The 11-month-old, previously healthy infant is brought to the emergency department after becoming increasingly lethargic over the past 24 hours. The infant’s vital signs are notable for a temperature of 40.8°C, heart rate 138 bpm, respiratory rate 31, and blood pressure 84/50 mmHg. Upon assessment, the nurse notes sensitivity to light and sound, bulging anterior fontanelle, and significant resistance to turning the head. Place the interventions in the correct order.

Question

The 11-month-old, previously healthy infant is brought to the emergency department after becoming increasingly lethargic over the past 24 hours. The infant&rsquo;s vital signs are notable for a temperature of 40.8&deg;C, heart rate 138 bpm, respiratory rate 31, and blood pressure 84/50 mmHg. Upon assessment, the nurse notes sensitivity to light and sound, bulging anterior fontanelle, and significant resistance to turning the head. Place the interventions in the correct order.

Accepted Answer

Obtain blood cultures and complete blood count , Insert a peripheral IV and begin broad spectrum antibiotic therapy , Begin fluid resuscitation with 5% dextrose in water with 0.45% NaCl and 20 mEq potassium chloride , Schedule a stat head CT , Gather supplies and injectable lidocaine for an urgent lumbar puncture. The patient is exhibiting signs of meningitis with increased intracranial pressure (ICP). The initial intervention is to obtain blood cultures first, then start antibiotics. The patient is exhibiting signs of septic shock (tachycardia, fever, and hypotension), so fluid resuscitation must be started as well. Although a lumbar puncture (LP) is important to diagnose meningitis, it is contraindicated in the patient with signs of increased ICP; therefore, a stat head CT would be performed prior to the lumbar puncture.

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