Case Analysis Viral Meningitis 1

Cotabato Medical Foundation College, Inc
Quezon Ave. Poblacion 8, Midsayap, Cotabato

Tel: 064-229-8207
CLINICAL
CASE ANALYSIS
WORKSHEET
Submitted by
Cartera, Nhorlyn C.
Combis, Angelika T.
Cordero, Genelyn C.
Dalamban, Alibai C.
Diamante, Lovely
Duhaylungsod, Angelo A.
Esmael, Norhainne A.
Gonzaga, Sweetsal Jane A.
Kadalum, Jeramin E.
Kamsa, Johanna H.
Kulidtod, Narissa E.
Date Presented:
Date Submitted:
2nd Semester SY 2020-2021
TABLE OF CONTENTS
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Page
COVER PAGE
Introduction………………………………………………………………………………….……………………….3
Scenario……………………………………………………………………………………………………………….…4
Phenomenon………………………………………………………………………………………………………………..7
Concept Map………………………………………………..................................................................................11
Learning Objectives…………………………………………….......................................……………………..…15
Clinical Case Analysis Worksheet
Patient’s Personal Data
I. Family Background……………………………………………………………………………………..16
II. Developmental Data……………………………………………………………………………………17
III. Chief Complaints…………………………………………………………………………………………18
IV. Health History…………………………………………………………………………………………….18
V. Complete Diagnosis of the case chosen………………………………………………………19
a. Definition……………………………………………………………………………………………..19
b. Etiology………………………………………………………………………………………………..20
c. Symptomatology…………………………………………………………………………………..25
d. Anatomy and Physiology……………………………………………………………………….28
e. Pathophysiology…………………………………………………………………………………...36
VI. Medical Management………………………………………………………………………………….37
a. Laboratory Interpretation……………………………………………………………………..37
b. Effects of Food in Pregnancy……………………………………………………………….…55
VII. Nursing Management………………………………………………………………………………...59
a. Nursing Diagnosis…………………………………………………………………………………59
b. Nursing Care Plan………………………………………………………………………………….60
VIII.Evaluation and Implication of the case to………………………………………………….68
a. Nursing Practice…………………………………………………………………..…………….68
b. Nursing Education………………………………………………………………………………68
c. Nursing Theory………………………………………………………………………..…………68
d. NursingResearch………………………………………………………………………..………..…....69
IX. Recommendations/Referrals/ Follow – ups……………………………………………..69
X. Journal Reading Related to the Case (EBP Readings)……………………………….….71
XI. REFERENCES………………………………………………………………………………………….….75
APPENDIX…………………………………………………….……………………………………………….…76
INTRODUCTION
Humans have been battling virus since before. today the world is combatting against
deadly virus. And many other viruses out there that are equally deadly, and some are even
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deadlier. Meningitis can also be potentially fatal disease; it is also a significant cause of illness in
the pediatric population. According to (CDC) reports last 2018, inpatient hospitalizations resulting
from viral meningitis range from 25,000 to 50,000 each year. In this case study, talks about
aseptic/ viral meningitis. - the most common form of meningitis in many countries. It is an
infection of the cerebral meninges. Viral meningitis typically presents with the acute onset of
fever, headache, photophobia, neck stiffness, and often nausea and vomiting. This is an acute, self-
limited, benign disease, although symptoms may be severe.
With our patient John, A 15-year-old male adolescent presented to the emergency
department (ED), with gradual-onset headache, photophobia, nausea, neck pain, sore throat, and
fever for 2 days. Prior to the diagnostic tests, and because of the increase in WBCs reflected in CBC
count and lumbar puncture findings, meningitis was determined as the diagnosis. And a Bio-Fire
Film Array polymerase chain reaction (PCR) test as part of cerebral spinal fluid testing – an
identified enterovirus as a causative pathogen.
Even though viral meningitis is less serious than bacterial meningitis, our group as a young
nursing students, aimed that this case study will provide as a reading material, and widen the
knowledge of the readers as a basis of care of a child, or person with suspected or confirmed
meningitis. By mastering its pathophysiology, its etiology, symptoms, and the nursing process
approach for the purpose of safe and effective nursing practice.
In this time of covid-19 crisis, this case analysis turned to be very challenging to us, as a
group we need to work collaboratively to achieve our goal to come out with this output. By
properly designating our assign task, we work as a team by consulting one another, coordinating
to our clinical instructor, to have the best understanding about the disease in our case study that
will help us handle effectively as a future nurse to our patients with viral meningitis.
With the acceptance and guidance from our dean of college of nursing, our clinical
instructors, we are optimistic that the content of this case study after it is presented, will become a
useful reference not only today yet also for the future.
SCENARIO
History of Present Illness

John, A 15-year-old male adolescent presented to the emergency department (ED), with
gradual-onset headache, photophobia, nausea, neck pain, sore throat, and fever for 2 days. The
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patient’s mother accompanied him to the ED when home remedies including ibuprofen and an
aspirin/caffeine combination drug were not providing relief of symptoms. The patient stated that
his pain was worsened by movement but did not radiate. He denied any alleviating factors, rating
his pain as 6 on the 0–10 numerical pain scale. The patient reported a recent respiratory illness
but denied known sick contacts or recent travel.
Allergies: no significant history.
Social history: The patient was a ninth grader, attended public school, and lived at home with his
mother, father, and a younger sister; denied alcohol, tobacco, or recreational drug use or sexual
activity.
Immunization status: The mother reported patient was current for immunizations
including the influenza vaccine received during the recent flu season.
Past surgeries: tonsillectomy and adenoidectomy.
Review of Systems General: reported fatigue and fever at home and upon presentation to the ED.
Skin: denied any rashes, lesions, wounds, or edema.
HEENT: reported headache, sore throat, and neck pain that increased with
movement. denied facial edema or disturbances/change in vision.
Respiratory: denied shortness of breath or cough.
Cardiovascular: denied chest pain and palpitations.
Gastrointestinal: denied abdominal pain, nausea, vomiting, or diarrhea; .0 . He
denied blood in stool or bowel incontinence.
Genitourinary: The patient denied urinary frequency, dysuria, urgency, retention,
incontinence, or hematuria. He denied genital signs or symptoms.
Musculoskeletal: The patient reported generalized body aches and neck pain.
Neurological: The patient reported generalized weakness. He denied numbness,
tingling, or decrease in sensation. He complained of moderate photophobia. His
mother denied the presence of confusion, altered mental status, speech changes, or
drowsiness.
Physical Examination
General: The examination revealed a mildly obese male adolescent with fever,
tachycardia, and elevated blood pressure.
Vital signs: O2 saturation 97% on room air; blood pressure 147/80 mmHg; heart
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rate 115 beats/min and regular, respirations 18 breaths/min, regular and

unlabored, an oral temperature of 103.8 °F (39.9 °C), weight 143 lb (99.8 kg),
height 5 ft 6 in. (166 cm), and body mass index of 31.
Skin: Capillary refill less than 2 s.
HEENT: Minimal cerumen noted. Trachea midline. No palpable lymphadenopathy
noted. Nuchal rigidity noted.
Respiratory: No signs of respiratory distress noted. Respirations regular and
unlabored.
Cardiovascular: Tachycardic with regular rhythm. Plus 2 radial and pedal pulses
noted.
Gastrointestinal: Normoactive bowel sounds present in all four quadrants. Negative
for Murphy’s and Rovsing’s signs; nontender at McBurney’s point.
Musculoskeletal: Equal grip and strength globally of extremities.
Neurological: Alert and oriented times four. Cranial nerves II–XII intact. Normal
sensation with 2-point discrimination. Deep tendon reflexes brisk and intact. Steady
gait and station. Positive Brudzinski’s and Kernig’s signs elicited.
Diagnosis
Rapid Strep and influenza tests - negative.
Complete blood cell (CBC) count
 white blood cell (WBC) count - 14,000 per cubic millimeter (mm3) of blood
 Lymphocytes - 46% lymphocytes
 Neutrophils - 52% neutrophils
Comprehensive metabolic panel (CMP) – normal
Blood cultures × 2 – obtained (yet no results)
Routine chest radiographs -no obvious source of infections
Urinalysis - no obvious source of infection.
Head computed tomographic (CT) scan without contrast - unremarkable for edema,
hemorrhage, or other neurological disorders.
Based on presenting symptoms, history, and physical examination findings, a clinical
diagnosis of meningitis was suspected.
Lumbar puncture (LP) Results
 increased WBC count of 178 per mm3
 with lymphocyte predominance
 slightly low glucose concentrations
 slightly elevated protein concentration
 negative Gram stain.
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Because of the increase in WBCs reflected in CBC count and LP findings, meningitis was
determined as the diagnosis. As part of CSF testing:
Bio-Fire Film Array polymerase chain reaction (PCR) test - identified enterovirus as the
infective pathogen.
PHENOMENON
PERSONAL DATA:
Name: John
Age: 15-year-old
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Gender: Male
Educational Attainment: 9th grade
Weight 143 lb (99.8kg),
Height 5ft 6 in. (166cm),
BMI: 31 (Mildly Obese)
AT THE EMERGENCY DEPARTMENT (ACCOMPANIED BY THE MOTHER)
Chief Complaint:
 gradual-onset headache
 moderate photophobia
 nausea
 generalized body aches and weakness
 neck pain increases with movement
 pain was worsened by movement but did not radiate, pain scale 6/10
 sore throat
 fatigue and fever at home for 2 days
Medicine Taken at Home:

 Ibuprofen
 Aspirin
 Caffeine combination.
Health History:
 No significant Allergies
 With Current Immunization of influenza vaccine during recent flu season.
 Status post: Tonsillectomy and Adenoidectomy
UPON ASSESSMENT PATIENT DENIED THE FF:

 Social:
 Recent travel history
 Use of alcohol, tobacco, recreational drug and sexual activity
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 Skin:
 Rashes
 Lesions
 Wound
 Facial edema
 HEENT:
 Disturbances/ change in vision
 Respiratory:
 Shortness of breath
 Cough
 Recent contact with known respiratory illness
 Cardiovascular:
 Chest pain and palpation's
 Gastrointestinal:
 Abdominal pain
 Vomiting
 Diarrhea
 Nausea
 Blood in stool or bowel continence
 Genitourinary:
 Urinary frequency
 Dysuria
 Urgency
 Retention
 Hematuria incontinence
 Genital signs or symptoms
 Neurological:
 Numbness
 Tingling or Decrease sensation
UPON ASSESSMENT THE MOTHER DENIED THE FF:

 Presence of confusion
 Altered mental status
 Speech changes
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 Drowsiness
PHYSICAL EXAMINATION:
 General:
 Fever
 Cardiovascular:
 Tachycardia with regular rhythm
 Plus 2 radial and pedal pulses noted
 Elevated blood pressure
 Skin:
 Capillary refill less than 2seconds
 HEENT:
 Minimal cerumen noted
 Trachea midline
 No palpable lymphadenopathy
 Nuchal rigidity noted
 Respiratory:
 No signs of respiratory distress noted
 Respiration regular and unlabored
 Normoactive bowel sounds present in all four quadrants
 Negative for Murphy's and Rovsing's signs: non-tender at McBurney's point
 Musculoskeletal:
 Equal grip and strength globally of extremities
 Neurological:
 Alert and oriented times four
 Cranial nerves II-IX intact
 Normal sensation with 2-point discrimination
 Deep tender reflexes brisk and intact
 Steady gait and station
 Positive Brudzinski's and Kernig's signs elicited.
VITAL SIGNS:
 O2 saturation 97% on room air
 blood pressure 147/80 mmHg
 heart rate 115 beats/mins and regular
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 respirations 18 breaths/min, regular and unlabored

 oral temperature of 103.8F (39.9C)
LABORATORY TEST RESULTS:

 Rapid Strep and Influenza tests-negative
 Comprehensive metabolic panel (CMP)- normal
 Blood culture x2- obtained (no results yet)
 Complete blood cells (CBC)count.
 White blood cells (WBC)count- 14,000 per cubic millimeter(mm3) of blood
 Lymphocytes- 46% lymphocytes
 Neutrophils- 52% neutrophils
 Routine chest radiographs- no obvious source of infection.
 Head computed tomographic (CT)scan without contrast- unremarkable for edema,
hemorrhage, or other neurological disorders.
 Urinalysis- no obvious source of infection.
Based on presenting symptoms, history and physical examination findings, a clinical

diagnosis of meningitis was suspected, then the physician ordered for lumbar puncture.
 Lumbar puncture (LP)Results:
 Increased WBC count of 178 per mm3
 With lymphocytes predominance
 Slightly low glucose concentrations
 Negative gram stain.
Because of the increase in WBC reflected in CBC count and LP findings, meningitis was
determined as the diagnosis. As part of CSF testing, then the physician ordered for PCR test.
 Bio-Fire Film Array polymerase chain reaction (PCR)test- identified enterovirus as the
infective pathogen.
Name: John
CONCEPT MAP
Age: 15-year-old
Gender: Male
Educational Attainment: 9th grade
Weight 143 lb. (99.8kg),
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Height 5ft 6 in. (166cm),
BMI: 31 (Mildly Obese)
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AT THE EMERGENCY DEPARTMENT (ACCOMPANIED BY THE MOTHER)
Chief Complaint:
 nausea
 pain was worsened by movement but
did not radiate, pain scale 6/10
 sore throat
Medicine Taken at Home:

 Ibuprofen
 Aspirin
 Caffeine combination
Health History:
 No significant Allergies
 With Current Immunization of influenza
vaccine during recent flu season.
 Status post: Tonsillectomy and
Adenoidectomy
UPON ASSESSMENT PATIENT DENIED THE FF:
 Social:
 Recent travel history
 Use of alcohol, tobacco, recreational drug
and sexual activity
 Skin:
 Rashes
 Lesions
 Wound
 Facial edema 11
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 HEENT:
 disturbances/ change in vision.
 Respiratory:
 Shortness of breath
 Cough
 Cardiovascular:
 Chest pain and palpation's
 Abdominal pain
 Vomiting
 Diarrhea
 Nausea
 Blood in stool or bowel continence
 Genitourinary:
 Urinary frequency
 Dysuria
 Urgency
 Retention
 Hematuria
 Genital signs and symptoms
 Neurological:
 Numbness
 Tingling
 Decrease sensation
UPON ASSESSMENT THE MOTHER DENIED THE FF.
 Presence of confusion
 Altered mental status
 Speech changes
 Drowsiness
PHYSICAL ASSESSMENT
 General:
 Cardiovascular:  Fever

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 Plus 2 radial and pedal pulses
noted
 Elevated Blood Pressure
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 Skin:
 Capillary refill less than 2 seconds
 HEENT:
 Trachea midline
 Respiratory:
 Normoactive bowel sounds present in all
four quadrants
 Negative for Murphy's and Rovsing's signs:
non-tender at McBurney's point
 Equal grip and strength globally of
extremities
 Neurological:
 Positive Brudzinski's and Kernig's signs
elicited.
VITAL SIGNS

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 respirations 18 breaths/min, regular
and unlabored
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LABORATORY TEST RESULTS
 Rapid Strep and Influenza tests-negative

 Complete blood cells (CBC)count.
 White blood cells (WBC)count- 14,000 per
cubic millimeter(mm3) of blood
 Lymphocytes- 46% lymphocytes
 Neutrophils- 52% neutrophils
 Comprehensive metabolic panel (CMP)-
normal
 Blood culture x2- obtained (no results yet)
 Routine chest radiographs- no obvious
source of infection.
 Urinalysis- no obvious source of infection.
 Head computed tomographic (CT)scan
without contrast- unremarkable for edema,
hemorrhage, or other neurological disorders
Based on presenting symptoms, history and physical examination

findings, a clinical diagnosis of meningitis was suspected.
 Lumbar puncture (LP)Results:

 Increased WBC count of 178 per mm3
 With lymphocytes predominance
 Slightly low glucose concentrations
 Negative gram stain.
Because of the increase in WBC reflected in CBC count and LP findings, meningitis was
determined as the diagnosis. As part of CSF testing, then the physician ordered for PCR test
 Bio-Fire Film Array polymerase chain reaction PCR

test- identified enterovirus as the infective pathogen.
LEARNING OBJECTIVES
General Objectives:
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After the completion and presentation of this clinical case study, the learners will be able to
acquire knowledge and skills in the nursing care management of a 15-year-old obese male with
viral meningitis. Specifically, the learners will:
1. discuss the phenomenon and concept map of the scenario.

2. obtain family background of the patient.
3. discuss the developmental data of the patient.
4. define terms related to the case.
5. discuss the basic etiology and symptomatology
6. review the anatomy and physiology of the nervous system.
7. explain the laboratory test performed to the patient and other basic laboratory test.
8. discuss the drugs administered to the patient.
9. identify priority nursing diagnosis for the patient.
10. develop nursing care plan according to the needs of the patient
11. discuss the implications of this case in nursing practice, education, research and nursing
theory application.
12. enumerate the recommendation/referral/follow-ups.
13. discuss journal of an evidence-based practice research related to our case.
CLINICAL CASE ANALYSIS WORKSHEET

CONCEPT: PEECLAMPSIA
PATIENT’S PERSONAL DATA:

Name (optional): John Age: 15 years old Sex: Male
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Height: 5 ft 6 in. (166 cm) Weight: 143 lb. (99.8 kg) BMI: 31 (mildly obese)
Educational background: Ninth grader, attended public school
I. FAMILY BACKGROUND:
 Number of Siblings: 2
PHYSICAL EXAMINATION:
 General:
 Fever
 Cardiovascular:
 Plus 2 radial and pedal pulses noted
 Elevated blood pressure
 Skin:
 Capillary refill less than 2 seconds
 HEENT:
 Trachea midline
 Respiratory:
 Normoactive bowel sounds present in all four quadrants
 Negative for Murphy's and Rovsing's signs: non-tender at McBurney's point
 Equal grip and strength globally of extremities
 Neurological:
 Positive Brudzinski's and Kernig's signs elicited.
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VITAL SIGNS:
 respirations 18 breaths/min, regular and unlabored
 Rating his pain as 6 on the 0–10 numerical pain scale
II. DEVELOPMENTAL DATA: Specify the Stage.

(Based on Havighurst’s and Erikson’s Life and Developmental Task/Psycho-Social).
Havighurst developmental data:(ADOLESCENCE 13 to 18 years old)
This developmental task the teenager is adjusting to some hormonal changes, achieving new
and more relation with age-mate of both sexes, desiring and achieving socially responsible
behavior and learning about who they are as individual.
Erick Erickson the Developmental task: (Identity versus Role Confusion 13 to 21 years old).
The fifth psychosocial stage takes place during the often-turbulent teenage years. This stage
plays an essential role in developing a sense of personal identity which will continue to influence
behavior and development for the rest of a person’s life.
During Adolescence, children explore their independence and develop a sense of self. Those
who Receive proper encouragement and reinforcement through personal exploration will emerge
from this stage with a strong sense of self and feelings of Independence and control. Those who
remain unsure of their beliefs and desires will feel insecure and confused about themselves and
the future.
When psychologist talk about identity, they are referring to all of the beliefs, ideals, and values
that help shape and guide a person’s behavior. Completing this stage successfully leads to fidelity,
which Erikson described as an ability to live by society’s standard and expectations. Ego identity is
the conscious sense of self that we develop through social interaction and becomes central focus
during the identity versus confusion stage of psycho-social development. our ego identity
constantly changes due to new experiences and information we acquire in our daily interactions
with others.
In our case, Patient John, a 15-year-old male adolescent, a ninth grader attended in a public
school and lives with his parent and sister. He was mildly obese and also presented himself to the
emergency departure along with his mother. During adolescence, life is getting more complicated
as they are going through a phase of changing from a child to being an adult. At this rate,
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adolescent begin to have the feeling of acquiring identity and certainly of who they are, the
concern about their social identity and which group they belong. As stated by the social history of
the Patient, “denied alcohol, tobacco or recreational drug use and sexually activity”. John actually
made a commitment without attempting any other identity exploration. However, without enough
exploration adolescents like John are likely to fail from creating a positive path because the
experience they have obtained is not helping at all. As a result, he will remain confused about his
identity and thus malignancy arise.
III. CHIEF COMPLAINTS:
 nausea
 pain was worsened by movement but did not radiate, pain scale 6/10
 sore throat
IV. HEALTH HISTORY:

Past illness/Surgery:
 Status Post Ttonsillectomy and adenoidectomy
 Recent immunization of influenza vaccine during flu season
Inclusive Period of Hospitalization: N/A
Present Illness:
 viral meningitis
 URTI
V. COMPLETE DIAGNOSIS OF THE CASE CHOSEN
a. Definition (at least 2 Definition with Bibliography)
Meningitis
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 Is an inflammation of the meninges (membrane surrounding the brain and the spinal cord)
and is caused by a viral, bacterial or fungal organism.
 An inflammation of the meninges of the brain and the spinal cord, most often caused by a
bacteria or viral infection and characterized by fever, vomiting, intense headache and stiff
neck.
Smeltzer, Suzanne C. and Bare, Brenda G.Lippincott. Brunner and Suddarth’s Textbook of
MEDICAL-SURGICAL NURSING. Eight Edition. Chapter 60, Page 1761.
The American Heritage.Dictionary of the English Language.Third Edition. Page 1127.
2. Viral meningitis
 Caused by a virus that specifically infects the meninges, or may be the result of an immune
reaction to a virus that does not specifically infect the brain (e.g chickenpox, measles and rubella
viruses).
 Can be distinguish from bacterial meningitis because it produces a milder disease, a low to
moderate inflammatory reaction in the CSF consisting primarily of lymphocytes.
Engelkirk, Paul G. Engelkirk, Janet Duben and Fader, Robert.Burton’s. MICROBIOLOGY for
the Health Sciences. Eleventh Edition. Chapter 17, Page 331.
M. Schaechter. G. Medoff. D. Schlessinger. Mechanism of Microbial Disease. Page 661.
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b. Etiology
List all the Basic Etiology Actual Etiology on Rationale (Include the reference as endnote)
the Patient
1. VIRUS  is more common than the bacterial form and generally -- but not always -- less
/
serious. A number of viruses can trigger the disease, including several that can cause
diarrhea.
/
 ENTEROVIRUS  live in the human gastro-intestinal tract and shed in the faeces it is transmitted faecal-
orally. Often spread through direct contact with respiratory secretions.
(www.nicd.ac.za.>files>nicd enterovirusFAQ_20160128 (1).pdf¿
 ARBOVIRUS  most commonly mosquitoes or other insects acquired arboviruses by biting infected
birds which are often have prolonged viremia without illness.
(Berhman, Richard E., Victor C. Vaughan, Nelson Textbook of Paediatrics, 13 th edition)
 occurs during primary contact with the virus or earlier primary infection may be due
 HERPES SIMPLEX VIRUS- 1&2- to type 1(oral) or type 2 (genital).
 aseptic meningitis maybe cause by HIV-1 itself. An early form of aseptic, HIV associate
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 HUMAN IMMUNODEFICIENCY meningitis develops within days to weeks after HIV infection.
VIRUS (Kulpa, L., etal., etiology of aseptic meningitis an encephalitis in an adult population.
Neurology 2006,66 (1); p. 75-80)
 capable of secluding itself in spinal and cranial nerve roots and ganglia as a latent or
 VARICELLA-ZOSTER VIRRUS suppressed infection, to express itself as later herpes zoster.
 may remain latent in various tissues and in leukocytes therefore, blood transfusion
maybe responsible for transmission of disease.
 CYTOMEGALOVIRUS (Berhman, Richard E., Victor C. Vaughan, Nelson Textbook of Paediatrics, 13 th edition)
 may occur during infectious mononucleosis but it also occur without hematologic
changes. There is no evidence that it may become latent in the nervous system.
 EPSTEIN-BARR VIRUS (Berhman, Richard E., Victor C. Vaughan, Nelson Textbook of Paediatrics, 13 th edition)
 viral meningitis occurs if mumps virus spreads into the outer protective layer of the
brain (the meninges)
 MUMPS (www.nhs.uk)
 Passed person to person or picked up from items touched by infection people and
then initially invade cells in the eye, nose or mouth. That subsequently allows further
spread to other body organs.
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 ADENO VIRUS (Charles Patrick Davis, MD,Phd & John P. Cunha, DO. FACOEP medicinenet.com)
 member of genus mammarenavirus and family avenavtridae. There are many viral
strains, which can differ in virulence.
(Armstrong’s Disease, Callitriechid Hepatitis available @: www. Cfsph.iastate.edu).
 LYMPHOCYTIC  Occurs by ingestion of EMCV- contaminated food, water & diseased careasses.
CHORIOMENINGITIS
(Margot Carocci & Labib Bakkali kassimi available @: ncbi. nlh. gov
 ENCEPHALOMYOCRDIA  reported in connection with serious lower respiratory tract disease. They may
precipitate asthma in children and chronic bronchitis in adult.
 RHIRO VIRUS
 suppresses the immune system. It has been associated with complications in very
organ of the body including pneumonia, febrile seizures and inflammation of the
brain and spinal cord. Which can cause nervous system damage.
 MEASLES VIRUS (Berhman, Richard E., Victor C. Vaughan, Nelson Textbook of Paediatrics, 13 th edition)
 a virus carried on droplets from in effected persons coughs and sneezes or in a blood
stream to the fetus of a pregnant woman.
(lowa department of public health).
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 RUBELLA  result of point mutation: allows a growth advantages in the presence of antibody.
Antigenic shift may arise by recombination between human and animal influenza
viruses during chance simultaneous infections.
 INFLUENZA VIRUS
 anoxia associated with pneumonia can result in brain damage.
 contaminated formities enable to transcript pathogens.

 PARAINFLUENZA VIRUS (Berhman, Richard E., Victor C. Vaughan, Nelson Textbook of Paediatrics, 13 th edition)
 a person with weak immune system is unlikely to get infected.
 ROTAVIRUS (medline.gov)
 It's an extremely serious illness. You or your child will need to get medical help right
 LIVE IRUS VACCINE away. It can be life-threatening or lead to brain damage unless you get quick
treatment
 Usually begins with oropharyngeal colonization and progresses to bloodstream
1. BACTERIAL INFECTIONS invasion and finally penetrates the blood barrier.
(brunner and suddarth’s textbook of medical-surgical nursing)
 Neissaria meningitis
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 Often cause severe, rapidly progressive illness in previously healthy host.

 Streptococcus pneumonae (in  Due to close contact with other children who are carriers or have serious H.
adults) influenzae disease
 Haemophilus influenzae (in
children and young adults)  Develop after a fungus spreads through the bloodstream from somewhere else in the
body, as a result of the fungus being introduced directly into the CNS.
(Charles P. Davis, MD, PhD available at medicinenet.com)
1. FUNGAL INFECTIONS
 is a form of meningitis characterized by inflammation of the membranes (meninges)
around the brain or spinal cord and caused by a specific bacterium known as
Mycobacterium Tuberculosis.
2. Tuberculous Meningitis (TBM)
c. Symptomatology
List all the Basic Actual Rationale (Include the reference as endnote)
Symptomatology Symptomatology
on the Patient
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Headache /  Are frequently the initial symptoms, the headache associated with meningitis is usually
severe and is the result of meningeal irritation.
(Smeltzer, Suzanne C., Brenda G. Bare, Brunner and Suddarth's Textbook of Medical-Surgical
Nursing, 8th Edition, P. 1762)
Photophobia /  Light sensitivity is a condition in which bright lights hurt your eyes, The Intracranial
condition such as meningeal irritation due to basal meninges especially around the
diaphragma sellae.
Stiff Neck /  is an early sign, any attempts at flexion of the head are difficult because of the presence of
spasm in the muscle of the neck. Forceful flexion causes severe pain.
Positive Kernig's Sign  When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely.
Had restriction in passive extension, because of spasm of the hamstring muscles.
 When the patient's neck is flexed, flexion of the knees and hips is produced; Passive flexion of
Positive Brudzinski's Sign the neck stretches the nerve roots through the inflamed meninges. Leading to pain and flexion
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movement of lower extremities.

 is generally present and remains high throughout the course of the illness, due to
/
Fever inflammatory response of immune system to combat the microorganism that causes infection.
 One of the striking features of meningococcal meningitis, reproduce in the bloodstream and
release poisons (septicemia), the infection progresses blood vessel can become damaged.
Skin Rash (Smeltzer, Suzanne C., Brenda G. Bare, Brunner and Suddarth's Textbook of Medical-Surgical
 Disorientation and memory impairment are common early in the course of the illness. The
changes that occur are dependent on the severity of illness as well as the individual response
Changes in level of to the physiologic processes.
consciousness (Smeltzer, Suzanne C., Brenda G. Bare, Brunner and Suddarth's Textbook of Medical-Surgical
 Seizures occur secondary to focal areas of cortical irritability. Signs of increasing ICP
secondary to purulent exudate or cerebral edema include the characteristic vital sign changes,
respiratory irregularity, headache, vomiting, and depressed levels of consciousness.
Seizure and increased ICP (Smeltzer, Suzanne C., Brenda G. Bare, Brunner and Suddarth's Textbook of Medical-Surgical
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 Patients with meningococcal meningitis, with signs of overwhelming septicemia. An abrupt

onset of high fever, extensive purpuric lesions over the face and extremities, shock, and signs
of disseminated intravascular coagulopathy.
Fulminating Infection (Smeltzer, Suzanne C., Brenda G. Bare, Brunner and Suddarth's Textbook of Medical-Surgical
 Pharyngitis is a viral infection, such as a cold or the flu. A sore throat caused by a enterovirus
revolves on its own.
/
Sore throat Nursing, 8th Edition, P. 1762)
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d. Anatomy and Physiology (Organ or System Involved)
The nervous system is the major controlling, regulatory, and communicating system in the body. It
is the center of all mental activity including thought, learning, and memory. Together with the
endocrine system, the nervous system is responsible for regulating and maintaining homeostasis.
Through its receptors, the nervous system keeps us in touch with our environment, both external
and internal.
The nervous system may be divided into the central nervous system (CNS), consisting of the brain
and spinal cord, and the peripheral nervous system (PNS), consisting of all nervous tissue outside
the brain and spinal cord.
The sensory division of the PNS transmits action potentials to the CNS; the motor division carries
action potentials away from the CNS.
Neurons
Cells of the Nervous System
Neurons
 Neurons receive stimuli and conduct action potentials. A neuron consists of a cell body,
dendrites, and an axon.
 Neurons are multipolar, bipolar, or pseudo-unipolar.
Glial cells
Glial cells are the support cells of the nervous system. They include astrocytes, ependymal cells,
microglia, oligodendrocytes, and Schwann cells.
Myelin Sheaths - Axons are either unmyelinated or myelinated.
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Organization of Nervous Tissue
Nervous tissue consists of white matter and gray matter. Gray matter forms the cortex and nuclei
in the brain and ganglia in the PNS. White matter forms nerve tracts in the CNS and nerves in the
PNS.
Brain
The human brain is the

central organ of the human nervous system, and with the spinal cord makes up the central
nervous system. The brain is consist of the cerebrum, the brainstem and the cerebellum. It
controls most of the activities of the body, processing, integrating, and coordinating the
information it receives from the sense organs, and making decisions as to the instructions sent to
Cerebrum
The cerebrum is the largest part of the brain. It is divided into left and right hemispheres by a
longitudinal fissure. Each cerebral hemisphere is further divided into lobes with specialized
functions.
Brainstem
The brainstem consist of medulla oblongata, the pons, and the midbrain. The brainstem contains
several nuclei involve in vital body functions, such as the control of the heart rate, blood pressure,
and breathing.
 The medulla oblongata contains nuclei that control activities such as heart rate, breathing,
swallowing, and balance.
 The pons contains relay nuclei between the cerebrum and cerebellum.
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 The midbrain is involved in hearing and in visual reflexes.
Cerebellum
The cerebellum is under the cerebrum and dorsal to the pons and medulla. Like cerebrum, it is
divided into two hemispheres. It helps to control voluntary muscle movements and to maintain
posture, coordination, and balance.
Diencephalon
The diencephalon is the part of the brain between the brainstem and the cerebrum. Its consists of
thalamus, the epithalamus, and the hypothalamus.
 Thalamus (main sensory relay center)

 Epithalamus (the pineal gland may play a role in sexual maturation)
 Hypothalamus (important in maintaining homeostasis)
Sensory function
Ascending tracts - transmit action potentials from the periphery to the brain. Each tract caries a
specific type of sensory information.
Sensory areas of the cerebral cortex
 Ascending tracts project to primary sensory areas of the cerebral cortex.

 Association areas are involved in recognizing the sensory input.
Descending tracts- project directly from upper motor neurons in the cerebral cortex to lower
motor neurons in the spinal cord and brainstem; indirectly, they project from basal nuclei, the
cerebellum, or the cerebral cortex through the brainstem to lower motor neurons in the spinal
cord.
Basal nuclei
 Basal nuclei help plan, organize, and coordinate motor movements and posture.
 People with basal nuclei disorders exhibits increased muscle tone and exaggerated,
uncontrolled movements when at rest.
Cerebellum
 The cerebellum is involved in balance, muscle tone, and muscle coordination.

 Through its comparator function, the cerebellum compares the intended action to what is
occurring and modifies the action to eliminate differences.
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Other brain functions

Communication between the right and left hemispheres
 Each hemisphere controls the opposite half of the body,

 Commissures connect the two hemispheres.
 The left hemisphere is thought to be the dominant analytical hemisphere, and the right
hemisphere is thought to be dominant for spatial perception and musical ability.
Speech
Speech involves the sensory speech area, the motor speech area, and the interactions between
them and other cortical areas.
Brain waves and consciousness
An EEG monitors brain waves, which are a summation of the electrical activity of the brain.
Memory
 Working (lasting a few seconds to minutes).

 Short-term ( lasting a few minutes)
 Long-term (permanent) memory.
Limbic System and Emotions
 The limbic system includes the olfactory cortex, deep cortical regions, and nuclei.
 The limbic system is involved with memory, motivation, mood, and other visceral function.
Olfactory stimulation is a major influence.
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Spinal cord
The spinal cord extends from the foramen magnum at the base of the skull to the second lumbar
vertebra. It has a central area of gray matter surrounded by white matter. The gray matter
projects toward the back and front as the dorsal and ventral horns. The white matter contains the
ascending and descending tracts (fiber bundles) that carry impulses to and from the brain.
Spinal nerves
 The spinal nerves exit the vertebral column at the cervical, thoracic, lumbar, and sacral
regions.
 The nerves are grouped into plexuses.
 The phrenic nerve, which supplies the diaphragm, is the most important branch of the
cervical plexus.
 The brachial plexus supplies nerves to the upper limb.
 The lumbosacral plexus supplies nerves to the lower limb.
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Nerves
A collection of cell bodies along the pathway of a nerve is a ganglion. A few nerves (sensory
nerves) contain only sensory neurons and a few (motor nerves) contain only motor neurons, but
most contain both types of fibers and are described as mixed nerves.
Meninges
The three connective tissue membranes surround and protect the brain and spinal cord from
mechanical trauma to support blood vessels and to form a continuous through which
cerebrospinal fluid (CSF) passes
 Dura meter consist of two layers and physically separated into dural folds and dural
venous sinuses. The folds hold the brain in place within the skull. The dural venous sinuses
collect blood from the small veins of the brain and empty into the internal jugular veins,
which exit the skull.
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 Arachnoid is the second meningeal membrane is the very thin. The space between the
dura mater and the arachnoid is the subdural space, which is normally only a potential
space obtaining a very small amount of serous fluid.
 Pia mater it is very tightly bound to the surface of the brain and spinal cord. Between the
arachnoid and mater and pia mater is the subarachnoid space, which is filled with
cerebrospinal fluid and contains blood vessels.
Ventricles
 The brain and spinal cord contain fluid-filled cavities; the lateral ventricles in the cerebral
hemispheres, a third ventricle in the diencephalon, a cerebral aqueduct in the midbrain, a
fourth ventricle at the base of the cerebellum, and a central canal in the spinal cord.
Cerebrospinal Fluid
Cerebrospinal fluid (CSF) is formed in the choroid plexuses in the ventricles. It exits through the
fourth ventricle and re-enters the blood through arachnoid granulations in the superior sagittal
sinus.
Cranial nerves
The cranial nerves are a set of 12 paired nerves that arise directly from the brain. There are two
general categories of cranial nerve functions: sensory and motor. Sensory functions can be divided
into the special senses, such as vision, touch and pain in the face. Motor functions are subdivided
into somatic and parasympathetic. Somatic cranial nerves innervate skeletal muscles in the head
and neck and parasympathetic cranial nerves innervates glands, smooth muscles throughout the
body, cardiac muscle of the heart.
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Autonomic Nervous System
The autonomic nervous system Is the division of the nervous system that controls the involuntary
actions of muscles and glands. The ANS has two division the sympathetic and parasympathetic
nervous system.
 Sympathetic Division motivates our response to stress, the so-called ‘’fight-or-flight’’

response. It increase heart rate and respiration rate, stimulates the adrenal glands, and
delivers more blood to skeletal muscles.
Parasympathetic Division returns the body to a steady state and stimulates maintenance activities,
such as digestion of food. Most organs are controlled by both systems and, in
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e. Pathophysiology
PREDESPOSING FACTOR PRECIPITATING FACTOR
15 YEARS OLD MALE RECENT RESPIRATOY ILLNESS

OBESE LIFESTYLE
VIRUS
Mode of (Enterovirus)
transmission
Fecal Oral Respiratory
Contamination (inhalation)
(GIT)
Upper
Respiratory Sore
Tract throat
(URI)
Once the virus is inside

the body the viruse
make copy of
themselves
Bloodstream
Viruse travel through

bloodstream to the brain
Viruse crosses the border between

bloodstream to the brain into the CSF
The viruses spread throughout the

CSF & infect the cell of meninges
Signs and Irritation and Laboratory test

symptoms Inflammation of the
Meninges  CBC
 Headache  LP
 Photophobia  PCR
Infection of the
 Nausea (Enterovirus)
meninges
 Neck pain
 Fever
Viral Meningitis
Anti-inflammatory drug
(There’s no specific treatment for
most viruses that can cause
meningitis)
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\VI. MEDICAL MANAGEMEN

T
a. Laboratory Interpreta tion
Basic Diagnostic
Procedures Required Purpose / Rationale Result of the Clinical Significance Nursing Responsibilities
with Normal Values Patient
Routine chest  Ageneral screening  Done  Normal lung fields, cardiac  Identify the patient before providing care,
radiographs tool for general  No obvious size, mediastinal structures, treatment, or services.
physical examinations source of thoracic spine, ribs, and  Inform the patient to the procedure,
 provides information infection diaphragm. assesses cardiopulmonary status.
regarding the  Obtain a history of the patient’s symptoms,
anatomic location and  Abnormal findings in complaints and other surgery and diagnostic
abnormalities of the Atelectasis, Bronchitis, procedure, including a list of known allergy.
heart, great vessels, Curvature of the spinal  Position the chest with the left side against
lungs, soft tissue of column (scoliosis), the image holder for a lateral view.
the chest and  Enlarged heart,  For portable examinations, elevate the head
mediastinum, and the enlarged lymph of the bed to the high Fowler’s position.
bones. nodes, Flattened  Ask the patient to inhale deeply and hold his
diaphragm. or her breath while the x-ray images are
 Foreign bodies lodged taken, and then to exhale after the images
in the pulmonary are taken.
system, Fractures of
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the sternum, ribs, and

spine.
 Lung pathology,
including tumors,
Malposition of tubes
or wires, Mediastinal
tumor and pathology,
Pericardial effusion,
Pericarditis, Pleural
effusion, Pneumonia,
Pneumothorax,
Pulmonary bases,
fibrosis, infiltrates,
Tuberculosis,
Vascular
abnormalities.
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Basic Diagnostic
Comprehensive  A blood test, to tract of  Done  Explain the procedure to the patient.
 The normal range is 70-99
Metabolic Panel any chronic condition  Normal  Assist the patient in the comfortable position.
mg/dL. High glucose result
(CMP) to provides information  During the procedure ask the patient to relax
cause Diabetes, if low result
in the blood sugar while the procedure is going on.
cause hypoglycemia.
(glucose) levels, the  Explain to the patient and family members
 Abnormal result of CMP
balance of electrolytes about the present condition.
electrolyte test are heart
and fluid as well as the
disease, kidney disease,
health of the kidneys
dehydrated.
and liver.
 High level of ALP, ALT, AST
and bilirubin can be sign of
a liver problem.
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Basic Diagnostic
Procedures Purpose / Rationale Result of the Patient Clinical Significance Nursing Responsibilities
Required with
Normal Values
 A noninvasive  Done  Assess if the patient is close to phobic to

Computed  Normal size, position, and
avoid injury during the scan.
procedure used that to  Unremarkable for
Tomography (CT) shape of intracranial  Identify and Inform the patient that the
assist in diagnosing edema,
Scan structures and vascular procedure assesses the brain.
abnormalities of the hemorrhage, or
system.  Obtain a history of the patient’s
head, brain tissue, other neurological
musculoskeletal system, symptoms, and
cerebrospinal fluid, disorders  Abnormal findings in: results of previously performed
and blood circulation. Abscess, Aneurysm, AVMs, laboratory tests and diagnostic and
Cerebral atrophy, Cerebral surgical procedures.
edema, Cerebral infarction,  Ensure results of coagulation testing are
Congenital abnormalities, obtained and recorded prior to the
Craniopharyngioma, Cysts, procedure; BUN and creatinine results
Hematomas (e.g., epidural, are also needed if contrast medium is to
subdural, intracerebral) be used.
Hemorrhage,  Note any recent procedures that can
Hydrocephaly, increased interfere with test results, including
intracranial pressure or examinations using barium iodine-based
trauma Infection, Sclerotic contrast medium. Ensure that barium
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plaques suggesting studies were performed more than 4

multiple sclerosis, Tumor, days before the CT scan.
Ventricular or tissue
displacement
Basic Diagnostic
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 Is a test that check for  Done  Explain to the patient that the blood culture
Blood culture  If you get a "positive" result
foreign invaders like -yet no result procedure is used to help identify the
on your blood test, the
bacteria, yeast, and organism causing his symptoms.
bacteria is present or yeast
other microorganisms  Inform the patient that he doesn’t need to
in your blood.
in your body, to detect restrict food and fluids.
 Negative means there's no
an infection in the  Advise the patient that he may experience
sign of them.
blood and identify the slight discomfort from the tourniquet and
 Increasing the volume of
cause. needle punctures.
blood cultured is suspected
 Call the physician if there are signs of infection
bacteremia may yield more
at the culture site: increasing pain, redness,
positive cultures.
swelling, purulent drainage,or fever.
Basic Diagnostic
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 A test to measure the

Lumbar puncture  Done  Appearance: Clear  Asses the client vital signs.
pressure around the
-Increased Opening pressure: 10-20 cm H2  Maintain the regular eating schedule. There
brain and spinal cord,
WBC count of O are no dietary or fluid restrictions before the
to assist in the
178 per mm3  WBC count: 0-5 cells/µL (< 2 test.
diagnosis of primary or
-With polymorphonucleocytes  Ask the doctor for specific guidelines about
metastatic brain or
lymphocyte [PMN]); normal cell counts discontinuing alcohol use, aspirin products,
spinal cord neoplasm,
predominance do not rule out meningitis or and blood-thinning drugs before the
cerebral hemorrhage,
-slightly low any other pathology procedure
meningitis, and others.
glucose  High WBC can cause damage  Check for any allergic reaction to latex or any
concentrations to spinal cord nerves, low medications.
-slightly WBC may indicate infection,  Tell the patient that should not drive
elevated inflammation or bleeding immediately after the test and make
protein into the cerebrospinal fluid. arrangements for transportation.
concentration  Glucose level: >60% of
-negative Gram serum glucose
stain  High glucose level can cause
damage to the small blood
vessels, low glucose level
can cause bacterial
infections, and tumors.
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 Protein level: < 45 mg/dL

 Increased protein level may
be a sign of a tumor,
bleeding, nerve
inflammation, or injury, a
decreased protein level in
the body is rapidly
producing spinal fluid.
Basic Diagnostic
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Polymerase chain  Is a laboratory  Done  A positive PRC test result  Assess the sign and symptoms of viral
reaction (PCR) test technique used to make -identified indicates the presence of meningitis.
multiple copies of enterovirus pathogen genetic material  Explain the procedure to the patient and Asses
segment of DNA as the but does not necessarily the patient in the comfortable position.
 To enhance infective confirm active infection.  During the procedure ask the patient to relax
understanding of pathogen  A negative PRC test result while the procedure is going on.
pathogenesis and indicates the absence of  Discuss to the patient and family members
helped identify pathogen genetic material about the present condition.
infection causes fir but not necessarily rule out
disease previously active infection.
considered idiopathic.
Basic Diagnostic
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Rapid Strep and  A test to detect genetic  Done  If the test is positive, you  To accurately recover organisms, rub a
Influenza test material from group A  negative have group A Streptococcus polyester swab over both tonsils or tosillar
strep bacteria in throat in your throat and you fossae, the nasopharynx posterior to uvula,
by swab the specimens probably have an infection. and the oropharynx.
in less than 8 minutes, In that case, your doctor  Avoid contamination from the tongue and
to help quickly see will write a prescription for buccal mucosa.
whether a child's sore a 5- to 7-day course of  Administer drug therapy, as ordered.
throat is caused by a antibiotics.  Tell the pateint why it’s important to complete
strep infection vs. other  When the results of a rapid the full course of treatment even if his
germs (usually viruses) strep test are negative it symptoms go away.
that don't require means your symptoms are  Instruct patient to wash their hands regularly.
antibiotic treatment. not being caused by strep A
bacteria.
Basic Diagnostic
Procedures Purpose / Rationale Result of the Patient Clinical Significance Nursing Responsibilities
Required with
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Normal Values
Complete Blood Cell  A group of test that Done  High WBC indicate that  Explain the procedure to the patient and
(CBC) count evaluate the cells that  White blood cell the immune system is Tell the patient not to eat beets and food
circulate in blood (WBC) count working to destroy an dyes it because can discolor the urine
including RBC and -14,000 per cubic infection, it also be sign of  Ask the patient if she taking medicine
WBC, to evaluate your millimeter physical or emotional  Instruct the patient to use the cotton ball
overall health and (mm3) of blood stress. or towelette to clean urethral area
detect a variety of  Low WBC cause by viral thoroughly to prevent external bacteria
diseases and infection that temporarily from entering the specimen
conditions such as disrupt the work of bone  Give a container and let the patient void
infections anemia and marrow. into the container.
leukemia.  Label the specimen container with patient
 Lymphocytes-  Low Lymphocytes it’s identifying information and send to the
46% hard for your body to fight laboratory immediately. A delay in
infection. Examining the specimen may cause false
 High Lymphocytes the test result when bacterial determination is to
result might be evidence be made.
of infection (viral,  Note that the sample was collected.
bacterial, other) cancer of
the blood or lymphatic
system.
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 Neutrophils- 52%  Low Neutrophils fight

certain infection
especially those caused by
bacteria.
 High Neutrophils due to
increased production in
the bone marrow as with
leukemia, or due to
physical or emotional
stress.
 Eosinophils
 Decreased: stress, burn
shock; adrenocortical
hyperfunction.
 Increased: allergies,
parasitic disease, cancer
(bone, ovary, testes,
brain), phlebitis,
thrombophlebitis, asthma,
emphysema, renal disease
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(renal failure, nephrotic

syndrome).
 Basophils
 Decreased: stress,
hypersensitivity reaction,
pregnancy,
hyperthyroidism.
 Increased: inflammatory
process, leukemia, healing
stage of infection or
inflammation, acquired
hemolytic anemia.
 Monocytes
 Decreased: lymphocytic
leukemia, aplastic anemia.
 Increased: viral disease
(infectious
mononucleosis, mumps,
herpes zoster), parasitic
diseases and others.
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 Red blood cell

(RBC) count  High RBC count may be a
result of sleep apnea,
pulmonary fibrosis, and
other conditions that
cause low oxygen levels in
the blood.
 Low RBC count, symptoms
include fatigue, shortness
of breath, dizziness,
weakness, or
lightheadedness.
 Hemoglobin
 Decreased: lymphocytic
leukemia, aplastic anemia.
 Increased: viral disease
(infectious
mononucleosis, mumps,
herpes zoster), parasitic
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diseases and others.
 Hematocrit
 A higher than normal

hematocrit can indicate
dehydration.
 A lower than normal
hematocrit can indicate
an insufficient supply
of the healthy red
blood cell (anemia).
 Platelet count
 Low platelet count may

also be called
thrombocytopenia, this
condition can range from
mild to severe, depending
on its underlying cause.
 High platelet count can
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cause blood clots to

prevent a massive loss of
blood after an injury.
Basic Diagnostic
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Urinalysis test  A screening test that  Done  False-positive result are  Instruct the patient to void directly into a
gives a general  no obvious caused by false elevation; clean dry container. Sterile, disposable
indication of the source of false-negative results are containers are recommended. Women
client's overall state of infection caused by false depression. should always have a clean-catch specimen if
health as well as the  Urinary tract: UTI a microscopic examination is ordered. Feces,
health of the urinary  Measure pH; the average discharges, vaginal secretions and menstrual
tract, to measure pH, value for urine pH is 6.0 blood will contaminate the urine specimen.
ketones, protein, sugar, but it can range from 4.5-  Collect specimens form infants and young
and other reducing 8.0. Acidic is 5.0 the children into a disposable collection
substances. Alkaline 8.0 apparatus consisting of a plastic bag with an
 Ketone the result is adhesive backing around the opening that
negative it means there’s can be fastened to the perineal area or
no ketone in the blood, if around the penis to permit voiding directly
positive it means their to the bag. Depending on hospital policy, the
diabetes is not under collected urine can be transferred to an
control. appropriate specimen container.
 High protein level in urine  Cover all specimens tightly, label properly
may be a sign of kidney and send immediately to the laboratory.
disease, low level of  If a urine sample is obtained from an
protein in urine are indwelling catheter, it may be necessary to
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normal. clamp the catheter for about 15-30 minutes

 If the level of blood sugar before obtaining the sample. Clean the
is low as is normally the specimen port with antiseptic before
case, the body can aspirating the urine sample with a needle
reabsorb the sugar from and a syringe.
this fluid before the kidney  Observe standard precautions when
to be excreted as urine, handling urine specimens.
high blood sugar occurs in  If the specimen cannot be delivered to the
diabetes when untreated. laboratory or tested within an hour, it should
be refrigerated or have an appropriate
preservative added.
b. Drug Study
Ordered Bran Dosage and Mechanism of
Medicine Classification d Route of Action Indication Contraindication Side Effects Nursing Responsibilities
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Name Administration
Ibuprofen Advil May inhibit  Used to Contraindicated in CNS: dizziness, 1. Discuss 14 rights of
nonsteroidal Capsule: 200mg
prostaglandins relieve pain patients headache, giving medication
anti- Injection:
synthesis to from various hypersensitive to nervousness. 2. Assist the patient to
inflammatory 800mg/8-mL
produce anti- conditions drug and in those CV: edema, sit or lie down if the
drugs (100mg/mL)
inflammatory, such as with angioedema, fluid retention. patient feels dizzy
(NSAIDs) single-dose vials
analgesic, and headache, syndrome of nasal EENT: tinnitus and rest until
Oral drops:
antipyretic dental pain, polyps, or GI: abdominal dizziness goes away.
40mg/mL,
effects. menstrual bronchospastic pain, bloating, 3. Monitor patient for
50mg/mL/1.25Ml
cramps, reaction to aspirin constipation, sign or symptoms of
Oral suspension:
muscle aches, or other NSAIDs decreased aseptic meningitis
40mg/mL,
or arthritis. appetite, (fever, headache,
100mg/5Ml
 Used to diarrhea, sensitivity to light,
Tablets: 100mg,
reduce fever dyspepsia, vomiting) and report
200mg, 300mg,
and to relieve epigastric immediately if they
400mg, 600mg,
minor aches distress, occur.
800mg
and pain due flatulence, 4. Tell patient to take
Tablets
to the heartburn, with meals or milk to
(chewable):
common cold nausea, non- reduce adverse GI
50mg,100mg
or flu. necrotizing reactions.
enterocolitis, 5. Tell the patient to
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vomiting. contact prescriber

GU: acute renal before using this
failure, drug if fluid intake
azotemia, hasn’t been adequate
cystitis, or fluid have been
hematuria. lost as a result of
Hematologic: vomiting or diarrhea.
agranulocytosis
, aplastic
anemia,
leukopenia,
neutropenia,
pancytopenia,
thrombocytope
aspirin used to nia, anemia,
reduce fever and prolonged
relieve mild to bleeding time.
Capsules: 325mg moderate pain Metabolic: 1. Discuss 14 rights of
Aspirin nonsteroidal Capsules thought to from condition contraindicated in hypokalemia, giving medication
anti- (extended- produce such as muscle patients hypoglycemia. 2. Remind patient taking
Asata
inflammatory b release): analgesia and aches, hypersensitive to Skin: pruritus, drug for a chronic
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drugs 162.5mg exert its anti- toothaches, drug in those with rash. condition not to stop
(NSAIDs) Suppositories: inflammatory common cold and NSAIDs induced drug without first
60mg, 120mg, effect by headaches. sensitivity discussing with
150mg, 160mg, inhibiting Aspirin reactions, G6PD prescriber.
200mg,300mg, prostaglandin used to reduce deficiency, or 3. Advise patient to take
600mg, 650mg and other pain and swelling bleeding disorder, CNS: agitation, drug with food, milk,
Tablets: 325mg, substance that in conditions such as cerebral edema, antacid or large glass
500mg sensitize pain such as arthritis. hemophilia, von coma, of water to reduce GI
Tablets receptors. willebrand confusion, reactions.
(chewable): Drug may disease, bleeding dizziness, 4. Be aware that aspirin
80mg, 81mg relieve fever ulcer, and headache, is a common
Tablets enteric- through hemorrhagic lethargy, constituent of a
coated: 80mg, central action states seizures, variety of the counter
81mg, 162mg, in the intracranial medication.
325g, 500mg, hypothalamic hemorrhage. 5. In a long term therapy
650mg, 975mg heat-regulating CV: monitor renal and
center. In low arrhythmias, liver function and
doses, drug hypotension, ototoxicity.
also appears to tachycardia
interfere with EENT: tinnitus,
clotting by hearing loss
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keeping a GI: antepartum

platelet- and postpartum
aggregating bleeding,
substance from interstitial
forming. nephritis,
papillary
necrosis, renal
failure.
Hematologic:
prolonged
bleeding time,
leukopenia,
thrombocytope
nia,
coagulopathy.
Hepatic:
hepatitis
Metabolic:
dehydration,
hyperkalemia,
hyperglycemia
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(children),
metabolic
acidosis,
respiratory
alkalosis.
Skin: rash,
bruising,
urticaria, hives.
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VII. NURSING MANAGEMENT

a. Nursing Diagnosis (Write five according to priority needs.)
1. Hyperthermia related to infection process as evidenced by increased body

temperature 103.8◦F (39.9◦c) and tachycardic HR-115 bpm secondary to viral
meningitis infection.
2. Infection related to presence of pathogenic microorganisms in the CSF as evidence
by presence of Enterovirus during PCR test secondary to viral meningitis.
3. Pain related to inflammation process as evidence by patient verbalization of
gradual-onset headache, neck pain, sore throat, and pain during movement rating
pain 6/10
4. Imbalanced nutrition: more than body requirement related to excessive weight gain
as evidence by BMI of 31 (Obesity).
5. Risk for ineffective cerebral tissue perfusion related to increased intracranial
pressure as evidence by viral meningitis.
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b. Nursing Care Plan (Develop 3 NCP from the 5 Nursing Diagnosis)

Data / Cues Needs Nursing Diagnosis Objective of Care Nursing Actions with Rationale Evaluation
(@ least 5 nursing interventions)
Subjective: P After 1 hr. Of 1. Assess the patient’s vital signs at least every 4
Hyperthermia r/t Goal met:
H
Fever for 2 days nursing hours.
Y infectious process as After 1 hr. Of nursing
S intervention, the Rationale: To assist in creating an accurate diagnosis
evidenced by intervention, the patient
I
Objective patient will be able and monitor effectiveness of medical treatment
O increased body was able to stabilizes
 Oral Temp.: L to stabilize body particularly the antibiotics and fever-reducing drugs.
temperature 103.8°F temperature within
O
103.8°F temperature and 2. Remove excessive clothing, blankets and
G (39.9°C) normal range.
(39.9°C) I within normal linens, adjust room temperature.
C
 Heart Rate: range. Rationale: To regulate the temperature of the
A Partially met:
115 bpm L environment and make it more comfortable for the
Rationale: After 1 hr. Of nursing
N Elevated body patient. intervention, the patient
E 3. Administer the prescribed antibiotic and anti-
temperature beyond partially stabilizes
E
D the normal variance pyretic medications. temperature within
S Rationale: Use the antibiotic to treat bacterial
usually greater than normal range.
___
B 39°C can be life infection, w/c is the underlying cause of the patient’s
O hyperthermia. Use the fever-reducing medication to
threatening. Not met:
D
Y stimulate hypothalamus and normalize body After 1 hr. Of nursing
temperature. intervention, the patient
T
H 4. Offer tepid sponge bath was not able to stabilize
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E Rationale: To facilitate the body in cooling down and temperature within

R
to provide comfort. normal range.
M
O
5. Encourage patient to increase fluid intake
R
E Rationale: Water regulates body temperature
G
U
L
A
T
I
O
N
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GOAL MET
Subjective: P Pain related to After 1hr of 1. Prevent stimulation and restrict visitors After 1hr of nursing
H
“Gradual-onset inflammation Nursing Rationale: Stimulation can increase
Y intervention the patient
headache, neck S process as evidence Intervention, the intercranial pressure, hence intensifying the was able to express
I
pain, sore throat, by patient patient will be able pain
O feelings of comfort relief
and pain was L verbalization of to express feelings 2. Teach the client diversional activities of pain by rating pain
O
worsened by gradual-onset of comfort, relief of such as listening music
G scale from 6/10 to 2/10.
movement but did I headache, neck pain, pain by rating pain Rationale: To divert client’s attention from
C
not radiate” as sore throat, and pain scale from 6/10 to pain
A GOAL PARTIALLY MET
stated by the L during movement 2/10. 3. Assist ROM exercises After 1hr of nursing
patient. rating pain 6/10. Rationale: Prevent joint stiffness and neck pain
N intervention the patient
E 4. Advice breathing exercise partially express feelings
E
Objective Rationale: to allow proper O2 supply in the
D of comfort, relief of pain
 Pain scale S Rationale: body. Clients tend to stop breathing during by rating pain scale from
___
-6/10. When patient is pain.
C 6/10 to 4/10.
O complaining of pain, 5. Administer analgesics such as
M
the patient seeks acetaminophen or NSAIDS as prescribed.
F GOAL NOT MET
O support, assistance Rationale: NSAIDS are given to relief pain. After 1hr of nursing
R
and relief
T intervention the patient
was not able to express
feelings of comfort and
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relief of pain.
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P After 1 month of 1. Review individual case for obesity.

Objective: Imbalanced Goal met:
H
nursing Rationale: Identifies and influences choice of
 Weight:143 Y nutrition; more than After 1 month of nursing
S intervention and some intervention.
lb. (99.8 kg) body requirements intervention and follow
I
follow up the client 2. Carry out and review daily food diary
 Height: 5ft O related to excessive up the client was able to
G will be able to (caloric intake, types and amounts of
6in. (166cm) weight gain as display weight loss with
I
display weight loss food, eating habits.
 Body mass C evidence by BMI of optimal maintenance of
A with optimal Rationale: Provides the opportunity to focus
index: 31 31 (obesity). health.
L
maintenance of on a realistic picture of the amount of food
N health. ingested and corresponding eating habits and Goal partially met:
E
E Rationale: feeling. Identifies patterns requiring changes or After 1 month of nursing
D a base on which to tailor the dietary program,
The health care intervention and follow
S
___ professionals help 3. Formulate an eating plan with the up the client partially
N patient, using knowledge of individuals
the patient identify display weight loss with
U
T inappropriate height, body built, age, gender, and optimal maintenance of
R individual patterns of eating, energy and
behaviors and health.
I
T consequences nutrient requirements.
I Rationale: A good reducing diet should contain
associated with
O
N weight gain that foods from all basic food groups with a focus on
improves overall low-fat intake mass. It is also helpful to keep the Goal not met:
health to our client plan as similar to patients usual eating pattern After 1 month of nursing
as possible.
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and lowers the risk 4. Determine current activity levels and intervention and follow
of developing plan progressive exercise up the client was not
complications. program(walking)tailored to the display weight loss with
individual’s goal and choice optimal maintenance of
Rationale: Exercise furthers weight loss by health.
reducing appetite, increasing energy. Toning
muscles, and enhancing cardinal fitness, sense
of wellbeing and accomplishment,
commitment on the part of the patient enables
the setting of the more realistic goals and
adherence to the plan.
5. Weight periodically as individually
indicated and obtain appropriate body
requirements
Rationale: Provides information about
effectiveness of therapeutic regimen and usual
evidence of patient’s efforts. During
hospitalization for controlled fasting daily
weighing may be required. Weekly weighing is
more appropriate after discharge.’
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VIII. EVALUATION AND IMPLICATION OF THE CASE TO:

a. Nursing Practice
 This study gives the learner an opportunity to enhance knowledge, skills
and rendering holistic approach for the Patient who have viral Meningitis.
The knowledge given by this study will serve as reference for the learners,
researchers and professionals more further studies.
b. Nursing Education
 Maintaining mental sharpness is beneficial to your overall health with a
good education. Nursing Students needs to be educated in the screening,
assessment, planning, implementation, and evaluation of viral Meningitis.
In the interim nurses continue to play a major role in the care and
education of those Patients with and at risk of viral Meningitis. We
recommend that there should be a community and school prevention
discussion about the prevention of any viral and Bacterial infections to
lessen the case of having viral infections appearing at any ages and to
broaden the knowledge of the learners towards the Disease.
c. Nursing Theory
 The theory of comfort by Katharine Kolcaba is best suited for our case
analysis and for the application of care to our patient John, 15, male
adolescents who have the signs and symptoms of viral Meningitis. Kolcaba's
Theory of comfort explains comfort as fundamental need of all human
being for relief, ease, or transcendence arising from health care situation
that are stressful. We relate this theory to our patient John that have a
symptoms of viral meningitis and seek comfort. With the help of the nurse
and the professionals with pertinent action promote comfort among
individual seeking health promotion, discomfort, recovery, treatment
among which everybody (at any age ) needs concerns for Comfort .
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d. Nursing Research
 There are many researchers who study the different kinds of management
of care for Viral Meningitis. In fact treatment for viral Meningitis mostly
Supportive. Rest, hydration, antipyretics and pain or anti-inflammatory
medications maybe given as needed. The most important decision is
whether to initiate antimicrobial theraphy emperically for bacterial
Meningitis while waiting for the cause to be identified. In most cases, there
is no specific treatment for viral Meningitis. Most people who get mild viral
Meningitis usually recover completely in 7-10 day without treatment. Anti-
viral medicine may help people with meningitis caused by viruses such as
herpesvirus and influenza. Both researchers and patient may benefit from
awareness to morbility of viral infections. Practice Level policies that
support the monitoring and management of viral Meningitis also improve
care.
IX. RECOMMENDATION/REFERRALS/FOLLOW-UPS
You may be able to prevent meningitis by avoiding infection with the viruses or bacteria
that cause it. These infections are passed to others when you cough, sneeze, kiss, or share
toothbrushes or eating utensils.
Take these steps to prevent infections:
1. Wash your hands. Proper hand-washing helps prevent the spread of germs. Teach
children to wash their hands often, especially before eating and after using the toilet,
spending time in a crowded public place or petting animals. Show them how to vigorously
and thoroughly wash and rinse their hands.
2. Practice good hygiene. Don't share drinks, foods, straws, eating utensils, lip balms or
toothbrushes with anyone else. Teach children and teens to avoid sharing these items too.
3. Stay healthy. Maintain your immune system by getting enough rest, exercising regularly,
and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.
4. Proper coughing etiquette. When you need to cough or sneeze, be sure to cover your
mouth and nose.
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5. Get immunized. Follow your doctor’s advice on getting immunization shots for diseases
that may cause bacterial meningitis, including flu and pneumonia vaccines. Vaccines can
protect against some diseases, such as measles, mumps, chickenpox and influenza which
can lead to viral meningitis. Make sure you and your child are vaccinated on schedule
6. Avoid sharing eating and drinking utensils – some viruses may be passed on in saliva.
7. Pain medications to help reduce fever and relieve body aches.
8. Drink plenty of fluids and take acetaminophen (Tylenol, others) to reduce your fever and
body aches. Also avoid any medications that may make you less alert. Don't go to work or
school.
10. Avoid bites from mosquitoes and other insects that carry disease that can affect Human.
Control mice and rats. If you have a rodent in or around your home. Follow appropriate
cleaning ang control precautions
12. Hospitalization. Severe viral meningitis must be treated in hospital. As the condition
can cause serious problems and requires close monitoring.
13. Patients with pneumococcal or viral meningitis do not require isolation.
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X. JOURNAL READINGS RELATED TO THE CASE

(Should be an Evidence-Based Practice (EBP) Reading: Attach the
photocopy of your journal reading)
DESCRIPTIVE ANALYSIS OF VIRALMENINGITIS IN A GENERAL HOSPITAL: DIFFERENCES

IN THE CHARACTERISTICS BETWEEN CHILDREN AND ADULTS
Summary
 Their study aims to identify the clinical and epidemiological
characteristics of viral meningitis in our environment and observe the
differences with age. Enteroviruses are the main pathogens involved in
viral meningitis (85–90%).2 Risk factors for meningitis caused by these
virus are young age, poor hygiene practices (such as lack of hand-
washing) and contact (such as that from staff in schools and
nurseries).Viral meningitis epidemics caused by enteroviruses have been
reported in the summer. Its incidence rate is under-diagnosed because it
presents mild symptoms in a great number of cases and people do not go
to hospital.7 In temperate climates such as that of Spain, infections
caused by enteroviruses are more common during the summer and
autumn months and the transmission mechanism is fecal-oral. The
materials and methods they used are retrospective and descriptive study
that included the patients admitted to the Hospital Complex of Toledo
between 2000 and 2008 who were diagnosed with viral meningitis. The
following parameters were collected: gender, age, sex, month and year of
hospital admission, mean stay, days of symptom evolution until
admission, existence of prodromal symptoms (arthralgias, myalgias,
malaise and nausea) and possible death. The patients were divided into
two age groups: children who were under the age of 15 years and adults
who were 15 years or older. With regards to meningitis, the symptoms
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were divided into various groups. Have headache only. 2.Have headache
and fever. 3.Have headache, fever and vomiting. As the result During the 9
years analyzed, 136 patients were identified on the database with viral
meningitis. The average age was 23 years old and there was a male
predominance of 69.8%. There were no deaths due to viral meningitis.
The cases of viral meningitis in children <15 years of age were 46
(33.8%), while there were 90 patients over that age (66.1%). The mean
age among children was 5-9 years old, while among adults it was 30 years
of age. In both groups, the male predominance continued – children
76.0% and adults 66.6% –; the differences found between the groups
were not statistically significant. The mean stay was clearly less in the
children's group (3.67 days) compared to the adults (6.59 days), with
some clearly significant differences (P < 0.000).
The grouping of the meningitis cases by months allowed us to see the
greater incidence rate in the summer months compared to the winter
months. The incidence rate between children and adults was not analysed
separately. Similarly, there were significant differences in the days of
parameter evolution of meningeal symptoms before admittance, children
1.83 days and adults, 2.93 (P < 0.0). The presence of prodromes before
meningitis was also greater in adults (18.8%) than in children (13.0%),
but there were no statistically significant differences. The clinical
presentation was similar in children and adults. In both groups, the
majority presented headache, fever and vomiting, with 54.3% in children
and 52.2% in adults, with no significant differences found. The isolated
presence of headache without fever appeared in only one adult patient.
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Reaction
 According to this journal Viral Meningitis can be transferable through
Contact accompanied by poor hygiene but Can be prevented .The greater
number of males is probably related to the predisposition of the
enteroviruses in affecting the male gender, as has been demonstrated in
other studies. This predominance is maintained in adult ages, which
would explain why the enteroviruses are also the most frequently
involved viruses at these ages, as they demonstrated in this study.in
addition , this study serves as a reference to us for learners, professionals
and resercahers . Many people are not practicing Proper Hygiene and love
to socialize without thinking the possible transmission of Viral infections .
Summer seems to be our favorite season of the year where we can spend
time to have Vacation with Family but viral meningitis are very active at
this point of the time . This study dtermine what age is viral meningitis is
prone for . The method they used is very Appropriate to have a better
outcome of the Study , The parameters collected are also brought a good
documentation and collection of data ,The researchers are well-eduacted
enough to conduct this kind of study .As the result of the study people at
the of 15 above had a great number that are having viral meningitis . At
the age of 15 and above they should be reinforce about the prevention of
this matter . It seems that viral meningitis is not as harmful as Bacterial
meningitis but its shouldn't be disregard this because it can be chronic
and possibly leads to bacterial Meningitis . Heache,fever and vomiting as
mostly Commonly appeared to children's than adults . We're Happy to
have this study because it give us a information about viral meningitis ,its
risk and its prevention which we can use as application of care towards
our Patient if we become a Registered nurse Someday . It also help us to
be educated to prevent and to deal with viral meningitis so that Summer
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is exciting and can still be the best season of the year with the good
memories to remember .

References:
J.J Zarranz.Enfermedades infecciosas del sistema nervioso central. Neurologia, pp.
269-329
H.A Rotbart. Viral meningitis. Semin Neurol, 20 (2000), pp. 277-292
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XI. REFERENCES
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Cotabato Medical Foundation College, Inc

Quezon Ave. Poblacion 8, Midsayap, Cotabato

History of Present Illness

Allergies: no significant history.

Past surgeries: tonsillectomy and adenoidectomy.

rate 115 beats/min and regular, respirations 18 breaths/min, regular and

AT THE EMERGENCY DEPARTMENT (ACCOMPANIED BY THE MOTHER)

Medicine Taken at Home:

UPON ASSESSMENT PATIENT DENIED THE FF:

UPON ASSESSMENT THE MOTHER DENIED THE FF:

 respirations 18 breaths/min, regular and unlabored

LABORATORY TEST RESULTS:

Based on presenting symptoms, history and physical examination findings, a clinical

AT THE EMERGENCY DEPARTMENT (ACCOMPANIED BY THE MOTHER)

Medicine Taken at Home:

UPON ASSESSMENT PATIENT DENIED THE FF:

UPON ASSESSMENT THE MOTHER DENIED THE FF.

 Tachycardia with regular rhythm

 O2 saturation 97% on room air

LABORATORY TEST RESULTS

 Rapid Strep and Influenza tests-negative

Based on presenting symptoms, history and physical examination

 Lumbar puncture (LP)Results:

 Bio-Fire Film Array polymerase chain reaction PCR

1. discuss the phenomenon and concept map of the scenario.

CLINICAL CASE ANALYSIS WORKSHEET

PATIENT’S PERSONAL DATA:

Educational background: Ninth grader, attended public school

II. DEVELOPMENTAL DATA: Specify the Stage.

Havighurst developmental data:(ADOLESCENCE 13 to 18 years old)

III. CHIEF COMPLAINTS:

IV. HEALTH HISTORY:

 Status Post Ttonsillectomy and adenoidectomy

 Recent immunization of influenza vaccine during flu season

Inclusive Period of Hospitalization: N/A

V. COMPLETE DIAGNOSIS OF THE CASE CHOSEN

a. Definition (at least 2 Definition with Bibliography)

The American Heritage.Dictionary of the English Language.Third Edition. Page 1127.

M. Schaechter. G. Medoff. D. Schlessinger. Mechanism of Microbial Disease. Page 661.

 contaminated formities enable to transcript pathogens.

 a person with weak immune system is unlikely to get infected.

 Often cause severe, rapidly progressive illness in previously healthy host.

movement of lower extremities.

 Patients with meningococcal meningitis, with signs of overwhelming septicemia. An abrupt

d. Anatomy and Physiology (Organ or System Involved)

Cells of the Nervous System

Myelin Sheaths - Axons are either unmyelinated or myelinated.

Organization of Nervous Tissue

The human brain is the

 The midbrain is involved in hearing and in visual reflexes.

 Thalamus (main sensory relay center)

Sensory areas of the cerebral cortex

 Ascending tracts project to primary sensory areas of the cerebral cortex.

 The cerebellum is involved in balance, muscle tone, and muscle coordination.

Other brain functions

 Each hemisphere controls the opposite half of the body,

Brain waves and consciousness

 Working (lasting a few seconds to minutes).

Limbic System and Emotions

Autonomic Nervous System