IDENTIFICATION DATA

Name: Sangeeeta

Age: 5 years

Sex: female

Birth weight: 2.5 kg

Date of Admission: 19-03-2024

MRD NO: 775159

Fathers name: Suresh

Address: Poonch Jammu

Diagnosis: Pyogenic Meningitis

Religion: Hindu

Informant: Mother

CHIEF COMPLAINTS
• High grade fever and chills
• Headache, malaise
• Convulsions
• Restlessness and irritability
• Altered sensorium

HISTORY OF PRESENT ILLNESS

Baby was admitted, with the complaint of altered sensorium since 3 days, fever since 2 days and
convulsion 2 episodes since 2 days. The child was apparently well before, when the child
developed fever which was intermittent in nature. On the same day child developed 1 episode of
convulsion generalized tonic clonic along with uprolling of eyeball and drooling of saliva. Then
the child was taken to Local hospital and treated there with which convulsions were under
control.
 HISTORY OF PAST ILLNESS
No significant history of any past chronic illness such as jaundice, TB, DM, asthma, pneumonia,
seizures etc. there is also no history of hospitalization in the past and also no surgical history.

BIRTH HISTORY

Antenatal: G2 P2 A0. Mother attended antenatal checkups 3 times during her pregnancy. She
was fully immunized with two doses of TT and also taken IFA tablets. She was in good health
status during her pregnancy.

Natal: She delivered a full-term baby through normal vagina delivery. Baby cried at the time of
birth, no history of birth asphyxia or aspirations. Breastfeeding was started within one hour after
delivery.

Post natal history: APGAR score was 8, birth weight was 2.5 kg. activity of baby was
normal.

FAMILY HISTORY
Has no family history of hypertension, diabetes, communicable disease, cardiovascular disease
or congenital anomaly. All of her family members are healthy.

36 years 32 years

5 years 3 years
 IMMUNIZATION

AGE VACCINE REMARKS

At birth BCG Given
OPV
Hep-B
6 weeks OPV Given
Rotavac 1
Pentavac 1
10 weeks OPV Given
Rotavac 2
Pentavac 2
14 weeks OPV/IPV Given
Rotavac 3
Pentavac 3
9 months Measles/MR 1 Given
16-24 months Measles/MR 2 Given
OPV
DPT booster
5-6 years DPT booster Not given yet

NUTRITIONAL PATTERN
• Recent weight: 17kg
• Expected weight: 18kg
• Appetite: Normal
• Eating habits: Vegetarian

GROWTH AND DEVELOPMENT

• Growth and development is appropriate to age.

ELIMINATION PATTERN
• Bowel: regular bowel movements
• Bladder: regular, voids 5-6 times a day

SLEEPING PATTERN
• Sleeping pattern is normal
 SOCIO ECONOMIC STATUS
• Average socio-economic background. Only father is the bread owner of the family.
• Family having own house, type of house is pucca.
• Family income per month is 10 thousand.

PSYCHOSOCIAL HISTORY

General Status of the Family

The child’s father is working as a labor with an annual income of Rs. 100000/- and her mother is
a housewife. Her father is the bread maker of the family. They are staying at their own house
which has a living room, 2 bed room, kitchen and bathroom and toilet.

Relationship with the friends & family: Have good relationship with the friends and
family.

Activities of Daily Living: The child is not able to perform his activities of daily living as
she is having seizure.

Play Activities: Unable to play due to her condition.

School Performance: The child is studying UKG. Good performances in the school.

Hobbies: Drawing and painting, playing with toy

PHYSICAL EXAMINATION

1. General Observation
Baby Sangeeta is moderately built, nourished, 5 year old female child, conscious and oriented to
time, place and person.

2. Vital Signs
Temperature: 99 o F
Respiration: 30/mt.
Pulse rate: 100/mt.
BP: 90/60 mmHg

3. Anthropometric Measurements
Height: 104 cms
Weight: 17 kg
4. Skin and Mucus Membrane
Color: Fair
Edema: No
Moisture: Moist
Temperature: Warm to touch
Turgor: Good
Texture: Good
Any Abnormal Discharges: Nil

5. Hair
Changes in Texture: No changes
Characteristics: Equally distributed and black in color.
Lice: Absent

6. Nails
Changes in Appearance: No changes
Cyanosis: Absent
Texture: Normal

7. Head
Skull/Cranium Size, Shape: Normal
Movements: Normal
Forehead: No scars

8. Face
Appearance: Normal
Color: Fair
Symmetry: Symmetrical
Movements: Normal

9. Eyes
Expression: Appears dull
Eye Lids: Eye lashes equally distributed
Lacrimation: Clear fluid expressed
Eyebrows: Equal, evenly distributed.
Conjunctiva: Clear
Sclera: White and moist
Cornea: Smooth, moist and round
Pupil: Pupils are equally reactive and accommodates light.
10. Ears
Appearance: No abnormal masses
Discharges: No abnormal discharges
Lesions: No lesions
Any Abnormalities: Nil

11. Nose
Appearance: No septal deviation
Discharges: Nil
Patency: Good
Sense of Smell: Good

12. Mouth and Throat

Lips: Normal, moist
Tongue: Not coated
Teeth: Intact in upper and lower jaw
Gums: Normal color
Buccal Mucosa: Normal
Palate: No cleft palate
Tonsils: No inflammations
Taste: Normal

13. Neck
General Appearance: No scars, Normal range of movements
Trachea: Centrally located, No abnormal masses
Lymph Nodes: Not enlarged
Thyroid Glands: Smooth, firm and non-tender
Salivary Glands: No inflammation
Cysts and Tumors: Nil

14. Chest and Respiratory System

Inspection: Size and shape is normal & symmetrical.
RR: 30 breaths/min
Palpation: No tenderness
Percussion: No fluid collection
Auscultation: Normal lung sounds heard

15. Cardio Vascular System

Inspection: Size and shape of the chest is within normal limits
Palpation: No pericardial rub or palpable sounds
Percussion: Cardiac borders well within normal limits, no cardiac or supracardiac dullness
Auscultation: S1 S2 heard well

16. Abdomen
Inspection: Size and shape of the abdomen is within normal Limits
Palpation: No lumps present, mild tenderness present,
Percussion: No fluid spaces could be found
Auscultation: peristaltic sounds heard.

17. Back
Spine, Curvature: Normal
Symmetry: Symmetrical
Tenderness: No tenderness

18. Genitalia
Normal female genitalia

19. Extremities
Deformities: No
Swelling/ Edema: No
Muscles: Normal strength
Lymph Nodes: Not enlarged
Joints: Normal ROM
Fingers and Toes: Normal
Nails: Normal

20. Central Nervous System

Birth Injuries: Absent
Seizures: Two episodes of seizure present
Speech: Normal
Sensory Motor Changes: Respond to touch and other stimuli
Gait Changes: Normal
Cognitive Changes: Well oriented and conscious
Reflexes: Normal

21. Urinary System

Urinary Tract Infections: No
Any Abnormalities: Nil
22. Gastro-Intestinal System
Diarrhea: Absent
Constipation: Absent
Bleeding: No
Worm Infestation: No
LABORATORY INVESTIGATIONS

Sl. Investigation Results Normal values Remarks

No.
1. Haemoglobin 9.3gm/dL 12-16gm/dL Normal
2. TC 10,500cells/cmm 4500-11000cells/cmm Normal
3. DC:
Prothrombin 70%
Lymphocyte 26%
Erythrocyte 4%
4. Glucose 60mg/dL 60-100 mg/dL Normal
5. Creatinine 0.3mg/dL 0.6-1.4 mg/dL Low
6. Sodium 139meq/L 135-148 meq/dL Normal
7. Potassium 3.5meq/L 3.5-5.2 meq/dL Normal
8. Chloride 107meq/L 95-106 meq/dL Elevated
9. Urea 20.5mg/dL 10-50 mg/dL Normal
10. Alkaline phosphate 416.5mg/dl
11. SGOT 128mg.dl
12. SGPT 39mg/dl
13. Platelet 1,25,000
14. CRP Positive
15. CSF
Glucose 37mg/dl
Protein 65mg/dl

SPECIAL INVESTIGATIONS
CT scan of Brain: Mild diffuse cerebral edema
 MEDICATIONS
Medication name Dosage Frequency Route Actions Side effects Nursing
responsibilities
1. Inj. Augmentin 300mg Bd IV Antibiotic Allergic reaction, Monitor ECG, check
nausea, vomiting, vital signs, and check
increased salivation, for other side effects
fever and chills

2. Inj. 30mg Q 6H IV Corticosteroid Agranulosis, aplastic,

Hydrocortisone
anaemia, wide spread Monitor the vital sign
exfoliative dermatitis, and BP. Check for
confusion and other signs and
headache. symptoms of the
patient.
5ml SOS Oral Antipyretic Allergic reaction,
3. Syp. fever, nausea, vomiting
Paracetamol

Monitor the vital sign

and BP. Check for
other signs and
symptoms of the
patient.

NURSING DIAGNOSIS
According to NANDA’s format of nursing diagnosis the following diagnosis are formulated:

1. Hyperthermia related to the disease condition.

2. Risk for injury related to seizure activity.
3. Risk for injury, hypoxia, and aspiration related to motor activity and loss of
consciousness (tonic- clonic seizure).
4. Interrupted family processes related to a child with a chronic illness.
5. Parental knowledge deficit related to disease condition, treatment and follow up
care.
NURSING CARE PLAN:

ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION EVALUATION

DIAGNOSIS
Subjective Hyperthermia Child will -Assess the -Child body Child’s fever
related to be able to condition of temperature
data: The reduced to some
increased maintain the child by
mother body normal body increased to 100.2oF extents.
monitoring
complaint that temperature. temperature. the vital sign. Monitored the
my child is -Avoid tight -Advised mother to vital 4th hourly.
clothing. Changed the
having fever avoid tight clothing position
-Maintain
since 3 days. proper -Provided proper frequently and
ventilation in her mother
ventilation. provided tepid
the room
Objective data: sponge
-Maintain
Temp: 99o F aseptic -Followed aseptic
Resp: 30bpm technique precautions during
while doing
Pulse: 100bpm the procedures.
procedures.
BP: -Monitor vital -Continuously
90/60mmHg signs at monitored vital
regular signs
intervals.
The child is -Administered
having fever and antibiotics as per
crying. -Administer prescription.
antibiotics as
prescribed by
doctor.
ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective Risk for Child will be -Assess the - Child has repeated Patient
injury free from seizure activity. remains free
data: The condition of the
related to injuries of of seizure
mother type of seizure. child. activity
complaint that seizure. -Encourage the - Encouraged mother
the child is mother to be with to be with child
having seizure. the child always. always.
Objective -Administer anti-
- Administered
data: epileptic
antiepileptic drugs
Temp; 99o F medication as
as per prescription.
Resp: ordered.

30breaths/min -Avoid sharp

- Advised mother to
Pulse: objects near to the
remove all the sharp
100bts/min client and
objects out of reach
BP: maintain safe
to the child.
90/60mmHg environment.
The mother is - Advised parents to
worrying and -Avoid situations
that are known to avoid situations that
crying.
precipitate a are known to
seizure like
precipitate a seizure
blinking light,
fatigue. like blinking light,
fatigue.
 NURSING GOAL PLANNING
ASSESSMENT IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective Risk for The client -Assess the - Child is small and Child feel relax
data: The injury, will not factors which having seizure and exhibits no
hypoxia, and experience sign of physical
mother aspiration injury, cause injury to activities. or mental injury
complaint that related to respiratory the child. - Educated parents not or aspiration.
motor activity distress or
whether my -Do not use use any restrains or
and loss of hypoxia.
daughter will consciousness. restrains and physical force to
have injury. She physical force to control seizure
says that my control the child activity.
daughter mouth movements. -Instructed mother to
is full of saliva -Place blanket place blanket under
when she is on under the the child’s head to
seizure. child’s head to prevent injury.
prevent injury. -Loosen the cloths to
Objective data: -Loosen clothing. facilitate breathing.
The mother -Keep side rails -Kept side rails in
looks anxious
raised when position.
and depressed.
child is
sleeping, resting -Advised parents to
or having allow seizure to end
without inference.
seizure.
-Allow seizure to
end without
interference.
 NURSING GOAL PLANNING
ASSESSMENT IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective Parental The parent -Assess the -Understanding Parent got
data: The knowledge will knowledge level level of parents adequate
maintain the knowledge.
client’s parent deficit knowledge of the parent. is poor. They follow
related to level up the order.
says that they -Maintain good
disease regarding
don’t know condition, the child’s interpersonal -Maintained good IPR
anything about treatment condition. relationship with with the client & his
and follow
the child up care. the parent. family members.
conditions. -Explain about the
causes, symptoms -Explained
Objective data: and the prevention regarding the
The client’s
of further causes, symptoms and
parents look
anxious and complications. preventive
asked many -Clarify the doubts and treatment
doubts.
of the parent. measures of the
-Explain the condition.
parents -Clarified the
regarding the doubts of the parents.
follow up and -Educated the parents
regarding the follow
home care of
up and home care of
child. the child.
-
HEALTH EDUCATION:

Pyogenic meningitis is a type of bacterial meningitis, which is an inflammation of the protective

membranes covering the brain and spinal cord, known as meninges.

It is mostly caused by bacteria which include streptococcus pneumoniae and Neisseria

meningitidis.

Risk factors include recent exposure to someone with bacterial meningitis, recent infections like
ear or sinus infections, immune system problems etc.

Symptoms in young children may include irritability, fever, poor feeding, bulging fontanelles
and seizures.

Bacterial meningitis is diagnosed through medical history, physical examination and tests such
as blood cultures and lumber puncture to analyze CSF.

Meningitis is a medical emergency and requires prompt treatment with antibiotics.

Vaccination is a key in preventing certain types of bacterial meningitis. Vaccines are available
for pneumococcus, meningococcus, haemophiles influenzae type b (Hib).

Good hygiene practices, such as regular handwashing and covering the mouth when coughing or
sneezing, can help prevent the spread of infections that can lead to meningitis.

Early detection and treatment are essential to minimize the risk of serious illness or death.