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

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 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

Expert Answer


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