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

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

*PLEASE ANSWER ALL 5 QUESTIONS

Answer 1

1. Language barriers are common obstacle in communication ,anxiety and fear will also affect the communication. To overcome these obstacles speak slowly and clearly,ask for clarification,frequently check for understanding,be patient and specific,avoid idioms.

2

• Anterior fontanel palpable and tense
• positive babinski reflex
• high pitched cry
• refusal of PO intake per mother

3

• .place on contact isolation and droplet precautions
• obtain blood culture,CMP
• place IV
• Administer ceftriaxone
• Administer Tylenol
• Assist with lumbar puncture
• Straight catheterization for urine specimen

4 vastus lateralis

5 WBC count elevated because of infection (bacterial meningitis)

Hb low-anemia occurs in bacterial meningitis

other investigations are normal