A

CASE
PRESENTATION
ON
MENINGITIS
 INTRODUCTION

As part of my child health nursing clinical posted on BMIMS hospital. There I took the case of
Mr. Munna Kumar of 6 yrs old admitted in BMIMS hospital with chief complaints of headache,
fever and vomiting since 5 days.

After doing all the investigation Dr. Vivek Mishra diagnosed it as meningitis. I took this case for
my case presentation under the supervision of Mr. Suresh Sankar Sataguni sir.
 IDENTIFICATION DATA

Name – Mr. Munna Kumar

Age – 6 yr

Sex – male

Registration no. 12022006568

Ward – Pediatric Ward

Address – Vill – Ghoshravaan, Thana – Giriyak, Nalanda

Religion – Hindu

Parent Education – 12th Pass

Parent Occupation – Business

Family Income – 15000/- Month

Date Of Admission – 20/07/22

Medical Diagnosis – Meningitis

Surgical Diagnosis – Nil ( No Significant Surgical Diagnosis)

Height – 112 Cm

Weight – 18.5 Kg

Developmental Stage – School Going

 HISTORY OF ILLNESS

History Of Present Illness

Mr. Munna Kumar of 6 yrs old child is admitted in BMIMS hospital with chief complaints of
headache , fever , vomiting, irritability since 5 days.

History Of Past Illness

Mr. Munna Kumar had headache, fever 1 month back

Past Surgical History

There is nothing significant regarding past surgical history

Present Surgical History

There is nothing significant regarding present surgical history.

 CHILD PERSONAL DATA

Obstetric History Of Mother

The child was born on 12th june 2016. The delivery was normal vaginal delivery. The child was
born full term after completion of 38 weeks the weight after birth was 2.890 kg. there was no
complication during baby birth.

Prenatal History

The mother had regular ANC check up and she took all vaccine like TT and take iron and
calcium supplement during pregnancy.

Natal History

The child was born by normal delivery wt. 2.890 kg and apgar score is 9
 ANTHROPOMETRIC ASSESSMENT

Height – 112 cm

Weight – 18.5 kg

Head circumference – 55 cm

Chest circumference – 53 cm

Mid arm circumference – 18 cm

Immunization Status

S.No. Age Vaccine Dose Given

1. At birth BCG+OPV+HepB Given
2. At 6 weeks OPV1+IPV1+Penta1+Rota1 Given
3. At 10 weeks OPV2+Penta2+Rota2 Given
4. At 14 weeks OPV3+Penta3+Rota3+IPV2 Given
5. 9 months Measles +Vit A Given
6. 16-24 months DPT+MMB+OPV Given
7. At 5 Yr DPT2 Given
 FAMILY HISTORY

Mr. Kameshwar Ray(29 yrs) Mrs. Rinku Devi (27 yrs)

Mr. Munna Kumar(6 yrs) Mr. Tunna Kumar (3yr)

List Of Family Members

S.No. Name Relation Age / Education Occupation Health

With Sex Status
Patient
1. Mr. Kameshwar Father 29 yr/ M 12TH Business Healthy
Ray PASS
2. Mrs. Rinku Devi Mother 27 yr/ F 10TH Housewife Healthy
PASS
3. Mr. Munna Self 6yr/ M NIL - Unhealthy
Kumar
4. Mr. Tunna Brother 3yr/ M NIL - Healthy
Kumar

Congenital problem – no significant history of congenital illness in his family

Psychological problem – no any risk factor among family regarding psychological problem.
Dietary Pattern

Breakfast – one cup milk , 5 biscuits, roti – 2

Lunch – chapatti – 2,vegetable – 1 bowl, dal – ½ bowl + rice

Snacks – biscuit – 5 to 6

Dinner – chapatti – 2, vegetable – ½ bowl, milk 1 cup

Play Habits

Child like to play with peer group children , child like to play with household article, child play
with ball and ride tricycle

Toilet training – normal

Sleep pattern – 8 to 10 hrs in 24 hrs

Schooling – child is going to 1st standard in primary school

Economic status – Family economic status is good and his family belong to middle class (APL) .
Family monthly income is 15000/-

Reflexes

Blinking – present

Sneeze – present

Glabellar – present

Papillary – present

Gag – present

Cough – present
 DEVELOPMENTAL MILESTONE

Book Picture Child Picture

Physical development
Temp - 37°C Temp – 37.9 °C
Height – 105- 115 cm Pulse – 90 b/m
Weight – age X 2 + 8kg Height 112 cm
Dentition – 20 teeth Weight – 18.5 kg
Pulse – 30-100 b/m Dentition – 20 teeth

Motor development –
Gross motor development –
Present
 Walk backwards head to toe
Present
 Throw and catch ball well
Fine motor
Present
 Tie shoe laces

Cognitive development
Present
Accurately describe events
Present
Classify objects according to relationship that
are similar

Language development Present

Use sentences with 4 to 6 words with all parts
of speech

Psychosocial development Present

 Play is associative Present
 Tries to follow rules but may cheat to
avoid losing
 PHYSICAL EXAMINATION

General Appearance

Nourishment – malnourished

Body build – thin

Health – unhealthy

Activity – dull

Mental Status

Consciousness – conscious

Look – dull

Posture

Body curve – normal

Movement – active

Height – 112cm

Weight – 18.5 kg
Skin Condition

Colour – fair

Texture – dry

Temp – warm (37.9°C)

Lesion – no lesion

Neck

Lymph node – not enlarged {range of motion restricted}

Thyroid gland – not enlarged

Chest

Thorax – shape is normal

Breath and sound – no wheezing sound

Heart – normal

Abdomen

Inspection – normal expansion and compression

Palpation – no organomegaly

Percussion- no collection of gas or fluid

Auscultation – normal bowel sound

Head And Face

Scalp – clean

Face – symmetrical

Eyes

Eyebrows – normal

Eye lashes – present and no infection

Eye lids – no edema

Conjunctiva – no infection

Cornea – no abrasion

Pupil – reaction to light

Ears

External ear – no discharge

Tympanic membrane – no perforation

Hearing – normal

Nose

External nose – no crust are seen

Nostrils – not deviation in septum

Extranities

 Normal range of motion

 No any congenital abnormalities
 No any lesion

Back

 No ladosis
 No kyposis
 No scoliosis

Genital and rectum

Discharge – no discharge

Catheterization – no catheterization

Reflexes

Blinking – present

Papillary reaction – present

Sneeze – present

Glabellar – present

Gag – present

Cough – present
 INVESTIGATION

Investigation Patient value Normal value

Hemoglobin 10.5 g/dl 12-16 g/dl
SGHPT 323 M/L 5-45 M/L
Alkaline phosphate 256.6 M/L 0.0-270 M/L
Total bilurubin 10.6 mg/dl 0.40-1.2 mg/dl
Direct bilurubin 6.76 mg/dl 0.0-0.40 mg/dl
WBC 17 X 103 / L (4-11) X 103 / L
CRP 12 mg/dl 26 mg/dl

CSF – low sugar and high WBC count

 DISEASE CONDITION

Definition – meningitis is defined as inflammation of the maninges covering brain and spinal
cord

Classification – depending upon etiological agents

1) Bacterial or pyogenic meningitis – caused by bacteria like – haemophilus influenza,

maningococus
2) Aseptic meningitis – caused by virus , fungi or protozoa. It is relatively common and less
serious . its symptoms are similar to flu
3) Tubercular meningitis – caused by mycobacterium tuberculosis .
PATHOPHYSIOLOGY
 CLINICAL MANIFESTATION

Book Picture Patient Picture

Poor feeding Present
Vomiting Present
Diarrhea Absent
Lethargy Present
Weak cry Present
Sleepiness Present
Fever Present
Irritability Present
High pitch cry Present
Sneeze Present
Seizures Absent
Bulging yontonal Present
Nuchal rigidity Present
 DIAGNOSTIC EVALUATION

Book Picture Patient Picture

H/T Done
P/E Done
Lumbar puncture Done
CSF Examination Done
Blood examination Done
CT / MRI Done
MEDICAL MANAGEMENT

 Commonly used antibiotics

 Penicillin
 Vancomycin
 Cefotaxim & amino – glycosides
 Manitol 0.5 mg/kg
 Frusemide 1mg/kg

NURSING MANAGEMENT

 Isolate the child

 Administration of drugs
 Provide comfort and rest
 Monitor the child condition
 Parental guidance and support
 Maintain fluid input and output and nutrition
 Control seizure and protect the child from injury

SURGICAL MANAGEMENT

 No any surgical management

s.no. Drug name Dose Frequency Action Side effect Nurse responsibility

1. Inj – rabebra tole 10 mg OD PPI Nausea , vomiting Monitor any side effects of medication

2. Inj. PCM 10 ml BD Antipyretics Dizziness, dry Check for adverse rection

mouth , nausea

3. Inj. Cefotaxime 500 mg BD Antibiotics Allerghic Check for contradiction

reaction, nausea

4. Inj . DNS 250 ml TLD Rehydration and chills Check for 5 rights of drugs
maintain blood
glucose level

5. Tab. ondam 2mg SOS antiemetic Constipation, Assess for allergy

fatigue

MEDICATION CHART
 NURSING DIAGNOSIS

S.No Problem Assessed Nursing Diagnosis

1. Ineffective tissue perfusion Ineffective tissue perfusion r/t cerebral edema as

(cerebral) evidenced by drowsiness.

2. Hyperthermia Hyperthermia r/t infection as evidenced by body

temperature above normal range.

3. Acute pain Acute pain related to meningial irritation as

evidenced by headache

4. Fluid volume deficit Fluid volume deficit r/t vomiting evidenced by three
episodes of vomiting

5. Risk for injury Risk for injury related to altereal neurodogico

regulatory function
Assessment NSG diagnosis Goal NSG intervention Rationale Evaluation
Subjective data Ineffective tissue Child will have  Monitor vital  Monitor vital After providing all
Parents of child say perfusion r/t to normal motor and and neurological signs and the care , child have
that my child has cerebral edema as cognitive and status neurological normal cognitive
headache and evidenced by sensory function  Assess for status and sensory
drowsiness drowsiness and decrease the nocheal  Assessed for function and
drowsiness rigidity , nocheal drowsiness
Objective data twitching and rigidity ,
By observation increased twitching and
patient has restlessness increased
drowsiness and he is  Monitor ABG restlessness
not alert and oxygen  Monitored ABG
saturation and oxygen
 Maintain head saturation
or neck in  Maintained head
middle position or neck in
providing pillow middle position
providing small
pillow
Assessment NSG diagnosis Goal NSG intervention Rationale Evaluation

Subjective data Hypothermia r/t Child will regain  Monitor vital  To know After providing all
Parents of child say inflammation as and maintain signs baseline data the care , child
that my child has evidenced by body normal body  Provide sponge  Reduce body regain and maintain
fever temperature above temperature bath and do not temperature normal body
the normal range use alcohol or  These decrease temperature 37 °C
Objective data alcohol warmth and
By observation of containing increase body
body temperature of substance cooling
child by  Remove all the  To promote
thermometer it is excess clothing clean air flow
101° F and body felt and covers and promoting
hot  Promote well heat loss
ventilation to
the patient
Assessment NSG diagnosis Goal NSG intervention Rationale Evaluation

Subjective data Acute pain related Child express  Assess the  To know the After providing all
Parents of child say to meningitis feeling of comfort general general the care , child will
that my child has Irritation as and relief from pain condition of the condition of the express feeling of
headache evidenced by patient patient comfort and relief
headache  Maintain a quite  Darken room from irritation
Objective data environment decrease photo
By observation and keep child phobia and
patient looks room darken irritation
irritated due to  Turn the patient  Promote
headache often and comfort and
position the reduced
client core fully irritation
 Administer  To reduce pain
analgesic as per
describe by
physician
Assessment NSG diagnosis Goal NSG intervention Rationale Evaluation

Subjective data Fluid volume deficit Maintain fluid  Assess the skin  Loss of fluid Fluid volume of
Parents of child say r/t vomiting as volume of patient at turgor and course and loss patient is
that my child is less evidenced by dry normal level mucous of skin turgor maintained to some
orienting after skin and mucous membrane for  Darker and less extent
vomiting since 2 membrane sign of urine indicate
days dehydration dehydration
 Assess the color  For rehydration
Objective data and amount of  For rehydration
By observation urine and maintaining
urine output is very  Encourage the normal body
less patient to take fluid volume
ORS
 Provide IV fluid
as per
prescribed and
also provided
fluid rich diet to
patient
 HEALTH EDUCATION

Date Topic Content

20/07/202 Diet  Explain the importance of balanced diet to the

2 parents
 Advise to give well cooked food
 Advice to give calories, protein, iron and calcium
rich food
21/07/202 Hygiene  Explain the importance of personal hygiene
2  Advice child to wash hand before and after taking
food
 Advise child to avoid taking outside food
22/07/202 Rest and sleep  Advice patient parents to make child sleep and take
2 proper rest
 Advice to take rest 2 to 3 hrs in day and 8 to 9 hrs in
night

23/07/202 Exercise  Explain to parents the benefits of exercise

2  Encourage child to play active game

24/07/202 Follow up  Explain the importance of follow up

2  Advice to care on regular follow up
 NURSING PLAN

Date And Time Activity Plan Activity Performed

20/07/2022
8:00 – 8:30 am Bed making Done bed making
8:00 – 9:00 am Check vital signs Checked vital signs
9:00 – 11:00 am Assist the nursing staff while Assisted the nursing staff
doing procedure while doing procedure
11:00 – 12:00 am Assist the giving medication Assisted the giving
medication
12:00 – 12:30 am History collection History collection done
12:30 – 1:30 am Mention the vital sign and Maintained nurses record
procedure in nurses record book according to doing
book procedure
21/07/2022
8:00 – 8:30 am  Bed making  Done bed making
 Check vital signs  Checked vital signs
 Assist the nursing staff  Assisted the nursing
while doing procedure staff while doing
 Assist the giving procedure
medication  Assisted the giving
 History collection medication
 Mention the vital sign  History collection done
and procedure in  Maintained nurses
nurses record book record book according
to doing procedure
 CONCLUSION

Self Evaluation

As a part of my child health nursing clinical posting. I took the care of Mr. Munna Kumar of age
6 years admitted in pediatric ward of BMIMS hospital with chief complaints of fever, vomiting,
headache since 5 days. After doing all the investigation, Dr. Vivek Mishra diagnosed as
meningitis. I took the case for case presentation under the supervision of Mr. Suresh Sankar
Satguni Sir . by taking this case, I came to know more about meningitis and its management

Patient Evaluation

Mr. Munna Kumar of 6 years old admitted in BMIMS hospital with chief complaints of fever,
vomiting and headache. After providing all the care to patient, the condition of patient is better
than earlier.