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cRachel Tino Panday

cc7 years old

cFemalecc c


cc ccAugust 15, 2003

 cSimona Subdivision, San Isidro, Taytay Rizal



 cFilipino

c
 cSingle

cRoman Catholic


cc
 cMarch 24, 2011

cc
 c 5:50 PMc

c

 cUpward rolling of eyeballs


c
  cc t/c CNS Infection: Bacterial Meningitis

dc
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  c c



c
 c 
Patient X has no past surgeries and blood transfusion. She has also
negative allergy to food and drug, but she have been positive before by having
measles, mumps and chickenpox.

 cc
  c 
The history of present illness started 4 days prior to admission when the
pt. had petechial rashes. No other associated sign and symptoms noted.

3 days PTA, still with rashes, she had high grade undocumented fever.
No consult done, she was given Paracetamol which decrease temporary lysis of
fever.

Few hours PTA, still with above symptoms but no rashes. She had
consciousness describe as upward rolling of eyeballs. She was brought at
Taytay emergency hospital and was advised admissions but due to lack of
facilities she was transferred to RMC hence admission.


c
 c  

Patient X has no history of Hypertension, Diabetes, and other heart
diseases.

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×c Round shape and symmetrical ×c Brown colour of skinc
×c Dry hair ×c Slight dry skinc
×c Frizzy hair ×c 
for rashesc
×c Not shiny ×c 
"demac

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×c hite sclera ×c Flabby soft non tender
×c Pinkish conjunctiva
   
×c Deep black colour of pupil,
with a diameter size of 2 mm ×c No "dema and Lesions

and reactive to light

×c Rolling eyeballs


 
×c " ual in size
×c No redness, deformities and
Lesions
×c 
pain and tenderness

 
×c Dry lips
×c ith foul smell of breath
×c ’ellowish colour of teeth
×c ith Oral Gastric Tube

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×c ith white patchesc

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DAT": March 24, 2011

SAMPL" NO. 6725

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Ph 7.425 Normal 7.35 7.45
PCOM 37.6 Normal 35 45
POM 87.8 Normal 80 100
Standard HCO 24.5 mmol/L Normal 22 27 mmol/L
OM Sat 97.0 mmol/L Normal >= 95%




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April 1, 2011
8 am 88 mg/dl Normal 70 110 mg/dl
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Hemoglobin 107 g/l Low 115 160
Hematocrit 0.33 g/l Low 0.37 0.47
Leukocyte 9.28 x10^g/L Normal 4.5 11.00
Platelets 316 x10^g/L Normal 150.00 400.00

Sample Type: Serum

Date Tested: March 24, 2011


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CR"AT Creatinine 92.35 mol/L Normal 53.00 130 00
BUN SP Blood Urea Nitrogen 6.68 mmol/L Normal 2.14 7.14
NA + Sodium 133.60 m" /L ù 135.00 145.00

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+ Potassium 4.71 mmol/L Normal 3.5 5.5
Cl Chloride 99.20 mmol/L Normal 96 112
iCa++ Ionized Calcium 0.86 mmol/L ù 1.05 1.30

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Bacterial Meningitis

Causative Factor:
Neisseria meningitis / Streptococcus pneumoniae

stimulates the release of cell wall "nters the Blood stream

fragments and lipopolysaccharides
it crosses the blood brain
inflammation the subarachnoid and pia barrier
meter
proliferates in the cerebrospinal
fluid CSF

 intarcranial presure ICP

CSF circulates through the

subarachnoid space

inflammatory cellular material from

the affected meningeal tissue enter
and accumulate

 glucose
protein levels
 BC count
idespreads Hemmorhage
ater house friderichsen Circulatory collapse Adrenal damage
syndrome

"ndothelial damage and

Vascular necrosis

Complications includes:
 Visual impairment Sign/Symptoms:

 Deafness  Nuchal rigidity stiff neck

 Seizures  Positive ernig's sign

 Paralysis  Positive Brudzinskin's sign

 Hydrocephalus  Photophobia

 Septic Shock

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 Meningitis is an inflammation of the Pia meter, the arachnoid and the
Cerebrospinal Fluid CSF
² filled subarachnoid space. Septic meningitis is
caused by bacteria. The most common pathogens causing septic meningitis are
Streptococcus pneumonia and Nisseria meningitides.

Once the causative organism enters the bloodstream, it crosses the

blood ² brain barrier and proliferates in the CSF. The host immune response
stimulates the release of cell wall fragments and lipopolysaccharides, facilitating
inflammation of subarachnoid and pia meter. Because the cranial vault contains
little room for expansion, the inflammation may cause increased intracranial
pressure ICP
. CSF circulates through the subarachnoid space, where
inflammatory cellular materials from the affected meningeal tissue enter and
accumulate. CSF studies demonstrate decreased glucose, increased protein
levels and increased white blood cell count.

The prognosis for bacterial meningitis depends on the causative

organism, the severity of the infection and illness, and the timeliness of
treatment. Acute fulminant presentation mat include adrenal damage,
circulatory collapse, and widespread hemorrhages aterhouse Friderichsen
syndrome
. The syndrome is the result of endothelial damage and vascular
necrosis caused by the bacteria. Complications include the visual impairment,
deafness, seizures, paralysis, hydrocephalus, and septic shock.

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 cRachel Tino Pandayc c c c c 
  ct/c CNS infection: Bacterial Meningitisc
c c  cAfter 2 days of nursing interventions, the patient will remain free of infection.
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  ct/c CNS infection: Bacterial Meningitisc
c c  cAfter 2 days of nursing interventions, the patient will remain free of infection.
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  c Risk for Infection c After shift, of  ash hands  To prevent the After shift of
 Catheter Insertion related to nursing before assisting risk of transmitting nursing
 Irritable feelings indwelling intervention, the the pt. And bacteria. intervention,
 Vital Signs catheters, drains pt. will manifest between the pt. remains
T: 36.5 ° c without any signs procedures with free from
PR: 85 bpm or symptoms of the pt. infection, but
RR: 23 cpm infection, and  "ncourage  To reduce risk of she still feels
Bp: 111/71 mmHg lessen the feel of fluid intake. bladder infection. irritable and
O2 Sat: 94 c irritability.  Monitor for  "levated uncomfortable.
elevated temperature is a The goal was
temperature. sign of infection.c partially met.

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