Mary Chiles College

Gastambide St. Sampaloc Manila

A Case Study Of
Meningitis

By:
Borre, Jessa Anne
Gervacio, Jonah Micah
Pastrana, Izza Mae
Mangalus, Maribel
BSN- III

Mr. Eligio S. Razalan RN. MSN PhD

March 9, 2016

OBJECTIVES OF THE STUDY

General
This case presentation aims to identify and determine the general health
problems and needs of the patient with an admitting diagnosis of Meningitis. This
presentation also intends to help patient promote health and medical understanding of
such condition through the application of the nursing skills.
Specific

To raise the level of awareness of patient on health problems that she may
encounter. To facilitate patient in taking necessary actions to solve and prevent the
identified problems with the relatives.
To help patient in motivating her to continue the health care provided by the health
workers,
To render nursing care and information to patient through the application of the
nursing skills.

Patients Data:
Name: Pt. M.G.C
Age: 27y/o
Status: Single
Address: 7027 A. Bonifacio St. San Dionisio, Paranaque City
Birthday: July 27,1988
Religion: Catholic
Nationality: Filipino
Date of Admission: 2/21/16, 1:55 am.
Diagnosis: CNS infection prob. . Bacterial Meningitis
RDx: TB Meningitis vs. Bacterial Meningitis

Chief Complaint:
-

Fever

Present history:
-

7 days PTC, Pt. Experienced abdominal pain with nape pain and intermittent
fever at maximum 39 degree Celsius. Self medicated, paracetamol 500mg/tab.

Past history:
-

(+) smoker
Occasional drinker

Past medical history:

-

Pt. Was admitted at Paranaque and Las Pinas Hospital but the pt. was withdrawn
and transferred to SLH.

Physical Assessment

BODY PARTS

TECHNIQUE

NORMAL

ACTUAL FINDINGS

FINDINGS
-light to brown
SKIN

inspection

- warm to touch
-no swelling

Hair and scalp

inspection

- smooth and soft

No lesions
Have rashes
Black and white in color

- black
- evenly distributed
- no lesions and
nodules

Nails

Inspection

-Round

Normal

- pink nail beds

-face is symmetrical
HEAD

inspection

-centered head

Slightly Enlarged.

position
--controlled
NECK

Inspection

movements

Normal

-round
EYES

Inspection

-blinking

Opens to pain.

symmetrically
Eye lids

Inspection

-moist and pink

Normal

-equal in size
EARS

Inspection

-symmetrical color

Normal

-symmetrical comor
NOSE

Inspection

-in midline

Normal

-no nodules and

lesions
-equal ROM
UPPER

Inspection

EXTREMETIES

-No swelling,

With lesions on the fingers.

rashes, lesions
-no deviation
-equal ROM

LOWER

Inspection

EXTREMETIES

-No swelling,

Normal

rashes, lesions
-no deviation
-no rashes, lesions

ABDOMEN

Vital Signs :
BP ; 110/80
Temp : 37
CR : 90
RR : 18

GCS : E2V2M3

Inspection

-rounded abdomen

Normal

GORDONS HEALTH PATTERN

Functional health pattern

BEFORE

AFTER

HOSPITALIZATION
NUTRITIONAL-METABOLIC

PATTERN

Patient eats 5

Patient has NGT.

The patient has

times a day as
verbalized by the

ELIMINATION PATTERN

guardian.
Patient usually
defecates 1 times a

Foley Catheter.

day and urinates 5

times a day as
verbalized by the
SLEEP AND REST

guardian.
The guardian said
that she usually
sleeps around 9-10

ROLE-RELATIONSHIP

in the evening .
The guardian said
that she loves his
family and his
friends.

The patient is
Stuppurous.

Hematology
February 27,2016
Result
-16.92(H)

Nornal Result
4.8-10.8

-4.41

4.2-5.4

-0.36(L)

0.37-0.47

-119(L)

120-160

81.9(L)

82-98

26.9(L)

28-33

(641.00)H

150-400

13.00

4-14.0

86.20(L)

40-70

6.80(L)

19-48

0.10(L)

2-8

6.70

0-15

0.20

0-5

32.8(L)

150-400

WBC
RBC
HEMATOCRIT
HEMOGLOBIN
MCU
MCH
PLATELET
RDW
NEUTROPHILS
LYMPHOCYTES
EOSINOPHILS
MONOPHILS
BASOPHILS
MCHC

INTRODUCTION

Meningitis is a relatively rare infection that affects the delicate membranes -called meninges (men-in'-jeez that cover the brain and spinal cord.
Bacterial meningitis can be deadly and contagious among people in close
contact.
Bacterial meningitis is caused by any one of several bacteria. The most common
bacteria causing meningitis in children and adults in the U.S. are Neisseria
meningitidis ("meningococcus"), Streptococcuspneumoniae("pneumococcus") and, in
older patients with decreased immunity,Listeria monocytogenes.
Haemophilus influenzae type b (Hib) was a common cause of meningitis in infants and
young children until the Hib vaccine was introduced for infants.
Vaccines are available for bothNeisseria meningitidis and Streptococcus
pneumoniae. They're recommended for all children and adults at special risk.
The bacteria can spread from person to person through coughing and sneezing.
If you are around someone who has bacterial meningitis, contact your health care
provider to ask what steps you need to take to avoid infection.
In many instances, bacterial meningitis develops when bacteria get into the
bloodstream from the sinuses, ears, or other part of the upper respiratory tract. The
bacteria then travel through the bloodstream to the brain.
Viral meningitis tends to be less severe and most people recover completely
without specific therapy.
Fungal meningitis is a rare form of meningitis and generally occurs only in
people with weakened immune systems.

Early symptoms of meningitis broadly include:

Vomiting

Nausea

Muscle pain

High temperature (fever)

Headache

Cold hands and feet

A rash that does not fade under pressure. This rash might start as a few small
spots in any part of the body - it may spread rapidly and look like fresh bruises.
This happens because blood has leaked into tissue under the skin. The rash or
spots may initially fade, and then come back.

In babies, you should look out for at least one of the following symptoms:

a high-pitched, moaning cry

a bulging fontenelle

being difficult to wake

floppy and listless or stiff with jerky movements

refusing feeds

rapid/ unusual/ difficult breathing

pale or blotchy skin

red or purple spots that do not fade under pressure

In older children, you should look out for:

a stiff neck

severe pains and aches in your back and joints

sleepiness or confusion

a very bad headache (alone, not a reason to seek medical help)

a dislike of bright lights

very cold hands and feet

shivering

rapid breathing

red or purple spots that do not fade under pressure

Risk Factors :
1.
2.
3.
4.
5.
6.
7.
8.
9.

Respiratory tract infection

Otitis media
Mastoiditis
Head trauma
Splenectomy
Sickle cell disease
7. Immunosuppressive therapy
Immunocompromised host
9. Alcoholic patients

The treatment for severe meningitis, which is nearly always bacterial (but can be viral),
may require hospitalization, and includes:

Antibiotics - usually administered intravenously by injection, or through an IV.

Corticosteroids - if the patient's meningitis is causing pressure in the brain,

corticosteroids, such as dexamethasone, may be administered to adults and
children.

Acetaminophen (paracetamol) - effective in bringing the patient's temperature

down. Other methods for reducing the patient's fever may include a cool sponge
bath, cooling pads, plenty of fluids, and good room ventilation.

Anti-convulsants - if the patient has seizures (fits), he/she will be given an anticonvulsant, such as phenobarbital or dilantin.

Oxygen therapy - if the patient has breathing difficulties oxygen therapy may be
given. This may involve a face mask, a nasal cannula, a hood, or a tent. In more
severe cases a tube may be inserted into the trachea via the mouth.

Fluid control - dehydration is common for patients with meningitis. If a

meningitis patient is dehydrated he/she may develop serious problems. It is

crucial that he/she is receiving adequate amounts of fluids. If the patient is

vomiting, or cannot drink, liquids may be given through an IV.

Blood tests - measuring the patient's blood sugar and sodium is important, as
well as other vital body chemicals.

Sedatives - these are given if the patient is irritable or restless.

DIAGNOSIS:
Investigations:

FBC

R/L/B

CRP

CBG

Glucose

ANATOMY AND PATHOPHYSIOLOGY

Cerebrospinal Fluid
Cerebrospinal fluid (CSF) is a colorless, transparent liquid that continuously circulates
through the cavities of the brain and spinal cord, and as such, it acts as an internal
circulation system to transport nutrients and wastes between the bloodstream and the
brain and spinal cord. This reducdant circulation protects the brain and spinal cord from
chemical injuries similar to the function of the blood-brain barrier. The CSF also
protects the brain and spinal cord from physical injuries by acting as a shock absorber
between the brain and spinal cord from the skeletal structures (cranium and vertebrae) .
From the choroid plexuses of each lateral ventricle, CSF flows into the third
ventricle through the interventricular foramina, which are two narrow oval openings.
The choroid plexuses in the third ventricle adds more CSF. Then, CSF flows into
the fourth ventricle throught the cerebral aqueduct. Again, the choroid plexuses in the
fourth ventricle adds more CSF. The fluid then enters the subarachnoid space through
the three openings in the roof of the fourth ventricle. These three openings are
a median aperture and a pair of lateral apertures. Then, CSF circultates in the central
canal of the spinal cord and in the subarachnoid space around the surface of the brain
and spinal cord.

Meninges
The meninges are three connective tissue coverings that encircle the spinal cord and
brain. The spinal meninges surround the spinal cord and are continuous with
the cranial meninges, which encircle the brain.
The meninges lined the cranial and vertebral cavities to protect the brain and the spinal
cord, and they are also attached to the cranial bones' inner surfaces, which facilitate the
crainal bones to stabilize the positions of the brain, blood vessels, lymphatic vessels,
and nerves.
These three connective tissue coverings are dura mater, which is composed of dense,
irregular connective tissue), arachnoid mater, which is composed of delicate collagen
fibers and some elastic fibers in a spiders web arrangement, and pia mater, which is
a thin transparent connective tissue layer consists of squamous to cuboidal cells within
interlacing bundles of collagen fibers and some fine elastic fibers .

All three spinal meninges cover the spinal nerve roots, structures that connect spinal
nerves to the spinal cord, up to the point where they exit the spinal column through the
intervertebral foramina. Triangular-shaped membranous extensions of the pia mater
suspend the spinal cord in the middle of its dural sheath. These extensions,
called denticulate ligaments, are thickenings of the pia mater. They project laterally
and fuse with the arachnoid mater and inner surface of the dura mater between the
anterior and posterior nerve roots of spinal nerves on either side. Extending all along
the length of the spinal cord, the denticulate ligaments protect the spinal cord against
sudden displacement that could result in shock.