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A
CASE STUDY
ON
CNS INFECTION
Submitted to;
Ms. Verlyn Perez RN,MSN
Submitted by;Marie Joy R. Luczon
Student Nurse
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I.INTRODUCTIONA febrile seizure is a convulsion in a child triggered by a fever. Such convulsions occur
without any underlying brain or spinal cord infection or other neurological cause. A
febrile seizure is a convulsion that occurs in some children with a high temperature
(fever). The vast majority of febrile seizures are not serious.A seizure triggered by a fever is usually harmless and typically doesn't indicate a long-
term or ongoing problem.
The first febrile seizure is one of lifes most frightening moments for parents. Most
parents are afraid that their child will die or have brain damage. Thankfully, simple
febrile seizures are harmless.
There is no evidence that simple febrile seizures cause death, brain damage, mental
retardation, a decrease in IQ, or learning difficulties.
However, a very small percentage of children go on to develop other seizure disorders
such as epilepsy later in life.
Although described by the ancient Greeks, it was not until this century that febrile
seizures were recognized as a distinct syndrome separate from epilepsy.In 1980, a consensus conference held by the National Institutes of Health described a
febrile seizure as, "An event in infancy or childhood usually occurring between three
months and five years of age, associated with fever, but without evidence of
intracranial infection or defined cause."It does not exclude children with prior
neurological impairment and neither provides specific temperature criteria nor defines
a "seizure."
Another definition from the International League Against Epilepsy (ILAE) is "a seizure
occurring in childhood after 1 month of age associated with a febrile illness not caused
by an infection of the central nervous system (CNS), without previous neonatal seizures
or a previous unprovoked seizure, and not meeting the criteria for other acute
symptomatic seizures".
Signs and SymptomsA fever, usually higher than 38.9 C
Loss of consciousness
Jerking of the arms & legs
Eyes rolled back in the head
Difficulty breathing
Vomiting & urinating
Crying or moaning
Incidence rateFebrile convulsions are common paediatric patients. According to studies, about 3-5% of
otherwise healthy children between the ages of 9 months and 5 years will have a seizure
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caused by a fever. Toddlers are most commonly affected. Most occur well within the
first 24 hours of an illness, not necessarily when the fever is highest.
Epidemiology
Between 2% and 4% of European children have a febrile convulsion; the peak incidenceis age 18 months.Most are the simple febrile seizure type. Complex febrile seizures
occur in about 20% and febrile status epilepticus in about 5%.
PrognosisGenerally the prognosis is good:
By definition, febrile seizures do not recur beyond the age of 5 years approximately.There is no evidence for an increased risk of death, even for children with status
epilepticus
Intellect is not affected.
Febrile seizures recur in about 30%. Risk factors for recurrence are: family history of
febrile seizures, onset aged
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Complications
Although febrile seizures may cause great fear and concern for parents, most febrile
seizures produce no lasting effects. Simple febrile seizures don't cause brain damage,
mental retardation or learning disabilities, and they don't mean your child has a more
serious underlying disorder.
Febrile seizures also aren't an indication of epilepsy, a tendency to have recurrent
seizures caused by abnormal electrical signals in the brain. The odds that your child will
develop epilepsy after a febrile seizure are small.
Only a small percentage of children who have a febrile seizure go on to develop epilepsy,
but not because of the febrile seizures.
Recurrent febrile seizuresThe most common complication of febrile seizures is the possibility of more febrile
seizures. About a third of children who have a febrile seizure will have another one
with a subsequent fever.
The risk of recurrence is higher if:
Your child had a low fever at the time of the first febrile seizure.
The period between the start of the fever and the seizure was short.
An immediate family member has a history of febrile seizures.
Tests and diagnosisAfter experiencing a febrile seizure, your child will likely have:
A physical exam
Blood tests
Urine tests
These tests can help determine possible causes of the fever and seizure.
If your doctor suspects a central nervous system infection, a lumbar puncture (spinal
tap) may be necessary. In this procedure, a doctor inserts a needle into your child's
lower back to remove a small amount of spinal fluid.
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This test can reveal evidence of infection in the fluid that surrounds the brain andspinal cord.Further tests such as an electroencephalogram (EEG)a test that
measures brain activitymay be necessary if your child had a complex febrile seizure.
II.NURSING HISTORY
Patient Profile
Name; Patient M
Age; 2 y/o
Sex; Female
Address; Purok 4 Bulanao Tabuk,Kalinga
Nationality; Filipino
Religion; Jehovahs Witness
Bithplace; S/A
Admission date ; August 15,2011
Time; 10;00 PM
Attending Physician: Dr. Ramirez/Dr.Pacicolan
PAST HEALTH HISTORY
No previous hospitalization. The patient was confined @ Cagayan Valley Medical
Center because of persistent high grade fever for 20 hours, upward rolling of eyeballs and
stiltering of extremities lasting to about 5 min x 1 episode.
PRESENT ILLNESS HISTORY
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The patient was admitted August 15, 2011 @ 10;00 pm with chief complaint of dizziness,
fever and headache increase in sleeping time.3 days prior to admission, the patient was noted to
have cough and colds. She was given with paracetamol syrup before she was hospitalized. The
patients parent consulted @ emergency room of CVMV hospital and was managed andsubsequently admitted.
FAMILY HEALTH HISTORY
The patients father stated that the family has no history of any disease and illness.
PEARSONS FUNCTIONAL PATTERN
Condition
before
Hospitalization
Condition
During
Hospitalization
PSYCHOLOGICAL She has good stress coping pattern
wherein she dont react to simple
things that is done to her, even if it
is not meant accidentally
Her coping stress pattern is not
quite good after she was
hospitalized. She usually cries
whenever she wants to or even
when you accidentally touch her
body.
ELIMINATION
Patients mother stated the patient
usually voids 5-6 times a day. The
patient usually wears her diaper all
night. She usually defecates twice
in a row.
Patients mother said that the
patient usually voids 2-3 times a
day. When she was hospitalized,
she defecates once. Mother
stated that the patient was
irritable when her diaper was full
of void or even when she made
pu-pu.
ACTIVITY Patients mother stated that she
used to be a jolly child that loves to
play with her cousin and her tita
and tita.She loved to go to the
neighbourhood just to hang
around.
Patient seems irritated all the
time. She doesnt want to play with
anybody even to her father and
mother.
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ROLE
RELATIONSHIP
PATTERN
She has a good relationship with
her family as stated by her mother.
She makes her family happy by
simply giving them simple sing and
dance sample
Her relatives especially her parents
are very concerned with her
present conditions.
SLEEP Patient M usually sleeps about 9 in
the evening until 7 in the morning.
She always took nap during
noontime for about 2-3 hours.
Patients mother stated that her
daughter sleep anytime she want
to. She was easily distracted by
environmental factors such as
noise an even the temperature
inside the room (hotness) .
OXYGEN Before she was admitted, she
inhaled deep and slow due to her
fever.She has difficulty of
breathing according to her.
During her hospitalization, she has
an order of o2 inhalation of 1-2
cpm because there is sign of DOB.
NUTRITION Before she was admitted, her
mother stated that she is fond of
eating any food that is served to
her.
She is NPO during the
hospitalization.
SPIRITUAL She is a christian.She and her
family they usually go to church
together. She was thought to
become a good citizen by her
parents.
Her mother stated that as soon as
they went out to the hospital, they
plan to visit the church.
Laboratory ResultHematology Normal
Values
Result Interpretation
Erythrocyte VolumeFraction
Male 0.40-0.54
Female 0.38-
0.47
0.36 Due to tachypnea
Mean Corpuscular 80-100 fL 78.4 Decrease in the
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Volume (MCV) volume of the
average RBC
Mean Corpuscular
Hemoglobin(MCH)
26-32 pg 25.6 Decrease in the
number of grams
ofhemoglobin/unit
volume
WBC Differential
Count
Neutrophils 0.35-0.65 81.8 Presence of
infections
Lymphocytes 0.20-0.40 12.7 Presence of
chronic infections
Monocytes 0.02-0.08 5.4 Presence of
certain infections
such as glandular
fever
Eosinophil 0.0-0.5 0.0 normal
I. PHYSICAL ASSESSMENT
A
1. GENERAL APPEARANCE/ HEALTH STATUSAppearance
and mental
statusTechnique
used Normalfindings Actual Findings Analysis
Body build Inspection Proportionate Proportionate NormalPosture andgait,
standing,
sitting and
walking
Inspection Erect posturecoordinated
movementProportionate Normal
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MEASUREMENTS:
Level of consciousness; spontaneous
Grooming: satisfactory
2VITAL SIGNS:NORMAL
FINDING
OUTCOME ANALYSIS
BODY
TEMPERATURE
37.0 C 38.4C Presence of on
infectionPULSE RATE 120-160BPM 132 BPM tachycardia
RESPIRATION 20-30CPM 36CPM tachypnea
BLOOD
PRESSURE
100/60MMHG 90/70MMHG NORMAL
Date of assessment: August 15, 2011Time of assessment: 9; 00 am
3 Head to Toe assessment
AREAASSESSED TECHNIQUEUSED NORMALFINDINGS ACTUALFINDINGS ANALYSIS
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Head
Skull
Hair
Scalp
Face
Eyes
Sclera
Pupils
Inspection
Inspection
Inspection
Inspection
Normocephalic
c& smooth
texture
No wounds, no
abrasion
Symmetrical
White
Black
Size of the
proportional
to size of thebody
Black &
smooth
straight
No wounds,
mo abrasion
Symmetrical
Flushed face
Teary eyes
Redness of the
eye
Red, watery
Black in color
and equal insize
Normal
Normal
Normal
Normal
Due to fever
Due to fever
Due to fever
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AREA ASSESSED TECHNIQUE USED NORMALFINDINGS ACTUALFINDINGS ANALYSISEars/ hearing
Pinna
Ear Canal
Inspection Normal voice
Tones audible
Parallel,
Symmetrical,
Proportional to the
size of the head
and bean shape
Ear canal has no
abundant cerumen/ear wax
Hair in the ear
canal are visible
Normal voice
Tones audible
Parallel,
Symmetrical,
Proportional to the
size of the head
and bean shape
Ear canal has no
abundant cerumen/
ear wax
Hair in the ear
canal are visible
Normal
Normal
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Nose and sinuses Inspection Nose is in midline
and symmetrical
(-) secretion ofmucous
Nose is in midline
and symmetrical
(-) secretion ofmucous
Normal
Mouth
Teeth
Tongue
Mucosal lining
Lips
Tonsils
Uvula
Inspection
(-) swelling of gums
and bleeding
Gums is pinkish in
color
In central position,
freely movable,
pinkish and with
prominent veins on
the sublingual area.
Moist
Symmetrical and lipmargin is well
defined
Lips is pinkish
(-) swelling
(-) swelling
Dry lips
(+) swelling of gums
and bleeding
Gums is reddish
In central position,
freely movable,
reddish
(STRAWBERY)
Moist
Symmetrical and lipmargin is well
defined
Lips is dry and
Reddish
(strawberry)
(-) swelling
(-) swelling
Because
of the
diffuse
erythema
and
prominent
papillae.
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2. Neck Inspection (-) rashes and
visible masses
(-) rashes Normal
3.Chest
Breath sound
Breast
Nipple
Areola
Heart
Inspection
Palpation
Auscultatio
n
Inspection
Inspection
Auscultatio
n
No scars
(-) tenderness and
masses
(+) broncho
vesicular breath
sound at 2nd ICS
Breast is even with
the chest wall
Nipple are round,
and equal in size
Areola are round
symmetrical, colorbrown
(-) arrhythmia,
bounding pulse
heart murmurs and
any abnormal
pulsation being
auscultated
No scars
(-) tenderness and
masses
(+) broncho
vesicular breath
sound at 2nd lungs
Breast is even with
the chest wall
Nipple are round,
and equal in size
Areola are round
symmetrical, colorbrown
(-) arrhythmia,
bounding pulse
heart murmurs and
any abnormal
pulsation being
auscultated
Normal
Normal
Normal
Normal
Normal
Normal
2. Posteriorthorax
Inspection
Palpation
No scars
Spine vertically
align; spinal column
is straight right and
left shoulder and
No scars
Spine vertically
align; spinal column
is straight right and
left shoulder and
Normal
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Lungs
Auscultaion
Percussion
hips are at the
same height
Fermitus is heardmost clearly at the
apex of the lungs
No effort when
breathing with
good breathing
pattern
(+) resonance NBS
(normal lung sound)
hips are at the
same height
Fermitus is heardmost clearly at the
apex of the lungs
No effort when
breathing with
good breathing
pattern
(+) resonance NBS
(normal lung sound)
Normal
3. Abdomen Inspection
Auscultation
Percussion
Palpation
Abdominal skin is
unblemished, no
scars, with flat and
rounded
abdomen/symmetric
al contour.
Audible bowelsound
(+) presence of
tympany
No evidence of
enlargement of the
liver
Abdominal skin is
unblemished, no
scars, with flat and
rounded
abdomen/symmetric
al contour
Active bowelsound (10-30 bowel
sound in every 5min)
tympany
No evidence of
enlargement of the
liver
Normal
Due toperistaltic
activity
Normal
Normal
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4. UpperExtremities
SkinArms
Finger
Nail
5. Lowerextremities
Legs
Inspection
Palpation
Inspection
Inspection
(-) scars at thelower forearm
smooth
With fine hair
evenly distributed
and few visible
veins
Symmetrical
With complete five
finger in each hand
smooth, convex
with pinkish nailbed
Smooth, convex
with pinkish nail
bed
(-) negative scars
Fine hair is evenly
distributed
Muscles
symmetrical, length
(-) scars at thelower forearm
With fine hair
evenly distributed
and few visible
veins
Symmetrical
Desquamation of
finger
Peeling and
erythema of the
fingertips.
Transverse grooves
of fingers and
toenails (Beaus
lines).
(-) negative scars
Fine hair is evenly
distributed
Muscles
symmetrical, length
symmetrical
Normal
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Feet
Toe
Nails
Inspection symmetrical
Dorsal surface is
smooth & warm
With convex nails,
pinkish nail bed and
good capillary refill
of 2-3 seconds
(+) short and with
clear and white
translucent tips toe
nails.
Dorsal surface is
smooth & warm
With convex nails,
pinkish nail bed and
good capillary refill
of 2-3 seconds
(-) long and dirty
toe nail
Normal
Normal
ANATOMY AND PHYSIOLOGY
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Anatomy of the Brain: Brain DivisionsThe forebrain is responsible for a variety of functions including receiving and processingsensory information, thinking, perceiving, producing and understanding language, and
controlling motor function. There are two major divisions of forebrain: the diencephalon and
the telencephalon. The diencephalon contains structures such as the thalamus and
hypothalamus which are responsible for such functions as motor control, relaying sensory
information, and controlling autonomic functions. The telencephalon contains the largest part
of the brain, the cerebrum. Most of the actual information processing in the brain takes place
in the cerebral cortex.
The midbrain and the hindbrain together make up the brainstem. The midbrain is the portion ofthe brainstem that connects the hindbrain and the forebrain. This region of the brain is
involved in auditory and visual responses as well as motor function.
The hindbrain extends from the spinal cord and is composed of the metencephalon andmyelencephalon. The metencephalon contains structures such as the pons and cerebellum.
These regions assists in maintaining balance and equilibrium, movement coordination, and the
conduction of sensory information. The myelencephalon is composed of the medulla oblongata
which is responsible for controlling such autonomic functions as breathing, heart rate, and
digestion.
The brain contains various structures that have a multitude of functions. Below is a list of
major structures of the brain and some of their functions.
Basal Ganglia
Involved in cognition and voluntary movement Diseases related to damages of this area are Parkinson's and Huntington's
Brainstem
Relays information between the peripheral nerves and spinal cord to the upper parts ofthe brain
Consists of the midbrain, medulla oblongata, and the ponsBroca's Area
Speech production Understanding language
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Central Sulcus (Fissure of Rolando)
Deep grove that separates the parietal and frontal lobesCerebellum
Controls movement coordination Maintains balance and equilibrium
Cerebral Cortex
Outer portion (1.5mm to 5mm) of the cerebrum Receives and processes sensory information Divided into cerebral cortex lobes
Cerebral Cortex Lobes
Frontal Lobes -involved with decision-making, problem solving, and planning Occipital Lobes-involved with vision and color recognition Parietal Lobes - receives and processes sensory information Temporal Lobes - involved with emotional responses, memory, and speech
Cerebrum
Largest portion of the brain Consists of folded bulges called gyri that create deep furrows
Corpus Callosum
Thick band of fibers that connects the left and right brain hemispheresCranial Nerves
Twelve pairs of nerves that originate in the brain, exit the skull, and lead to the head,neck and torso
Fissure of Sylvius (Lateral Sulcus)
Deep grove that separates the parietal and temporal lobesLimbic System Structures
Amygdala - involved in emotional responses, hormonal secretions, and memory
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Cingulate Gyrus - a fold in the brain involved with sensory input concerning emotionsand the regulation of aggressive behavior
Fornix - an arching, fibrous band of nerve fibers that connect the hippocampus to thehypothalamus
Hippocampus - sends memories out to the appropriate part of the cerebral hemispherefor long-term storage and retrievs them when necessary
Hypothalamus - directs a multitude of important functions such as body temperature,hunger, and homeostasis
Olfactory Cortex - receives sensory information from the olfactory bulb and is involvedin the identification of odors
Thalamus - mass of grey matter cells that relay sensory signals to and from the spinalcord and the cerebrum
Medulla Oblongata
Lower part of the brainstem that helps to control autonomic functionsMeninges
Membranes that cover and protect the brain and spinal cordOlfactory Bulb
Bulb-shaped end of the olfactory lobe
Involved in the sense of smellPineal Gland
Endocrine gland involved in biological rhythms Secretes the hormone melatonin
Pituitary Gland
Endocrine gland involved in homeostasis Regulates other endocrine glands
Pons
Relays sensory information between the cerebrum and cerebellumReticular Formation
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Nerve fibers located inside the brainstem Regulates awareness and sleep
Substantia Nigra
Helps to control voluntary movement and regualtes mood
Tectum
The dorsal region of the mesencephalon (mid brain)Tegmentum
The ventral region of the mesencephalon (mid brain).Ventricular System - connecting system of internal brain cavities filled with cerebrospinal fluid
Aqueduct of Sylvius - canal that is located between the third ventricle and the fourthventricle
Choroid Plexus - produces cerebrospinal fluid Fourth Ventricle - canal that runs between the pons, medulla oblongata, and the
cerebellum
Lateral Ventricle - largest of the ventricles and located in both brain hemispheres Third Ventricle - provides a pathway for cerebrospinal fluid to flow
Wernicke's Area
Region of the brain where spoken language is understood
PATHOGENESIS AND PATHOPHYSIOLOGYThe pathophysiology of febrile seizures is unknown. The role of cytokine network
activation is presently being studied along with an increased susceptibility to febrile
seizures associated with specific interleukin alleles.Circulating toxins, immune reaction products, and viral or bacterial invasion of the
central nervous system have been implicated, together with relative lack of myelination
in the immature brain and increased oxygen consumption during the febrile episode.
Immaturity of thermoregulatory mechanisms and a limited capacity to increase cellular
energy metabolism at elevated temperatures have been suggested as contributory
factors .
http://biology.about.com/library/organs/brain/blsubstantianigra.htmhttp://biology.about.com/library/organs/brain/bltectum.htmhttp://biology.about.com/library/organs/brain/bltegmentum.htmhttp://biology.about.com/library/organs/brain/blventricles.htmhttp://biology.about.com/library/organs/brain/blaqueduct.htmhttp://biology.about.com/library/organs/brain/blchoroidplex.htmhttp://biology.about.com/library/organs/brain/blfourthvent.htmhttp://biology.about.com/library/organs/brain/bllateralvent.htmhttp://biology.about.com/library/organs/brain/blthirdvent.htmhttp://biology.about.com/library/organs/brain/blwernicke.htmhttp://biology.about.com/library/organs/brain/blwernicke.htmhttp://biology.about.com/library/organs/brain/blthirdvent.htmhttp://biology.about.com/library/organs/brain/bllateralvent.htmhttp://biology.about.com/library/organs/brain/blfourthvent.htmhttp://biology.about.com/library/organs/brain/blchoroidplex.htmhttp://biology.about.com/library/organs/brain/blaqueduct.htmhttp://biology.about.com/library/organs/brain/blventricles.htmhttp://biology.about.com/library/organs/brain/bltegmentum.htmhttp://biology.about.com/library/organs/brain/bltectum.htmhttp://biology.about.com/library/organs/brain/blsubstantianigra.htm8/3/2019 A Case Study on Cns Infection
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A recently documented pathogen associated with febrile seizures is human Herpes virustype 6. This is the etiologic agent for infant rosella, a common infection of infants and
toddlers usually associated with fever greater than or equal to 103F.
It is postulated that the direct viral invasion of the brain or fever causes the initial
febrile seizure, and that the virus might be reactivated by fever during subsequent
illnesses, causing recurrent febrile seizures.
COURSE IN THE WARDDATE TIME DOCTORS ORDER RATIONALE
8/15/11 10pm Pls. admit to Pedia Ward under theservice of Dr. Ramirez/Dr.Pasicolan
For continuouscare, monitoring
and treatment
Secure consent for admission For legal purposesWt. 10.3 kg
BP-80/50
Temp-39.5CR-124
RR-34
TPR q shift and record Serves as baselinedata
NPO Patient is underobservation
Diagnostics
CBC ; APL
Urinalysis;SG
SE
Hgb nowCranial CT scan
EEG
To providebaseline data on
patients
hematology
CBC:To determinethe extent of the
disease process.To
determine the
blood type and its
composition
Urinalysis;Todetermine
characteristics
and components
of urine which are
not usually presentthat also signal
infection in the
urinary system
Hook for D5 0.3 NaCl 500 ml to run@38-39 uggts/min x 8 hours
To replace fluidloss and for
further
nourishment
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Chloramphenicol 260 mg IV q 6 hours(-)ANST
It has an effectagainst susceptible
bacteria, serve as
antibiotic
Paracetamol 105 mg IV q 4 hoursRTC
To decreasetemperature andfor mild pain
Diazepam 2 mg IV q 4 hours RTC It suppresses thespread of seizure
activity(prevent
seizure)
O2 inhalation 1-2 cpm/nasal cannula Inhalation ofOxygen aimed at
restoring toward
normal to
pathophysiologic
alterations of gas
exchange in the
cardiopulmonary
system.
Monitor IV q and record To serve asbaseline data
Monitor I and O q shift and record To serve asbaseline data
Watch out for seizure Dr. Pasicolan To prevent anyfurther injury
Seizure precaution @ bedside To preventfurther injury
Refer For furtherevaluation and
management
8/16/11 NPO Still the patient isunder observation
afebrile Cont. D5 0.3 NaCl @38-39 ugtts/min To continue inreplacement of
fluid loss and for
further
management
(-) seizure Follow-up CBC with APL and SE CBC:To determinethe extent of thedisease process.To
determine the
blood type and its
composition
(-) DOB Still for cranial CT Scan and EEG To visualize ifthere is affected
part on the cranial
8/3/2019 A Case Study on Cns Infection
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area
Continue medications andmanagement
For continuoustreatment
Continue vital signs monitoring For baseline dataand to monitor
alteration Seizure precaution @ bedside To prevent
further injury
8/16/11 10am DAT To provideadequate nutrition
in order to regain
strength
IVF of D5 IMB 500 ml to run @ 32-33ugtts/min
To continue inreplacement of
fluid loss and for
further
nourishment
Continue medications andmanagement
For continuoustreatment
Continue vital signs monitoring For baseline dataand to monitor
alteration
Refer HAMA To continuemedications at
home with
physicians consent
PARACETAMOLCLASSIFICATION DOSAGE INDICATION CONTRAINDICATION ADVERSE
REACTION
Antipyretics 105 mg IV q 4
hours RTC
Inhibits
synthesisof
prostaglan
dins that
may serve
as
meditators
of pain and
Products
containingame,saccharinalco
hol,aspartame,sac
charin sugar
tartrazine should
be avoided in
patients who have
hypersensitivity or
GI;hepat
failure,hotoxicity
(overdose)
GU:rena
failure
Derm;ras
8/3/2019 A Case Study on Cns Infection
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fever,prima
rily in the
CNShas no
significant
anti-
infllammatory
property of
GI toxicity.
intolerance to
these compounds.
CHORAMPHENICOLCLASSIFICATION DOSAGE INDICATION CONTRAINDICATION ADVERSE
REACTION
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Antibiotic 260 mg IV q
6 hours (-)
ANST
May rarely
cause
systemic
hematologic
toxicity ifused
chronically
and in
excessive
causes.It
has bactero-
static
effect,effe
ct against
susceptible
bacteria;pre
vent cell
replication
Contraindicated
in patients
hypersensitive to
drug or its
components andin those with
perforated
eardrum.
EENT;ear
irritation or
itching
Skin;urticar
DIAZEPAM
CLASSIFICATION DOSAGE INDICATION CONTRAINDICATION ADVERSE REACT
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Anxiolytics 2 mg IV q 6
hours
A
benzodi
azepine
that
probablypotentia
tes the
effects
of
GABA,d
epresses
the
CNS,an
d
suppress
es the
spread
of
seizure
activity.
Contraindicated
in patient
hypersensitivity
to drug or soy
protein; inpatients
experiencing
shock, coma or
acute alcohol
intoxication.
CNS;drow
ss,dysarthi
rred speec
CV;hypote
n,bradycarCv collaps
EENT;dipl
blurred vis
Respirator
piratoryde
sion,apnea
AssessmentNursing
DiagnosisPlanning Nursing Interventions Rationale
Objective:
:
Hyperthermia Short term:
Long Term:
After 2 days of
nursinginterventions,
the patient will
be able to befree of
complications
and maintain
coretemperature
within normalrange.
>
>
> > >
>
>
>
.
Assessment Nursing Planning Nursing Interventions Ration
8/3/2019 A Case Study on Cns Infection
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Diagnosis
Subjective:
Objective:
the patient manifested:
> body weakness
> weight of 7.9kg
> loss of appetite
> poor muscle tone
the patient may manifest:
> abnormal laboratory
studies
> pallor
Imbalance
Nutrition: Less
than the bodyrequirement
related toeconomicalfactors.
Short term:
After 4 hours of
nursing interventions,
the patients willidentify measures to
promote nutrition andfollow the treatment
regimen
Long Term:
After 2 days of nursing
interventions, the will
demonstrate
behaviours or lifestylechanges to regain
appropriate weight.
>Review patients records.
>Assess underlying
condition.
>discuss eating habits and
encourage diet for age.
> Note total daily intake
includes patterns and time
of eating.
>Consult physician for
further assessment and
recommendation regarding
food preferences andnutritional support.
>To ob
data.
>To despecific
interve
>To ac
needs o
with th
diet for
>To re
that sho
in the c
intake.
>For g
understfurther
specific
AssessmentNursing
DiagnosisPlanning Nursing Interventions Rationale
Subjective:
Objective:
The patientmanifested:
>Body temperature
Ineffective
tissue
perfusion
realated todecreased
Hgb
concentration
in blood asevidenced bylow Hgb
count in CBC
Short term:
After 4 hours of nursingintervention, the patient
will demonstrate
behaviour lifestylechanges to improve
circulation.
Long term:
> Establish rapport.
> Monitor VS.
> Determine factors related
to individual situation.
> Evaluate for signs of
infection especially when
immune system is
> To gain patient a
trust and promote
cooperation.
> To monitor patie
> To gain informa
regarding the cond
>To observe for p
8/3/2019 A Case Study on Cns Infection
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changes.
>Skindiscoloration
The patient maymanifest:
> Anemia
result After 2 days of nursing
intervention, the
patients S.O. willverbalize understanding
of the condition.
compromised.
> Discuss individual riskfactors.
> Elevate head of bed atnight.
> Discuss the importance
of a healthy diet..
risk factors.
> This information
necessary for the cS.O.
> To increase gravblood flow.
>To promote a hea
to help increase RBsynthesis and Hgb
faster recovery.
AssessmentNursing DiagnosisPlanningNursing InterventionsRationaleExpected OutcomeS =
O = the patient manifested:
>body weakness
>fatigue
>poor muscle tone
=The patient may manifest:
>elevated body temperature
>Hgb = 112
>WBC = 22.9
>RBC = 3.97
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>HCT = 0.34
>Platelet count = 234
Risk for (spread) of infection
Short Term:
After 3 hours of nursing interventions, the patient will verbalize understanding of ways on how to prevent
spread of infection.
Long Term:
After 1week of nursing interventions, the patient will be free from infections and further complications
>Establish good working relationship with the client and S.O.
>Monitor and record vital signs
> Determine pts individual strength
>Provide peaceful environment
>Provide adequate rest and sleep.
>Emphasize importance of hand washing
>Provide safety measures
>Monitor I & O
>Check IV and Regulate IVF
>Advice pt to increase oral fluid intake when allowed
>To gain their trust and cooperation
>For comparative baseline data
>To know when to assist client
8/3/2019 A Case Study on Cns Infection
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>To promote optimum level of functioning
>To prevent fatigue and conserve energy
>.to prevent occurrence of further infections
>To prevent falls and injuries
>To note for imbalances
>To ensure proper hydration
> To replace fluid electrolyte loss
Short Term:
After 3 hours of nursing interventions, the patient shall have verbalized understanding of ways on how to
prevent spread of infection.
Long Term:
After 1week of nursing interventions, the patient shall have been free from infections and further
complications.
AssessmentNursing DiagnosisPlanningNursing InterventionsRationaleExpected
OutcomeSubjective:
Objective:
the patient may manifest the following:
>Fever
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>Convulsion
>Low
>Low Hgb Level = 112
Risk for injury related to possible convulsion.Short term:
After 4 hours of nursing interventions, the SO will modify environment as indicated to enhance safety.
Long term:
After 2 days of nursing interventions, the SO will verbalize understanding of individual factors that
contribute to possibility of injury.
>establish rapport
>monitor and record Vital Signs
> ascertain knwlge of safety needs/ injury prevention
> note clients gender, age, developmnt stage, decision makng ability, level of cognition/competence
>provide health care within a culture of safety
> identify interventions/safety devices
> discuss importance of self monitoring of conditions/ emotions
> To gain patients trust
>To obtain baseline data
> to prevent injuries in home, community, and work setting
>affects clients ability to protect self/others and influence choice of interventions/ teachings
>to prevent errors resulting in client injury, promote client safety and model safety behaviors for
client/SO
>to promote safe physical environment and individual safety
8/3/2019 A Case Study on Cns Infection
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>it can contribute to occurence of injury
Short term:
The SO shall have modified environment as indicated to enhance safety.
Long term:
The SO shall have verbalized understanding of individual factors that contribute to possibility of injury.
DISCHARGE CARE PLAN
MEDICATION Instructed and explained to the
patient the importance of taking
medication as well as the duration
in taking medicine
Advised SO to continue givingvitamin supplements to patient to
boost her immune system
EXERCISE Advised to avoid strenuous
activities and have moderateexercises lie adduction and
abduction of upper and lower
extremities
TREATMENT Instructed patient to follow strict
compliance with the medicines
ordered and have regular wound
dressing
Advised SO the importance ofadherence to treatment regimen
HYGIENE Encouraged patient to haveproper hand washing regularly,brush teeth 3 times a day and takea bath daily
OPD Advised SO to come back
@CVMC for further follow-up
check-up after discharged
SO is advised to consult doctor if
8/3/2019 A Case Study on Cns Infection
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any problems or complications
encountered
DIET Advised SO to give nutritious
foods which is high in protein and
essential vitamins
Encouraged SO to increased fluidintake of the patient
SPIRITUAL Encouraged the SO to have strong
faith for fast recovery of the
patient
Advised SO not to be discouragedand lose hope even if there are
many problems theyve encountered