Meningitis Case Study
J.H. is a 5-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 tr
...
Meningitis Case Study
J.H. is a 5-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.”
1. What are some of the obstacles you 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
findings 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
3. Where you would assess the Babinski reflex on an infant?
J.H. 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.
J.H. 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) 50mg suppository per rectum for irritability
4. Prioritize the order of your interventions, with 1 being your first action and 7 being your last
action.
Administer ceftriaxone (Rocephin)
Place IV
Straight catheterization for urine specimen
Place on contact isolation and droplet precautions
Assist with lumbar puncture
Administer Tylenol
Obtain blood culture, CMP
5. You have a difficult time placing the IV line and the physician writes an 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 injection for an infant.
6. Before administering the ceftriaxone (Rocephin), you must verify the dose with another RN. The
therapeutic range is 100mg/kg loading dose and then 80mg/kg daily. J.H. weighs 3.5 kg. Is the
loading dose ordered safe? Is it therapeutic? Show your work.
7. Interpret J.H.'s laboratory findings, and explain the rationale for abnormal results.
J.H. Chart
Laboratory Test Results
Urinalysis
pH 7.2
Color Clear
Leukocytes Negativ
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