A nurse is caring for a 15-year-old adolescent who has cellulitis of the left lower call.

Exhibits

The nurse is assessing the adolescent 24 hr after the initial visit. How should the nurse interpret the findings?

For each finding, click to specify whether the finding is an Indication of potential improvement or an indication of potential worsening condition. There must be at least 1 selection in every row. There does not need to be a selection in every column.

• 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.

A. Wrap the ankle with an elastic bandage: Applying an elastic bandage provides compression, which helps reduce swelling by limiting fluid accumulation in the injured tissues. Compression also supports the ankle and helps prevent further injury.

B. Encourage active exercise of the ankle: Active exercise immediately after a sprain can increase swelling and worsen the injury. Rest and immobilization are essential in the initial phase to promote healing and minimize inflammation.

C. Place the ankle below the level of the heart: Positioning the ankle below heart level promotes blood pooling and increases swelling. Elevation above heart level is recommended to help reduce edema.

D. Apply ice packs directly to the ankle in 60 min intervals: Ice helps reduce swelling and pain, but applying ice directly to the skin can cause tissue damage. Ice packs should be wrapped in a cloth and applied intermittently (usually 15–20 minutes on, then off) to avoid frostbite and skin injury.