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NURSING CARE PLAN Pedia TB Meningitis

ASSESSMEN
T
SUBJECTIVE:
Nilalagnat
ang
anak ko as
verbalized by
the
mother.
OBJECTIVE:
Flushed
skin,
warm to
touch.
Increased
respiratory
rate.
V/S taken as
follows:
T: 37.8
P: 110
R: 45

DIAGNOSIS

INFERENCE

Hyperthermia
related to
infectious
process and
dehydration.

Tuberculosis
meningitis is
the most
severe form of
tuberculosis.
It causes
severe
neurologic
deficits or
death in more
than half of
cases.
Tuberculois
meningitis
begins
insidiously
with a gradual
fluctuating
fever, fatigue,
weight loss,
behavior
changes,
headache,
and vomiting.
This early
phase is

PLANNING

INTERVENTIO
N

RATIONALE

After 4 hrs. of
Independent:
Dysrhythmias
nursing
and ECG
interventions, Monitor heart
changes are
the client will
rate and
common
maintain core
rhythm.
due to
temperature Record all
electrolyte
within normal
sources of
imbalance
range.
fluid loss such
and
as urine,
dehydration
vomiting.
and direct
Promote surface
effect of
cooling by
hyperthermi
means of
a on blood
tepid sponge
and cardiac
bath.
tissues.
Wrap
To monitor or
extremities
potentiates
with cotton
fluid and
blankets.
electrolyte
Provide
loses.
supplemental To decrease
oxygen.
temperatur
Administer
e by means
replacement
through
fluids and
evaporation
electrolytes.
and

EVALUATIO
N
After 4 hrs.
of nursing
intervention
s, the client
was able
maintain
core
temperatur
e within
normal
range.

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followed by
neurologic
deficits, loss
of
consciousness
, or
convulsions. A
dense
gelatinous
exudates
(outpouring)
forms and
envelops the
brain arteries
and cranial
nerves. It
creates a
bottleneck in
the flow of the
cerebrospinal
fluid, which
leads to
hydrocephalu
s.

conduction.
Maintain bed
To minimize
rest.
shivering.
Provide high
To offset
calorie diet,
increased
tube feedings,
oxygen
or parenteral
demands
nutrition.
and
Administer
consumptio
antipyretics
n.
orally or
To support
rectally as
circulating
prescribed by
volume and
the physician.
tissue
perfusion.
To reduce
metabolic
demands
and oxygen
consumptio
n.
To increased
metabolic
demands.
To facilitate
fast
recovery.