Siena College of Taytay College of nursing Taytay, Rizal

Case Presentation On Central Nervous System Infection

Amang Rodriguez Memorial Medical Center (ARMMC) Marikina City
Medicine Ward GROUP 1A August 5-7, 2013 to August 12-14, 2013

Clinical Instructor: Sir Allan Valenzuela, RN, MAN

I. Introduction A. Background of study

Central Nervous System (CNS) infections remain an important cause of morbidity and mortality worldwide. In 2004, globally there were 340,000 deaths estimated by the World Health Organization. In the Philippines, according to World factbook that CNS infection happens often with a seasonal distribution; death occurs in 515% of cases. There are many infectious pathogens known to cause CNS infection, including the broad categories of bacteria, viruses, fungi, mycobacteria, and parasites. The central nervous system, or CNS, comprises the brain, the spinal cord, and associated membranes. Under some circumstances, bacteria may enter areas of the CNS. If this occurs, abscesses or empyemas may be established. In general, the CNS is well defended against infection. The spine and brain are sheathed in tough, protective membranes. The outermost membrane, the dura mater, and the next layer, the arachnoids, entirely encase the brain and spinal cord. However, these defenses are not absolute. In rare cases, bacteria gain access to areas within the CNS. Bacterial infection of the CNS can result in abscesses and empyemas. Abscesses have fixed boundaries, but empyemas lack definable shape and size. CNS infections are classified according to the location where they occur. For example, a spinal epidural abscess is located above the dura mater, and a cranial subdural empyema occurs between the dura mater and the arachnoid. As pus and other material from an infection accumulate, pressure is exerted on the brain or spinal cord. This pressure can damage the nervous system tissue, possibly permanently. Without treatment, a CNS infection is fatal. Our groups decided to take this case because its not as usual as the cases that weve handled before and were able to establish good communication skills with the patient and family.

A. General Objectives Within 48 hours of exposure at Amang Rodriguez Memorial Medical Center in Medicine Ward, Group 1 of the 4th year nursing students of Siena College Taytay, is aiming to acquire the proper attitude with our client. To apply the 11 core competencies and we also aim to enhance our knowledge and hone my nursing skills in order to provide holistic care and support to our client in Amang Rodriguez Memorial Medical Center. B. Specific Objectives To be able to: 1. Establish rapport with our client as well as to her significant others to help them recognize and give importance to their health. 2. Assess the client in able to identify and analyze present health problems using the areas of assessment. 3. Identify and analyze present health problems of my client that might place him at risk and be able to use my nursing skills to help him. 4. Review my knowledge about anatomy and physiology of the Central Nervous System. 5. Formulate appropriate nursing interventions that will solve, reduce or lessen the health problems of my client, by involving her as well as the members of our group. 6. Review the 10 rights of giving medication 7. Implement my nursing care plans; and 8. Evaluate the effectiveness of my nursing plan. C. Significance of the Study The importance of this study is much recognized since it would build up competence and enhance skills to ourselves in dealing with such case again. Moreover, it was observed that perfect way to widen our knowledge in

handling with this type of illness is to conduct a study to a CNS infection patient. D. Scope and Limitation This case study was conducted on August 5, 2013 at Amang Rodriguez Memorial Medical Center in Marikina, City to a 25 years old man who has been diagnosed of CNS infection.

E. Theoretical Framework Lydia Halls nursing theoryCore, Care and Cure Model

Lydia Hall was a rehabilitation nurse and fundamental nursing theorist of the 1960s. She asserted that individual care could be seen in three different areas: care (the body); core (the person); and cure (the illness). Her theory helped pave the way to modern nursing, where nurses use critical thinking and medical knowledge to treat and heal a patient, rather than merely carry out doctors' orders.

The core is the person or patient to whom nursing care is directed and needed. The core has goals set by himself and not by any other person. The core behaved according to his feelings, and value system. The cure is the attention given to patients by the medical professionals. The theory contains of three independent but interconnected circlesthe core, the care and the cure. .According to the theory, the core is the person or patient to whom nursing care is directed and needed. The core has goals set by himself and not by any other person, and that these goals need to be achieved. The core, in addition, behaved according to his feelings, and value system. The cure, on the other hand is the attention given to patients by the medical professionals. The model explains that the cure circle is shared by the nurse with other health professionals. These are the interventions or actions geared on treating or curing the patient from whatever illness or disease he may be suffering from. The care circle explains the role of nurses, and focused on performing that noble task of nurturing the patients, meaning the component of this model is the motherly care provided by nurses, which may include imited to provision of comfort measures, provision of patient teaching activities and helping the patient meet their needs where help is needed. It is easy to understand from the model that in all of the circles of the model, the nurse is always presents the bigger role she takes belongs to the care circle where she acts a professional in helping the patient meet his needs and attain a sense of balance.

Core The patients goal is not primarily his self but his family. He works for his family as a call center agent. Patient experienced lack of sleep and lack of rest. Care He keeps on lying in bed. We assess his vital signs. Provide significant others of information about the importance of taking care of self and promote healthy living. Cure The physician ordered medications. The patient has an IV of PNSS. He is on a TPN diet.

II. Nursing Assessment A. Personal data: Name: R. M. Address: Antipolo, City Age: 25 years old Gender: Male Place of birth: Antipolo, City Date of birth: January 1, 1988 Religion: Roman Catholic Civil status: Single Nationality: Filipino Education Attainment: College Graduate Occupation: Call Center Agent Date admitted: 7/31/13 Time admitted: 7:10am ROD: Apreel Marie P. Noble, MD B. Chief Complaint Fever for 5 days C. Impression and Diagnosis To consider Central Nervous System Infection D. History of Past Illness Upon the interview we asked the mother of our patient about the past history illness of patient R.M. she told us that last September 2012, patient R.M. undergone an operation of appendectomy in Taytay Doctors. December 2012 to June 2013 he was hospitalized for having asthmatic pneumonia in Antipolo Doctors and ARMMC. According to her mother he doesnt have any allergies, no accident or injuries.

E. History of Present Illness According to her mother, last July 26, 2013 patient R.M. is at home then suddenly they notice that he cannot verbalized words, cant move his body and also experiencing fever and chills. His family decided not to bring him in the hospital because, they were still observing his condition. Then four days after they already brought him to ARMMC on July 31, 2013 at 7:10am. F. Family History According to his mother, there is no history of illness in their family G. Patients Concept of Health and Illness and Hospitalization For his health is a condition of the body whether it is having illness or not and hospitalization is when having diseases and accidents that cannot be cured without a physician.