Nursing Care plan for Tuberculous Meningitis
Tuberculous meningitis is meningitis caused by complications of primary tuberculosis. Histologically tuberculous meningitis is meningo-encephalitis (tuberculosis) which occurs membranes and tissue invasion into the central nervous system.
According to Lincoln, the clinical manifestations of tuberculous meningitis are grouped into three stages:
1. Stage I (initial stage / non-specific stage / prodromal phase)
Prodromal, lasts 1-3 weeks.
Usually the symptoms are not typical, arise slowly, with no neurological abnormalities.
Symptoms:
- Fever (not too high).
- Weakness.
- Decreased appetite (anorexia).
- Abdominal pain.
- Headache.
- Disturbed sleep.
- Nausea, vomiting.
- Constipation.
- Apathy.
- Irritable.
If a tubercle rupture into the subarachnoid space stage I will be brief so often overlooked and will go straight into stage III.
2. Stage II (transitional stage / phase of meningitis)
In this phase occurs in the lining of the brain stimulation / meninges.
Characterized by neurologic abnormalities, due to exudate that forms above the arch cerebral.
Examination of a stiff neck (+), Kernig and Brudzinski reflexes (+) except in infants.
With the passage of time, formed infiltrates (gray jelly mass) at the base of the brain " cause brain / brain stem.
In this phase, the organization experienced exudate which will result in cranial nerve palsies and hydrocephalus, disturbance of consciousness, papilledema light and the presence of tubercles in the choroid. Vasculitis causes focal disorders, cranial nerves and spinal cord sometimes . Hemiparesis which arise due to infarction / ischemia, quadriparesis may occur as a result of bilateral infarction or severe brain edema.
In children younger than 3 years old, irritable, and vomiting are the main symptoms, while rarely complained of headaches. While the older children, headache was the main complaint, and diminishing consciousness.
Symptoms:
As a result of stimulation of the meninges "severe headache and vomiting" (main complaint).
As a result of inflammation / constriction of arteries in the brain: disorientation, confusion, seizures, tremors, hemiballismus / hemichorea, hemiparesis / quadriparesis, loss of consciousness
Disorders of the brain / brain stem / cranial nerve disorders: Cranial nerves are often affected is the brain nerves III, IV, VI, and VII
Signs: strabismus, diplopia, ptosis, sluggish pupillary reaction, blurred vision disorders.
3. Stage III (Personal / paralytic phase)
Acceleration of the disease occurs, lasting for ± 2-3 weeks .
Impaired brain function more clearly .
Caused by brain stem infarction due to vascular lesion exudates or strangulation by the experience of the organization.
Symptoms :
- Irregular breathing.
- High fever.
- Papilledema.
- Hyperglycemia.
- Diminishing consciousness, irritable and apatis, drowsiness, stupor, coma, extensor muscles become stiff and spasm, opisthotonos, pupils dilated and did not react at all.
- Pulse and breathing become irregular.
- Hyperpyrexia.
- Finally, the patient may die.
Hydrocephalus can occur in approximately two thirds of patients, especially those whose disease has lasted more than 3 weeks. This occurs when treatment is delayed or inadequate.
Nursing Care Plan for TB Meningitis
Nursing Diagnosis : Self-Care Deficit related to changes in the central nervous system, physical weakness.
Goal
a) The long-term goal
Self-care are met.
b ) Short-term goals
After a given action for 1 day less nursing care gradually fulfilled.
Outcomes:
- Daily activities can be done while the patient pain and can be done after discharge from the hospital.
- Body weight did not go down.
- Intact skin.
- Normal bowel and bladder.
Intervention :
1. Observation level of functioning of patients.
Rationale : Determining the level of the patient's needs.
2. Instruct the patient to express feelings about the inability to perform self-care.
Rationale : Helps patients in getting a better level of functioning.
3. Provide assistance and support as needed such as bathing, bowel and bladder, hygiene, dressing and eating.
Rationale : It will increase the feeling of independence.
4. Provide all measurements / tools and food hygiene.
Rationale : In order to save energy.
5. Maintain indwelling catheter if necessary.
Rationale : To empty the bladder in a patient unconscious.
