Question

Written Case Presentation 30% This case presentation will assess your knowledge on the disorder of your choice. You are required to present your case presentation in 1,500 – 2,000 words. All sources are to be referenced using the APA format guideline with a minimum of 2 sources. You can access the elibrary for medical and surgical nursing textbooks through the library portal.

Select one (1) disorder from the following: Meningitis, Anemia, Diabetes Mellitus

You are required to follow the guidelines below.

1. Introduction: Define the disorder/disease Etiology Causes

2. Pathophysiology of disease

3. Clinical manifestations

4. Effects of the disease process on the body systems.

5. Drugs: Name of drug, Dosages, frequency, indication, side effects (2)

6. Drug effects on body system: Select one (1) drug and write on pharmacodynamics, mechanism of action, metabolism.

7. Physical Examination: Describe what you may elicit while performing a physical examination on the client with the disorder. Any positive or pertinent negative physical findings on examination should relate to the disorder.

8. Laboratory and diagnostic tests: Describe the laboratory and diagnostic evaluations.

9. Nursing management: Outline the nursing management of the disorder.

10. Evaluation: Evaluate the clients general condition.

Answer 1

Meningitis is inflammation of the meninges, which cover and protect the brain and spinal cord. The three main causes of meningitis are bacterial, viral and fungal infections. It is also classifies into septic and aseptic. Septic meningitis is caused by bacteria. In aseptic meningitis, the cause is viral or secondary to cancer or having a weakened immune system such as HIV.

PATHOPHYSIOLOGY..

Most cases of meningitis are caused by an infectious agent that has colonized or established a localized infection elsewhere in the host. Potential sites of colonization or infection include the skin, the nasopharynx, the respiratory tract, the gastrointestinal (GI) tract, and the genitourinary tract. The organism invades the submucosa at these sites by circumventing host defenses (eg, physical barriers, local immunity, and phagocytes or macrophages).An infectious agent (ie, a bacterium, virus, fungus, or parasite) can gain access to the CNS and cause meningeal disease via any of the 3 following major pathways:

Invasion of the bloodstream (ie, bacteremia, viremia, fungemia, or parasitemia) and subsequent hematogenous seeding of the CNS.

A retrograde neuronal (eg, olfactory and peripheral nerves) pathway (eg, Naegleria fowleri or Gnathostoma spinigerum).

Direct contiguous spread (eg, sinusitis, otitis media, congenital malformations, trauma, or direct inoculation during intracranial manipulation).

Once the organism enters the blood stream, it crosses the blood brain barrier and proliferate in the cerebro spinal fluid. The host immune system stimulates the release of cell wall fragments and lipopolysaccharides, facilitating inflammation.

CLINICAL MANIFESTATION

The classical symptoms include.

Fever

Headache

Neck stiffness

Neck stiffness (nuchal rigidity)

Other symptoms can include nausea, vomiting, photalgia (photophobia), sleepiness, confusion, irritability, delirium, and coma. Patients with viral meningitis may have a history of preceding systemic symptoms (eg, myalgias, fatigue, or anorexia).

EFFECT OF THE DISEASE ON THE BODY.

Memory loss/lack of concentration/difficulty retaining information.

Clumsiness/co-ordination problems.

Headaches.

Deafness/hearing problems/tinnitus/dizziness/loss of balance.

Epilepsy/seizures.

Weakness/paralysis/spasms.

Speech problems.

Loss of sight/vision problems.

DRUGS. Empiric antimicrobial therapy should cover all likely pathogens in the context of this clinical setting. Trimethoprim-sulfamethoxazole (TMP-SMX) is effective against many aerobic gram-positive and gram-negative bacteria, but its use in bacterial meningitis is limited to patients with Listeria monocytogenes meningitis who have a penicillin allergy.

Steroid (typically, dexamethasone) therapy. In certain patients, consideration of intrathecal antibiotics

Other types of meningitis are treated with specific therapy as appropriate for the causative pathogen, as follows :Fungal meningitis - Cryptococcal (amphotericin B, flucytosine, fluconazole), Coccidioides immitis (fluconazole, amphotericin B, itraconazole), Histoplasma capsulatum (liposomal amphotericin B, itraconazole), or Candida (amphotericin plus 5-flucytosine). Tuberculous meningitis (isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin).

Adult dose..

Cefotaxime – 2 g IV every 4 hours

Ceftriaxone – 2 g IV every 12 hours

Vancomycin – 750-1000 mg IV every 12 hours or 10-15 mg/kg IV every 12 hours

Drug details about Vancomycin.

Action. Inhibits bacterial cell wall synthesis.

Uses. Resistant staphylococcal infections, pseudomembranous colitis, endocarditis, meningitis.

Sideeffects. Hypotension, ototoxicity, nephrotoxicity, leukopenia, anaphylaxis..

Physical examination.

Nuchal rigidity, positive kernings sign, positive brudzinskis sign, photophobia, rash, disorientation, seizures.

Laboratory tests. CT, MRI, Bacterial culture and gram staining of CSF and blood. Complete blood count (CBC) with differential, serumum electrolytes, serum glucose (which is compared with the CSF glucose), blood urea nitrogen (BUN) or creatinine and liver profile

Nursing management.

Instituting infection control precautions, assisting with pain management, assisting with getting adequate rest, implementing interventions, management of fever and ensuring close neurological monitoring.