REGIONAL INSTITUTE OF PARAMEDICAL & NURSING SCIENCES

PRACTICE TEACHING

ON

NURSING CARE OF A PATIENT WITH BRAIN ABSCESS

Subject: Medical Surgical Nursing -I

SUBMITTED TO SUBMITTED BY

MISS LALNUNTLUANGI HNAMTE MELINDA LALHMANGAIHI

1st YEAR BSc. (N)
ROLL NO- 4
DATE OF SUBMISSION: ……………………….
DATE OF PRESENTATION: ……………………
 IDENTIFICATION DATA

Name of student teacher : Melinda Lalhmangaihi

Name of Evaluator :Mrs. Laltanpuii

Subject : Medical Surgical Nursing-I

Unit :

Topic : BRAIN ABSCESS

Date & Time of Teaching : 19.02.2024

Duration : 30mins

Group of Students : 4th Semester B Sc. (N).

Size of group : 49 Students.

Venue : Academic Block 3, RIPANS

Method of Teaching : Lecture with Discussion

AV Aids : Chart, PPT, Handout,Whiteboard

Language : English

Previous Knowledge : The students have some knowledge about Brain Abscess.
GENERAL OBJECTIVES: At the end of the topic the students will acquire knowledge on brain abscess, apply the knowledge gained to
manage brain abscess and formulate nursing care plan for a patient with brain abscess..

SPECIFIC OBJECTIVES: At the end of the topic, the students will be able to

1) Define ‘Brain abscess’.

2) Classify the different types of brain abscess according to etiology.
3) Enlists the etiological factors for brain abscess.
4) Explain the clinical manifestations of brain abscess.
5) Mention the possible complications related to brain abscess.
6) Explain the treatment modalities for specific brain abscess.
7) Provide ideal nursing care to a patient with brain abscess.
8) Plan health education program on the prevention and management of brain abscess.
[Link] CONTRIBUTORY TIME CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVES LEARNING
ACTIVITIES
1 To arouse the interest 2mins INTRODUCTION:
of the audience.
2 To aware the topic to 1min ANNOUNCEMENT OF THE TOPIC: PPT
the audience.
‘NURSING CARE OF A PATIENT WITH
BRAIN ABSCESS’
3 To explain the 1min DEFINITION: Lecture PPT Define brain
meaning of bleeding Handout abscess?
A brain abscess is a bacterial brain infection,
disorders.
also called a cerebral abscess. It is a collection
of infectious material of brain parenchyma,
between the dura and the arachnoid
linings(subdural abscess) or between the dura
and the skull (epidural abscess).

Brain abscess is a pus filled swelling in the

brain usually due to bacterial or fungal
infection of the brain tissue or severe head
injury.

4 To illustrate the 2mins RELATED ANATOMY AND Lecture PPT What do you
related anatomy and PHYSIOLOGY; understand by the
physiology physiology of
brain and
meninges?
 Functions of Brain: The brain enables;
 Thoughts and memories.
 Memories and emotions.
 Movements (motor functions0, balance
and coordination.
 Perception of various sensation
including pain.
 Automatic behavior such as breathing,
heart rate,sleep and temperature control.
 Regulation of organ function.
 Speech and language functions.
 Stress response.
5 To analayse the 3mins ETIOLOGY/ RISK FACTORS: Lecture PPT What factors are
etiological factors for handout responsible for a
brain abscess. 1. Intracranial subdural abscesses, are caused brain abscess to
by purulent drainage between the dura and occur?
arachnoid. It can result from pus from the
meninges, middle ear or mastoid, sinuses,
septicemia, or skull fracture. It occurs most
frequently in children and young adults.
 2. Intracranial epidural abscesses, typically
involving an infection of the cranium,
commonly occur because of chronic mastoid-
itis or sinusitis, head trauma, or craniotomy.
Abscesses may be related to a subdural
empyema (collection of purulent drain age
originating from nasal sinuses, meninges,
middle ear, of skull osteomyelitis), meningitis,
or intraparenchymal abscess

3. Spinal epidural abscesses occur in the spinal

canal external to the dura. Epidural penetration
may seed through the blood and occur from
infected adjacent tissue (eg, infected pressure
ulcer), from another infected site (eg, skin), or
contamination from spinal surgery or spinal
instrumentation (eg, lumbar puncture).

4. Brain abscess can occur from pulmonary

infection, bacterial endocarditis , skull fracture
and prior brain trauma or surgery.

5. Fungal brain abscesses are commonly seen

in HIV-positive patients and other populations
that are immunosuppressed.

6 To elaborate the 1min PATHOPHYSIOLOGY: Lecture Chart Restate the

pathophysiology of pathophysiology
different types of Pathogenic organisms entering into the of brain abscess.
bleeding disorders brain through various routes;
↓
Collection of infectious material in the brain
tissues.
↓
Increased intracranial pressure.
↓
Brain abscess
7. To describe the 2mins CLINICAL MANIFESTATIONS: Lecture PPT What are the
clinical manifestations handout common clinical
of brain abscess. 1. Headache is poorly localized with a dull manifestations of
ache. brain abscess?

2. Increased ICP may result in nausea,

vomiting, and decreased LOC.

3. Fever is found in less than 50% of cases.

4. Neurologic findings, such as hemisensory

and paresis deficits, aphasia, and ataxia, may be
present.

5. Seizures are frequently present.

6. Dental abscess, sinusitis, and otitis media

may be present.

7. Signs and symptoms of a cerebral subdural

empyema include severe headache, fever,
nuchal rigidity, and signs of meningeal
irritation (Kernig and Brudzinski sign;

8. Patients with intracranial epidural abscess

commonly present with fever, lethargy, and
severe headache.

9. Spinal epidural abscesses may be evidenced

by severe back pain, fever, headache, lower-
extremity weakness or paralysis, nuchal
rigidity, Kernig sign, and local tenderness.
8. To enlist the 1min DIAGNOSTIC EVALUATIONS: Lecture Flash card What are the
diagnostic evaluations  CT scan and MRI with contrast to diagnostic tools
for brain abscess. locate the sites of abscess. for evaluating
 Blood cultures are obtained to identify brain abscess?
the organism; positive Gram stain,
 leukocytosis, and elevated erythrocyte
sedimenta- tion rate (ESR) will be
found.
 Cultures are obtained from the
suspected source of infection, using
stereotaxic needle aspiration or brain
surgery
 A metastatic brain abscess may be
differentiated from a meta- static tumor
by CT scan or MRI.
 EEG detects seizure disorders.
increased WBC count and increased
pressure of the CSF.

9 To elaborate the 2mins COMPLICATIONS: Lecture cum PPT MENTION ANY

possible complications  The brain abscess can rupture into the discussion. handout TWO POSSIBLE
of brain abscess. ventricular space, causing a sudden COMPLICATION
increase in the severity of the patient's S
headache.
 Papilledema
 Permanent neurologic deficits, such as
seizure disorders, visual defects,
hemiparesis, and CN palsies, may be
present.
 Delayed treatment of a spinal epidural
abscess may result in transection
syndrome, in which flaccid paraplegia
with sensory loss occurs at the level of
the abscess.
 chronic otitis media, intracranial and
intratemporal com- plications
frequently result from progressive bony
erosion, which may expose the dura,
labyrinth, and facial nerves.
10 To describe the 2mins MEDICAL MANAGEMENT: PPT
medical management  Patient will need to stay in the hospital Handout
of brain abscess. until the condition is stable.
 A very large dosage of antibiotic
medication is injected directly into a
vein
 if fungal infection is suspected then
antifungal medications will also be
given
 Intravenous treatment with antibiotics
should continue for 3-6 weeks,
 Additional treatment of the source of
infection (sinusitis, mastoiditis,
endocarditis, etc.) may be indicated.
 corticosteroid drugs such as
dexamethasone are used to ease the
swelling

11 To 1min SURGICAL TREATMENT: Lecture PPT What are the

Handout surgical
 The abscess is opened surgically and management for
the infectious material is removed and brain abscess?
washed out thoroughly.
 Needle aspiration guided by CT or MRI
scan may be needed for a deep abscess

12 To explain the nursing 5mins NURSING MANAGEMENT: Lecture PPT What are the
management of brain Nursing Assessment: Handout nursing diagnoses
abscess. a) Obtain history of previous infection, and management
immunosuppression,headache and for barain abscess?
related symptoms.
b) Perform neurological assessment.
c) Assess vital signs and fluid intake and
output.
d) Evaluate for lung and skin changes.
Nursing Diagnoses:
a) Acute pain related to cerebral mass
b) Impaired Environmental Interpretation
Syndrome related to disease process.
c) Risk for Injury related to neurologic
deficits.
d) Anxiety related to surgery, prognosis,
and relapse.

NURSING INTERVENTIONS:

Nursing diagnosis I: Acute pain related to

cerbral mass.

Goal : To relieve pain.

a) Assess the intensity and location of

pain.
b) Provide comfort measures, such as
quiet environment, posi- tioning with
head slightly elevated, and assistance
with hygiene need.
c) Provide passive relaxation techniques,
such as soft music and back rubs.
d) . Administer pain medications, as
ordered.

Expected outcome: verbalized reduced

level,of pain.

Nursing Diagnosis II: Impaired

Environmental Interpretation Syndrome related
to disease process.

Goal : To promote thought processes.

a) Frequently monitor vital signs, LOC,

orientation, and seizure activity.
 b) Report acute changes, which can signal
increased ICP, to health care provider.

c) Prepare the patient for repeated

diagnostic tests to evaluate response to
therapy and surgery.

d) Administer medications, as ordered,

noting response and adverse reactions.

Expected outcome: Oriented and obey

commands.

Nursing Diagnosis III: Risk for Injury related

to neurologic deficits.
Goal : To minimizing neurologic deficits and
prevent from injury.
a) Maintain a safe environment with side
rails up, call light within reach, and
frequent observation.

b) Evaluate other CN function and report

changes.

c) Refer to occupational therapist, speech

therapist, or other rehabilitation
specialist to provide adjunct to nursing
rehabilitation.

Expected outcome: Free from self harm and

accidents.

Nursing diagnosis IV: Anxiety related to

surgery, prognosis, and relapse
Goal: To reducing anxiety.
a) Prepare the patient and family for
surgery when indicated. Encourage
discussion with surgeon to understand
risks and benefits of the procedure.
 b) Explain postoperative progression and
nursing care

Expected outcome: Reduced anxiety regarding

disease process and procedures.

13 To impart the methods 1min Health education: Lecture PPT What important
for health education. a) To continue follow up for certain kinds points are
of infection that may result in brain necessary to stress
abscess. in health education
b) Continue with rehabilitation to regain for the patient?
neurological deficits.
c) Continue with pharmacological
regiment strictly.
d) Observe for recurrence.

14 To highlight the 1min PROGNOSIS: Lecture PPT Is the prognosis

prognosis for brain With treatment, the death rate is about 10% to for brain abscess
abscess. 30%. The earlier treatment is received, the good or worst?
better. Some people may have long-term
nervous system problems after a brain abscess
or surgery.

15 The students will be 2mins SUMMARIZATION: Lecture PPT

able to recollect the Quick review of the topic
topic.

16 Assess knowledge 3mins RECAPITULIZATION:by asking questions

regarding the topic a) What do you understand by brain
abscess?
b) What are the clinical manifestations of
brain abscess?
c) Mention the causes of brain abscess.
d) How will you manage a patient with
brain abscess?
Enhance further ASSIGNMENT:
knowledge regarding
the topic Prepare one nursing care plan for a patient with
subdural brain abscess apart from what we
have discussed in the topic.
BIBLIOGRAPHY:

[Link] (2021). Lippincott Manual of Nursing Practice.

Wolters Kluwer Health India.

Waugh, A, & Grant, A. (2010).Ross and Wilson Anatomy and Physiology in Health and Illness.

Churchill Livingstone Elsevier.

Sharma, S.K.,& Madhjavi, S. (2018).Brunner and Suddarth’s Textbook of Medical-Surgical Nursing.

Wolters Kluwer (India) [Link].

Hickey V Joanne.(2014).The Clinical Practice of Neurological and Neurosurgical Nursing.

Wolters Kluwer Health (India).

Ansari Javed.(2017). A Textbook OF Medical AND Surgical Nursing-II.

[Link] & Company (Medical Publisher) India.

Brain abscess. StatPearl.

http//[Link].