Kamis, 30 Agustus 2012

NURSING CARE IN PATIENTS WITH MENINGITIS

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I will be sharing meningitis nursing care to patients
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Definition
 
Meningitis is an inflammation of the lining of the brain (arachnoid and piamater). Bacteria and viruses are a major cause of meningitis.
Pathophysiology
 
The brain is covered by three layers, namely: dura mater, arachnoid, and piamater. Cerebrospinal fluid is produced in the ventricles choroid plexus moving / flowing through sub-arachnoid in the ventricular system and the entire brain and spinal cord, reabsorbed through arachnoid villi are structured like the spokes in the subarachnoid layer.
 
Organism (virus / bacteria) that can cause meningitis, cerebrospinal fluid enters the bloodstream through the blood vessels in the brain. Nasal (nasal secretions) or ear secretions caused by the fracture of the skull can cause meningitis due to a direct relationship between cerebrospinal fluid with the environment (the outside world), microorganisms can enter the brain through the fluid runs into the subarachnoid space. The presence of pathological microorganisms are the cause of inflammation of the piamater, arachnoid, and ventricular cerebrospinal fluid. Exudate formed will spread, both the cranial and spinal nerves to which can lead to further neurological deterioration, and exudate can lead to blockage of the normal flow of cerebrospinal fluid and cause hydrocephalus.
Etiology
 
Meningitis is caused by a variety of organisms, but most patients with meningitis have predisposing factors such as skull fractures, infections, brain surgery or spinal cord. As mentioned above that the meningitis is caused by viruses and bacteria, the meningitis is divided into two major parts: purulent meningitis and serous meningitis.

Bacterial Meningitis
 
The bacteria that most commonly cause meningitis are haemofilus influenza, Nersseria, Diplokokus pneumonia, Sterptokokus group A, Stapilokokus Aurens, Escherichia colli, Klebsiela and Pseudomonas. The body will respond to the bacteria as foreign and responds with inflammation in the presence of neutrophils, monocytes and lymphocytes. Fluid exudate composed of bacteria, fibrin and leucocytes formed subarahcnoid room will be collected in the cerebrospinal fluid that can cause a thin layer was thick. And collection of fluid will cause an increase in intracranial. This will cause the brain tissue will undergo infarction.
Meningitis Virus
 
This type of meningitis is often called aseptic meningitis. This is usually caused by various kinds of diseases caused by viruses, such as mumps, herpez herpez simplex and zoster. Exudate that usually occurs in bacterial meningitis do not occur in viral meningitis and was not found organisms in cerebrospinal fluid cultures. Inflammation occurs in the lining around the brain and koteks cerebri. Mechanisms or responses of brain tissue to the virus varies depending on the cell type involved.
Prevention
 
Meningitis can be prevented by identifying and properly understand the position presdis factors such as otitis media or respiratory tract infections (such as tuberculosis) which may lead to serous meningitis. In this case the most important thing is to complete treatment (antibiotics) although symptoms of infection has disappeared.Upon the occurrence of meningitis appropriate treatment should be quickly overcome. To identify the causative organism or janis and quickly provide appropriate therapy for protecting the organism causes serious complications.

Assessment of Patients with meningitisHistory of the disease and treatment
 
Factor is very important to know the history of the disease as to what kind of germs that cause. It should be clearly asked about symptoms such as when to start an attack, heal or get worse. After that you need to know is the health status of the past to investigate the presdiposisi factors such as respiratory infections, or a fracture of the skull, etc..
Clinical Manifestations• At the beginning of the disease, fatigue, changes in power to remember, a change in behavior.• In accordance with the rapid course of the disease the patient becomes stuporous.• Headache• Pain-pain in muscles• The reaction of the pupil to light. Photofobia when light is directed at the patient's eye• The dysfunction of the nerves III, IV, and VI• The movement of the motor in the early disease is usually normal and the advanced stages can occur hemiparese, hemiplegia, and decreased muscle tone.• Reflex Brudzinski and Kernig reflex (+) to bacterial meningitis and viral meningitis are not on.• Nausea• vomiting• Fever• Tachycardia• Seizures can be caused by irritation of the cortex cerebri or hyponatremia• Patients feel scared and anxious.
Laboratory
 
Laboratory tests that are characteristic of meningitis is the analysis of cerebrospinal fluid. Lumbar puncture can not be done in patients with increased cranial pressure tintra. Analysis of cerebrospinal fluid examined for cell count, protein, and glucose concentrations.A blood test is primarily red blood cell count usually rises above normal values.
 
Serum electrolytes and serum glucose assessed to identify the presence of an electrolyte imbalance, especially hyponatremia.Blood glucose levels compared with cerebrospinal fluid glucose levels. Normal cerebrospinal fluid glucose level is 2/3 of the value of serum glucose and glucose levels in patients with meningitis decreased brain fluid of normal values.
Radiography Examination
 
A CT scan performed to determine the presence of cerebral edema or other neurological diseases. The results are usually normal, except in very severe disease already.
TreatmentPengobatab usually given the most appropriate antibiotic.
 
For each of microorganisms that cause meningitis:Antibiotics OrganismPenicillin G
Gentamicyn
Chlorampenikol PneumoccocciMeningoccocciStreptoccocci
KlebsiellaPseudomonasProleus
Haemofilus Influenza Tuberculosis Therapy• Streptomicyn• INH• PAS Micobacterium Tuber culosis
Nursing DiagnosisNursing diagnoses that may arise are:
Impaired tissue perfusion due to increased intracranial pressureDestination• The patient returned to, the state of neurological status before illness• Increased patient awareness and sensory function
Expected outcomes• Vital signs are within normal limits• reduced head pain• The increased awareness• An increase in cognitive or loss and no signs of increased intracranial pressure.
Action PlanINTERVENTION RATIONALIZATIONPatients total bed rest with supine sleeping position without a pillow will change in pressure can cause intakranial the risk for brain herniationMonitor signs of neurological status with the GCS. Can reduce brain damage lanjtMonitor vital signs such as blood pressure, Nadi, temperature, and carefully Resoirasi on systolic hypertension In normal autoregulation to maintain a state of altered systemic blood pressure fluctuations. Autoreguler failure will cause cerebral vascular damage that can be manifested by an increase in systolic and diastolic pressure decreased diiukuti by. While the increase in temperature can describe the course of infection.Monitor intake and output hyperthermia can lead to increased IWL and increase the risk of dehydration, especially in patients who do not Sadra, nausea which lowers intake by mouthHelp patients to limit vomiting, coughing. Instruct the patient to exhale when moving or turning in bed. This activity can increase intracranial pressure and intra-abdominal. Exhale while moving or changing positions can protect themselves from the effects of the ValsalvaCollaborationGive fluids perinfus with strict attention.Minimize the burden of vascular and fluctuations in intracranial pressure, fluid and fluid vetriksi can reduce cerebral edemaMonitor AGD when needed oxygen delivery possible presence of acidosis accompanied by the release of oxygen at the cellular level can cause cerebral ischemicProvide appropriate therapy such as physician advice: Steroids, Aminofel, Antibiotics.Given therapy can decrease capillary permeability.Lowering cerebral edemaMenurunka metabolic cells / consumption and seizures.
Headache in relation to the brain lining irritationDestinationPatients seen decreases pain / pain control
Criteria for evaluation• Patients can sleep in peace• Memverbalisasikan decrease pain.
Action PlanINTERVENTION RATIONALIZATIONIndependentTry to create a safe and quiet environmentSlow down their reaction to external stimuli or sensitivity to light and encourage patients to restCold compress (es) on the head and a cold cloth on the eye may cause vasoconstriction of blood vessels of the brainPerform active or passive motion exercises in accordance with the tender conditions and caution can help to relax tense muscles and can reduce pain / disconfortCollaborationGive analgesicsIt may be necessary to reduce the pain. Note: Narcotics are contraindicated because of impact on neurological status that it is difficult to assess.
Potential occurrence of injury in connection with the seizures, mental status changes and a decreased level of consciousnessPurpose:Patients were free from injury caused by seizures and decreased consciousness

Action PlanINTERVENTION RATIONALIZATIONIndependentmonitor strain on the hands, feet, mouth and other facial musclesPreview tribalitas central nervous system requires evaluation in accordance with the appropriate interventions to prevent complications.Prepare a safe environment such as bed boundaries, safety boards, and suction devices are always close to the patient. Protecting patients when seizures occurMaintain total bedrest for acute fae Reduce the risk of falls / hurt if vertigo, sincope, and ataxia occurredCollaborationProvide appropriate treatment doctors advise such as diazepam, phenobarbital, etc..To prevent or reduce seizures.Note: Phenobarbital may cause respiratory depression and sedation.
Resource Library• Donnad, Medical Surgical Nursing, WB Saunders, 1991• Capita Selekta Medicine Faculty of medicine, Aesculapius Media, 1982• Brunner / Suddarth, Medical Surgical Nursing, JB lippincot Company, Philadelphia, 1984

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