Acute Pain and Impaired Physical Mobility NCP for Tuberculous Meningitis

Tuberculosis meningitis is a TB infection of the brain and the spinal cord. The initial symptoms can be irritability and restlessness. Later the patient may develop other symptoms such as a stiff neck, headaches, vomiting, variations in mental behaviour, seizures, or coma.

Nursing Care Plan for Tuberculous Meningitis

Nursing Diagnosis I :

Acute pain related to the process of infection in the central nervous system

Goal:
1. Long-term goal
Pain is gone.

2. Short-term goals
The pain gradually diminished

Outcomes:

• Clients reported no pain, or pain can be controlled.
• Shows posture relaxed and able to sleep / rest appropriately.

Intervention
1. Provide a quiet environment, the room is rather dark as indicated.
rational:
Lowering the reaction to outside stimulation or sensitivity to light and improve the rest / relaxation.

2. Put an ice bag on head, clothes on cold eyes.
rational:
Increases vasoconstriction, blunting sensory perception which will further decrease the pain.

3. Support to find a comfortable position, such as head a little bit higher.
rational:
Lowering of meningeal irritation, discomfort resultant further.

4. Give range of motion exercises active / passive appropriately and do massase muscular shoulder or neck area.
rational:
Can help relax the muscle tension that increases the reduction of pain or discomfort.


Nursing Diagnosis II :

Impaired physical mobility related to neuromuscular damage

Goal:
1. Long-term goal
Physical mobility increased / improved

2. Short-term goals
Impaired physical mobility gradually decreased

Outcomes:
Client is able to mobilize.

Intervention
1. Check back ability and the functional state of the damage.
rational :
Identify possible damage affecting functionally and intervention options that will be done.

2. Assess the degree of immobilization of the client by using the scale dependence.
rational :
The client is able to self (value 0) or need help / tools are minimal (score 1) ; need help being supervised / taught (score 2) ; need help / tools that continuously and special tools (value 3) , or depending on the total the provision of care (Grade 4) ; someone in all categories are equally at risk of accidents , but the category with a value of 2-4 has the greatest risk for the occurrence of such hazards in connection with immobilization.

3. Give or aids to perform range of motion exercises / ROM.
rational :
Mobilization and maintain joint function / normal position and reduce the occurrence of venous limb static.

4. Provide meticulous skin care, massage with moisturizer and change linen / clothes wet and keep the linens are kept clean and free of wrinkles.
rational :
Improves circulation and skin elasticity and reduce the risk of skin excoriation.