Inflammation of the brain and surrounding tissues, usually caused by infection. Meningoencephalitis is a condition that's usually caused by a virus, bacterium, parasite or other microorganism. Examples include West Nile virus, mumps or tuberculosis. Symptoms vary, depending on the cause. They may include fever, confusion, vomiting, seizures or, if left untreated, death. Treatment may include antibiotics, antivirals or supportive care, depending on the origin of the disease.

1. CASE PRESENTATION
ON
Acute meningoencephalitis

2. DEMOGRAPHIC PROFILE:
Name : Aradhya
Age : 2 and half years old
Sex : Female
Date of birth :
Date of admission :16th February, 2020
Ip number : 4198
Diagnosis : acute meningoencephalitis
Educational status of mother : illiterate
Father name : Mr. Shyam Sharan
Address : palam vihar gurgaon

3. HISTORY OF THE CHILD:
Chief complaint:
 Seizures from morning -3 to 4 episodes
 High grade fever (102degree Celsius) – since 2 to 3 days
 Altered level of consciousness since morning
Present medical history:
Aradhya, developed fever 8 days ago for 2 days, which was relieved spontaneously. After
then the child was well for next 3 to 4 days with mild cough. On 16th of this month
suddenly the child developed seizures while playing with her toys and become
unconscious, her parents took her to some nearby private hospital but due to financial
crisis child got transferred to kalawati hospital. After reaching to the emergency ward of
kalawati the child had one cardiac arrest. CPR done and the child got intubated.

4. On admission the findings are
Temp: -370C, pulse rate: - 60b/min respiration 12b/min…child SPO2 IS
80% on oxygen by mask 4L/min.
Per abdomen: soft and no tenderness is present
Investigation done on admission are: CBC, CXR, ABG analysis done.
Past medical history:
no significant past medical history
Present surgical history:
no history of any surgical procedure
Past surgical history:
no history of any surgical procedure in past

5. BIRTH HISTORY; -
Antenatal history: -
mother received folic acid and iron calcium supplements during her pregnancy. Mother
received two doses of TT. Attended ante natal clinic. Mother undergone all the
investigations, including ultrasounds, no abnormalities are ruled out.
Intra natal history; -
 place of delivery : government hospital
 type of delivery : LSCS
 condition of the baby at birth : poor, had cried after 3 min of birth
 birth weight : 1.5kg
Neonatal history; -
Child delivered prematurely at 33wks and the child was LBW (1.5kg). cried immediately
after birth. Child was kept in NICU for 2 days under observation

6. s.no Name Relation
with child
Age/sex education Health status
1 Mr. shyam sharan father 24yrs/male Illiterate healthy
2 Mrs. Arti devi mother 23yrs /female Illiterate healthy
3 Miss. Aradhya self
21/2yrs/female
- In ICU on vent
FAMILY HISTORY:
Type of family: - nuclear family
Family medical history; - no significant history of any congenital or
hereditary disease in the family.

7. PERSONAL HISTORY;
 child likes to eat non veg
 sleeps at least 10 to 12 hours a day
 child takes bath on alt. days with warm water
 child is not started schooling yet

8. SOCIOECONOMIC HISTORY:
Type of house : concrete
Ventilation : adequate
Water supply : tap water
Drainage system : covered
Toilet facility : own latrine
Recreational facilities ; aradhya use to play indoor as well as outdoor play
Medical facility : there is one govt. dispensary in their locality
Religion ; Hindu
Occupation of parents ; private job of father, mother is house maker
Total income of the parents ; 8 to 10 thousand in a month
IMMUNIZATION HISTORY; immunized till date

9. Patient value Normal
range
REMARKS
Head circumference: 50cms 49 -
50cms
Baby anthropometric
measurements are normal
Chest circumference: 53cms 50-54cms
Abdominal circumference: 52cms -
PHYSICALASSESSMENT:
•Growth measurement
•Weight: 9.9kgs
•Expected weight of this child according to his age is 8kgs, therefore the child’s weight
is adequate according to her age.
•Height: child can’t stand as the child is on ventilatory support

10. Patient value Normal range REMARKS
Temperature: 37 degree
Celsius
36.5- 37.5
degree C
Vital signs
are normal
Pulse: 90beats/MIN 80-
110beats/min
Respiration: 30breaths/mi
n
26-40
breaths/min
•Physiological measurement

11. Neurological assessment;
Child is opening eyes to the pain
No verbal response
Glasgow coma scale of the child is E2V2M3—7/15
General appearance:
 Consciousness : unconscious
 Activity : unconscious
 Cleanliness : hygiene maintained
 Body built : well built
 Nourishment : proper

12. SKIN
 Colour : pallor
 Texture : smooth
 Turgor : normal
 Capillary refill ; 3sec
 Temperature :37 degree Celsius
 Lesions : absent
HEAD & SCALP:
 Size : normal
 Shape : round and symmetrical in shape
 Hair : normal black hair
 Scalp : clean and free from pediculosis

13. EYES:
 Eye brows : symmetrical and evenly distributed
 Eye lids : normal
 Eye lash : normal distribution and black in colour
 Sclera : white in colour
 Conjunctiva : anaemic
 Eyeball : normal
 Eye muscle : normal
 Pupil : B/L unequal pupil, lt. dilated
 Vision : can’t check, child is unconscious
EARS:
 Hearing ability : can’t check, child is unconscious
 External canal : can’t check, child is unconscious
 Discharges : no discharge
 Use of hearing aids : no

14. NOSE:
 Septal deviation : centrally located, no deviation
 Epistaxis : not present
 Discharges : no discharge
 Nasal polyp : no
MOUTH & THROAT:
 Lips : dry
 Tongue : dry and pink
 Gums : healthy
 Dentition : teeth present
 Throat : no swelling present

15. NECK:
 Thyroid enlargement : absent
 Lymph node : not palpable
 Range of motion : neck rigidity present in the child
CHEST:
 Shape : symmetric
 Movements : normal
 Respiratory rate : 28 breaths/min
 Respiratory sound : B/L clear
 Heart rate : 90 b/min
 Heart sound : S1 and S2 heard

16. NECK:
 Thyroid enlargement : absent
 Lymph node : not palpable
 Range of motion : neck rigidity present in the child
CHEST:
 Shape : symmetric
 Movements : normal
 Respiratory rate : 28 breaths/min
 Respiratory sound : B/L clear
 Heart rate : 90 b/min
 Heart sound : S1 and S2 heard

17. BACK AND SPINE:
 Posture : normal
 Deformities : none
GENETALIA:
 Lymph nodes : no lymphadenopathy found
 Urethral opening : child is having foley’s catheter
 Testes : no abnormalities found
 Congenital defects : not any
ANUS:
 Sphincter control : child is not conscious therefore stool
passing in diaper
 Lesions : absent
 Inflammation : absent

18. EXTREMITIES:
 Gait : can’t be observed
 Contour : normal
 Mortality : immobile
 Deformities : none
INTEGUMENTRY SYSTEM:
 Skin colour : pale
 Temperature :37 degree Celsius
 Nails : clubbing of nails not found

19. GROWTHAND DEVELOPMENT HISTORY;
Child has not achieved al the milestones of growth and
development successfully till date:
Neck holding- 6 month
Sit without support- 1 yr
Stand without support- 2 yrs.
Walking-2 yrs.
Language development- presently able to speak 2 to 3 words
with meaning

20. Sl.no Investigation Patients values Normal values
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Haemoglobin
WBC
Platelet count
Sodium
Potassium
Creatinine
SGPT
SGOT
ALK. Phosphatase
Total Calcium
CRP
Lymphocytes
Neutron- segs
Blood group
5.6g/dl
26.5*10000/cum
415*10000/cumm
157meq/l
4.9meq/l
0.31mg/dl
35.9U/L
80.8U/L
268U/L
9.3mg/dl
30.5mh/l
14.4%
20.9 * 10000/ul
B+
12-15g/dl
450O-11000/cumm
1.5-4lac/cumm
136-145mEq/l
3.5-5.1mEq/l
0.72-1.18 mg/dl
1-34U/L
1-31U/L
44-147IU/L
8.6 – 10.2mg/dl
0.0 – 6.0 mg/l
DAIGNOSTICANDLABORATORY TEST:

21. OTHER INVESTIGATION/ EXAMINATION
Lumbar puncture done on 17th feb- sample sent and
result is awaiting
Planned CECT – date not confirmed

22. Drug name Dose Route Frequency Action
Inj. Mannitol
Inj. Monocef
Inj. Acyclovir
Inj. Pantop
Inj. Valparin
Inj. Midaz
Inj. Vit K
IVF
I76ml DNS +1.7ml KCL
15ml
400mg
80mg
10mg
80mg
19mg
5mg
I/V
I/V
I/V
I/V
I/V
I/V
I/V
I/V
Q/D
BD
TDS
BD
BD
8 hourly
Stat
8 hourly
Osmotic diuretic
Antibiotic
Antiviral drug
Proton pump inhibitor
Anti-convulsant
Benzodiazepine
Anti-coagulant
MEDICATION

23. MENINGOENCEPHALITIS

24. INTRODUCTION
 Meningitis is an infection of the membranes
covering the brain and spinal cord. This covering is
called the meninges.
 Encephalitis is an inflammation of the brain.
Usually the cause is a viral infection, but bacteria
can also cause it. It can be mild or severe. Most
cases are mild.

26. PATHOPHYSIOLOGY OF ACUTE MENINGITIS: -

27. In book picture In child
 The most common causes of meningitis are viral
infections. These infections usually get better without
treatment.
 But bacterial meningitis infections are very serious. They
may result in death or brain damage, even if treated.
-
PRESENT
Meningitis may also be caused by:
 Chemical irritation
 Drug allergies
 Fungi
 Parasites
 Tumors
-
-
CAUSES: -

28. Many types of viruses can cause meningitis:
 Enteroviruses: These are viruses that also can
cause intestinal illness.
 Herpes viruses: These are the same viruses
that can cause cold sores and genital herpes.
However, people with cold sores or genital
herpes do not have a higher chance of
developing herpes meningitis.
 Mumps and HIV viruses.
 West Nile virus: This virus is spread by
mosquito bites and has become an important
cause of viral meningitis in most of the United
States.
NOT PRESENT IN THE CHILD

29. SYMPTOMS
Enteroviral meningitis occurs more often than bacterial meningitis
and is milder. It usually occurs in the late summer and early fall. It
most often affects children and adults under age 30.
Symptoms may include:
 Headache
 Sensitivity to light (photophobia)
 Slight fever
 Upset stomach and diarrhoea
 Fatigue

30. Bacterial meningitis is an emergency. You will need immediate treatment in a hospital.
Symptoms usually come on quickly, and may include:
 Fever and chills, especially in newborns and children
 Mental status changes
 Nausea and vomiting
 Sensitivity to light
 Severe headache
 Stiff neck
 Other symptoms that can occur with this disease:
 Agitation
 Bulging fontanelles in babies
 Decreased alertness
 Poor feeding or irritability in children
 Rapid breathing
Unusual posture, with the head and neck arched backward (opisthotonos)

31. EXAMS AND TESTS: -
 Fast heart rate
 Brudzinski’s sign

32. Kernig’s sign
 Fever
 Mental status changes
• Stiff neck

33.  a lumbar puncture (spinal tap) should be done to remove a sample of
spinal fluid (cerebrospinal fluid, or CSF) for testing.

34. Other tests that may be done include:
 Blood culture
 Chest x-ray
 CT scan of the head

35. TREATMENT: -
 Antibiotics are used to treat bacterial meningitis.
 Antibiotics do not treat viral meningitis. But antiviral medicine
may be given to those with herpes meningitis.
Other treatments will include:
 Fluids through a vein (IV)
 Medicines to treat symptoms, such as brain swelling, shock, and
seizures

36. OUTLOOK (PROGNOSIS): -
 Early diagnosis and treatment of bacterial meningitis is essential
to prevent permanent neurological damage.
• Viral meningitis is usually not serious, and symptoms should
disappear within 2 weeks with no lasting complications.

37. POSSIBLE COMPLICATIONS: -
Without prompt treatment, meningitis may result in the
following:
 Brain damage
 Buildup of fluid between the skull and brain (subdural effusion)
 Hearing loss
 Buildup of fluid inside the skull that leads to brain swelling
(hydrocephalus)
 Seizures
 Death

38. PREVENTION: -
Certain vaccines can help prevent some types of bacterial
meningitis:
Haemophilus vaccine (HiB vaccine) given to children helps
Pneumococcal vaccine is given to children and adults
Meningococcal vaccine is given to children and adults; some
communities hold vaccination campaigns after an outbreak of
meningococcal meningitis.
Household members and others in close contact with people who
have meningococcal meningitis should receive antibiotics to
prevent becoming infected

39. NURSING DIAGNOSIS:
Altered sensorium related to altered cerebral issue perfusion
secondary to meningitis
Imbalance nutrition, less than body requirement related to NPO
status.
Impaired physical mobility related to decreased level of
consciousness.
Risk of infection related to invasive lines, foley’s catheter
procedure.
Ineffective family coping related to the disease condition of the
child.

40. PROGESS NOTE:
Day 1- (18th feb, 2020)
The child is unconscious and is on ventilator on SIMS mode, I/V cannula present on the cephalic vein on left
side of the hand. On site of cannula no signs for thrombophlebitis. Foley’s Cather is present, urine output for
last 24 hours is 420ml. total neurological assessment is E2V2M3 THAT IS 7/15. Child is febrile. Childs
pupils are dilated.
All the required and needed Nursing care are given.
 Vitals signs checked
Temp :38’C
Pulse :124b/min
Respiration :28b/min
SPO2 :98% on ventilator support
B.P. :108/79mm/hg
 Medication provided as per physician order
 General assessment of the child is carried out
 Personal hygiene of the child maintained.
 Intake output is maintained.

41. Day 2 -19th feb,2020
The condition of the child is still same and there are no signs of improvements are present, child is on
ventilator on SIMS mode V.O.45/PEEP -5 /F-40 /FiO2 0.40%, pulse of the child is 122/min, SPO2 is 90%. I/V
cannula present on the cephalic vein on left side of the hand. On site of cannula no signs for thrombophlebitis.
Foley’s Cather is present, urine output for last 24 hours is 360ml. total neurological assessment is E2V2M3
THAT IS 7/15. Child is febrile.
All the required and needed Nursing care are given.
 Vitals signs checked
Temp :38’C
Pulse :122b/min
Respiration :22b/min
SPO2 :90% on ventilator support
B.P. :96/69mm/hg
 Medication provided as per physician order
 Oral and ET suctioning done
 General assessment of the child is carried out
 Personal hygiene of the child maintained.
 Intake output is maintained.

42. Day 3 -20th feb,2020
Childs general condition is stable. personal hygiene of the child is maintained. child had a spike of
fever in the night since morning the child’s temperature is maintained to normal range.
All the required and needed Nursing care are given.
 Vitals signs checked
Temp :36.6’C
Pulse :96b/min
Respiration :22b/min
SPO2 :96% on ventilator support
B.P. :104/mm/hg
 Medication provided as per physician order
 Oral and ET suctioning done
 General assessment of the child is carried out
 Personal hygiene of the child maintained.
 Intake output is maintained.

43. Day 4 -21th feb,2020
Childs general condition is critical. Childs is having MODS. Urine output of the child is 30ml
in last 24 hours. personal hygiene of the child is maintained. child is having fever since 24
hours.
All the required and needed Nursing care are given.
 Vitals signs checked
Temp :39’C
Pulse :110b/min
Respiration :18b/min
SPO2 :90% on ventilator support
B.P. :87/46mm/hg
 Medication provided as per physician order
 Oral and ET suctioning done
 General assessment of the child is carried out
 Personal hygiene of the child maintained.
 Intake output is maintained.

44. HEALTHEDUCATION
 taught parents about the importance of maintaining personal
hygiene and environmental hygiene of the child of the child.
 Taught the parents about how to prevent the injury to the child by
explaining safety measures to them
 Parents are taught about hoe to give NG feed to the child properly.
 Taught the parents about the importance of changing position of
the child in every 2 hours to prevent pressure ulcers to the child

45. SUMMARY ANDCONCLUSION
Aradhya, female child, 2 and half years old came with the
complaint of seizures and unconsciousness. Child had an arrest and
received CPR on admission. Now the child is on ventilatory
support on SIMS mode with V.O.45/PEEP 5/F-40/FiO2 0.40%,
Pulse 98b/min, spo2. Child is having MODS and in serious
condition.