QUESTION FOUR Agya Kwakye a 47 year old man was admitted to the medical ward with the diagnosis of cerebrospinal meningitis. He has altered consciousness and appeared very weak. Using the above scenario: A. Explain cerebrospinal meningitis in not more than thirty words. B. List five diagnostic investigations that could help in diagnosing the condition. C. Describe your nursing management for Agya under the following headings; i. Positioning. ii. Observations. iii. Rest and sleep. iv. Personal hygiene. SOLUTION TO QUESTION FOUR A. EXPLANATION OF CEREBROSPINAL MENINGITIS Meningitis describes a sudden inflammatory disease that affects the covering or lining of the brain and spinal cord. It is characterized by headache, neck stiffness, seizures, fever and altered level of consciousness. B. FIVE DIAGNOSTIC INVESTIGATIONS THAT COULD HELP DIAGNOSE THE CONDITION 1. Physical examination like kerning’s sign and Brudzinki’s sign. 2. Lumber puncture. 3. Culture and sensitivity test. 4. White Blood Cell (WBCs) Count. 5. Computerized tomography (CT) scans. 6. Chest X-ray. 7. Cerebrospinal fluid (CSF) protein estimation. C. DESCRIPTION OF NURSING MANAGEMENT UNDER THE FOLLOWING HEADINGS (i). Positioning 1. Assist the conscious client to assume any suitable position in bed that promote comfort and prevent any complication. 2. If client is unconscious, ensure that he is nursed in the most appropriate position, preferably the lateral position or semi-prone position (unless intubated) in order to keep the airway patent and to e enhance dribbling of saliva. 3. Ensure that the position of client is changed frequently every two hours in order to enhance circulation and prevent bed sores. 4. The head of the unconscious client should be kept neutral and supported with pillows, towel rows, or soft collar in order to prevent hyper-flexion, airway obstruction and impeding of venous drainage from the head. 5. If the bed is adjustable, elevate the head end of bed by about 10 – 30o in order to facilitate drainage of secretions from the mouth and prevent aspiration. 6. Ensure spine alignment by supporting the trunk with enough pillows in order to promote comfort and maintain proper alignment of the body. 7. The uppermost arm is brought forward in front of the client with its elbow slightly bent and wrist extended. The lower arm should be brought alongside the face with palm facing upwards. 8. The uppermost leg of the client should be flexed (at the knee), brought forward and then supported with pillows. The lower leg should be extended straight in line with the spine. This position of the legs prevents internal rotation of the hip. (ii). Observations 1. Monitor vital signs on admission and subsequently by checking temperature, pulse respiration and blood pressure in order to ensure that they are within their normal ranges. 2. Assess client’s level of consciousness by using the Glasgow coma scale or any appropriate tool in order to plan and render appropriate nursing care. 3. Observe client for convulsion by nursing him closer to nurses’ station in order to prevent associated injuries and other untoward complications. 4. Maintain accurate intake and output chart by closely monitoring client’s intravenous infusions, oral fluids and eliminated fluids (urine, vomitus, and watery stool) in order to ensure that normal hydration and electrolyte balance. 5. Observe urine, vomitus and stool for their colour, odour, consistency and other characteristics by using your senses in order to identify and report any abnormality to the charge nurse or physician. 6. Assess client’s skin integrity by using Waterlow Scale or any appropriate tool in order to prevent and monitor for signs of pressure ulcer. 7. Monitor site of cannula insertion for closely in order to identify abnormalities like infiltration, signs of infections and other associated complications of I.V therapy. 8. If client is unconscious observe his mouth for the presence of secretions by checking on the pillows and bed linens in order to prevent aspiration. 9. Assess bowel pattern by observing stool for colour, odour, consistency, frequency and size in order to prevent constipation and abdominal discomfort. (iii). Rest and sleep 1.Provide a bed suitable for client’s condition which should be free from creases, crumps and moisture in order to ensure comfort and enhance sleep. 2. Ensure a quiet environment by restricting visitors in order to avoid disturbing client unduly and encourage rest. 3. Plan and carry out nursing activities in a manner that minimizes disturbance and ensures complete bed rest. 4. Ensure a well-ventilated environment by putting on fans opening nearby windows and doors in order to encourage rest induce sleep. 5. Encourage or assist client to take a warm bath in order to enhance circulation and induce sleep. (iv). Personal hygiene 1. Assist client to bath or perform bed bath at least twice daily taking good care of perineal areas and under skin folds in order to boost self-confidence, prevent odour and infection. 2. If client experiences incontinence of urine or stool, perform bed bath every time he soils himself in order to prevent infection and maintain normal skin integrity. 3. Provide good oral hygiene by assisting the conscious client clean mouth at least twice daily or before and after eating in order to boost appetite. 4. If client is unconscious perform oral care at least twice daily to keep mouth clean and to prevent any oral infection. 5. Appropriate care should be given to client’s hair, feet and hands in order to ensure proper grooming and boost self-esteem.
Posted on: Fri, 06 Jun 2014 22:26:06 +0000
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