Abigail Barachina

BSN-3A

Meningitis
Meningitis is an infection of the fluid of a person's spinal cord and the fluid that surrounds the brain. People sometimes refer to it as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. Knowing whether meningitis is caused by a virus or bacterium is important because the severity of illness and the treatment differ. Viruses, fungi, protozoa, or bacteria may cause meningitis. Different forms of the disease have different mortality rates. In all forms, the meninges become inflamed, causing pressure on the spinal cord and brain. Patients experience headaches, neck-aches and lower backaches. Viral meningitis is generally less severe and resolves without specific treatment, while bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability. Infectious Process: Etiologic agent - meningococcal, cryptococcal , syphilitic, and pneumococcal meningitis. Reservoir - Humans are the reservoir for S. pneumoniae, N. meningitidis, H. influenza. Portal of exit - is the path by which an infectious agent leaves the body and transmitted by droplet transmission include influenza, meningitis Mode of transmission - meningococcal meningitis is transmitted to a healthy person by airborne droplets from the nose and throat. Portal of entry - are often earnosethroat-related in cases of both acute and chronic cases. Susceptible host - Meningitis is very common in children aged 5 and younger as well as teens aged 15 to 24 years old.

Diphtheria
Bacterial infection in the upper respiratory tract. Typically it is characterized by sore throat, swollen neck glands, high temperature and breathing difficulties. Through means of successful immunization diphtheria is now very rare in the United States and Europe. However it's still common in countries where immunization programs are not an integral part of standard public health care. It is a potentially fatal disease with an estimated 5-10% fatality rate. In children under 5 and adults over 40 the fatality rate may sometimes reach 20%. In the 4th century B.C. Hippocrates described the disease. There are records of descriptions of diphtheria type diseases in ancient Egypt and Syria. A major epidemic swept through much of Europe during the 17th century; during this period it was referred to as the strangling angel of children because it caused the death of many children by suffocation.

Infectious Process: Etiologic agent Corynebacterium diphtheria , Corynebacterium ulcerans Reservoir - Humans are the usual reservoir and carriers are usually asymptomatic. Portal of exit - sometimes, may be the skin where cuts, wounds and ulcers not properly attended to may get infected with the diphtheria bacilli. Mode of transmission - Person-to-person transmission occurs through oral or respiratory droplets Portal of entry The upper respiratory tract is the most common portal of entry for C. diphtheriae. It can also invade the skin and, more rarely, the genitalia, eye, or middle e Susceptible host - Children not vaccinated for C. diphtheria. Immunocompromised ; Poorly immunized adults.

COMPLICATIONS: Myocarditis caused by the action of diphtheria toxin on the heart muscles. Polyneuritis that includes paralysis of the soft palate, the ciliary muscles of the eyes, pharynx, larynx or extremities. Airway obstruction may lead to death through asphyxiation. Cervical adenitis Otitis media Bronchopneumonia

DIAGNOSTIC TEST: Swab from nose and throat or other suspected lesions Virulence test Schick test Molony test Loeffler slant

TREATMENT MODALITIES: Specific treatment of diphtheria is determined by the physician based on: - Overall health and medical history - Extent of the condition, and - Tolerance for specific medications, procedures and therapies. Penicillin is usually effective in treating respiratory diphtheria before it releases toxins in the blood. Antitoxin can be given in combination with penicillin Fractional doses are given in positive cases, with the following schedule: 0.05 ml(1:20 dilution) SQ 0.05 ml(1:10 dilution) SQ 0.10 ml undiluted - SQ 0.20 ml undiluted SQ 0.50 ml undiluted IM 0.10 ml undiluted IM The above doses are given 15 minutes intervals if no reaction is noted. If there is any, the remaining dose is given after an hour. Erythromycin , 40 mg/kg bw in 4 doses for x7 to 10 days. Supportive therapy: - Maintenance of adequate nutrition - Maintenance of adequate fluid and electrolyte balance. - Bed rest - O2 inhalation

NURSING MANAGEMENT: Patient must be advised to take full bed rest for at least 2 weeks. Patient must not be permitted to bathe by himself. The patient must avoid exertion during defecation in order to conserve energy and decrease cardiac workload. Soft diet is recommended. Small, frequent feedings are advised. Patient must be encouraged to drink full juices rich in Vitamin C to maintain the alkalinity of the blood and increase his/her resistance. Ice collar must be applied to the neck. Nose and throat must be taken care of.