This paper describes the pathophysiological changes that occur in Waterhouse Friderichsen and ethical issues surrounding the end-of-life for persons affected by this condition…
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To have a clear description of Waterhouse Friderichsen, a hypothetical client scenario will be used. Other than concentrating on the primary organ affected by Waterhouse Friderichsen, other organs affected by the same will also be discussed. The final section under this medical condition will focus on impacts of healthcare and nursing. The hypothetical case study will be of a 35 year old female patient who was found with signs and symptoms associated with Waterhouse Friderichsen. Majority of cases have been reported in children, but the increased rate of meningococcal infections have led to high incidences of Waterhouse Friderichsen in adults. In many cases, patients with Waterhouse Friderichsen die within 24hrs, but a few have managed to survive beyond 48hrs. Cases of full recovery have also been reported in some regions. This fact proves that the syndrome is not fatal when early diagnosis is made. Worldwide incidences of Waterhouse Friderichsen syndrome are not many, although cases of the condition go unnoticed in many instances (Manchanda et al, 2008). Case Analysis This is a hypothetical case of a 35 year old female patient who got admitted after showing signs of high grade fever accompanied by chills and vomiting over a period of 7days. The patient also had a skin rash on the abdomen and trunk, which appeared on the 5th day of infection. Following admission, the patient developed a hemorrhagic rash. On assessing the family history, there was no any significant information to associate the infection with family history. Medical examination revealed that the patient was unstable, and there was the presence of cyanosis. The patient was febrile with a pulse rate of 90/min and a systolic BP of 70mmHg. Neurological examination revealed positive signs of Kerning and Brudzinski. There were rashes all over the body but predominated on the abdomen and trunk. Collection of CSF was done under aseptic conditions and its processing done under standard bacteriological procedures. Microscopy on CSF was done routinely, and a cell count of 9400/mm3 was reported. Of the total cell count, 86% were polymorphs while 14% were lymphocytes. An increase in CSF proteins to 309mg%, and a decrease in glucose to 20mg% were reported. A Gram stain preparation of the CSF revealed pus cells accompanied with gram-negative diplococcus. CSF cultures were done on MacConkey agar, chocolate agar, and blood agar and incubated overnight. After overnight incubation, there were tiny translucent colonies on blood agar and chocolate agar. Standard bacteriological procedures identified the tinny translucent colonies to be those of Neisseria meningitides. A CT scan conducted on the patient confirmed adrenal hemorrhage, which is present in Waterhouse Friderrichsen syndrome. Antibiotic sensitivity using 5 antibiotics showed no resistance to any of the antibiotics under examination. Antibiotics under examination were sulfamethoxazole, chloramphenicol, ceftriaxone, trimethoprim, and penicillin. The patient was put on ceftriaxone and steroids but went into a shock. On the third day of admission, water Friderichsen syndrome was reported as the cause of death. Discussion Waterhouse Friderichsen syndrome was reported first in 1911 by Rubert Waterhouse. This syndrome is caused by failure of the adrenal gland due to massive bleeding into the gland. The cause of bleeding is a bacterial infection, most common bacteria being meningococcus Neisseria meningitides. This medical condition presentswith rash, fever, coagulopathy, rash, and shock. During the course of its development, multiple organs are affected, leading to multiple system failure. One significant sign in Waterhouse
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