Question

Meningitis Case Study

Jason Hinojosa is a 5-week-old infant brought to the emergency department by his mother, who speaks little English. Her husband is at work. Mrs. Hinojosa is young, anxious, and appears frightened. Through a translator, Mrs. H. reports that her son has not been eating, sleeps all the time, and “is not normal.”

1. What are some of the obstacles you will need to consider, recognizing that Mrs. H. does not speak or understand English well?

2. You perform your primary assessment and question Mrs. H. with a translator. Which of these finding are abnormal and need to be reported? Select all that apply and state rationale.

a. Anterior fontanel palpable and tense

b. Pupils equal and +3

c. Temperature 96.8°F (36°C) rectally

d. Heart rate: 85 beats/min

      e. Positive Babinski reflex

      f.   High-pitched cry

      g. Refusal of PO intake per mother

ANSWER: A, C, D, F, G

Jason is admitted to the medical unit with the diagnoses of meningitis and rule out sepsis. The ED physician gives the orders shown in the chart.

Emergency Department Orders:

CBC with differential

Blood culture

CMP

UA

Cerebrospinal fluid (CSF) for culture, glucose, protein, cell count (following lumbar puncture)

Ceftriaxone (Rocephin) 260mg IV now (loading dose)

Acetaminophen (Tylenol) 50 mg suppository per rectum for irritability

3. Prioritize the order of your interventions, with 1 being your first action and 7 being your last action.

            a. Administer Ceftriaxone (Rocephin)                                                          ________

            b. Place IV                                                                                         ________

            c. Straight catheterization for urine specimen                                   ________

            d. Place on contact isolation and droplet precautions                       ________

            e. Assist with lumbar puncture                                                          ________

            f. Administer Tylenol                                                                        ________

            g. Obtain blood culture, CMP                                                                       ________

4. You have a difficult time placing the IV line and the physician writes and order to give the Rocephin IM while you wait for the vascular access team to place the IV. Name the appropriate site for an IM for an infant.

5. Interpret Jason each laboratory findings and explain the rationale for abnormal results.

Laboratory Tests Results:

Urinalysis

            pH                  7.2

            Color               Clear

            Leukocytes     Negative

Complete Blood Count

            Hct                  32%

            HgB                 10.5 g/dL

            WBC               22,000/mm³

            Sodium           141 mEq/L

Answer 1

1) Due to language difficulty detailed history collection is not possible also it will lead to delay treatment.

2) palpable fontanel is due to increased intracranial pressure, child will be crying and refuse feeding due to illness.

3) priority

- Place contact isolation and droplet precautions

- Assist in lumbar puncture

- Place IV

- Administer ceftriaxone

- Obtain blood culture

- Administer tylenol

- straight catheterization for urine specimen

3) Vastus lateralis muscle of infants

4) Wbc count is increased due to infection