IDENTIFICATION DATA

• Patient name :JAYA

• Age : 9 MONTH
• Gender : female
• IPD No : 127587
• Bed no : 630
• Consultant doctor: Dr Anil patel
• Date of admission: 03/06/2023
• Educational status: Educated (12th pass)
• Marital status : Married
• Occupation : Housewife
• Income : 7000/-
• Religion : Hindu
• Address : Vesu surat
• Diagnosis : MENINGITIS

CHIEF COMPLAINTS
Breathing difficulty

HISTORY OF PRESENT ILLNESS

My patient was asymptomatic 5 days back the she develop chest pain since 4
days sneezing and runny nose since 5 days fatigue and muscle ache since 4
days chills since 2 days and productive cough. Then she come to civil hospital
for further investigation she is diagnosed with pneumonia.

PAST MEDICAL HISTORY

There is no significant of past medical history.

PRESENT SURGICAL HISTORY

There is no any significant of present surgical history.

PAST SURGICAL HISTORY

There is no any significant of past surgical history.

FAMILY CHART
Name of the Relationship Age / sex occupation Health Educational
family with patient status status
member
1.Mrs Rita Patient 35/F Housewife healthy 12TH pass
devi Educated

2.Mr Akas Husband 40/M Private Healthy Educated

ray company
worker
3.sunilkumar SON 11/M _ Healthy Studying

_
4.JAYA DOUGHTER 8MONTH unhealthy -

FAMILY TREE FAMILY KEY

SOSCIOECONOMIC HISTORY
Family income per month : 30,000/-
Earning member : 02
Maintainance of hygiene : Good
Housing : Pakka
Electricity : Domestic
Water supply : Handpump
Drainage system : Close
Sanitation : Good
Relationship with neighbeur :Good

PERSONAL HISTORY
Dietory habits : Mixed diet
Sleeping pattern : Improper
Life style : Moderate
Relationship with family member : Good
Elimination : Proper
Habits of person : No any bad habits of smoking or alcohol

PHYSICAL EXAMINATION
VITAL SIGNS :
Name of the vital sign Normal value Patient value Remark
1. Temperature 98.6f 101 f Hyperthermia

2. Pulse 60-90blm 87b/m Normal

3. Respiration 16-20 22b/m

4. Blood pressure 120/80mmhg 110/80mmhg Normal

5. Spo2 95-100% 94% Normal

GENERAL APPEARANCE
• Look : Dull
• Consciousness : Conscious
 • Orientation : Well oriented
• Body : Moderate
• Health status : Unhealthy
• Hygiene : Good

HAIR
• Colour : Black
• Texture : Normal
• Grooming : Not groomed
• Distribution : Good

HEAD
• Shape : Normocephalic
• Scalp : Presence of dandruff
• Face : Normal
• Subjective symptoms: No

EYE
• Eye brouse : Symmetrical
• Eye lashes : Equally distributed
• Eye lids : Pupil
• Sclera : White
• Conjunctiva : Normal
•

NOSE
• Nasal septum : Midline
• Nasal pathway : Pteent
• Sense of smell : Normal
• Rhinorrhea : Absent

MOUTH AND PHARYNX

• Lips : Pink
• Gums : Pink
 • Tounge : Moist
• Teste : Normal
• Teeth : Normal
• Halitesis : Absent
• Speech : Clear
• Mucus membrane : Moist

EAR
• Pinna : Normally placed
• Cerumen : Absent
• Hearing : Normal
• Otorrhea : Absent

NECK
• Lymph node : No enlarge
• Thyroid gland : Not enlarged
• Movement of neck : Possible
• Trachea : Midline
• Jugular vein : Not distended

CHEST
• Type of chest : Symmetrical
• Hair distribution : Absent
• Breast : Symmetrical
• Aerela and nipple : Proper
• On inspection (respiratory rate)-20
• On palpation : Presence of mass
• On percussion : Dull
• On auscultation : Cracked sound

ABDOMEN
• Inspection : flat
• Palpation : No mass formation
• Percussion : No fluid accumulation
• Auscultation : No bowel sound
UPPER EXTRAMITIS
• ROM/Movement : Possible
• Anatomical deformities : Absent
• Edema/ Swelling : Absent
• Lymph node : Not enlarged
• Joints : No complaints

LOWER EXTRAMITIES
• ROM/Movement : Possible
• Anatomical deformities : Absent
• Nail : Normal
• Varicose vein : Absent
• Joints : No complaints
• Edema/swelling : Absent
• Dependency level : Independent

GENITAL (FEMALE)
• Anatomical deformities : Absent
• Hydrocele : Absent
• Menstrual history : Regular
• Condition of uterus : Normal
• Voiding : Continent

BACK
• Bed sore : Absent
• Colour : Normal
• Pressure paint : Absent
• Vertebral deformities : No deformities

INTEGUMETORY SYSTEM
• Skin texture : Normal
• Skin colour : Fair
• Hydration : Moderate
• Discoloration : Absent
NEUROLOGICAL ASSESMENT
• Level of consciousness : Conscious
• Memory : Intact
• Orientation : Well oriented
• Insight : Present
• Judgement : Present

INVESTIGATION
LAB TEST PATIENT LAB NORMAL VALUE
TEST

Hemoglobin 12 % 12-16%

Platelet 1.5 Lac 1.5-4Lac/cum

RBC 1.6 1.5-4.5million

TLC 6000/cumm 4000-11000/cumm

Lymphocyte 26% 40%

Monocyte 6% 2-10%

Eosinophill 4% 1-6%

Serum creatinine 0.9mg/dl 0.9-1.2mg/dl

Serum sodium 136meq/l 135-145meq/l

Serum potassium 3.2meq/l 3.5-6.0meq/l

SGPT 7.56U/L 7.56U/L

SGOT 52 5-40%

RBC Indices
PCV 40% 40-50%
MCV 86% 71-95%
MCH 28eg 27-32eg
MCHC 33gm/dl 30-35gm/dl

MEDICATION CHART
NAME OF DOSE ROUT FREQUENC ACTION SIDE EFFECT
THE E Y
DRUG
Terbutilin 2.5mg Iv Od Terbutaline Headache
e is used to Chest pain
prevent
and treat
wheezing,
shortness
of breath,
and chest
tightness
caused by
asthma,
chronic
bronchitis,
and
emphysem
a
Morphin 5mg/m Iv Od Morphine • constipation.
l works • headache or
directly on dizziness.
opioid • fatigue or
receptors drowsiness
in the (especially
central right after a
nervous dose)
system. • loss of
It reduces appetite,
feelings of nausea and
pain by vomiting.
 interruptin
g the way
nerves
signal pain
between
the brain
and the
body.

MENINGITIS:
INTRODUCTION:
Meningitis is inflammation of the layers of tissue that cover the brain and
spinal cord (meninges) and of the fluid-filled space between the meninges
(subarachnoid space).
DEFINITION:
Meningitis is an infection and inflammation of the fluid and membranes
surrounding the brain and spinal cord. These membranes are called meninges.
The inflammation from meningitis typically triggers symptoms such as
headache, fever and a stiff neck.
TYPES OF MENINGITIS:
• Viral Meningitis. A group of mild respiratory viruses called enteroviruses
usually causes viral meningitis. ...
• Bacterial Meningitis. A meningitis infection caused by bacteria is much
more serious. ...
• Fungal Meningitis. Other less common types of meningitis include those
caused by a fungus. ...
• Parasitic Meningitis. ...
• Amebic Meningitis.
Video

ETIOLOGY: Several different bacteria can cause meningitis. Streptococcus

pneumoniae, Haemophilus influenzae, Neisseria meningitidis are the most
frequent ones. N. meningitidis, causing meningococcal meningitis, is the one
with the potential to produce large epidemics.
BOOK PICTURE PATIENT PICTURE
• Streptococcus • Streptococcus
• Middle ear infection • Middle ear infection
• Cerebral absess • Droplet infection
• Droplet infection from nasal • Salmonella
sinus mastoid • Head injury
• Head injury • Mycobacterium
• Mycobacterial tuberculosis • tuberculosis

PATHOPHYSIOLOGY :
The pathogenesis
complex
immune
result from
response
interplay
cytokines
and
between
[3,4].
released
pathophysiology
Much
virulence
of
within
the damage
factors
the
ofCSF
bacterial
of
from
asthe
thethis
meningitis
pathogens
host
infection
mountsinvolve
and
isanbelieved
theahost to

From its original recognition in 1805 until the early 1900s, bacterial meningitis
due to Haemophilus influenzae and Streptococcus pneumoniae was virtually
100 percent fatal. In 1913, Simon Flexner's introduction of intrathecal
meningococcal antiserum decreased the mortality of meningococcal meningitis
from 75 to 31 percent, but the clinical outcome did not dramatically improve
for all three meningeal pathogens until the advent of systemic antimicrobial
therapy in the 1930s [1].
Despite the effectiveness of antibiotics in clearing bacteria from the
cerebrospinal fluid (CSF), bacterial meningitis in adults continues to cause
significant morbidity and mortality worldwide. As an example, in the largest
prospective study to date of 1412 episodes of community-acquired bacterial
meningitis, the case-fatality rate was 17 percent, and unfavorable outcomes
occurred in 38 percent [2]. (See "Neurologic complications of bacterial
meningitis in adults".)
The pathogenesis and pathophysiology of bacterial meningitis involve a
complex interplay between virulence factors of the pathogens and the host
immune response [3,4]. Much of the damage from this infection is believed to
result from cytokines released within the CSF as the host mounts an
inflammatory response. (See "Neurologic complications of bacterial meningitis
in adults".)
The clinically important issues related to the pathogenesis and
pathophysiology of bacterial meningitis will be reviewed here. The clinical
features, treatment, prognosis, and prevention of bacterial meningitis in adults
and children and issues related to chronic and recurrent meningitis are
discussed separately. (See "Clinical features and diagnosis of acute bacterial
meningitis in adults" and "Initial therapy and prognosis of community-acquired
bacterial meningitis in adults" and "Treatment of bacterial meningitis caused
by specific pathogens in adults" and "Bacterial meningitis in children older than
one month: Clinical features and diagnosis" and "Bacterial meningitis in
children older than one month: Treatment and prognosis" and "Approach to
the patient with chronic meningitis" and "Approach to the adult with recurrent
infections", section on 'Meningitis'.)

SIGN AND SYPTOMS

BOOK PICTURE PATIENT PICTURE
Severe headache Poor feeding
Irritability Vomiting

Middle ear infection Diarrhea

High grade fever Weak cry

Seizer tachycardia Sleeplessness, lethargy

DIAGNOSTIC EVALUATION:
BOOK PICTURE PATIENT PICTURE
History collection History collection

Physical examination Physical examination

CSF evaluation for pressure CSF evaluation for pressure

Blood culture Blood culture

MRI MRI, CT SCAN

MANAGEMENT:
BOOK PICTURE PATIENT PICTURE
ANTIMICROBIAL THEORY ANTIBIOTIC PICTURE
Ceftriaxone Cephalosporin : increase intracranial
pressure mannitol
Cefataxime Antipyretic : aspirin, heparin
Anti inflamtory :dexamethasone
Antibiotic : penicillin Analgesics: hydrocortisone,
Antiviral:acvlovir methadone
Anti inflammatory-dexamethasone

NURSING MANAGEMENT:
BOOK PICTURE PATIENT PICTURE
• Management of airway by o2 • Provide supportive care to
administration patient
 • To control body temperature • Provide cold sponging
• Monitor regular vital sign • Check the vital sign
• Maintain personal hygiene of • Maintain personal hygiene of
patient patient

NURSING DIAGNOSIS:
• impaired gas exchange related to abnormality as evidence by
destruction of alveolar capacity membrane.
• Infective airway clearance related to alveolar imfflamatiom edema as
evidence by sputum production.
• Imbalance nutrition less than body requirements related to disease
condition as evidence sputum production, fever
• Activity intolerance related to hypoxia as evidence by imbalance o2
supply and demands.
• Anxiety related to disease process as evidence by fear of treatment.
NURSING CARE PLAN
ASSESSME NSG GOAL INTERVENTION RATIONAL EVALUATIO
NT DIAGNOSI N
S
Subjective impaired To • Assess Assessed The patient
data: gas maintai the the was able to
patient exchange n general general establish a
mother related to breathin condition condition normal
complainin abnormali g of patient of the breathing
g about my ty as pattern patient pattern
child is not evidence • Monitor Monitore
properly by the vital d the vital
destructio sing sing
Objective n of
data: alveolar • Maintain Maintaine
I observe capacity patient d patient
by irregular membran clear clear
breathing e. airway airway
pattern ,
weak
peripheral
pulse
2.
ASSESSME NSG GOAL INTERVENTION RATIONAL EVALUATIO
NT DIAGNOSI N
S
Subjective impaired To • Assess Assessed The patient
data: gas maintai the the was able to
patient exchange n general general establish a
mother related to breathin condition condition normal
complainin abnormali g of patient of the breathing
g about my ty as pattern patient pattern
child is not evidence • Monitor Monitore
properly by the vital d the vital
destructio sing sing
Objective n of
data: alveolar • Maintain Maintaine
I observe capacity patient d patient
by irregular membran clear clear
breathing e. airway airway
pattern ,
weak
peripheral
pulse

HEALTH EDUCATION:
HYGIENE:
• wash your hand frequently.
• Maintain strict aseptic technique
 • Make sure that body is clean
DIET
• Give patient complimentary feeding along with breastfeeding.
• Complimentary foods mudt contain protein.
MEDICATION:
• Take your medication timely
• Never skip a doses.
• Assist the child in administration of medication.
EXERCISE:
• Don’t strain your muscles
• Do not perform active exercise.
• Chek frequently
FOLLOW UP:
• Follow the doctors order as pr given time.

SUMMARY:
Meningitis is an inflammation of the protective membranes covering the brain
and spinal cord. A bacterial or viral infection of the fluid surrounding the brain
and spinal cord usually causes the swelling, severe injuries, cancer. Certain
drugs and the other type of infection also can cause meningitis.
CONCLUSION:
Meningitis is an infective disease emergency meningitis and encephalitis are
neurological emergency. Prompt diagnosis and treatment is needed to
improve survival. Neurological sequel is common aften these infections which
require long term rehabilitation.

BIBLIOGRAPHY:
Brunner and Suddarth’s text book of medical surgical nursing
South Asian edition volume 1
SEA Editors: Suresh k. Sharma S. Madhavi
International editors: Janice L. Hinkle Kerry H. Cheever
PAGE NO:1768-1770.