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
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
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:
Complete Blood Count
HgB 10.5 g/dL
Sodium 141 mEq/L