Abdu A.pptx

Abdu A.pptx

• 1.
  Case presentation onTreatment Extra pulmonaryand Tuberculosis Meningitis From medical ward
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  Presentation outline •Case Identification •Subjectivefinding •Objective finding •Assessment •Treatment •Care plan
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  Case identification • Name:Mr J.A • Age: 64 • Sex: M • Address :from Oromiya , JARSOO • Date of admission 21/4/11 • Ward : Medical –TB ward • Bed number :90 • Card number :337484
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  Anthropometric measurement • Age:64 • Weight :82 kg • Height : 1.68 m • BMI : 21.03
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  Subjective finding • J.Ais a 64-year-old, 82-kg man who is brought to the emergency department after a 4-day period during which he became progressively disoriented, febrile to 40.5◦C, and obtunded. He also had severe headaches during this time. • Physical examination revealed moderate nuchal rigidity and a positive Brudzinski sign (neck resistant to flexion). • An initial diagnosis of possible meningitis was made, and a lumbar puncture ordered. • The cerebrospinal fluid (CSF) appeared turbid, and laboratory analysis revealed an elevated protein concentration of 200 mg/dL,a decreased glucose concentration of 30 mg/dL, and a white blood cell count of 500/μL (85% lymphocytes). • A Gram stain of the spinal fluid and a sputum smear for AFB were negative; other laboratory tests were within normal limits. • A diagnosis of tuberculous meningitis was presumed. Discuss the presentation and prognosis of tuberculous meningitis.
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  • Medication history: He has not treated • Past medication history : no .FH: He has no family history of DM , HTN cardiac or renal disease . Social : had a history of cigarette smoking before he was first diagnosed for TB but he denies to smoking after then.
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  Objective finding GA :acute sick looking HEENT : pink conjunctivitis Chest : there is decreased air entry on right side of posterior lower 1/3 of chest . CVS : S1 and S2 well heard no gallop and murmur ABD : flat moves with respiration , there is tenderness on epigastric area , no ascitis .
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  • MS :has tenderness on the back  No deformity • ISH : no rash • CNS : COTPP
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  Objective finding • Laboratoryfindings • The cerebrospinal fluid (CSF) appeared turbid • an elevated protein concentration of 200 mg/dL • a decreased glucose concentration of 30 mg/dL, • a white blood cell count of 500/μL (85% lymphocytes). • Gram stain of the spinal fluid and a sputum smear for AFB were negative; • ; other laboratory tests were within normal limits. • Nucleic acid amplification tests and interferon-γrelease assays may aid in the diagnosis of tuberculosis
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  Assessment • irreversible braindamage or death .Complications . Cryptococcal Meningitis . HSV encephalitis
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  Treatment • Treatment shouldbe initiated in J.A with daily administration of isoniazid 300 mg, rifampin 600 mg, pyrazinamide 2,000 mg, • and ethambutol 1,600 mg for the first 2 months. • After this initial phase of treatment, J.A should receive daily isoniazid and rifampin for an additional 7 to 10 months, although the optimal duration of therapy is unknown. • In addition, because J.A is older, pyridoxine 10 to 50 mg/day should be given to prevent the occurrence of peripheral neuropathy from isoniazid. It also • should be remembered that rifampin may impart a red to orange color to the CSF.
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  • Isoniazid readilypenetrates into the CSF, with CSF concentrations reaching up to 100% of those in the serum. • Rifampin is often included in tuberculous meningitis regimens and may be associated with reduced morbidity and mortality; however, even with inflammation, CSF concentrations of rifampin are only 6% to 30% of those found in the serum. • Ethambutol should be used in the highest dosage to achieve bactericidal concentrations in the CSF because its CSF concentrations are only 10% to 54% of those in the serum. Streptomycin penetrates into the CSF poorly even with inflamed meninges.
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  CORTICOSTEROIDS • Corticosteroids inmoderate to severe tuberculous meningitis • appear to reduce sequelae and prolong survival. • The mechanism for this benefit is likely owing to reduction of intracranial pressure. • Dexamethasone 8 to 12 mg/day (or prednisone equivalent) for 6 to 8 weeks should be used and then tapered slowly after symptoms subside.
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  DTP • Mr J.Ahas Treated with PTB , EPTB and TB Meningitis so the recommended regimen according to the updated NATIONAL GUIDELINES FOR TB, DR-TB AND LEPROSY IN ETHIOPIA is
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  Care plan • MonitorVital signs • Monitor for side effects of the medications To do LFT , TSH , RFT , LP ,CSF and audiometric test • Patient education ( adherence counseling and nutritional diet ) • Follow the dose of the medications • Do Culture and DST test
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  Goal of therapy •To cure the TB patient and restore quality of life and productivity • To prevent recurrence of the disease • To decrease transmission of the disease • To avoid toxic medicine effects, • To Improve the clinical condition of patients and to manage complications.
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  Intervention • the patientsshould be treated according to updated new regimen . • contacted the doctor and communicate based on evidence .