agents that cause primarily encephalitis are not discussed in this
article.
Meningitis can also be classified according to its etiology. Acute bacterial
meningitis denotes a bacterial cause of this syndrome. This is usually characterized by an
acute onset of meningeal symptoms and neutrophilic pleocytosis. Depending on the
specific bacterial cause, the syndrome may be called, for example, Streptococcus
pneumoniae meningitis,
meningococcal
meningitis,
or Haemophilus
influenzae meningitis. Fungal and parasitic causes of meningitis are also termed
according
to
their
specific
etiologic
agent,
such
as
cryptococcal
meningitis,Histoplasma meningitis, and amebic meningoencephalitis.
Aseptic meningitis is a broad term that denotes a non-pyogenic cellular response,
which may be caused by many different etiologic agents. In many cases, a cause is not
apparent after initial evaluation. Patients characteristically have an acute onset of
meningeal symptoms, fever, and cerebrospinal pleocytosis that is usually prominently
lymphocytic. After an extensive workup, many of these cases are found to have a viral
etiology and can then be reclassified as acute viral meningitis (eg, enterovirus meningitis,
herpes simplex virus [HSV] meningitis). While viruses cause most cases of aseptic
meningitis, it can also be caused by bacterial, fungal, mycobacterial, and parasitic agents.

Anatomy and Physiology

As the most complex system, the nervous system serves as the body control center and
communications electrical-chemical wiring network. As a key homeostatic regulatory and
coordinating system, it detects, interprets, and responds to changes in internal and
external conditions. The nervous system integrates countless bits of information and
generates appropriate reactions by sending electrochemical impulses through nerves to
effector organs such as muscles and glands. The brain and spinal cord are the central
nervous system (CNS); the connecting nerve processes to effectors and receptors serve as
the peripheral nervous system (PNS). Special sense receptors provide for taste, smell,
sight, hearing, and balance. Nerves carry all messages exchanged between the CNS and
the rest of the body.

The neuron transmits electric signals like an electric wire. The perikaryon (cell body) is
the neuron central part. Dendrites, short branches, extend from the neuron. These input
channels receive information from other neurons or sensory cells (cells that receive
information from the environment). A long branch, the axon, extends from the neuron as
its output channel. The neuron sends messages along the axon to other neurons or directly
to muscles or glands.

Neurons must be linked to each other in order to transmit signals. The connection
between two neurons is a synapse. When a nerve impulse (electrical signal) travels across

a neuron to the synapse, it causes the release of neurotransmitters. These chemicals carry
the nerve signal across the synapse to another neuron.

Nerve impulses are propagated (transmitted) along the entire length of an axon in a
process called continuous conduction. To transmit nerve impulses faster, some axons are
partially coated with myelin sheaths. These sheaths are composed of cell membranes
from Schwann cells, a type of supporting cell outside the CNS. Nodes of Ranvier (short
intervals of exposed axon) occur between myelin sheaths. Impulses moving along
myelinated axons jump from node to node. This method of nerve impulse transmission is
saltatory conduction.
The brain has billions of neurons that receive, analyze, and store information about
internal and external conditions. It is also the source of conscious and unconscious
thoughts, moods, and emotions. Four major brain divisions govern its main functions: the
cerebrum, the diencephalon, the cerebellum, and the brain stem.
The cerebrum is the large rounded area that divides into left and right hemispheres
(halves) at a fissure (deep groove). The hemispheres communicate with each other
through the corpus callosum (bundle of fibers between the hemispheres). Surprisingly,
each hemisphere controls muscles and glands on the opposite side of the body.
Comprising 85 percent of total brain weight, the cerebrum controls language, conscious
thought, hearing, somatosensory functions (sense of touch), memory, personality
development, and vision.

Gray matter (unmyelinated nerve cell bodies) composes the cerebral cortex (outer portion
of the cerebrum). Beneath the cortex lies the white matter (myelinated axons). During

embryonic development, the cortex folds upon itself to form gyri (folds) and sulci
(shallow grooves) so that more gray matter can reside within the skull cavity.
The diencephalon forms the central part of the brain. It consists of three bilaterally
symmetrical structures: the hypothalamus, thalamus, and epithalamus. The hypothalamus
'master switchboard' resides in the brain stem upper end. It controls many body activities
that affect homeostasis (maintenance of a stable internal environment in the body).
The hypothalamus is the main neural control center (brain part that controls endocrine
glands). The pituitary gland lies just below the hypothalamus. The pituitary gland is a
small endocrine gland that secretes a variety of hormones (organic chemicals that
regulate the body's physiological processes). When the hypothalamus detects certain
body changes, it releases regulating factors (chemicals that stimulate or inhibit the
pituitary gland). The pituitary gland then releases or blocks various hormones. Because of
this close association between the nervous and endocrine systems, together they are
called the neuroendocrine system.

The hypothalamus also regulates visceral (organ-related) activities, food and fluid intake,
sleep and wake patterns, sex drive, emotional states, and production of antidiuretic
hormone (ADH) and oxytocin. The pituitary gland produces both these hormones.
The thalamus is a relay and preprocessing station for the many nerve impulses that pass
through it. Impulses carrying similar messages are grouped in the thalamus, then relayed
to the appropriate brain areas.
The epithalamus is the most dorsal (posterior) portion of the diencephalon. It contains a
vascular network involved in cerebrospinal fluid production. Extending from the
epithalamus posteriorly is the pineal body, or pineal gland. Its function is not yet fully
understood; it is thought to control body rhythms.
At the rear of the brain is the cerebellum. The cerebellum is similar to the cerebrum: each
has hemispheres that control the opposite side of the body and are covered by gray matter
and surface folds. In the cerebellum, the folds are called folia; in the cerebrum, sulci. The
vermis (central constricted area) connects the hemispheres. The cerebellum controls
balance, posture, and coordination.

The brain stem connects the cerebrum and cerebellum to the spinal cord. Its superior
portion, the midbrain, is the center for visual and auditory reflexes; examples of these
include blinking and adjusting the ear to sound volume. The middle section, the pons,
bridges the cerebellum hemispheres and higher brain centers with the spinal cord. Below
the pons lies the medulla oblongata; it contains the control centers for swallowing,
breathing, digestion, and heartbeat.

The reticular formation extends throughout the midbrain. This network of nerves has
widespread connections in the brain and is essential for consciousness, awareness, and
sleep. It also filters sensory input, which allows a person to ignore repetitive noises such
as traffic, yet awaken instantly to a baby's cry.
The spinal cord is a continuation of the brain stem. It is long, cylindrical, and passes
through a tunnel in the vertebrae called the vertebral canal. The spinal cord has many
spinal segments, which are spinal cord regions from which pairs (one per segment) of
spinal nerves arise. Like the cerebrum and cerebellum, the spinal cord has gray and white
matter, although here the white matter is on the outside. The spinal cord carries messages
between the CNS and the rest of the body, and mediates numerous spinal reflexes such as
the knee-jerk reflex.
Meninges, three connective tissue layers, protect the brain and spinal cord. The outermost
dura layer forms partitions in the skull that prevents excessive brain movement. The
arachnoid middle layer forms a loose covering beneath the dura. The innermost pia layer
clings to the brain and spinal cord; it contains many tiny blood vessels that supply these
organs.
Another protective substance, cerebrospinal fluid, surrounds the brain and spinal cord.
The brain floats within the cerebrospinal fluid, which prevents against crushing under its
own weight and cushions against shocks from walking, jumping, and running.
PNS: somatic (voluntary) nervous system, autonomic (involuntary) nervous system
The peripheral nervous system includes sensory receptors, sensory neurons, and motor
neurons. Sensory receptors are activated by a stimulus (change in the internal or external
environment). The stimulus is converted to an electronic signal and transmitted to a
sensory neuron. Sensory neurons connect sensory receptors to the CNS. The CNS

processes the signal, and transmits a message back to an effector organ (an organ that
responds to a nerve impulse from the CNS) through a motor neuron.
The PNS has two parts: the somatic nervous system and the autonomic nervous system.
The somatic nervous system, or voluntary nervous system, enables humans to react
consciously to environmental changes. It includes 31 pairs of spinal nerves and 12 pairs
of cranial nerves. This system controls movements of skeletal (voluntary) muscles.
Thirty-one pairs of spinal nerves emerge from various segments of the spinal cord. Each
spinal nerve has a dorsal root and a ventral root. The dorsal root contains afferent
(sensory) fibers that transmit information to the spinal cord from the sensory receptors.
The ventral root contains efferent (motor) fibers that carry messages from the spinal cord
to the effectors. Cell bodies of the efferent fibers reside in the spinal cord gray matter.
These roots become nerves that innervate (transmit nerve impulses to) muscles and
organs throughout the body.

Twelve pairs of cranial nerves transmit from special sensory receptors information on the
senses of balance, smell, sight, taste, and hearing. Cranial nerves also carry information
from general sensory receptors in the body, mostly from the head region. This
information is processed in the CNS; the resulting orders travel back through the cranial
nerves to the skeletal muscles that control movements in the face and throat, such as for
smiling and swallowing. In addition, some cranial nerves contain somatic and autonomic
motor fibers.
The involuntary nervous system (autonomic nervous system) maintains homeostasis. As
its name implies, this system works automatically and without voluntary input. Its parts
include receptors within viscera (internal organs), the afferent nerves that relay the
information to the CNS, and the efferent nerves that relay the action back to the effectors.
The effectors in this system are smooth muscle, cardiac muscle and glands, all structures
that function without conscious control. An example of autonomic control is movement
of food through the digestive tract during sleep.
The efferent portion of the autonomic system is divided into sympathetic and
parasympathetic systems. The sympathetic nerves mobilize energy for the 'Fight or Flight'
reaction during stress, causing increased blood pressure, breathing rate, and bloodflow to
muscles. Conversely, the parasympathetic nerves have a calming effect; they slow the
heartbeat and breathing rate, and promote digestion and elimination. This example of

intimate interaction with the endocrine system is one of many that explain why the two
systems are called the neuroendocrine system.
The relationship between sensory and motor neurons can be seen in a reflex (rapid motor
response to a stimulus). Reflexes are quick because they involve few neurons. Reflexes
are either somatic (resulting in contraction of skeletal muscle) or autonomic (activation of
smooth and cardiac muscle). All reflex arcs have five basic elements: a receptor, sensory
neuron, integration center (CNS), motor neuron, and effector.
Spinal reflexes are somatic reflexes mediated by the spinal cord. These can involve
higher brain centers. In a spinal reflex, the message is simultaneously sent to the spinal
cord and brain. The reflex triggers the response without waiting for brain analysis. If a
finger touches something hot, the finger jerks away from the danger. The burning
sensation becomes an impulse in the sensory neurons. These neurons synapse in the
spinal cord with motor neurons that cause the burned finger to pull away. This spinal
reflex is a flexor, or withdrawal reflex.
The stretch reflex occurs when a muscle or its tendon is struck. The jolt causes the muscle
to contract and inhibits antagonist muscle contraction. A familiar example is the patellar
reflex, or knee-jerk reflex, that occurs when the patellar tendon is struck. The impulse
travels via afferent neurons to the spinal cord where the message is interpreted. Two
messages are sent back, one causing the quadriceps muscles to contract and the other
inhibiting the antagonist hamstring muscles from contracting. The contraction of the
quadriceps and inhibition of hamstrings cause the lower leg to kick, or knee-jerk.
Sense organs
The sense organs are highly specialized structures that receive information from the
environment. These organs contain special sense receptors ranging from complex
structures, such as eyes and ears, to small localized clusters of receptors, such as taste
buds and olfactory epithelium (receptors for smell).
Smell and taste are chemical senses, which contain chemoreceptors that respond to
chemicals in solution. Food chemicals dissolved in saliva stimulate taste receptors in taste
buds. The nasal membranes produce fluids that dissolve chemicals in air. These
chemicals stimulate smell receptors in olfactory epithelium. The chemical senses
complement each other and respond to many of the same stimuli.
Photoreceptors, which include rods and cones, in back of the eye respond to light energy.
Rods provide dim-light, black-and-white vision, and are the source of peripheral vision.
Cones operate in bright light and provide color vision. Cones are most concentrated at the
back center of each eye. Rods are more numerous than cones, and surround the cones.
Information from the rods and cones travels via the optic nerve into the brain for
interpretation.

The ear has two specialized functions: sound wave detection and interpretation of the
head position in space. Sound waves enter the outer ear through the external auditory
canal (ear canal) and strike the tympanic membrane (eardrum). Vibration of the eardrum
moves three ossicles (small bones) inside the middle ear, which in turn stimulate the
organ of Corti (hearing receptor in the inner ear). Impulses travel from the organ of Corti
through the vestibulocochlear nerve to be interpreted by the brain.
The ear also contains equilibrium (sense of balance) receptors. The vestibular apparatus,
a group of equilibrium receptors in the inner ear, sense movement in space. Maculae
receptors in the vestibule monitor static equilibrium (head position with respect to gravity
when the body is still). Cristae receptors in the semicircular canals monitor dynamic
equilibrium (movement). Impulses from the vestibular apparatus travel along the
vestibulocochlear nerve to appropriate brain areas. These centers start responses that fix
the eyes on objects and stimulate muscles to maintain balance.
Mechanoreceptors respond to mechanical energy forces: touch, pressure, stretching, and
movement. Ranging in complexity from free nerve endings beneath the skin to more
complex tactile receptors at the bases of hair, mechanoreceptors change shape when
pushed or pulled.
Different types of skin receptors sense different environmental stimuli. Free nerve
endings sense pain. Specialized receptors such as Merkel's discs and Meissner's
corpuscles sense touch. Pacinian corpuscles sense deep pressure. Naked nerve endings
are thought to be responsible for sensing temperature.
Other types of sensory receptors provide the brain information on the body.
Interoreceptors in body organs inform the CNS about internal conditions such as hunger
and pain. Proprioceptors in joints, tendons, and muscles detect changes in position of
skeletal muscles and bones. This information allows humans to be aware the positions of
their trunk and limbs without having to see them.
Definition
Meningitis (men-in-JIE-tis) is an inflammation of brain and spinal cord meninges
by bacteria, virus, or fingi. Bacterial meningitis is also known as meningococcal
meningitis. Aseptic meningtis is a form of meningitis in which there is no organism
growth on culture, making the causative agent viral, protozoan, oor fungal. This is usually
self-limiting and not contagious.
Etiology
Bacterial meningitis is caused by bacteria and is rare, but is usually serious and
can be life-threatening if it's not treated right away.
Common agents are:
Group B streptococcus

Escherichia coli
Listeria monocytogenes
Streptococcus pneumoniae (pneumococcus)
Neisseria meningitidis (meningococcus)
Haemophilus influenza type b (Hib)

Viral meningitis is caused by viruses.

Common agents are:

Coxsackievirus

Poliovirus

Hepatitis A

Herpesvirus
Epidemiology
Although meningitis is a notifiable disease in many countries, the exact incidence
rate is unknown. Bacterial meningitis occurs in about 3 people per 100,000 annually in
western world. Population-wide studies have shown that viral meningitis is more
common, at 10.9 per 100,000, and occurs more often in the summer. In Brazil, the rate of
bacterial meningitis is higher, at 45.8 per 100,000 annually. In Sub-saharan Africa, large
epidemics of meningococcal meningitis occur in the dry season, leading to it being
labeled the "meningitis belt"; annual rates of 500 cases per 100,000 are encountered in
this area, which is poorly served by Health Care. These cases are predominantly caused
by meningococci. The most recent epidemic, affecting Nigeria, Niger, Mali,BurkinaFaso, West African meningitis outbreak.and is ongoing.
Meningococcal disease occurs in epidemics in areas where many people live
together for the first time, such as army barracks during mobilization, college campuse
and.
There are significant differences in the local distribution of causes for bacterial
meningitis. For instance, N. meningitides groups B and C cause most disease episodes in
Europe, while group A meningococci are more common in China and amongst Hajj
pilgrims. In the "meningitis belt" of Africa, group A and C meningococci cause most of
the outbreaks. Group W135 meningococci have caused several recent epidemics in Africa
and during the Hajj. These differences are expected to change further as vaccines against
common strains are introduced.

Transmission
Meningitis is spread by direct contact with a carriers secretions, especially by
respiratory droplets. People may be carriers only, without having he actual disease.
High-risk groups
1. Anyone who lives in close contact with many people.
2. Anyone who has frequent upper respiratory infections.
3. Anyone who has had trauma or an invasive procedure involving the brain,
spinal cord, or sinuses.
Signs & Symptoms
1. Signs of infection
a. Fever
b. Chills and malaise
2.
Signs of increased intracranial pressure
a. Headache
b. Vomiting
3.
Signs of meningeal irritation
a. Nuchal rigidity (stiff neck)
b. Opisthotonos (backward arching of the body in muscle spasms)
c. Photophobia (sensitivity to light)
d. Diplopia (double vision)
e. Delirium, stupor, coma: indicates a decreasing level of consciousness, an
agitated state followed by a progressive decrease in consciousness, and
ultimately a lack of any response.
f. (+) Brudzinskis sign (involuntary flexion of the knees caused by flexing
the neck)
g. (+) Kernigs sign (strong resistance to attempts to extend the knee from the
flexed thigh position)
4. Children may exhibit any of the signs and symptoms listed above, as well as
these signs:
a. Bulging fontanelle
b. Twitching, seizures, and coma

Treatment

Bed rest
I.V. fluid administration
Oxygen therapy

Medications for:
-Bacterial infection
-Muscle aches
-Seizures
-Fever
-Pressure on the brain

Anticonvulsant (prevent seizures ): Phenytoin (Dilantin),

Phenobarbital (Barbita, Luminal, Solfoton)
Analgesic or antipyretic (to treat fever and muscle aches ): acetaminophen
(Tylenol or Panadol), nonsteroidal anti-inflammatory drugs (NSAIDs) Aspirin
ibuprofen, ketoprofen, and naproxen
(reduce pressure within the brain): Dexamethasone (corticosteroid medicine),
Mannitol (Osmitrol)
Antibiotics - depend on the isolated microorganism

Prevention

(MMR) vaccine (measles, mumps, and rubella )

Haemophilus vaccine (HiB vaccine))
meningococcal vaccine (MCV4)
pneumococcal conjugate vaccine
Good personal hygiene
Avoiding people who have meningitis.

Laboratory and Diagnostic Exam

Meningitis is diagnosed by analysis of the spinal fluid. Spinal fluid is obtained by a
procedure called the lumbar puncture or spinal tap in which a needle is introduced into
the space between vertebraeL-3 and L-4, because the spinal cord ends at L-2. Spinal fluis
is withdrawn from the subarachnoid space.
Cerebrospinal Fluid Analysis
TEST
Pressure
Color
Cells
Protein
Glucose

NORMAL
<200mm H20
Clear
RBC: None
WBC: Very few
15-75 mg/dL
50-75mg/dL or >50% of

ABNORMAL FINDINGS
Increased
Cloudy/Milky white
Positive neutrophils
Elevated
Decreased

blood glucose
* A CBC will indicate acute infection. Bacterial antigen testing may also be done.
*A Grams stain will determine the presence of bacteria. A full culture should be done
with sensitivity.
* Radiography: skull and spine x-rays used to identify sinus infections, fracture, or
osteomyellitis; chest x-rays may be used to identify respiratory infections, abscesses,
lesions, or granulomas.
*CT scan: will usually be normal in uncomplicated cases of meningitis, but can show
diffuse enhancement in some types or show hydrocephalus.
*Electroencephalogram: may be performed to show slow wave activity.

Pathophysiology

BACTERIA

Invasion of the nasopharynx

Enters the bloodstream &

Crosses the blood-brain barrier

Proliferates the CSF

Inflammation of the
subarachnoid & pia mater

Increased ICP

Theoretical Framework

Pure or
Fresh water

Light

Pure water

Wellness
Or
Disease

Efficient
Drainage

Cleanliness
Nightingales Environmental Theory
Florence Nightingale defined nursing as the act of utilizing the environment of the
patient to assist him in his recovery. Based on her theory the five environmental factors:
pure or fresh air, pure water, efficient drainage, cleanliness and light affect clients illness
or health. Any deficiencies in these five factors produced lack of health or illness.

CASE STUDY
Biographic Data

Patient: C.A.M (Second Child)

Sex: Male Age: 9 months (July)

Address: Sitio Taguisan Bagong Nayon, Antipolo City

Weight 8.6kg

Birth Day: October 24, 2008

Mother: Marites A. Magbanua

Age: 33years old

Occupation: Housewife

Birth Date: February 14 1976

Father: Henry V. Magbanua (Security Guard)

Age: 36 years old

Occupation: Security Guard

Birth Date: August 16 1973

Religion: Catholic

Socio-Economic History

Place and nature of dwelling: Own House, Slight crowded area, Good Ventilation.

Source of Water: Nawasa, Mineral

Type of lightning: Electricity, Florescent

Number of persons living in the house: 4

Member of the Family who work: 1 (Father)

Financial Status: 5,000.00/month

Admission

Confined Date: June 23, 2009

Time: 11:20am

Verbalized by the Mother: Fever, Convulsion

Behavior: Irritable

Medication Given By the Mother: Paracetamol

June 19 2009, Patient is febrile and lasted for four days; by June 23, 2009 @ 10pm
patient was confined due to Convulsion at NCH.

Physical Examination

General Appearance and Condition: Asleep, not in Distress

Temperature: 38.30C

Pulse Rate: 128bpm

Weight: 8.6kgs

Height: 69cm

Head Circumference: 94cm

Chest Circumference: 46cm

Abdominal circumference: 45cm

Blood Pressure: 100/60 mmHg

Flushed and Warm Skin

HEENT: slightly pinkish, palpebral conjuctiva

Thorax and Spine: No deformity in Lungs

Nervous System

Cerebrum: awake

Cerebellum: No nystagmusNA

2-3mm ERTC when awake, pinpoint when asleep

III,IV,VI- (+) bicomeal reflex

VII- no facial assemtry

IX- (+) gag reflex

XI- midline tongue

Motor: cannot move all

Sensory: withdrawal and pain

Meningeal Signs:
Nuchal ridigity (+)
Kernigs Sign (+)
Brudzinskis sign (+)

Past and Present Illness

Otitis Media @ 6months

Fever for 4 days PTA

Cough & cold

Diarrhea

Immunization
Vaccine

BCG

DPT

OPV

MEASLES

HEPA B

MMR

Developmental Milestones

AGE

DEVELOPMENTAL MILESTONE

NORMAL

2 months

Social smile

2months

5 months

Moro reflex disappears

5-6months

6months

Sits with support

6 months

8months

Sits without support

8months

9months

Creeps or crawl

9months

Nutritional-Metabolic Pattern
Soft Diet:

Bottle Feed: 4ounce

Rice Porridge

Biscuit

Water

Systems Review
A review of all health problems of body systems:
General: Fever
EENT: Eye redness, ear discharge
Skin: Warm and flushed
Respiratory: Cough & cold
GIT: diarrhea
GUT: dysuria
Laboratory and Diagnostic Exams

CT Scan

no lesion intact
Ventricles normal
Midline structure undisplaced
Sella/pineal gland/posterior fossa unremarkable
Anterior fontanelle infused

IMPRESSION:
Meningitis with subdural empyema as described
Cerebrospinal Fluid Analysis
TEST
Pressure
Color
Cells
Protein
Glucose

NORMAL
<200mm H20
Clear
RBC: None
WBC: Very few
15-75 mg/dL
50-75mg/dL or >50% of

ABNORMAL FINDINGS
220 mm H20
Cloudy
Positive neutrophils
84mg/dL
30mg/dL

blood glucose
Gram Staining
Showed that it is positive for the microorganism Streptococcus pnuemoniae, a
gram-positive coccus that appear in pairs.
Pharmacologic Intervention

Drug
Chloramphenicol

Action
Antibiotic

Drug
Diazepam 2.5 mg
IV

Drug
Metronidazole

Side effects
CNS: dizziness,
drowsiness,
lethargy,
depression, light
headedness,
disorientation,
anger, manic or
hypomanic
episodes,
restlessness,

Action
Produces
anxiolytic
effect and
CNS
depression
Controls
seizures by
enhancing
presynaptic
inhibition.

Action
Antiinfectives,
antiprotozoa

Side effects
CNS: confusion,
delirium,
depression,
headache,
peripheral
neuropathy

Side effects
Seizures, dizziness,
headache

Indication

Contraindications

Serious infection
when less
potentially
dangerous drugs are
ineffective or
contraindicated
Children: 50 to 100
mg/kg/day I.V. in
divided dose q 6
hrs.

Hypersensitivity to
drug, Severe renal or
hepatic impairment,

Indication
anxiety; Children
age 6 months &
older- 1 to 2.5 mg
P.O three to four
times daily;

Prophylaxis for
bacterial

Contraindications
Hypersensitivity to
drug, other
benzodiazepines,
alcohol or
tartazine,Coma or
CNS depression,
Narrow-angle
glaucoma

Indication
Contraindications
Treatment of the
Hypersensitivity
following anaerobic
infections:intra-

ls, antiulcer
agents

Drug
Penicillin G

Action
Bactericidal
action
against
susceptible
bacteria

abdominal
infections,CNS
infection,
septicemia,
Endocarditis

Side effects
seizures

Indication
Contraindications
Treatment of a wide Previous
variety of infections hypersensitivity to
penicillins, procaine
or benzathine

Nursing Diagnosis
Hyperthermia related to positive bacterial infection as manifested by flushed and
warm to touch skin.
Acute pain related to meningeal irritation with spasm of extensor muscles (neck,
shoulders and back) as manifested by positive kernigs and brudzinskis sign.
Risk for ineffective cerebral tissue perfusion related to increased intracranial
pressure
Risk for infection related to presence of infective organisms
Risk for injury related to presence of infection
Altered thermoregulation related to compression of hypothalamus
Altered family processes related to having a child with a serious illness
Nursing Management
Monitor vital signs constantly. Determine oxygenation from arterial blood gas
values and pulse oximetry
Give oxygen to maintain arterial partial pressure of oxygen
Reduce high fever to decrease load on heart and brain from oxygen demands
Rapid intravenous fluid replacement may be prescribed, but take care not to
overhydrate patient because of risk of cerebral edema
Assess clinical status continuously; evaluate skin and oral hygiene; promote
comfort; and protect patient during seizures

 Implement infection control precautions and respiratory isolation until 24 hours

after start of antibiotic therapy
Inform family about patients condition

Nursing Care Plan

CUES

NURSING
DIAGNOSIS

GOAL

Subjective:

Hyperthermia
related to
positive
bacterial
infection as
manifested by
flushed and
warm to touch
skin.

Short term:

Mataas pa
din ang lagnat
niya
hanggang
ngayon as
verbalized by
the patients
mother.

Within 1 hour of
nursing
intervention, the
patients elevated
temperature of
38.2oC will lessen
to 37.4oC.
Long term:

NURSING
INTERVENTIO
N
Establish rapport
to mother to gain
trust and
cooperation
Promote surface
cooling by means
of undressing
( heat loss by
radiation and
conduction)

Objective:
-flushed skin
-warm to
touch skin
-T.38.2oC
-PR 109
-RR 34
-BP 90/60

Within 3
consecutive days
of nursing
intervention, the
patients body
temperature will
return to its
normal range.

Demonstrate on
ways on how to
do proper Tepid
Sponge Bath
using wet and dry
cloth
Provide nutritious
diet to meet
increased
metabolic
demands
Administer
antipyretics as
ordered

EVALUATION

After 1 hour of
nursing
intervention, the
goal is partially
achieved as
manifested by
temperature of
37.7oC.

CUES

Subjective:

NURSING
DIAGNOSIS

Acute pain
related to
Umiiyak yan meningeal
kapag
irritation with
nagagalaw
spasm of
yung batok
extensor
niya tska nung muscles (neck,
may ginawa si shoulders and
doctor sa
back) as
kanya
manifested by
positive
Objective:
kernigs and
- facial
brudzinskis
grimace
sign.
- irritable
-(+)
Brudzinskis
sign
-(+)
Kernigs sign

GOAL

NURSING
INTERVENTIO
N

EVALUATION

Short term:

Use pain rating

scale appropriate
to its age

After 2 hours of
nursing
intervention,
there is no sign
of facial grimace
and irritability
from the patient.

Within 2 hours of
nursing
intervention, the
patients pain
from 8 will
reduce to 4 using
the facial pain
rating scale.

Assess for
neurologic status
and vital signs
Position on the
side with head
gently supported
in extension
Promote rest by
keeping
stimulation in the
room to a
minimum
Institute
respiratory
isolation
Monitor and
record carefully
intake and output
Administer
mediation as
ordered

CUES

NURSING
DIAGNOSIS

GOAL

Objective:
- lethargic
- change in
motor
responses
- changes in
papillary
reaction

Risk for
ineffective
cerebral tissue
perfusion
related to
increased
intracranial
pressure

Within an hour of
nursing
intervention, the
nurse will be able
to educate the
patients mother
about the causes
and symptoms of
ineffective
cerebral tissue
perfusion.

NURSING
INTERVENTIO
N
Educate patients
mother about the
causes of
ineffective
cerebral tissue
perfusion.
Observe carefully
for signs of
increased
intracranial
pressure such as;
lethargy, shrill
cry, hyperactive
reflexes,
decreased pulse
and respiratory
rate, increased
blood pressure
and temperature
Carefully monitor
the rate of all IV
infusions to
prevent
overhydration
Check for the
urines specific
gravity to detect
oversecretion or
undersecretion of
ADH due to
pituitary pressure
Measure head
circumference
and weight

EVALUATION

After an hour of
nursing
intervention, the
patients mother
is educated about
the causes and
symptoms of
ineffective
cerebral tissue
perfusion.

Monitor vital
signs

Discharge Planning
Medicines:
-take your (antibiotics) medications as prescribed by physician.
-do not quit taking your (antibiotics) meds until your physician say so
Wellness:
-eat a variety of healthy foods such as fruits and vegetables
-drink more liquid like water, juices and milk
-avoid stress by providing calm and clean environment, stress causes slow healing.
Health teaching:
-teach patients mother how to perform oral care and its benefits
Check-up:
-teach patients mother to have a regular check-up in the health center or in the nearest
hospital.