Category: SCIENCE BLOG

DESCRPITION
DEFINITION
The inflammation of meninges (membranes surrounding the brain and spinal cord) which is caused by viral, bacterial or fungal organisms.
Classification
There are three classifications –
1. Aseptic – viral or causes or meningeal irritation from other causes such as brain abscess, encephalitis, leukaemia etc.
2. Septic — bacterial origin ex. Meningococcus, Neisseria meningitides, Staphylococcus, Influenza Bacillus.
3. Tuberculous – Tubercle Bacillus

Pathophysiology
The causative organisms enter the blood stream, cross the blood brain barrier, and trigger an inflammatory reaction in the meninges. Independent of the causative agents, inflammation of the subarachnoid and piamater occurs. Increased intra cranial pressure results. Meningeal infections generally originate in one of two ways: either through the blood stream from other infections or by direct extensions. In a few cases, the cause is iatrogenic or secondary to invasive procedures or devices.
Bacterial meningitis is the most significant form. The common bacterial pathogens are Neisseria meningitides, Streptococcus, Pneumoniae and Haemophylus Influenzae.
Clinical signs
Headache, Neck stiffness, Photophobia (intolerance to bright light), Irritability
Changes in level of consciousness, disorientation, memory impairment
Behavioural changes, coma
Positive Kernig’s sign
Vomiting bradycardia, increased ICP (intra cranial pressure)
Phonophobia (intolerance to loud noises)
Abnormal skin colour, cold extremities
Petechial rash
Morphology
• Grossly, pyogenic meningitis shows a thick layer of supportive exudates covers the leptomenings over the surface of the brain.
Diagnosis
• Culture of CSF
• Blood culture
• Urine specimen
• MRI
• CT-Scan

Management
1. Medical management
• Antimicrobial therapy- penicillin, ampicillin chloramphenicol
• Vancomycin, along with refampin is given for bacterial infection
• For dehydration or shock, fluid volume expenders are given
• Seizures are controlled by diazepam or phentoin
• Osmotic diuretics used to treat cerebral edema ex. Mannitol

2. Nursing management
• Management resolve around, prevention of dehydration, electrolytes imbalance and edema and fever.
• Body weight, serum electrolyte and urine volume are closely monitored.
• Arterial pressure is monitored to asses cardiac or respiratory failure and risk of shock
• Asses the patient neurologic status.
• Watch for cyanosis, cold extremities.
• Administer I.V. (intra venous) fluids and medications.
• Monitor vital signs and neurological status.
• Provide basic patients need care.
Complications
The complications of meningitis can be severe. The longer persistent in a human and child without treatment, the greater the risk of seizures permanent neurological damage including-
• Hearing loss
• Memory difficulty
• Learning disabilities
• Brain damage
• Gait problems
• Seizures
• Kidney failure

Description:– It is commonly known as Angina; is chest pain often due to Ischemia of the heart muscle , due in general to obstruction or spasm of the coronary Arteries.
The term derives from the Latin Angina (infection of the throat) and the Latin pectus (Chest) and can therefore, be translated as “a strangling feeling in the chest”
There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle
Classification:- the angina pectoris has classified under 2 category that is-
1) Stable Angina
2) Unstable Angina

1) Stable Angina:- Also known as effort Angina, this refers to the more common understanding of angina related to Myocardial Ischemia. Typicl presentation of stable angina is that of chest discomfort and associated symptions precipitated by some activity (running, walking, etc) with minimal or non existent symptoms at rest or with administration of sublingual nitroglycerin. Symptoms typically abate several minutes following cessation of precipitating activities and recur when activity resumes. In this way, stable angina may be thought of as being similar to intermittent claudication symptoms.

2) Unstable Angina(UA):- It is define ass angina pectoris that changes or worsens .
It has at least one of these 3 features:
a) It occur at rest, usually lasting 3-5 min. is severe and of new onset(i.e., within the prior 4-6 weeks)
b) It occur with a crescendo pattern(i.e., distinctly more severe prolonged or frequent than before)
c) It may occur unpredictably at rest, which may be a serious indicator of an impending heart attack.
The pathophysiology of UA is the reduction of coronary flow due to transient platelet aggregation on apparently normal endothelium, coronary artery spasms or coronary thrombosis
Cause:-
1). Major risk factors; > Age(> 55 year for men, > 65 for women)
> Cigarette smoking
> Diabetes mellitus
> Family history of premature cardiovascular disease
> Hypertension
– kidney disease
2) Other medical problems;
Profound Anemia, uncontrolled Hypertension, Hyperthyroidism and hypoxemia

Signs and symptoms:- Angina pectoris can be quite painful, but many patients with angina complain of chest discomport rather than actual pain
The discompert is usually described as:-
A pressure, heaviness, tightness, squeezing, burning, or choking sensation
– In this case , the BP and pulse rate increases
– Myocardial ischemia
– Autonomic Symptoms like nausea
– , vomiting, and pallor
Major risk factors Angina pectoris:-
1) Smoking,
2) Diabetes,
3) High cholesterol,
4) High BP,
5) Sedentary lifestyle and
6) Family history of premature heart diseases

Treatment:-
 The most specific medicine to treat Angina is NITROGLYCERIN.
 Balloon Angioplasty
 Coronary bypass surgery
 Beta blocker (atenolol,propranolol)
 Calcium channel blockers (nifedipine,amlodipine)