Case Scenerio MENINGITIS

CHILD HEALTH NURSING
CASE SCENERIO ON MENINGITIS

Miss Riya aged 7 years presented to the pediatric emergency department with the chief
complains severe headache, fever and vomiting.
History of illness
The patient was apparently well 3 days back when he had developed a headache, vomiting
and fevers with a temperature maximum of 101 degrees F (38.3 degrees C).
Antenatal:
• No ANC visits
• No TT vaccines
• Iron and calcium taken
Perinatal history:
• Normal term, spontaneous vaginal delivery (patient not sure of exact date)
• Baby cried at birth.
• Baby weight:-2.5 kgs
• Breast feeding at 4 hours of life.
Post natal history:
• No h/o Excessive bleeding
• No other complications
Dietary History:
Immunization history:
• Immunization as per EPI schedule with strictly all vaccines given to child.
Developmental History
• H/o normal developments
*On Examination
General Examination:
Ill looking child in obvious discomfort.Awake and alert, but slow to engage in conversation,
GCS 15/15
Normal weight for age
Vitals
Temperature: 40 degrees C (104 degrees F)
Blood pressure: 100/68 mm/Hg
Pulse: 110/m
Respiratory rate: 30/m
Neurological :
Awake and alert, normal level of consciousness
Higher function intact
Photophobia
++ Neck stiffness
Positve Kernig and positive Brudenski signs
Gait normal
Tone normal
Reflexes 2/4 for both upper and lower limbs

Lab Investigations:
Lumbar puncture: CSF (cerebrospinal fluid) is visibly hazy
The CSF analysis: 450 WBCs, 95% neutrophils, 5% monocytes, total protein 75, glucose 25
mg/dl.
Gram stain of the CSF shows many WBCs with few gram positive cocci.
CT scan of the brain is normal
Management and Treatment
IV cefuroxime 195mg/BD
Acetoaminophen 250 mg/BD
REQUIREMENTS:
 Kardex
 Nurses Notes
 Medicine cards if administered
 Investigation chart
 Feeding chart
 Nursing process according to NANDA diagnosis
 Immunization schedule
 Growth and Development:
 Head to foot examination

 Play therapy and play materials
Health Education
Follow –up &Medication schedule
Personal hygiene
Environmental hygiene
Immunization
Prevention of infection
KARDEX
Sn Nursing care plan

no Medication Dose Route Fre Tim
que e
ncy Time
1. Cefuroxime 195 mg IV BD 8-8  Monitor vital signs hourly. 7 am
 Assess neurological status 8 7: 15 am

2. 250 mg Oral BD 8-8 hourly
Acetoaminophen
 Assess for signs of meningeal

8- irritation.
8 7:30 am
 Elevate head of bed up to 30° to
45° with the client’s head in
2 neutral position.
 Maintain head or neck in midline

position, provide small pillow for
support. 8 am
 Perform tepid sponge.

10 am
 Provide adequate fluid intake.
 Decrease external stimuli such as

quiet environment, soft voice, and
gentle touch and keep child’s
room darkened.
 Restrict visitors.
 Assist child with ROM exercises 11 am
 Encourage frequent rest periods

and teach patient to pace activity.
11:30 am
 Encourage use of relaxation
techniques and diversional
activities.
 Encourage parents to stay with

infant and involve the parents in
care of child.
 Allow expressions of concern and

opportunity to ask questions about
condition and recovery of ill 12pm
infant.
 Provide information regarding

hospital routines and modalities
of treatment.
 Teach the importance of

continuing medical follow-up and
obtaining vaccinations as
appropriate.
 Provide written instructions and

schedule to follow and inform to
administer full course of
antibiotic to child.
Name: Master Riya Age: 7 years
Diagnosis: Meningitis IP No: 1234
Religion: Hindu Doctor:
TPR & BP Diet: Solid diet

NURSES NOTES:
Name: Master Riya Diagnosis:Meningitis

Age/Sex: 7 years /Female
IP No: 1234
Nursing Interventions
Date Diet Tim
e
16/05/1 The child is awake and alert, but slow to engage in conversation, 7 am
9 is awake and alert, in moderate distress..
 Vitals stable
7:15 am
 Weight- 20 Kgs
 Assessed neurological status-

7:20 am
*GCS 15/15 Photophobia

*++ Neck stiffness
*Gait normal
*Tone normal
*Reflexes 2/4 for both upper and lower limbs
 Assessed for signs of meningeal irritation –

*Headache
*Photobia
*Nuchal rigidity
*Kernig’s sign +
*Brudzinki’s sign +.
 Elevated head of bed up to 30° to 45° with the client’s head in
neutral position.
 Maintained head or neck in midline position, provide small pillow

for support.
 Performed tepid sponge. 8am
 Provided fluid intake upto 3000 ml/day
 Decreased external stimuli such as quiet environment, soft voice,

and gentle touch and kept child’s room dark.
 Restricted visitors.
 Assisted child with ROM exercises 10 am
 Provided rest in between the activities.
 Provided painting books. 11am
 Encouraged parents to stay with infant and involve the parents in

care of child.
 Allowed expressions of concern and opportunity to ask questions

about condition and recovery of ill infant.
 Provided information regarding hospital routines and modalities of

treatment. 12 pm
 Taught the importance of continuing medical follow-up and

obtaining vaccinations as appropriate.
 Provided written instructions and schedule to follow and inform to

administer full course of antibiotic to child.

Case Scenerio MENINGITIS

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CHILD HEALTH NURSING

CASE SCENERIO ON MENINGITIS

• Iron and calcium taken

• Baby cried at birth.

• Baby weight:-2.5 kgs

• Breast feeding at 4 hours of life.

Post natal history:

• No h/o Excessive bleeding

• H/o normal developments

Normal weight for age

Temperature: 40 degrees C (104 degrees F)

Blood pressure: 100/68 mm/Hg

Respiratory rate: 30/m

Awake and alert, normal level of consciousness

Higher function intact

Positve Kernig and positive Brudenski signs

Reflexes 2/4 for both upper and lower limbs

Lumbar puncture: CSF (cerebrospinal fluid) is visibly hazy

CT scan of the brain is normal

Management and Treatment

Acetoaminophen 250 mg/BD

 Medicine cards if administered

 Nursing process according to NANDA diagnosis

 Growth and Development:

 Head to foot examination

Sn Nursing care plan

1. Cefuroxime 195 mg IV BD 8-8  Monitor vital signs hourly. 7 am

 Assess neurological status 8 7: 15 am

 Assess for signs of meningeal

 Maintain head or neck in midline

 Perform tepid sponge.

 Decrease external stimuli such as

 Assist child with ROM exercises 11 am

 Encourage frequent rest periods

 Encourage parents to stay with

 Allow expressions of concern and

 Provide information regarding

 Teach the importance of

 Provide written instructions and

Name: Master Riya Age: 7 years

Diagnosis: Meningitis IP No: 1234

Religion: Hindu Doctor:

TPR & BP Diet: Solid diet

Name: Master Riya Diagnosis:Meningitis

 Assessed neurological status-

*GCS 15/15 Photophobia

 Assessed for signs of meningeal irritation –

 Maintained head or neck in midline position, provide small pillow

 Performed tepid sponge. 8am

 Provided fluid intake upto 3000 ml/day

 Decreased external stimuli such as quiet environment, soft voice,

 Assisted child with ROM exercises 10 am

 Provided rest in between the activities.

 Provided painting books. 11am

 Encouraged parents to stay with infant and involve the parents in

 Allowed expressions of concern and opportunity to ask questions

 Provided information regarding hospital routines and modalities of

 Taught the importance of continuing medical follow-up and

 Provided written instructions and schedule to follow and inform to