CASE study t/c bacterial menigitis , AGE with moderate signs of dehydration ruled out electrolyrte imbalance

8/12/2019 CASE study t/c bacterial menigitis , AGE with moderate signs of dehydration ruled out electrolyrte imbalance

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I. INTRODUCTION

Gastroenteritis or infectious diarrhea is a medical condition characterizedbyinflammation ("-itis") of thegastrointestinal tract that involves both

thestomach ("gastro"-) and thesmall intestine ("entero"-), resulting in some

combination ofdiarrhea,vomiting,andabdominal pain and cramping. Dehydration may

occur as a result. Gastroenteritis has been referred to as gastro, stomach bug,

and stomach virus. Although unrelated toinfluenza,it has also been called stomach

flu and gastric flu.

Signs and symptoms

Gastroenteritis typically involves bothdiarrhea andvomiting,or less commonly,

presents with only one or the other. Abdominal cramping may also be present. Signs

and symptoms usually begin 1272 hours after contracting the infectious agent. If due

to a viral agent, the condition usually resolves within one week. Some viral causes may

also be associated withfever,fatigue, headache, andmuscle pain.If thestool is bloody,

the cause is less likely to be viral and more likely to be bacterial. Some bacterial

infections may be associated with severe abdominal pain and may persist for several

weeks.

Children infected with rotavirus usually make a full recovery within three to eight

d H i i f i f i i f f h
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Small_intestinehttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Dysenteryhttp://en.wikipedia.org/wiki/Dysenteryhttp://en.wikipedia.org/wiki/Myalgiahttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Small_intestinehttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Inflammation


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consume the food. Some foods commonly associated with illness include raw or

undercooked meat,poultry,seafood, and eggs; raw sprouts; unpasteurized milk and

soft cheeses; and fruit and vegetable juices. In the developing world, especially sub-

Saharan Africa and Asia,cholera is a common cause of gastroenteritis. This infection is

usually transmitted by contaminated water or food.

ToxigenicClostridium difficileis an important cause of diarrhea that occurs more often

in the elderly. Infants can carry these bacteria without developing symptoms. It is a

common cause of diarrhea in those who are hospitalized and is frequently associated

with antibiotic use.Staphylococcus aureusinfectious diarrhea may also occur in thosewho have used antibiotics. "Traveler's diarrhea"is usually a type of bacterial

gastroenteritis. Acid-suppressing medication appears to increase the risk of significant

infection after exposure to a number of organisms, including Clostridium

difficile, Salmonella, and Campylobacter species. The risk is greater in those

takingproton pump inhibitorsthan withH2 antagonists.

Parasitic

A number ofprotozoanscan cause gastroenteritismost commonlyGiardia lamblia

butEntamoeba histolyticaandCryptosporidiumspecies have also been implicated. As a

group, these agents comprise about 10% of cases in children. Giardia occurs more

commonly in the developing world, but this etiologic agent causes this type of illness to
http://en.wikipedia.org/wiki/Poultryhttp://en.wikipedia.org/wiki/Cholerahttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Traveler%27s_diarrheahttp://en.wikipedia.org/wiki/Traveler%27s_diarrheahttp://en.wikipedia.org/wiki/Traveler%27s_diarrheahttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/H2_antagonisthttp://en.wikipedia.org/wiki/H2_antagonisthttp://en.wikipedia.org/wiki/H2_antagonisthttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/Giardia_lambliahttp://en.wikipedia.org/wiki/Giardia_lambliahttp://en.wikipedia.org/wiki/Giardia_lambliahttp://en.wikipedia.org/wiki/Entamoeba_histolyticahttp://en.wikipedia.org/wiki/Entamoeba_histolyticahttp://en.wikipedia.org/wiki/Entamoeba_histolyticahttp://en.wikipedia.org/wiki/Cryptosporidiumhttp://en.wikipedia.org/wiki/Cryptosporidiumhttp://en.wikipedia.org/wiki/Cryptosporidiumhttp://en.wikipedia.org/wiki/Entamoeba_histolyticahttp://en.wikipedia.org/wiki/Giardia_lambliahttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/H2_antagonisthttp://en.wikipedia.org/wiki/Proton_pump_inhibitorshttp://en.wikipedia.org/wiki/Traveler%27s_diarrheahttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Clostridium_difficilehttp://en.wikipedia.org/wiki/Cholerahttp://en.wikipedia.org/wiki/Poultry


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with blood in the stool, those who might have been exposed to food poisoning,and

those who have recently traveled to the developing world. Diagnostic testing may also

be done for surveillance. Ashypoglycemiaoccurs in approximately 10% of infants and

young children, measuring serumglucosein this population is recommended.

Electrolytesandkidney functionshould also be checked when there is a concern about

severe dehydration.

Dehydration

A determination of whether or not the person hasdehydrationis an important part of theassessment, with dehydration typically divided into mild (35%), moderate (69%), and

severe (10%) cases.In children, the most accurate signs of moderate or severe

dehydration are a prolongedcapillary refill,poorskin turgor,and abnormal

breathing. Other useful findings (when used in combination) include sunken eyes,

decreased activity, a lack of tears, and a dry mouth. A normal urinary output and oral

fluid intake is reassuring. Laboratory testing is of little clinical benefit in determining the

degree of dehydration.

Prevention

Lifestyle
http://en.wikipedia.org/wiki/Food_poisoninghttp://en.wikipedia.org/wiki/Food_poisoninghttp://en.wikipedia.org/wiki/Food_poisoninghttp://en.wikipedia.org/wiki/Hypoglycemiahttp://en.wikipedia.org/wiki/Hypoglycemiahttp://en.wikipedia.org/wiki/Hypoglycemiahttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Electrolyteshttp://en.wikipedia.org/wiki/Electrolyteshttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Skin_turgorhttp://en.wikipedia.org/wiki/Skin_turgorhttp://en.wikipedia.org/wiki/Skin_turgorhttp://en.wikipedia.org/wiki/Skin_turgorhttp://en.wikipedia.org/wiki/Capillary_refillhttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Electrolyteshttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Hypoglycemiahttp://en.wikipedia.org/wiki/Food_poisoning


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those made from wheat or rice) may be superior to those based on simple

sugars. Drinks especially high in simple sugars, such assoft drinksand fruit juices, are

not recommended in children under 5 years of age as they may increase diarrhea. Plainwater may be used if more specific and effective ORT preparations are unavailable or

are not palatable. Anasogastric tubecan be used in young children to administer fluids if

warranted.

Dietary

It is recommended that breast-fed infants continue to be nursed in the usual fashion,and that formula-fed infants continue their formula immediately after rehydration with

ORT. Lactose-free or lactose-reduced formulas usually are not necessary.[42]Children

should continue their usual diet during episodes of diarrhea with the exception that

foods high insimple sugarsshould be avoided. TheBRAT diet(bananas, rice,

applesauce, toast and tea) is no longer recommended, as it contains insufficient

nutrients and has no benefit over normal feeding. Someprobioticshave been shown to

be beneficial in reducing both the duration of illness and the frequency of stools. Theymay also be useful in preventing and treatingantibiotic associated diarrhea.Fermented

milk products (such asyogurt)are similarly beneficial.Zincsupplementation appears to

be effective in both treating and preventing diarrhea among children in the developing

world.
http://en.wikipedia.org/wiki/Soft_drinkshttp://en.wikipedia.org/wiki/Soft_drinkshttp://en.wikipedia.org/wiki/Soft_drinkshttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Gastroenteritis#cite_note-MMWR2003-42http://en.wikipedia.org/wiki/Gastroenteritis#cite_note-MMWR2003-42http://en.wikipedia.org/wiki/Gastroenteritis#cite_note-MMWR2003-42http://en.wikipedia.org/wiki/Simple_sugarhttp://en.wikipedia.org/wiki/Simple_sugarhttp://en.wikipedia.org/wiki/Simple_sugarhttp://en.wikipedia.org/wiki/BRAT_diethttp://en.wikipedia.org/wiki/BRAT_diethttp://en.wikipedia.org/wiki/BRAT_diethttp://en.wikipedia.org/wiki/Probioticshttp://en.wikipedia.org/wiki/Probioticshttp://en.wikipedia.org/wiki/Probioticshttp://en.wikipedia.org/wiki/Antibiotic_associated_diarrheahttp://en.wikipedia.org/wiki/Antibiotic_associated_diarrheahttp://en.wikipedia.org/wiki/Antibiotic_associated_diarrheahttp://en.wikipedia.org/wiki/Yogurthttp://en.wikipedia.org/wiki/Yogurthttp://en.wikipedia.org/wiki/Yogurthttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Zinchttp://en.wikipedia.org/wiki/Yogurthttp://en.wikipedia.org/wiki/Antibiotic_associated_diarrheahttp://en.wikipedia.org/wiki/Probioticshttp://en.wikipedia.org/wiki/BRAT_diethttp://en.wikipedia.org/wiki/Simple_sugarhttp://en.wikipedia.org/wiki/Gastroenteritis#cite_note-MMWR2003-42http://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Soft_drinks


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those in thedeveloping world being primarily affected. As of 2011, in

those less than five, there were about 1.7 billion cases resulting in

0.7 million deaths with most of these occurring in the world's poorestnations. More than 450,000 of these fatalities are due to rotavirus in

children under 5 years of ageCholera causes about three to five million

cases of disease and kills approximately 100,000 people yearly.In the

developing world children less than two years of age frequently get six or

more infections a year that result in clinically significant gastroenteritis.

Gastroenteritis is associated with many colloquial names, including"Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint",

among others. It has played a role in many military campaigns and is

believed to be the origin of the term "no guts no glory".

Locally, In July 22, 2004, the Department of Health (DOH), Philippines

declared an epidemic (outbreak) of a water/food-borne disease called

acute gastroenteritis in 45 towns in Central Pangasinan. Acutegastroenteritis is a human enteric (intestinal) disease primarily caused by

ingestion of spoiled or bacterial contaminated water or food.

2. OBJECTIVES
http://en.wikipedia.org/wiki/Developing_worldhttp://en.wikipedia.org/wiki/Cholerahttp://en.wikipedia.org/wiki/Montezuma%27s_revengehttp://en.wikipedia.org/wiki/Montezuma%27s_revengehttp://en.wikipedia.org/wiki/Cholerahttp://en.wikipedia.org/wiki/Developing_world


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knowledge according to the case of the chosen case of the client. The

study will also teach the students to learn how to interconnect with other

health care providers and to be more familiar with those documents thatthe hospital has with their clients

5. Scope of limitation of the study

The study will only focus about the case of the client which is t/c bacterial

meningitis AGE with moderate sings of dehydration R/O electrolyte

imbalance which is the condition of the chosen client and to the otherrelevant information about the case of the client.

Conceptual and Nursing Theory

DOROTHEA ELIZABETH OREM

(SELF-CARE DEFICIT NURSING THEORY)


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II. CLINICAL SUMMARY

A. General Data Profile

NAME: Mr. Jhon Cris Magdalena

ADDRESS: Brgy Anoling Gen. Nakar Quezon

AGE: 4y/o

BIRTHDAY: 01/21/2010

BIRTHPLACE: Quezon

NATIONALITY: Filipino

RELIGION: Catholic

OCCUPATION: Child

DATE OF ADMISSION: 4/19/2014

ADMITTING DIAGNOSIS: Bacterial Meningitis

ADMITTING PHYSICIAN: Dr Arlan Lopez

B. REASON FOR CONFINEMENT


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e. HOSPITALIZATION

-The patient was confined on april 17 in the hospital in gen. Nakar because he was bitten by adog after that he was brought to san lazaro for further medical management.

f. DOMESTIC TRAVEL

-Laguna and manila area

D. FAMILY HISTORY

LEGEND

MALE DEAD MALE

FEMALE DEAD FEMALE


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III. Function Health Pattern

Function Health Pattern Before Hospitalization During Hospitalization Interpretation

Health Management

Pattern

Was brought first

to the health

center due to dog

bite

First time to be

hospitalize

He seeks

medical

attention whe

he has been

bite by the do

Nutritional/Metabolic

a. number of meals per day

b. appetite

c. glass of water per day

d. body built

3 times a day

with very good

appetite

3-4 glasses of

water

with normal body

built

3 times a day

with good appetite

maximum of 5

glasses of water

slightly smaller

than before

Due to the

disease proce

the body wasn

able to resist

the bacteria

that make his

body smaller

before

hospitalizatio

Elimination

a. frequency of urination

b. amount of urine per day

c. frequency of bowel

movement

d consistency of the feces

3-5 times per day

moderate

1-2 times per day

f d

4-8 times per day

scanty

1-2 times per day

t t l

The frequency

is higher due t

higher

consumption

water also


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Self-Perception/ Self-

Concept

Not aware of self-

perception

Not aware of self-

perception

He is not awa

of self-

perceptionbecause hes

still a kid and

doesnt have a

sufficient

knowledge on

that.

Coping/Stress None None He doesnt

know whatstress is and

doesnt know

how to cope

about it.

Values/Beliefs His parents taught

him about God.

He still believes in

God as what his

parents taughthim.

As a child hes

not aware of i

only he believon Him.


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IV. PHYSICAL ASSESSMENT

Date of assessment: May 19, 2014

General appearance:

The patient is weak and pale in appearance. He wears tidy clothes exactly for his ectomorphic

body. Upon assessment, the client is lying on bed, with a blood pressure of 90/60mmHg, pulse

rate of 92 beats per minute, respiration rate of 43 breaths per minute, and temperature of 36.7C.

BODY PART NORMALFINDINGS

ACTUAL FINDINGS INTERPRETATION/ANALYSIS

A. HEAD1.Skull Proportional to the

body, with

prominences in the

frontal areaanteriorly and the

occipital area

posteriorlysymmetrical in all

planes.

Proportional to the size

of the body,

asymmetrical by larger

on the right side.

As the mother say it

may be due to injury

that happened to the

client.


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2. Eyelids

3. Lid margins

without difficulty,

evenly distributed

and parallel witheach other.

Upper lids cover a

small portion of the

iris, cornea, and thesclera when the eyes

are open. When the

eyes are closed, thelids meetcompletely.

Symmetrical color is

the same as the

surrounding skin.

Clear without

scaling or secretions,

lacrimal ductopenings are evident

at the nasal ends.

Upper lids cover a

small portion of the

iris, cornea, and thesclera when the eyes

are open. When the

eyes are closed, thelids meet completely.Symmetrical color is

the same as the

surrounding skin.

Clear, without scaling

or secretions, pale.

Normal.

Normal.


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C. EARS

1. Hearing Acuity

2. Ear Canal

D. NOSE

1. Internal Nares

2. Septum

E. MOUTH

Pinkish, clean, with

scant amount ofcerumen and a few

ciliaAble to hear whisper

spoken words 2 feet

away.

No erythema, no

scaling, no swelling,absence of foreignbody and odor.

Midline,

symmetrical, andpatent

Clean, pinkish, withfew cilia.

Straight.

Pinkish, symmetrical

Cerumen and a few

cilia.

Able to hear whisper

spoken words 2 feet

away.

No erythema, no

scaling, no swelling,absence of foreignbody and odor.

Midline, symmetrical,

and patent

Clean, pinkish, withfew cilia.

Straight.

Pinkish, symmetrical

Normal.

Normal.

Normal.

Normal.

Normal.

Normal.

Normal.


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Hard Palate

6. Uvula

7. Tonsils

8. Voice

F. Neck

G. Range ofMotion

At the center,

symmetrical, andfreely movable.

Pinkish, non-

inflamed, no

exudates.

No hoarseness and

well-modulated.

Proportional to the

size of the body and

head, symmetricaland straight.

Freely movable withrelative ease.

At the center,

symmetrical, andfreely movable.

Pinkish, non-inflamed,

no exudates.

Unable to verbalize

words.

Proportional to the size

of the body and head,

symmetrical andstraight.

Limited movements

Normal

Normal

Due to body

weakness that the

client is experiencingas a symptom of the

disease

Normal

Due to bodyweakness that the

client is experiencing


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respiration

Auscultation

Palpation

K. Chest

(Thorax)

I nspection

by respiration.

Audible bowelsounds (5-30/min);absence of arterial

bruits and friction

rubs.

No tenderness;

relaxed abdomenwith smooth,

consistent tension.

Chest symmetrical,skin intact, no

tenderness, nomasses.

Audible bowel sounds

(36/min).

No area of tenderness;

no presence of lumpsand absence of lesion.

Not proportion, withrashes noted.

Respiration of 43

breaths per minute.

On assessment ofgastroenteritis there

is hyperactive bowelsounds. (Medical-

surgical nursing,

pg.319)

Normal

Normal


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M.Nails

N. Shoulders,Arms, Elbows,

H d d

appears equal with

good muscle tone.

Nails aretransparent, smooth,

& convex with pink

nail beds & whitetranslucent tips.

Five fingers in eachhand. As pressure isapplied to the nail

bed, it appears white

or blanched & pink

color returnsimmediately as

pressure is released.

Performs with

relative ease.

Complete fingers, 5each hand.

Nails are thick,

transparent, & convexwith pale nail beds &

white translucent tips.

As pressure is applied

to the nail bed, it

appears white and

color returns after 5seconds.

Performs with relative

ease.

With deviation fromnormal

Patients with anemia

may exhibit delayed

capillary refilldiminished blood

flow to the peripheryand compensatoryvasoconstriction.

(Medical Surgical Nursingby Black 5thedition p.1571)

Normal


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Palpation

P. Legs, Knees,Ankles, Toes

Adduction and

Abduction.

beds appear white or

blanched; pink color

returns whenpressure is released

(2 seconds).

Performs with

relative ease.

white or blanched;

pink color returns

when pressure isreleased (5 seconds).

Performs with relative

ease.

capillary refill

diminished blood

flow to the peripheryand compensatory

vasoconstriction.(Medical Surgical Nursingby Black 5thedition p.1571)

Normal

V. Course in the ward

Date Doctors order Interpretation

April 20, 2014

9:30pm

Please admit to PAV

Secure consent for

admission and

management

Monitor V/S every 4hrs

Monitor intake and

>for continue management

>For approval of admission and

further management

>to have baseline date

>to monitor status of fluid and


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PCEC 0.1ml x 2 sites

ATS 1.500 IV #2 given

outside

TT 0.5ml given outside

>anti-rabies vaccine

>anti tetanus serum

>anti-tetanus

Date Doctors order Interpretation

April 20, 2014

11:55pm

Hold Phenobarbital

May give diazepam only

if with active seizures at

2.5mg TIV

Start ceftriaxone 90mg

TIV now then once a day

ANST ()

Please carry out other

orders

Addendum:

STAT serum Na , k , cl , Ca

determination for fecalysis

, monitor Hgt every 8hrs

Ranitidine 9mg TIV every

8hrs

Refer

>the patient dont have seizure

episode

>give only during muscle spasm

occur if necessary

>antibiotic drug

>to note and to know if the NOD

done the specific orders

>for serum determinations and

specimen collection

>to reduce acidity


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April 23,2014

puncture please secure

consent for the procedure

For chest X-ray ADL today

For gastric aspirate AFB X3

For PPD

Educate patients relative

regarding proper hygiene

Please secure official chest

x-ray result and other lab

test done since admission

Start O2 weaning

Discontinue ranitidine once

feeding is tolerated

infection such as meningitis, for

approval from the patient and

relatives before proceeding to

the procedure.

>way to diagnose disease.

>to detect bacteria called acid

fast bacilli in fluid or tissue

samples

>performed to check if you have

any tuberculosis infection

>the doctor wanted to see all lab

results that he/she has ordered

>the oxygen saturation of the

patient has normalize

>the patient was able to tolerate

soft foods thats why this drug

was ordered to be discontinue


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Continue present

management

April 26, 2014 Continue IVF D5IMB to run

for 40cc/hr

DAT

Discontinue O2 support

Start FESO4 syrup 5ml OD

Continue present medical

management

Monitoring V/S , I and O

record every shift

O2 sat every 4hrs

>the patients hemoglobin and

hematocrit is low

>there is an occurrence with

difficulty of breathing

April 27,2014 Still to submit specimen

for stool exam

Request CBC with APL

>this order was produced

because the client was need for

fecalysisi and the client cannot

be treted accordingly unless

there is aneatment exact

organism for

This request was ordered


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April 30, 2014

May 1,2014

Please refer to clarify for

Nutritional build up

Multivitamins +iron syrup

5ml OD

Ascorbic acid syrup 5ml OD

To follow D5IMB 500ml at

40ml/hour

Continue IVF of the same

rate

Inject glycerin support

rectal now

Continue present

management

was at the normal range

>to provide additional energy

with protein,vitamins and

minerals

>this is given because the

doctor wanted to have

supplementary nutrition to the

child


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May 4,2014

IVF: PNSS 1L to run at 40

cc/hr DFA

Follow up lab results

Resume ceftriaxone 90mg

TIV OD via soluset to run for

30mins.

For request CBC with APL

May give diazepam 3mg TIV

every 12hrs for sputum

GS/CS for PPD

Sched for tetanus toxoid

Tetanus 1- april 20

Tetanus 2- may20

Will refer patient for pedia

neuro

WOF recurrence of seizure

Start metronidazole 90mg TIV

every 6hrs ANST()

Continue meds.

For fecalysis

>this isotonic solution is to

correct the hyponatremia that

the client has experienced

>it is used to diagnose and

monitor treatment

>for use as an antibiotic

>for muscle spasm and seizures

>for anti tetanus

>for refereal and further

management

>seizure precation

>anti protozoan

For collection of another

specimen to see if the organ

ism is stil present in the stool


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May 7,2014

May 8, 2014

May 9,2014

May 10,2014

May 11,2014

contrast

Work out toward TB meningitis

Proceed with ct scan

Still cranial ct scan

Maintain IVF same rate

Continue present management

For BUN, UREA

For cranial ct scan with contrast

today

Ct scan not done


Still for CT SCAN


To see if there is a

inflammation of the brain

as well as hemorrhage

This is a hypotheses of the

doctor

>to see if the urinary system is

still functioning


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May 16,2014

May 17,2014

Still awaits ct scan result

Awaits result AFB smear gastric

aspiration

Shift oxacillin 250/5ml every

6hrs x 7days

Possible discharge

Facilitate cranial ct scan result

Continue other medication

Possible discharge once with

cranial ct scan result

Insert bisacodyl suppository

rectum now then at bedtime

Please follow up ct scan c/o

relatives

Continue present

>for treatment for constipation


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VI. LABORATORY RESULTS:

Date: May 02, 2014

CBCExam Name Result Reference Range Interpretation

WBC 6.70 4.8-10.8 Normal

RBC 4.90 4.5-5.9 Normal

Hemoglobin 113.6 140-175 Low

Hematocrit 0.352 0.415-0.504 Low

MCV 72.00 82-98 Low

MCH 23.21 28-33 Low

MCHC 32.28 33-36 Low

Platelet Count 496 150-400 High

RDW 21.70 11.4-14.0 High

Neutrophil 71.70 40-70 HighLymphocyte 15.90 19.0-48.0 Low

Eosinophil 3.80 2.0-8.0 Normal

Monocyte 7.80 0.00-15.0 Normal

Basophils 0.80 0.00-5.0 Normal


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Date: April 21, 2014

CBCExam Name Result Reference Range Interpretation

WBC 10.50 4.8-10.8 Normal

RBC 4.93 4.5-5.9 Normal

Hemoglobin 116 140-175 LowHematocrit 0.361 0.415-0.504 Low

MCV 73.00 82-98 Low

MCH 23.52 28-33 Low

MCHC 32.18 33-36 Low

Platelet Count 309 150-400 Normal

RDW 19.10 11.4-14.0 High

Neutrophil65.50 40-70 Normal

Lymphocyte 19.30 19.0-48.0 Normal

Eosinophil 9.50 2.0-8.0 High

Monocyte 5.20 0.00-15.0 Normal

Basophils 0.50 0.00-5.0 Normal


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- The physician ordered to take this test to check the water and

electrolyte balance of the client body and to check the progress

of diseases of the kidneys or adrenal glands. These tests will

measure the concentration of electrolytes that are needed for

both the diagnosis and management of renal, endocrine, acid-

base, water balance, and many other conditions. Their importance

lies in part with the serious consequences that follow from therelatively small changes that diseases or abnormal conditions may

cause. This result finds that the client sodium is high which

indicate Hypernatremia and the rest electrolytes are normal.

- The BUN test is stands for blood urea nitrogen. The blood urea

nitrogen test is primarily used, along with thecreatinine test,to

evaluate kidney function of the client in a wide range of

circumstances, to help diagnosekidney disease,and to monitor
http://labtestsonline.org/understanding/analytes/creatininehttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/glossary/chronichttp://labtestsonline.org/glossary/acutehttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/understanding/analytes/creatinine


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B.Microscopic

Test Result ReferenceFat Globules Few present

Leukocytes 2-4/ HPF Few present

Red Blood Cells 4-8/HPF Few present

Muscle Fibers Few present

Food Particles Varies w/ diet

Yeast Cell MANYOthers

MISCELLANEOUS

C.Biochemical

Test Result Reference


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Platelets

Abnormal increases or decreases in cell counts as revealed in a complete blood count

may indicate that the client have an underlying medical condition that calls for further

evaluation. And based on the result of CBC exam last April 21, 2014, which the RBC

and WBC is Normal. Hemoglobin and Hematocrit is Low., thats why the result of MCV,

MCH and MCHC is also low because the three tests are calculated using the amount of

hemoglobin and hematocrit to determine whether the red blood cells are in normal sizeand if they contain the appropriate amount of hemoglobin. The RDW is high, which

indicates that the red blood cells vary a lot in size. The RDW level can be high because

of iron deficiency, because iron is needed to make hemoglobin. The Eosinophil is also

high, maybe because due to allergic diseases and infections from parasites.

April 27, 4014

The physician ordered to repeat the CBC test because of the abnormal findings


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parasites, viruses, or bacteria and poor nutrient absorption.A fecalysis is also

performed to check for the presence of any reducing substances such as white

blood cells, sugars, or bile and signs of poor absorption on the client stool. Based

on the client result of fecalysis, theres a presence ofTrichuris trichiura it is a

roundworm, known as the Human Whipworm that indicates the client had

infection.
http://eol.org/pages/2926825/overview/http://eol.org/pages/2926825/overview/http://eol.org/pages/2926825/overview/


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VII. Drug study

Name of DrugMechanism of

Action

Indication Contraindication Analysis

Ascorbic Acid Stimulates

collagen

formation and

tissue repair;involved in

oxidation-

reduction

reactions

Vitamin C

deficiency with

poor nutritional

habits

Hypersensitivity to

tartrazine or sulphites

To increase

patient

immunity and

to stimulatescollagen

formation and

tissue repair

Generic Name:

Bacillus Clausii

Brand Name:

Erceflora

Contributes to

the recovery of

the intestinal

microbial floraaltered during the

course of

microbial

disorders ofdiverse origin. It

produces various

vitamins,particularly

B it i

Acute and

chronic

diarrhea

Immunocompromised

patient

The patient

experiencing

loose watery

stool which is amanifestation

of the present

disease, the

physicianordered this

drug to promote

normalize theintestinal flora.


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Generic Name:

Cloxacillin

Brand Name:Cloxapen

A penicillinase-resistant

penicillin that

inhibits cell-wall

synthesis duringmicroorganism

multiplication.

Bacteria resistpenicillins by

producing

penicillinases

Systemicinfections

Hypersensitivity tothe drug

The physicianordered this

drug to inhibit

cell synthesis

that result tomultiplication

of the

microorganismwhich is the

action of the

drug.

Generic Name:Diazepam

Brand Name:

Valium

Depresses theCNS at thelimbic and

subcortical levels

of the brain and

suppresses thespread of seizure

activity produced

by epileptogenicfoci in the cortex,thalamus, and

limbic structure

Muscles spasm,severe recurrentseizure

Hypersensitivity tothe drug. Patientexperienced shock

and coma.

Seizure episodeis the chiefcomplaint of

the patient, the

physician

ordered thisdrug to lessen

the seizure

episode bydepressing theCNS at the

limbic and

subcorticallevels of brain


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ordered thisdrug to inhibits

uptake of

glucose and

other nutrientsin susceptible

helminths

Generic Name:

Metronidazole

Brand Name:Flagyl

A direct-acting

trichomonacide

and amebicidethat works at

both intestinalandextraintestinal

sites. Its thought

to enter the cells

ofmicroorganisms

that contain

nitroreductase.Unstablecompounds are

then formed that

bind to DNA andinhibit synthesis

Bacterial

infections

Hypersensitivity to

the drug or other

nitroimidazolederivatives

The present

disease caused

by bacterialinfection

resulting togastrointestinalproblems such

as diarrhea and

constipation.

Hence, thephysician

ordered this

drug to inhibitsynthesis ofmicroorganisms

that causes cell

death.


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Generic Name:

Ranitidine

Brand Name:Zantac

Competitivelyinhibits action of

histamine on the

H2 at receptor

sites of parietalcells, decreasing

gastric acid

secretion

Duodenal andgastric ulcer

Hypersensitive todrug and those with

acute porphyria

The patient isexperiencing

vomiting, to

prevent this

episodes thephysician

ordered this

drug todecrease gastric

acid secretions

Zinc Sulfate Participate in

synthesis andstabilization ofproteins and

nucleic acids in

subcellular and

membranetransport system

To prevent

individual traceelementdeficiencies in

patients

receiving long-

term totalparenteral

nutrition

Hypersensitivity Children need

vitamins suchas zinc becausezinc is one of

important

vitamins for

growth and forthe

development

and health ofbody tissue

-


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VIII. ANATOMY AND PHYSIOLOGYMeningitis, in general, is the inflammation of the protective membranes surrounding the

brain and spinal cord. In the case of bacterial meningitis, this inflammation is caused by

bacterial infection. In order to inflame these protective membranes, the bacteria must somehow

enter the bloodstream and bypass the blood-brain barrier.

Blood-Brain Barrier

Since the brain is such a delicate organ, nature has taken extra measures to protect the

brain by creating the blood-brain barrier to limit the diffusion of substances from the bloodstreaminto brain tissue selectively.

The blood-brain barrier mainly consists of tight junctions, which seals the endothelial

cells that line the brain capillaries. Astrocytes, a type of neuroglia from the brain, closely

attached to the endothelial cells and release chemicals to regulate the permeabilities of the tight

junctions. The major sites of the blood brain barrier are the arachnoid membrane, choroid plexus

epithelium, and the cerebral microvascular endothelium.

Only a few kinds water-soluble substance can move across the blood-brain barrier,such as glucose by active transport, urea, creatinine, and ions move across by slow diffusion.

On the other hand, lipid-soluble substances can easily cross the blood-brain barrier, such as

oxygen, carbon dioxide, alcohol, and most anesthetic agents.

When bacteria break through the blood-brain barrier, an infection occurs in the


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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 moreCSF. The fluid then enters the subarachnoid spacethrough 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.


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and connective tissue located in the epidural space, a space between the dura mater and the wall

of the vertebral canal.

The middle meninx is an avascular covering called the arachnoid mater. It is deep to the

dura mater and is continuous with the arachnoid mater of the brain. Between the dura mater andthe arachnoid mater is a thin subdural space, which contains interstitial fluid.

The innermost meninx is the pia mater, which adheres to the surface of the spinal cord

and brain. Within the pia mater are many blood vessels that supply oxygen and nutrients to the

spinal cord. Between the arachnoid mater and the pia mater is the subarachnoid space,

which contains cerebrospinal fluid that serves as a shock absorber and suspension system for the

spinal cord and brain .

All three spinal meninges cover the spinal nerve roots, structures that connect spinalnerves 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.


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Digestive System

The primary function of the digestive system is to break down the food we eat into smaller partsso the body can use them to build and nourish cells and provide energy. There occurs propulsion which

is the movement of food along the digestive tract. The major means of propulsion is peristalsis, a series

of alternating contractions and relaxations of smooth muscle that lines the walls of the digestive organs

and that forces food to move forward. It secretes digestive enzymes and other substances liquefies,

adjusts the pH of, and chemically breaks down the food. Mechanical digestion is the process of physically

breaking down food into smaller pieces. This process begins with the chewing of food and continues

with the muscular churning of the stomach. Additional churning occurs in the small intestine throughmuscular constriction of the intestinal wall. This process, called segmentation, is similar to peristalsis,

except that the rhythmic timing of the muscle constrictions forces the food backward and forward rather

than forward only. Chemical digestion which is the process of chemically breaking down food into

simpler molecules. The process is carried out by enzymes in the stomach and small intestines. Then

absorption or the movement of molecules (by passive diffusion or active transport) from the digestive

tract to adjacent blood and lymphatic vessels. Absorption is the entrance of the digested food into the

body. And lastly, defecation which is the process of eliminating undigested material through the anus.

But because of acute gastroenteritis the normal functions were altered. The infectious agents

that cause acute gastroenteritis causes diarrhea by adherence mucosal invasion enterotoxin


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The human digestive system is a complex series of organs and glands that processes food. In

order to use the food we eat, our body has to break the food down into smaller molecules that it can

process; it also has to excrete waste.

Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food

as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs

from the mouth to the anus, plus a few other organs (like the liver and pancreas) that produce or store

digestive chemicals.

The Digestive Process:

The start of the process - the mouth: The digestive process begins in the mouth. Food is partly

broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes

are produced by the salivary glands and break down starches into smaller molecules).

On the way to the stomach: the esophagus - After being chewed and swallowed, the food enters

the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic,

wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This

muscle movement gives us the ability to eat or drink even when we're upside-down.

In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a

very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids

is called chyme.

I th ll i t ti Aft b i i th t h f d t th d d th fi t t f


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epiglottis - the flap at the back of the tongue that keeps chewed food from going down the windpipe to

the lungs. When you swallow, the epiglottis automatically closes. When you breathe, the epiglottis

opens so that air can go in and out of the windpipe.

esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle movements

(called peristalsis) to force food from the throat into the stomach.

gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a digestive

chemical which is produced in the liver) into the small intestine.

ileum - the last part of the small intestine before the large intestine begins.

jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and the ileum.

liver - a large organ located above and in front of the stomach. It filters toxins from the blood, and makes

bile (which breaks down fats) and some blood proteins.

mouth - the first part of the digestive system, where food enters the body. Chewing and salivary

enzymes in the mouth are the beginning of the digestive process (breaking down the food).

pancreas - an enzyme-producing gland located below the stomach and above the intestines. Enzymes

from the pancreas help in the

digestion of carbohydrates, fats and proteins in the small intestine.

i t l i h th i l t th t f f d i th h f th th t i t th


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IX. PATHOPHYSIOLOGY

Ingestion of fecally

contaminated food & water

Secretion of F&E in the

intestinal lumen

Excessive gas formation

Direct invasion of the bowel

wall

Stimulation and destruction

of mucosal lining of the bowel

wall

Endotoxins are released

Digestive & absorptive

malfunction

Increase peristaltic

movement

Predisposing Factors

Age

Malnutrition

Precipitating Factors

Contaminated food

and water


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Ingestion of fecallycontaminated food & water

Secretion of F&E in the

intestinal lumen

Excessive gas formation

Direct invasion of the bowel

wall

Stimulation and destruction

of mucosal lining of the bowelwall

Endotoxins are released

Digestive & absorptive

malfunction

Increase peristaltic

movement


Age

Malnutrition

Precipitating Factors

Contaminated food

and water

Fecalysis

(Presence ofTrichuris

trichiuraova)
http://eol.org/pages/2926825/overview/http://eol.org/pages/2926825/overview/http://eol.org/pages/2926825/overview/http://eol.org/pages/2926825/overview/http://eol.org/pages/2926825/overview/http://eol.org/pages/2926825/overview/


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- Any age are at risk

Steptococcus

pneumoniae

Naso har n eal

Precipitating Factors- Environment-Poor Hygiene

- Malnutrition-Poor immune system

Im lantation

Enters the blood From wounds

Invades the CNS

Disease Process - PINK

Di VIOLET


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If Treated:- Early Diagnosis &Prompt Treatment

- Antibiotics- Antipyretics- Analgesics- Corticosteroids / Anti-

inflammatory agents- Anti-emetics- Avoid cooling too

much- Place in a quiet &

dark environment

If Not Treated

Thrombophlebitisof veins and

venous sinuses

Good Prognosis

Congestion andinfarction of

surrounding tissue

Adhesion Formation

Cranial nerve alsies

Visual or auditory

Early Treatment Delayed Treatment

Memoryim airement

Profound learningdisabilities

Bacterial Menin itis

Seizures


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PATHOPHYSIOLOGY

Predisposing Factors- Any age are at risk

Steptococcus

pneumoniae

Naso har n eal

Precipitating Factors- Environment-Poor Hygiene

- Malnutrition-Poor immune system

Im lantation

Enters the blood From wounds

Invades the CNS

Disease Process - PINK

Disease - VIOLET

I i d h i l bilit


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X. Nursing Care Plan Prioritization:

Nursing Diagnosis Ranking RationaleFluid volume deficient related to

excessive loose watery stool.1st It should be the first to be prioritized

because according to Callista Roys

adaptation model, fluid and electrolytes is

the 3rd

physiologic needs of man.

Source:(Kozier, Erb, Berman, and Burke,

2000).

Impaired skin integrity related to

presence of skin lesions.2nd It should be the second to be prioritized

because according to Callista Roys

adaptation model, the senses including the

senses of the skin which is the 7th

physiologic needs of man.

Source:(Kozier, Erb, Berman, and Burke,

2000).

Impaired physical mobility related to 3rd It should be the last to be prioritized


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XI. NURSING CARE PLAN

Assessment Nursing

Diagnosis

Planning Interventions Rationale Evaluation

Objectives:

-decreased urine

output

-sudden weight loss

Weight: 9kg.

-increased body

temperature with

temperature of

39 C.

-decreased skin

turgor

-increased capillary

refill: 5sec.

-dry skin/mucous

membranes

-vomiting

-loose watery stool

-Bowel movement

of 4 a day.

Fluid volume

deficient related

to excessive

loose watery

stool.

After nursing

interventions the

client will maintain

fluid volume at a

functional level as

evidenced by

adequate urinary

output, stable vital

signs, good skin

turgor and moist

mucous membranes.

-Assess vital signs; note strength of

peripheral pulses.

-Administer IV fluids as indicated.

-Monitor vital signs.

-Change position frequently.

-Provide frequent oral care as well as eye

care.

-Administer medications(e.g., antiemetic or

antidiarrheals)(antipyretics)

-To evaluate degree of fluid

deficit.

-To correct losses to

reverse pathophysiologic

mechanisms.

-To determine current

health status.

-To promote comfort and

safety.

-To prevent injury formdryness.

-To limit gastric/intestinallosses.

-To reduce fever.

After nursing

interventions the

client maintained

fluid volume at a

functional level as

evidenced by

adequate urinary

output, stable vital

signs, decreased

capillary refill: 2sec.,

good skin turgor and

moist mucous

membranes.


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Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation

Objectives:

-Disruption of skin

surface (epidermis)

-Destruction of skin

layers(dermis)

-invasion of body

structures

-damaged tissue e.g.,

integumentary

Impaired skin

integrity related to

presence of skin

lesions.

After nursing interventions

the client will demonstratebehaviors/ lifestyle changes

to promote healing and

preventcomplications/recurrence.

-Note laboratory

results pertinent tocausative factors (e.g.,

studies such as

Hb/Hct).

-Obtain a history ofcondition, includingage at onset, date of

first episode, howlong it lasted, original

site, characteristics of

lesions, and anychanges that have

occurred.- Inspect skin on a

daily basis, describinglesions and changes

observed.-Periodically

remeasure wound andobserve for

complications (e.g.,infection, dehiscence).

-Keep the affectedarea clean/dry,

prevent infection, andstimulate circulation

to surrounding areas.

-To assess causative/

contributing factors forhaving skin lesions.

-To assess extent ofinvolvement/ injury of theaffected area.

To assist client with

correcting/minimizingcondition and promote

optimal healing.

-To monitor progress ofwound healing.

-To assist bodys natural

process of repair.

After nursing interventions

the client demonstratedbehaviors/ lifestyle changes

to promote healing and

preventcomplications/recurrence.


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Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation

Objectives:

-limited range of

motion

-difficulty turning

-slowed movement

-functional level: 3

which indicate

require help from

another person.

-inability to walk

Impaired physical

mobility related to

neuromuscular

impairment.

After nursing

interventions the

client will increase

strength and function

of affected and/or

compensatory body

part.

-Assess nutritional status

and energy level.

-Determine degree of

immobility in relation to

previously suggested scale.

-Observe movement when

client is unaware of

observation.

-Instruct in use of side rails

for position

changes/transfers.

-Support affected body

parts/joints using pillows,

foot support and so forth.

-To identify causative/contributing

factors.

-To assess functional ability.

-To note any incongruencies with

reports of abilities.

-To promote optimal level of

function and preventcomplications.

- To maintain position of functionand reduce risk of pressure ulcers.

After nursing

interventions the

client increased

strength and function

of affected and/or

compensatory body

part.

Documents

CASE study t/c bacterial menigitis , AGE with moderate signs of dehydration ruled out electrolyrte imbalance