Meningitis

INTRODUCTION
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs. Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore the condition is classified as a medical emergency. The most common symptoms of meningitis are headache and neck stiffness associated with fever, confusion or altered consciousness, vomiting, and an inability to tolerate light (photophobia) or loud noises (phonophobia).
In adults, a severe headache is the most common symptom of meningitis – occurring in almost 90%
of cases of bacterial meningitis, followed by nuchal rigidity (inability to flex the neck forward passively due to increased neck muscle tone and stiffness). Nuchal rigidity occurs in 70% of adult cases of bacterial meningitis. Other signs of meningism include the presence of positive Kernig's sign or Brudzinski's sign. Kernig's sign is assessed with the patient lying supine, with the hip and knee flexed to 90 degrees. In a patient with a positive Kernig's sign, pain limits passive extension of the knee. A positive Brudzinski's sign occurs when flexion of the neck causes involuntary flexion of the knee and hip. Although Kernig's and Brudzinski's signs are both commonly used to screen for meningitis, the sensitivity of these tests is limited.
Our group decided to take this particular case because based in our knowledge before; meningitis can be acquired through a head injury or contusion. We became more interested with the case as we get hold of the patient’s chart. Then we found out that meningitis has lots of origin or roots. And as we go on with her chart, we found the three common signs of meningitis, the nuchal rigidity, headache and fever. We want to have more background and knowledge about this disease, because there are still many people that are not aware of this disease, and we want to share our gained knowledge for them to become aware and they will know the risk factors on how it is being acquired. If they become aware of this, they will learn and know how to prevent such diseases and there will be less mortality rate due to meningitis. We are hoping that through this case presentation each of one of us will understand this very well to help other people in the community to become more aware and will live a healthy lifestyle.

Patient History
 Patient’s Name: Ms. EE
 Hospital Number: 493132
 Address: Block 16 Planters, Cainta Rizal
 Date of Birth: April 19, 1991
 Age: 19 Occupation: unemployed
 Birthplace: Pasig
 Nationality: Filipino
 Religion: Catholic
 Date Admitted: May 4, 2010 @ 9:18 pm
 Attending Physician: Felix Roberto G. Torres

II. NURSING HISTORY

A. PAST HEALTH HISTORY
 The client, Ms. EE has had childhood illness such as measles and as she can remember she acquired this when she was 8 years old. She forgot if she has a complete immunization. She has no known allergies to any food, drugs, insects or any other environmental agents. She also said that there is no one her family has known communicable or infectious disease. It is her first time to be hospitalized with her chief complaint, which is neck stiffness. Despite of this she does not take any medications to ease her pain.

B. HISTORY OF PRESENT ILLNESS
 Two weeks prior to admission, patient had carbuncle in the forehead, then after a week the carbuncle spread on nape and right leg. Neither consultation done nor medication taken. Then 5 days prior to admission, the patient developed fever, headache, nausea without vomiting. And still neither consultation done nor medication taken. And 2 days after, she experienced pain of the neck and jaw, drooping of the left eyelid with associated changes in sensorium. The patient consulted at San Lazaro Hospital hence admitted.
C. FAMILY HISTORY
 The patient denied of having any familial disease. She said that every member of their family has no known communicable or non-communicable disease.

III. PATTERNS OF FUNCTIONING

A. PSYCHOLOGICAL HEALTH
 Ms. EE seems to cope very well in every problem she encounters. But during our interaction with her we found out that she is not a demonstrative person, a shy type and does not want to be asked of so many questions especially about her health conditions.. When it comes to her cognitive patterns, her memory stays the same however she experiences problems when it comes to her eye sight(drooping of the left eyelid), hearing( otitis media), and smelling( with nasal discharges). She’s proud of whom she is but still, she said that she’s not yet satisfied with everything that she has. Now that she’s in the hospital, she looks depressed and not interested in expressing her thoughts and feelings. Before she got hospitalized she’s a happy and living in an ordinary world, as a teenager, she does some night life and fond of having friends. But now, she’s in the hospital, she’s a little bit bored and worried about her condition.

 Interpretation:
EE exhibits an unhealthy lifestyle. She’s quite satisfied with what she has right now but still she tries to improve in every aspect. Her self-esteem is negatively projected. She seems having a hard time to adjust with certain problems and tries to hide them.
 Analysis:
Each person has certain psychologic needs, such as the need for love, security, and self-esteem, which must be met to maintain psychologic homeostasis. When one or more of these needs is not met or is threatened, certain coping mechanisms are activated to protect the person and provide psychologic homeostais.
 The coping mechanisms families and individuals develop reflect their individual resourcefulness. Families may use coping patterns rather consistently over time or may change their coping strategies when new demands are made on the family. The success of a family largely on how well it copes with the stresses it experiences. (Fundamentals of Nursing 7th ed. by Kozier, Barbara et al. pp 189 and 193)
B. SOCIO CULTURAL PATTERNS
 The patient is a typical filipina. She observes the Lenten season, Christmas day, and other Filipino traditions. She believes in certain Filipino myths like that of not sweeping the floor at night for it will surely bring misfortune. During her spare time, she can be seen watching the television. She’s also fond of going to the mall and some parks. And whenever she can, she takes a nap in the afternoon to compensate for her sleepless nights due to her anxiety. She describes her environment as something that is not conducive to healthy living. She has a good relationship with her neighbors. She is unemployed, but whenever her budget is short, she gets help from her siblings. She admitted that their environment is not that conducive for a healthy living, but still their barangay is doing some clean up to improve their community. Before she got hospitalized, her mother is always at her side and during her hospitalization her mother is still there. She prays before she go to sleep at night.

• Interpretation:
EE adheres to what her family has lived up to.
She follows cultural norms and respects other cultures as well.
 Analysis:
A person’s perceptions of and reactions to hospital experience are influenced by individual factors, including family health beliefs and practices, economic factors and cultural and ethnic backgrounds. (Fundamentals of Nursing by: Taylor et al. P 791)
Having a support network (family, friends, or a confidant) and job satisfaction helps people avoid illness. Support people also help the person confirm that illness exists. People with inadequate support networks sometimes allow themselves to become increasingly ill before confirming the illness and seeking therapy. Support people also provide the stimulus for an ill person to become well again.(Fundamentals of Nursing 7th Edition by Barbara Kozier et al. p. 178, 406)
SPIRITUAL PATTERNS
 The patient’s belongs to a Religious affiliation called Roman Catholic but admitted that she attend the Sunday mass occasionally. She’s not active in joining religious groups.
 Interpretation:
The patient is observing religious practices as a
catholic.
 Analysis:
Both positive and negative experiences can influence spirituality, and in turn are influenced by the meaning of a person’s spiritual beliefs attribute to them. (Fundamentals of Nursing by: Taylor et al. p. 982)

ACTIVITIES OF DAILY LIVING
Activities of Daily Living Before
Hospitalization
During
Hospitalization
Interpretation and Analysis
1.
Nutrition She eats more than three times a day. It includes lots of rice, meat, poultry, vegetables, and at times a few serving of fruits. She’s not picky when it comes to food. She drinks plenty of fluids. She ate a three day recall in the hospital. When she got hospitalized, her appetite changed. However she eats whatever is served to her. Interpretation:
Changes occurred when it comes to the patient’s appetite. She takes enough calories per day.
Analysis:
The nutritional habits established during young adulthood often lay the foundation for the patterns maintained throughout a person’s life. Many young adults are aware of the food groups but may not be knowledgeable about how many servings of each group they need or how much constitutes a serving.
- Kozier, Barbara et al. Fundamentals of Nursing Concepts, Process, and Practice, 7th Edition. p. 1180

Activities of Daily Living Before
Hospitalization
During
Hospitalization
Interpretation and Analysis
2. Elimination She defecates once or twice a day and she said that her stools are brown and are soft with foul smell. She experiences no pain in defecating. She voids at least 5 times a day and more especially when she drinks a lot of fluids. She said that her urine is yellow and has an aromatic
odor. During her first week in the hospital, she didn’t void or defecate because she finds doing such hard. But now, she sees to it that she regularly excretes her wastes because she’s also afraid of further complications. Her stool is sometimes scanty and sometimes is copious in amount and brownish in color and with odor. The urine is yellowish in color. Interpretation:
The patient experienced discomfort when she was admitted to the hospital. Her bladder and bowel movement changed due to sudden change in environment.
Analysis:
Bowel and bladder movements differ according to each person; they do not necessarily occur daily. http://www.virginia.edu/studenthealth/ Activities of Daily Living Before
Hospitalization
During
Hospitalization
Interpretation and Analysis
3. Exercise Ms. EE doesn’t perform exercises regularly, for her, walking is her major exercise, but at times, when she feels like it, she jogs along their street in the morning. She’s able to move minimally because of her condition. But she said that she follows what the nurses tell her Interpretation:
She’s contented with her own physical activities. She doesn’t consider exercising a priority, thus there are greater chances of impaired physical mobility.
Analysis:
People often define their health and physical fitness by their activity because mental well being and the effectiveness of body functioning depend largely on their mobility status.
Kozier, Barbara et al. Fundamentals of Nursing Concepts, Process, and Practice, 7th Edition. p. 394

Activities of Daily Living Before
Hospitalization
During
Hospitalization
Interpretation and Analysis
4. Hygiene She takes a bath twice a day, one in the morning and one in the evening. She bathes for 10-20 minutes. She brushes her teeth after every meal and said that she sees to it that it will last for at least 3 minutes. She does not received bed bath and bed shampoo everyday but performs sponge bath at least once a day.. She still brushes her teeth but only when she remembers to do so or if there’s someone to assist her. Interpretation:
Her personal hygiene changed much. She appears not well-groomed.
Analysis:
Bathing produces a sense of well being. it is refreshing and relaxing and frequently improves morale, appearance and self-respect.
Kozier, Barbara et al. Fundamentals of Nursing Concepts, Process, and Practice, 7th Edition. p. 394

Activities of Daily Living Before
Hospitalization
During
Hospitalization
Interpretation and Analysis
5. Substance Abuse EE drinks constantly. She’s a habitual drinkers and smokers. No substance abuse Interpretation:
The client is a habitual drinker and smoker. This just goes to show that the patient is living an unhealthy lifestyle.
Analysis:
The cardiovascular is affected by cigarette smoking. Nicotine increases the heart rate, blood pressure, and peripheral vascular resistance, increasing the heart’s work load. Smoking causes vasoconstriction, and in areas where vessels already are narrowed by atherosclerosis, tissue oxygenation can be impaired.
Recent studies suggest that moderate alcohol use may actually reduce the risk of heart disease; however, excessive alcohol intake affects oxygenation several ways. Alcohol is a respiratory depressant, slowing respiration. Alcohol abusers often are malnourished, increasing their risk of anemia and infections. Excess alcohol intake also increases the risk of hypertension.
Kozier, Barbara et al. Fundamentals of Nursing Concepts, Process, and Practice, 7th Edition. p. 1339

Activities of Daily Living Before
Hospitalization
During
Hospitalization
Interpretation and Analysis
6. Sleep and Rest She usually sleeps for 6 hour. From 11pm to 5am. She said that she’s unsatisfied with it and she still feels sleepy during daytime. She sleeps earlier especially when the room is quiet. Interpretation:
EE’s sleep cycle improved when she got confined to the hospital. She appears contented and shows no sign of sleep deprivation.Analysis:The sleep wake cycle is very important to young adults they usually have an active lifestyle, and are thought to require 7 to 8 hours of sleep each night but mat may do well on less.Kozier, Barbara et al. Fundamentals of Nursing Concepts, Process, and Practice, 7th Edition. p. 1116

Activities of Daily Living Before
Hospitalization
During
Hospitalization
Interpretation and Analysis
7. Sexual Activity She’s a lesbian, She doesn’t think of it any more. She’d rather do something else more important than thinking of it. No sexual activity Interpretation:
The patient lacks fulfillment in this physiologic aspect. Her perspective detached her from performing and satisfying her sexual urges.
Analysis:
People experience sexual gratification in many ways, and what is considered normal differs from one individual to another and among cultures.
Fundamentals of Nursing by: Taylor et al. p. 932

Physical Assessment: System Review
General survey:
 Vital Signs: Temperature: 36.9 ° via Axilla Pulse Rate: 66 bpm Respiratory Rate: 29 bpm Blood Pressure: 110/60 mmHg
• Pale and weak in appearance
• Conscious, and coherent
• Thin and slightly slouched
• Appears depressed and shows withdrawal
• With minimal body odor Integumentary system:
• Pallor skin and nail beds
• Normal skin turgor
• With healing wounds on the forehead
• Presence of dandruff on scalp
EENT:
Eyes
• No edema or tearing
• Black in color, equal in size, PERRLA (Pupil Equally Round Reactive to Light Accommodation)
• Both eyes coordinated

Ears:
• With discharges on both ears- foul smelling and greenish
• Symmetrical
• Able to hear on both ears
Nose:
• Symmetric and straight
• With yellowish nasal discharges
Throat:
• No complaints of difficulty in swallowing
Musculoskeltal System:
• Equal on both sides
• weakness and flaccidity on left leg,
• with poor ROM
• (+) nuchal rigidity
• No swelling and tenderness
• No bone deformities
Respiratory:
• Equal lung symmetry
• With equal lung expansion
• Crakles heard upon auscultation
• presence cough with bloody sputum, scanty in amount
Cardiovascular:
• with full pulsations
• normal heart rate
• no sound heard on auscultations

G.I tract:
• no diarrhea
• no evidence of liver or spleen enlargement
• audible bowel sounds
• no tenderness
• with normal bowel movement