Etiology: Meningitis usually results from a viral
NURSING ASSESSMENT:
BP 90/50, HR98, Temp 102.4, RR22, O2Sat 99% on room
air. Ht- 105 cm in Wt-17kg Head FOC: 51cm
General Appearance: Patient is somnolent. Recognizes
and names the family members around her. She knows
that she is in the hospital. Meningeal signs: positive
Brudzinski sign, negative Kernig sign. Facial musculature
is symmetric, tongue is midline, and speech is
understandable. Motor exam: moves all extremities.
Sensory exam: wakes in response to tactile stimuli.
Cerebellar exam: finger-to-nose movements normal,
with no past pointing. Romberg test not performed.
DTRs 2+ and symmetric in all extremities, no clonus; toes
downgoing. Gait not observed.
Skin- Skin is warm to touch; without rashes,
neurocutaneous stigmata, or dysmorphic features. Lips
dry.
HEENT- Atraumatic, normocephalic cranium. Pupils
equal and react to light and accommodation. Extraocular
movements are intact with a conjugate gaze, with no
nystagmus. Visual fields appear full to confrontation.
Funduscopic exam reveals optic discs with clear margins,
and spontaneous venous pulsations are present. Ears:
Tympanic membranes visualized with positive light
reflex; orophyanx without erythema, exudate, or
swelling. Buccal membranes sticky to touch. Lips dry.
Thorax-
Lungs- Lungs with symmetrical excursion; clear, without
rales, rhonchi, wheezing. Respiratory rate is increased.
Heart- Heart rate is regular; no murmurs, rubs, or
gallops. Capillary refill less than 2 seconds. Extremities
warm
Abdomen- Abdomen soft, with no guarding or
tenderness or distension; normoactive bowel sounds
auscultated in all four quadrants
Genitals-No issues, per mother.
Trunk/Spine-
Extremities- Overall appearance is of a slender, normal-
height preschool child. Moves all extremities. DTRs 2+
and symmetric in all extremities, no clonus; toes
downgoing. Gait not observed
HISTORY OF PRESENT ILLNESS(HPI):
experienced a low-grade fever of
100 F (37.8 C, oral), cough, runny
nose, decreased appetite, and
fever. She was seen by her local
physician and treated with
azithromycin for otitis media of the
right ear. Mother reports that the
medication caused a rash and that
she stopped the medication.
Mother noted that she was
irritable. No reported rash,
vomiting, or diarrhea. Appetite has
been slightly decreased. She rubs
her forehead, saying that the light
hurts her eyes and loud noises
make her headache worse. She
complains of a worsening
PAST MEDICAL HISTORY (PMH):
Patient reports that she feels like
her "head is big." The light hurts her
eyes; she complains that it hurts to
turn her head from side to side. No
complaints of problems with ears,
nose, or throat. Recent ear infection
MEDICAL-SURGICAL MANAGEMENT:
Admit, blood cultures, labs, urinalysis, urine
culture and sensitvity, droplet isolation, CT
scan, lumbar puncture, IV fluids, fever, IV
cefoTAXime Droplet isolation, neurology
consult, seizure precautions
management.
infection, but the cause may also be a bacterial
infection. Less commonly, a fungal infection may
cause meningitis. Because bacterial infections are the
most serious and can be life-threatening, identifying
the source of the infection is an important part of
developing a treatment plan
Incidence:
Most cases of meningitis in the U.S. are caused by a
viral infection, but bacterial and fungal infections also
can lead to meningitis. Depending on the cause of
the infection, meningitis can get better on its own in
a couple of weeks or it can be a life-threatening
emergency requiring urgent antibiotic treatment
Pathophysiology:
Meningitis is an inflammation of the membranes
(meninges) surrounding your brain and spinal
cord.
slow-growing organisms invade the membranes
and fluid surrounding your brain
bacteria enter the bloodstream
migrate to the brain and spinal cord.
But it can also occur when bacteria directly
invade the meninges,
MEDICATIONS :
Dexamethasone Sodium Phosphate Injection
Cefotaxime Injection - (Claforan) [ELECTOLYTE]
Dextrose 5% in 0.45% Sodium Chloride with [IV
FLUIDS]
Potassium Chloride 20 mEq/1000 mL (D5 1/2NS
with 20 mEq KCL/1000 mL) [IV FLUIDS]
Acetaminophen Rectal Suppository - (Tylenol,
Feverall) PRN [ANALGESIC, ANTYPIRETUIC]
Ibuprofen Tablet - (Advil, Motrin, Motrin IB) PRN
[NSAIDS]
 DIAGNOSTIC TEST(S) :
CT scan normal. Lumbar puncture done in
emergency department; results pending.
Blood cultures done in emergency
department; results pending
Emergency Department Laboratory Results
DAY/TIME Fri 1340
HEMATOLOGY White Blood Cell Count 11,600
Red Blood Cell Count 4.78
Hemoglobin 12.6
Hematocrit 39
Mean Corpuscular Volume 82
Platelets 198,000
DIFF: Neutrophil Segs 6308
DIFF: Neutrophil Bands 812
DIFF: Lymphocytes 4200
DIFF: Monocytes 180
DIFF: Eosinophils 100
DIFF: Basophils 0
Reticulocytes 1.0
CHEMISTRY
Glucose 114
Sodium 137
Potassium 4.6
Chloride 103
Carbon Dioxide 25
Creatinine 0.41
Blood Urea Nitrogen 16
Uric Acid
Calcium 9.4
Phosphorus
Magnesium
Bilirubin (Total) 0.6
Protein (Total) 6.3
Albumin 4.2
Alkaline Phosphatase 280
Alanine Aminotransferase
(Formerly Serum Glutamicpyruvic
Tranasminase)
40
Aspartate Aminotransferase
(Formerly Serum Glutamic-
Oxaloacetic Tranasminase)
45
Color Yellow
Nursing Diagnosis #1:
. Impaired Social Interaction related
to decreased level of
consciousness, hospitalization, and
isolation
Nursing Goals:
The childs social interaction will be
near normal despite isolation.
Nursing Interventions with rationale
#1:
1.Educate parents and other visitors to
use proper infection control techniques.
R:Family members help fulfill the
emotional and social needs of the ill and
contagious child.
2.Encourage parents to help with daily
activities such as feeding and bathing. R:
Parents have a sense of control and a
feeling that they are doing something to
enhance the childs recovery
3. Have age-appropriate games and toys
in the room. R: sensory stimulation helps
the child achieve a sense of well-being
4.Play with the child. When the child is
feeling better R: involvement in the
childs care provides the child with a
sense of security
5. Encourage watching
television/videotape or listening to the
radio/audiotape. R: Providing the child
with toys and games as well as sensory
stimulation helps the child achieve a
sense of well-being
Evaluation#1: Goal met The childs
social and developmental needs are met
by family members despite the childs
illness and hospitalization.
Nursing Diagnosis #2:
Risk for Injury related to infection of
cerebrospinal fluid and potential
sequelae
Nursing Goals: The child will not
develop cerebral edema as a result of
water retention.
Nursing Interventions with
rationale#2:
1.Monitor blood gas analysis of
oxygen delivery when needed. R:
The possibility of acidosis may lead
to ischemic cerebral.
2.Give intravenous fluids with strict
attention. R: Minimizing the burden
of vascular and fluctuations in
intracranial pressure
3.Help the patient to limit vomiting,
coughing. Instruct patient to exhale
when moving or turning in bed. R:
can increase intracranial pressure
4. Monitor vital signs such as BP,
pulse, temperature, respiration, and
caution in systolic hypertension .R:
autoregulation to maintain a state
of altered systemic blood pressure
fluctuations.
5. Monitor signs of neurological
status R:To reduce further brain
damage.
Evaluation: Goal met, loss and no
signs of increased intracranial pressure.
Priority Nursing Diagnosis #3:
Risk for infection r/t
immunosuppression AEB
Nursing Goals: Patient will be able to
control infection with management
Nursing Interventions with
rationale#3:
1. Monitor laboratory results, especially
complete blood count, white blood cell
count (WBC), differential and absolute
neutrophils. Abnormal results provide
data that provide a basis for early
detection of infection.2. Teach
measures for prevention of infection,
such as avoiding crows and not
cleaning fish tanks or litter boxes. These
are high-risk sources of infection.3.
Teach the importance of compliance to
the medication/treatment regimen.
Compliance with the treatment and
medications are important to prevent
illness.4. Monitor respiratory, urinary,
mucosa and skin systems. Changes in
these systems are often a basis for early
detection of infection. 5. Practice
proper hand-washing and use aseptic
technique when providing care. Hand
washing is the single most effective
intervention to decrease the risk of
Infection.
Evaluation: Goal met. Patient is able to
manage infection with treatment given.