Learning objectives: Orientation (10 min)
At the end of this PBL session, students will be able to:
Discus the normal structure and function of neurologic system.
Discuss incidence and prevalence (epidemiology) of meningitis.
Discuss risk factors (biological, behavioral and socio-cultural) associated with
meningitis.
Characterize and relate key clinical manifestations (symptoms) and finding
(signs) of meningitis.
Explain the mechanism of (pathophysiology) of how these S/S happened.
Identify appropriate lab investigations and Interpret results.
Identify cause/etiology of the meningitis problem based on lab investigations
Discus cause effect relationship
Discuss the biochemical changes occurred in the test/image results
Discuss ethical issues related with investigations and management of the
meningitis.
Discuss the management principles, treatment options, and outcome of
meningitis.
Discuss the nursing managements of a child admitted with meningitis.
PBL case
Module name: pediatrics Nursing III
Problem: Fever
Total hours: 240 min
PART ONE: - TRIGGER (15 min)
A four-year-old male child came to pediatrics OPD with compliant of high body temperature of
three days duration. His mother verbalized that their residence is low land area and her child
condition made her anxious.
Part Two: – History (30 min)
This child was relatively healthy before three days. He started to develop high body temperature.
He also has non-productive type of cough. He had episodes vomiting. He had runny nose before
the fever. He has loss of appetite.
Otherwise: He has no
diarrhea
CVA tenderness
fast breathing
history of previous admission
Part three: P/E(30 min)
G/A: acute sick looking
V/S and Anthropometric measurement: RR-38, breath/min, PR-96 bpm, T0-38.50c, Wt-16 kg,
Ht-102 cm, MUAC-13 cm.
HEENT: pink conjunctiva, non icteric sclera
LGS: no swollen lymph nodes
CHEST: no chest indrawing, clear and resonant, good air entry
CVS: S1 and S2 well heard, no gallop and murmur
ABDOMEN: protuberant abdomen, moves with respiration, no visible veins, active bowel
sound.
GUT: no costovertebral angle tenderness
INTEGUMENTARY: no skin rash
MSS: no deformity, no joint swelling, no joint tenderness.
CNS: lethargic, nuchal rigidity
Part Four: Investigation (20 min)
Investigations Result Reference
CBC WBC 103 /mcL 20 5-10
Hgb(g/dL) 12 9.5-15.5
HCT (%) 36 32-44
CSF Color Turbid Clear
White blood 2 <1
cells (/mcL)
Polymorphonuclear 40% None
cells/mcL (26%–35%)
Lymphocytes/mcL 5 ≤5
Protein 60 5–45
(mg/dL)
Glucose 30 45–72
(mg/dL)
Urinalysis 2-3 WBC/
MICROSCOPY NEG
HPF
Widal Non-reactive Non-reactive
Weil flex Non-reactive Non-reactive
Blood film No No
hemoparasite hemoparasite
seen
Part five: – Case summary/ Synthesis /validation of key point’s regarding the specific cased
to be approached /solved (for Tutors use only)
Patient problem: Fever
A four-year-old male child was presented to Pediatrics OPD with high body temperature
of 03 days duration. He also has vomiting, non-productive cough, and had runny nose..
He has no fast breathing and chest indrawing. He is lethargic and has nuchal rigidity. Lab
investigation revealed increased WBC, CSF is turbid in color, increased protein and
decreased glucose and predominant cells are polymorphonuclear cells.
Main Dx: Bacterial meningitis
DDX:
Pneumonia
Malaria
UTI
Typhoid fever
Typhus
Measles
Nursing diagnoses
Actual nursing diagnoses
Hyperthermia related to disease process as evidenced by high body temperature.
Poor appetite related to disease process as evidenced by care giver verbalization.
Ineffective breathing pattern related to disease process as evidenced by coughing.
Anxiety related to change in health status of child as evidenced by expressed concern
and worry about seriousness of illness.
Potential nursing diagnoses
Risk for ineffective cerebral tissue perfusion related to increased intracranial pressure
Risk for deficient fluid volume related to vomiting
Risk for impaired skin integrity related prolonged hospitalization.
Nursing goals
o The child will have body temperature within the normal range for his age
o The child will have improved appetite
o The parents anxiety will be relieved
o The child will have effective breathing pattern
o The child will not experience ineffective cerebral tissue perfusion
o The child will not experience deficient fluid volume
o The child will not experience impaired skin integrity
Medical Management
Restrict fluid intake to 70% of calculated maintenance.
Ceftriaxone 100mg/kg/d for 10 days.
Dexamethasone 0.6mg/kg QID in case
of suspected H. Influenza meningitis
Nursing management
Restrict fluid intake to 70% of calculated maintenance.
Monitor urine output and daily weight
Support feeding
Monitor vital sign
Reassure the parents
Changing the position of the child every two hours.
Administer prescribed antipyretics
Prevent aspiration
Administer prescribed medications timely
