Case Pre -Meningitis

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INTRODUCTION
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs. Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore the condition is classified as a medical emergency. The most common symptoms of meningitis are headache and neck stiffness associated with fever, confusion or altered consciousness, vomiting, and an inability to tolerate light (photophobia) or loud noises (phonophobia). In adults, a severe headache is the most common symptom of meningitis – occurring in almost 90% of cases of bacterial meningitis, followed by nuchal rigidity (inability to flex the neck forward passively due to increased neck muscle tone and stiffness). Nuchal rigidity occurs in 70% of adult cases of bacterial meningitis. Other signs of meningism include the presence of positive Kernig's sign or Brudzinski's sign. Kernig's sign is assessed with the patient lying supine, with the hip and knee flexed to 90 degrees. In a patient with a positive Kernig's sign, pain limits passive extension of the knee. A positive Brudzinski's sign occurs when flexion of the neck causes involuntary flexion of the knee and hip. Although Kernig's and Brudzinski's signs are both commonly used to screen for meningitis, the sensitivity of these tests is limited. Our group decided to take this particular case because based in our knowledge before; meningitis can be acquired through a head injury or contusion. We became more interested with the case as we get hold of the patient’s chart. Then we found out that meningitis has lots of origin or roots. And as we go on with her chart, we found the three common signs of meningitis, the nuchal rigidity, headache and fever. We want to have more background and knowledge about this disease, because there are still many people that are not aware of this disease, and we want to share our gained knowledge for them to become aware and they will know the risk factors on how it is being acquired. If they become aware of this, they will learn and know how to prevent such diseases and there will be less mortality rate due to meningitis. We are hoping that through this case presentation each of one of us will understand this very well to help other people in the community to become more aware and will live a healthy lifestyle.

Patient History
Patient’s Name: Ms. EE
Hospital Number: 493132
Address: Block 16 Planters, Cainta Rizal
Date of Birth: April 19, 1991
Age: 19 Occupation: unemployed
Birthplace: Pasig
Nationality: Filipino
Religion: Catholic
Date Admitted: May 4, 2010 @ 9:18 pm
Attending Physician: Felix Roberto G. Torres

II. NURSING HISTORY

A. PAST HEALTH HISTORY
The client, Ms. EE has had childhood illness such as measles and as she can remember she acquired this when she was 8 years old. She forgot if she has a complete immunization. She has no known allergies to any food, drugs, insects or any other environmental agents. She also said that there is no one her family has known communicable or infectious disease. It is her first time to be hospitalized with her chief complaint, which is neck stiffness. Despite of this she does not take any medications to ease her pain.

B. HISTORY OF PRESENT ILLNESS
Two weeks prior to admission, patient had carbuncle in the forehead, then after a week the carbuncle spread on nape and right leg. Neither consultation done nor medication taken. Then 5 days prior to admission, the patient developed fever, headache, nausea without vomiting. And still neither consultation done nor medication taken. And 2 days after, she experienced pain of the neck and jaw, drooping of the left eyelid with associated changes in sensorium. The patient consulted at San Lazaro Hospital hence...
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