2. MENINGITIS – CEREBROSPINAL FEVER
Is the inflammation of the meninges of the brain
and spinal cord as a result of bacterial infection.
3. ETIOLOGIC AGENT
Pneumococcus,Staphylococcus, Streptococcus and
tubercle bacillus.
Neisseria meningitides (Meningococcus)
Incubation period:
1-10 days
Mode of transmission:
Respiratory Droplet
4. ETIOLOGIC AGENT
Diagnostic test:
Lumbar puncture
X ray of spinal cord
Gram staining
Smear and blood culture
Smear from petichiae
Urine culture
5. CLASSIFICATIONS
1. Acute meningococcemia
Invade the blood stream without involving the meninges
Nasopaharyngitis
Petichial purpuric or ecchymotic hemorrhages scatter
over the entire body
Adrenal lesions
Adrenal medullary haemorrhage Water house-
Friderichsen syndrome
Fulminnt type
6. CLASSIFICATIONS
2. Aseptic Menigitis
3. A. syndrome characterized by
headache,fever,vomiting and meningeal
symptoms
4. Fever 40 oC
7. CLASSIFICATIONS
5. Signs of meningeal irritation
Stiff neck or nuchal rigidity
Opisthotonus
+ Brudzinki sign
+ kernig’s sign
Exaggerated and symmetrical deep tendon reflexes
8. CLASSIFICATIONS
6. Sinus arrhythmia, irritability, photophobia, diplopia
and other visual problems
7. Delirium, deep stupor and coma
8. Signs of intracranial pressure
bulging fontanels in infants
nausea and vomiting (projectile)
blurring of vision
alteration in sensorium
9. COMPLICATIONS MENINGITIS
1. Subdural effusion
2. Hydrocephalus
3. Deaf-mutism
4. Blindness of either one or both eyes
5. Otitis media and mastoiditis
6. Pneumonia or bronchitis
7. Subdural effusion
8. Hydrocephalus
9. Deaf-mutism
10. Blindness of either one or both eyes
11. Otitis media and mastoiditis
12. Pneumonia or bronchitis
10. MODALITIES OF TREATMENT
1. If meningitis is left untreated it has a mortality rate
of 70-100%
2. Treatment includes appropriate antibiotic theraphy
and vigorous supportive care
3. IV antibiotics are usually given for two weeks and
are followed by oral antibiotics such as
ampicillin
cephalosporins (ceftriaxone)
aminoglycosides
11. MODALITIES OF TREATMENT
4. Digitals glycoside (digoxin) is administered to
control arrhythmias
5. Mannitol is given to decrease cerebral edema
6. An anticonvulsant or sedative is needed to reduce
restlessness and convulsions
7. Acetaminophen us helpful in relieving headache
and fever
12. NURSING MANAGEMENT
1. Assess neurologic signs often. Observe the
patient’s level of consciousness and check for
increased intracranial pressure (ICP) (signs
include plucking at bedcovers, vomiting, seizures
and changes in motor functions and vital signs).
2. Watch out for the deterioration of the patient’s
condition, which may signal an impending crisis.
3. Monitor fluid balance. Maintain adequate fluid
intake to avoid dehydration, but avoids fluid
overload because of the danger of cerebral
edema. Measure central venous pressure and
intake and output.
13. NURSING MANAGEMENT
4. Watch out for anyh adverse reaction to the
antibiotics and/or other drugs. Avoid infiltration
and phlebitis
5. Position the patient carefully to prevent joins
stiffness and neck pain. Turn the patient often
avoid pressure sores and respiratory
complications. Assist with ROM.
6. Maintain adequate nutrition and elimination
7. Ensure the patient’s comfort
14. NURSING MANAGEMENT
8. Provide reassurance and support to the patient
and the family
9. Follow strict aseptic technique when treating
patients with head wounds or skull fractures
10. Isolation is necessary, especially if nasal culture is
positive
15. PREVENTATION
1. Several caccines are available to protect against
ceratin types of meningitis
2. Teach client with chronic sinusitis or other chronic
infections the importance of proper and prompt
medical treatment
3. Give rifampicin as prophylaxis , as ordered by the
physician
4. Implement the universal precaution
17. RABIES
Causative Agent
Rhabdovirus
Incubation Period
1 week to seven –and –a half in dogs
Ten days to fifteen years in human
Incubation depends on the following factors
Distance of the bite to the brain
Extensiveness of the bite
Species of the animal
Richness of the nerve supply in the area of the bite
Resistance of the host
18. RABIES
Period of Communicability
5 days before the onset off symptoms
Mode of Transmission:
Bite of a rabid animal
Break on the skin
19. CLINICAL MANIFESTATIONS
1. Prodromal /Invasive phase
A. fever,anorexia=,malaisesorethroat,copious
salivation,lacrimation,irritability,hyperexcitability
Apprehensiveness,restlessness
There is pain at the original site of bite
Sensitive to light
Pain and aches in different parts of the body
Anesthesia, numbness and tingling burning and cold
sensations may be felt
Mild to difficulty in swallowing.
20. CLINICAL MANIFESTATIONS
2. Excitement or neurological phase
Marked excitation and apprehension
Delirium associated with nuchal rigidity
Maniacal behaviour
Severe painful spasm of the muscles of the mouth
Aerophobia
Profuse drooling
Tonic contractions of the muscles
Death may occur
21. CLINICAL MANIFESTATIONS
3. Terminal /paralytic phase
Quiet and unconscious
Bowel and urinary control
Sapsms cease and there is progressive paralysis
Tachycardia and labored irregular respiration
Death occurs due to paralysis, circulatory collapse
23. MODALITIES OF TREATMENT
1. Wash the wounds from the bite and scratches with
soap and running water for at least three minutes
2. Check the patient immunization status .
3. Tetanus antiserum infiltrated around the wound or
IM after neg. skin test
4. Give anti-rabies vaccines both passive and active
depending on the site and size of the bite.
24. NURSING MANAGEMENT
1. Isolate the patient
2. Give emotional and spiritual support
3. Provide optimum comfort
4. Darken the room and provide a quiet environment
5. Should not bathed and there should not be
running water in the room or within the hearing
distance of the patient
6. If IV fluid has to be given , it should be wrapped.
7. Concurrent and terminal disinfection should be
carried out.
25. PREVENTION AND CONTROL
1. Vaccination of all dogs
2. Enforcement of regulation for the pick-up and
destruction of stray dogs
3. Ten-to fourteen day confinement of any dog that
has bitten a person
4. Availability of laboratory facilities for observation
and diagnosis
5. Providing public education especially to children
on the avoidance and reporting of all animals that
appear sick.
26. POLIOMYELITIS
INFANTILE PARALYSIS /HEINE –MEDIN Disease
Is an acute infectious diseases characterized by
changes in the CNS which may result in pathologic
reflexes, muscle spasms, and paresis or paralysis.
27. POLIOMYELITIS
Causative Agent
Brunhilde
Lansing
Leon
Incubation period
7-21 days for paralytic cases
Period of Communicability
3days 3 months of illness
28. POLIOMYELITIS
Mode of Transmission:
Person to person
Direct contact with infected oropharyngeal secretions
and feces
Indirectly through flies,contaminated water,food
untensils and other articles.
Predisposing causes of Poliomyelitis
Age 60% are under 10 years of age
Sex. Males are more prone to the disease
Heredity not hereditary
Environmental and hygienic condition
29. POLIOMYELITIS
Types of Poliomyelitis
1. The abortive
Not invade the CNS
Headache and sorethroat
Slight and moderate fever
Occasional vomiting
Low lumbar pain
The patient usually recovers within 72 hours
Accounts of 4-8%
30. POLIOMYELITIS
2. Non paralytic
A. all the signs of the abortive type are observed
Types of spasm of thew muscles of the hamstring
Changes in deep and superficial reflexes
Pain in the neck back arms leghs and abdomen
Inability to place the head in between the knees
Positive pandy’s test
Transient paresis may occur
Meningeal irritation persisting for about 2 weeks
31. POLIOMYELITIS
3. Paralytic
Positive Hoynes sign
Paralysis occurs
Less tendon reflexes
Positive kernig’s sign
Weakness of the muscles
Hypersensitivity to touch
32. PARALYTIC
Spinal paralytic
Paralysis occurs in muscles innervated by the motor
neurons of the spinal cord
Bulbar
Bulbospinal
33. TETANUS
Tetanus is an infectious disease caused by
Clostridium tetani, which produces a potent
exotoxin with prominent systematic neuromuscular
effects such as generalized spas modic
contarctions of the skeletal musculator
34. TETANUS
INCUBATION PERIOD
three days to three weeks in adults and three to thirty
days in the new born
CAUSATIVE AGENT
Clostridium tetani
Sources of infection :
Animal and human feces
Soil dust
Plaster of paris unsterile sutures pins and scissors and
rusty materials
35. TETANUS
Mode of transmission
Rugged , traumatic wounds and burns
Umbilical stump
Babies delivered to mothers without tetanus toxoid
immunization
Dental extraction circumsion and ear piercings
Unrecognized wounds
36. CLINICAL MANIFESTATIONS
1. Neonate
Feeding and difficulties and sucking difficulties
Cry excessively cry is short and voiceless
Suck results in spasms and cyanosis
Fever due to infection and dehaydartion
Jaw becomed so stiff that the babay cannot suck or
swallow
Tonic or rigid muscular contractions, spasms or
convulsions are provoked by stimuli
Cyanosis and pallor develop
Severe cases may end in flaccidity exhaustion and
finally death
37. CLINICAL MANIFESTATIONS
2. Older children and adult
a) Tetanus remains localized signs of onset are spasm
and increased muscle tone near the wound
b) If it becomes systemic or generalized signs include
If hypertonicity , hypereactive deep tendon reflexes
tachycardia , profuse sweating, low grade fever and painful
involuntary muscle contractions
Neck and fatal muscle rigidity ( trismus)
Grinning expressions ( risus sardonicus) – pathognomonic
sign of the disease
Board like abdomen/abdominal rigidity
38. OPISTHOTONUS
Intermittent tonic convulsions lasting from several
minutes which may result in cyanosis and sudden
death.
In severe cases Laryngospasm is followed by the
accumulation of secretions in the airways.
Fracture of the vertebrae may occur during spasms.
39. OPISTHOTONUS
COMPLICATIONS :
Laryngospasm:
Hypostatic Pneumonia
Hypoxia due to laryngospasm and decreased oxygen
Atelectasis and pneumothorax
Traumatic glositis and mecroglossia
40. MODALITIES OF TREATMENT
1. Specific
Within 72 hours after punctured wound, the patient should
receive ATS,TAT or TIG especially if the patient not have
previous immunization
Tetanus Toxoid .5 cc IM
PEN G Na.
Muscle relaxant
2. Non specific
Oxygen inhalation
NGT Feeding
Tracheostomy
Adequate fluid , electrolyte and caloric intake
41. GOOD NURSING CARE
Maintain an adequate airway
Provide cardiac monitoring
Maintain an IV line for medication and emergency
care if necessary
Carry out efficient wound care
Avoid stimulation : warn visitors not to upset or
overl;y stimulate the patient
Prevent contractures and pressure sore
Watch out for urinary retention
Closely monitor vital signs and muscle tone
Provide optimum comfort measures.