Laboratory Tests

CSF Analysis Glucose Total Protein LDH WBC RBC Differential Lymphocyte count Color Transparency 100% colorless Clear increased 40-8% 19 mg/dL 142 mg/dL 56 u/L 6 x10^8/L 43 u/L decreased increased decreased increased increased 45-75 15-45 150-250 0-5 0

Salmonella Typhi IgG Antibodies Test Positive: Indicative of previous Salmonella typhi infection, relapse/ re-infection

Pharmacological Treatment

Sodium Chloride Dosage: 2 tabs QID Classification: electrolyte Action: Sodium is the major cation of the bodys extracellular fluid. It plays a crucial role in maintaining the fluid and electrolyte balance. Excess retention of sodium results in overhydration(edema, hypervolemia), which is often treated with diuretics. Abnormally low levels of sodium result indehydration.

Indication: prophylaxis of heat prostration or muscle cramps; chloride deficiency due diuresis or salt restrictions; prevention or treatment of extracellular volume depletion Nursing Responsibilities: a.Monitor electrolytes, ECG, liver and renal function studies b.Note level of consciousness c.Assess the heart and lung sounds d.Observe S&S of hypernatremia, flushed skin, elevated temperature, rough dry tongue, and edema e.Monitor VS and I&O f.Assess urine specific gravity and serum sodium levels

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Streptomycin Dosage: 1 gram OD IM Classification: Antibiotic, anti-tubercular,anti-infective Action: Inhibits CHON synthesis strains of gram negative bacteria, mechanisms of lethal action fully understood, but functional integrity of cell membrane appears to be disrupted. Indication: >Infections caused by susceptible strain of mycobacterium tuberculosis. > Serious infections caused by susceptible strains of Yersinia Pestis Nursing Responsibilities: Use in route only: give by deep IM injection. Ensure adequate hydration of patient before and during the therapy. Monitor for hearing changes. This drug can only be given by injection. Report hearing changes,dizziness, pain at injection site, rash. Mannitol Dosage: 1 gram OD IM Classificationa: diuretic, anti-glaucoma, anti-hemolytic

Action: Elevates plasma osmolality, causing water to flow from tissues, such as brain and eyes, and from CSF, into extracellular fluid, thereby decreasing intracranial and intraocular pressure. As an osmotic diuretic, mannitol increases the osmolarity of glomerular filtrate, which decreases water reabsorption. This leads to increased excretion of water, sodium, chloride, and toxic substances. As an irrigant, mannitol minimizes the hemolytic effects of water used as an irrigant and r educes the movement of hemolyzed blood from the urethra to the systemic circulation, which prevents hemoglobinemia and serious renal complications. Indication: >Acute oliguric renal failure >Toxic overdose >Edema > Increased Intracranial Pressure (ICP) >Intraocular pressure (IOP

Nursing Responsibilities: * Dont administer mannitol through same I.V. line as blood or blood products. * If crystals form in mannitol solution exposed to low temperature, place solution in hot- water bath to redissolve crystals. * Use a 5-micron in-line filter when administering drug solution of 15% or greater. * During I.V. infusion of mannitol, monitor vital signs, central venous pressure, and fluid intake and output every hour. Measure urine output with indwelling urinary catheter, as Check weight and monitor BUN and serum creatinine electrolyte levels daily. * Provide frequent mouth care to relieve thirst and dry mouth. * Inform patient that he may experience dry mouth and thirst during mannitol therapy. * Instruct patient to report chest pain, difficulty breathing, or pain at I.V. site. * Use urinary catheter in comatose or incontinent patients because therapy is based on strict evaluation of fluid intake and output. If patient has urinary catheter, use an hourly urometer collection bag to evaluate output accurately and easily. * Drug can be used to measure glomerular fitration rate. * Drug is commonly used in chemotherapy regimens to enhance dieresis of renally toxc drugs. .