A nurse is admitting an 8-year-old child to the pediatric unit..

Exhibits

The nurse suspects the child has bacterial meningitis.

Drag words from the choices below to fill in each blank in the following sentence.

The child is at greatest risk for developing

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and

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Rationale for Correct Answers:

• Hydrocephalus: Inflammation of the meninges can block cerebrospinal fluid (CSF) flow, leading to ventricular dilation and hydrocephalus, a known complication of bacterial meningitis.
• Seizures: Meningeal irritation and increased intracranial pressure can cause seizures. Children with altered mental status and fever are at heightened risk.
• Subdural effusions: These may develop due to inflammation and accumulation of fluid between the dura and arachnoid layers, often seen in pediatric meningitis cases.
• Hearing loss: Sensorineural hearing loss may result from inflammation or damage to the auditory nerve or cochlea. It’s a well-documented sequela of meningitis.

Rationale for Incorrect Choices:

• Laryngospasm: Typically associated with airway irritation or hypocalcemia, not a common or expected complication of meningitis.
• Demyelination: More commonly linked to conditions like multiple sclerosis. Meningitis does not typically cause demyelination of neurons.
• Guillain-Barré syndrome: An autoimmune condition often triggered by viral illness, not by meningitis. It involves peripheral nervous system demyelination, unrelated to this case.

• Administer broad-spectrum antibiotics: Prompt initiation of antibiotics is critical in suspected bacterial meningitis to prevent rapid progression and reduce neurological complications. Treatment should begin even before culture results return. Delay in treatment increases the risk of morbidity and mortality.
• Implement isolation precautions: Droplet precautions should be initiated immediately due to the possibility of meningococcal meningitis, which is highly contagious. These precautions protect healthcare staff and other patients. Isolation continues until 24 hours after antibiotics are started.
• Assist with a lumbar puncture: Lumbar puncture is a primary diagnostic tool to confirm meningitis and identify the pathogen in cerebrospinal fluid. It helps guide targeted antibiotic therapy. This should be done after initiating antibiotics if there's no contraindication.
• Administer an antipyretic: Fever increases metabolic demand and can worsen neurologic symptoms like seizures or confusion. Antipyretics like acetaminophen help reduce fever and improve comfort. Controlling temperature also stabilizes cardiovascular and respiratory effort. This supports overall treatment goals.
• Encourage ambulation: The child is lethargic, photophobic, and has altered mental status, making ambulation unsafe and unnecessary. Activity can increase intracranial pressure or fall risk. Rest is important during acute neurologic illness. Mobility is not a priority until the child stabilizes.
• Provide external stimulation: Children with meningitis often experience neurologic hypersensitivity and irritability. External stimulation, such as bright lights or loud noises, can worsen symptoms. A calm, quiet environment is needed to reduce distress. Limiting stimulation aids in neurologic recovery.
• Initiate seizure precautions: Meningitis increases the risk of seizures due to inflammation of the brain and elevated temperature. Altered mental status and photophobia further heighten this risk. Seizure precautions include padded side rails and having emergency medications ready. Safety preparation is essential.