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CASE STUDY – MENINGITIS J.H. is a 2-week-old infant brought to the emergency department (ED) by his mother, who speaks little English. Her husband is at work. She is young and appears frightened and anxious. Through a translator, Mrs. H. reports that J.H. has not been eating, sleeps all of the time, and is “not normal.” You perform your primary assessment and question Mrs. H. with a translator. The anterior fontanel and posterior fontanels are bulging A rectal temp of 36° C (96.8° F) The pupil assessment : equally reactive to light and pulse of 85 , positive Babinski’s reflex . Irritability, high-pitched crying, and feeding refusal was observed. J.H. is admitted to the medical unit with the diagnoses of meningitis and rule out sepsis. The ED physician orders the following: Emergency Department Orders CBC with differential Blood culture Complete metabolic panel (CMP) Urinalysis (UA) Cerebrospinal fluid (CSF) for culture, glucose, protein, cell count (following lumbar puncture) Ceftriaxone (Rocephin) 260 mg IV now (loading dose) Acetaminophen (Tylenol) 50 mg suppository per rectum for irritability. Laboratory Test Results Urine pH 7.2 Color Clear Leukocytes Negative Complete blood count Hct 32% HgB 10.5 g/dL WBC 22,000/mm 3 Sodium 125 mEq/L Cerebrospinal Fluid Analysis CSF Clear Gram stain Pending Protein 300 mg/dL (elevated) Leukocytes 1030 cells/microliter (elevated) Glucose 40 mg/dL (decreased) J.H. is diagnosed with Escherichia coli meningitis. His medical care plan will include 14 to 21 days of antibiotic therapy. You are developing his nursing plan of care. Mrs. H., through her translator, asks you what could have caused her baby to be sick since he had an immunization when he was born. She asks whether he should get “more shots” so this won’t happen again. You reinforce to Mrs. H. that infants have immature immune systems, and they are vulnerable to infections until they have been immunized. Please help me answer the below,,, Slide 4: Analyzing Cues: Problem list (minimum of 3 actual and 2 potential) Slide 5 Prioritizing/Planning: Prioritize the problems and write the goal for each. *****Answers should be patient specific and not a cut and paste from a source***** (Professor said) Thank you!!

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