stories untold

unknown_dean

T_T sori baby ko.

sori d ka napanindigan ni momi.

d k inlam kung san ka nla dinala. d kita nadalaw nung 1. at d kita natirikan ng kandila. sori.

pero mahal na mahal ka ni momi. pinagdasal kita. nagrosary ako. i know it's not enough. sori baby ko.

bukas, magsisimba ako. ipagtitirik kta ng kandila.

sna naaalala tau ng tatay mo.

sna pinagtirik ka nya ng kandila.

anu ba gs2 mong name baby ko?

sabi ng tatay mo, baby girl ka daw. kamukha daw kta. may nunal sa ilong. cute kaso d pango. patangos. mana sa kanya.

haiz. hanggang description nlang kami sau. sna nakita ka namin. sna kasama ka na namin ngaun. 1 yr and 6mos. ka na sna ngaun.

mahal na mahal ka namin baby ko. ikaw ang panganay namin.

YOU'LL BE FOREVER IN OUR HEARTS, BABY NAMIN.

PS. WE LOVE YOU.

unknown_dean

pkisagot nmn po pls. tnx!

unknown_dean

dinugo ako ngaun!

pucha negative!

lagot ako kay bf pg nlman.

unknown_dean

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Name: Ross Anne C. Cruz                                                                   Mrs. Rufina Singian

Group no.: A4                                                                                                           020609

WCC-Antipolo

MENINGITIS

Meningitis is the inflammation of the meninges of the brain and spinal cord as a result of viral and bacterial infection. Such inflammation may involve the three meningeal membranes – the dura matter, the arachnoid, and the pia matter.

Etiologic Agent

The disease can be caused by several kinds of organisms which include the pneumococcus, staphylococcus, streptococcus, and tubercle bacillus. The specie Neisseria meningitides (meningococcus) is the organism causing most epidemics of meningitis.

Incubation Period

Incubation period varies, the extreme limits being set from 1-10 days.

Mode of Transmission

• Meningitis is transmitted by respiratory droplets through nasopharyngeal mucosa.
• It can also be transmitted by direct invasion through otitis media.
• Meningitis may result after a skull fracture, a penetrating head wound, lumbar puncture or ventricular shunting procedures.

Diagnostic Procedures

1. Lumbar puncture
   1. Diagnostic purposes
      • To obtain specimen, the CSF
      • To take x-ray of the spinal canal and cord
   2. Therapeutic purposes
      • To reduce intra-cranial pressure
      • To introduce serum and other medications
      • To inject an anesthetic agent
2. Gram staining
3. Smear and blood culture
4. Smear from petechiae
5. Urine culture

Classification

1. Acute meningococcemia
   • Meningococci invade the bloodstream without inoling the meninges.
   • It usually starts with nasopharyngitis followed by sudden onset of high grade fever with chills, nausea, vomiting, malaise, and headache.
   • Petechial, purpuric, or ecchymotic hemorrhages scatter over the entire body and mucous membrane.

•  
  • The adrenal lesions start to bleed into medulla which extends to the cortex.
  • The combination of meningococcemia and adrenal medullary hemorrhage is known as Waterhouse-friderichsen syndrome.
  • Waterhouse-friderichsen syndrome is the rapid development of petechiae to purpuric, and echymotic spots in association with shock.
  • The condition runs a short course and is usually fatal. This frequently occurs in fulminant type.

2.         Aseptic meningitis

•  
  • It is benign syndrome characterized y headache, fever, vomiting, and meningeal symptoms.
  • It begins suddenly with a fever of up to 400C, alterations in consciousness (drowsiness, confusion, stupor), neck and spine stiffness, which is slight at first.
  • Characteristic sign of meningeal irritation
    1. Stiff neck or nuchal rigidity
    2. (+) Brudzinski’s sign
    3. (+) Kernig’s sign
    4. Exaggerated and symmetrical deep tendon reflexes

•  
  • Sinus arrhythmia, irritability, photophobia, diplopia, and other visual problems.
  • Delirium, deep stupor, and coma
  • Signs of intra-cranial pressure
    1. Bulging fontanel in infants
    2. Nausea and vomiting (projectile)
    3. Severe frontal headache
    4. Blurring of vision
    5. Alteration in sensorium

Complications

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

Modalities of Treatment

1. If meningitis is left untreated it has a mortality rate of 70 to 100 percent.
2. Treatment includes appropriate antibiotic therapy and vigorous supportive care.
3. Usually IV antibiotics are given for two weeks and are followed by oral antibiotics such as:
4. Digitalis glycoside (digoxin) is administered to control arrythmias.
5. Manitol is given to decrease cerebral edema.
6. Anticonvulsant or sedative is needed to reduce restlessness and convulsions.
7. Acetaminophen is helpful to relieve headache and fever.

Nursing management

• Assess neurologic signs often. Observe the patient’s level of consciousness and check for increased intra-cranial pressure (ICP) (plucking at bedcovers, vomiting, seizures, change in motor functions and vital signs).
• Watch for the deterioration of patient’s condition, which may signal an impending crisis.
• Monitor fluid balance. Maintain adequate fluid intake to avoid dehydration, but avoid fluid overload because of the danger of cerebral edema. Measure central venous pressure and intake and output.
• Watch for adverse reaction of antibiotics and other drugs. Avoid infiltration and phlebitis.
• Position the patient carefully to prevent joint stiffness and neck pain. Turn the patient often to avoid pressure sores and respiratory complications. Assist with ROM.
• Maintain adequate nutrition and elimination.
• Ensure patient’s comfort.
• Provide reassurance and support to the patient and the family.
• Follow strict aseptic technique when treating patients with head wounds or skull fractures.
• Isolation is necessary especially if nasal culture is positive.

Prevention

• Several vaccines are available to protect against certain types of meningitis.
• Teach clients with chronic sinusitis or other chronic infections the importance of proper and prompt medical treatment.