Exhibits

Which of the following complications should the nurse identify as being potential risks for this child? Select all that apply.

• 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. Ask the child to hold their breath while the IV catheter is placed: This technique is not appropriate for a preschool-age child. Breath-holding may increase anxiety and is more applicable to older children or adults during procedures such as injections or venipuncture.

B. Place the IV catheter on the dominant arm: The non-dominant arm is usually preferred for IV insertion to reduce interference with the child's movement and play, and to prevent dislodgement of the catheter during activity.

C. Apply vapocoolant spray before the IV insertion: Vapocoolant sprays provide topical analgesia and can reduce the pain and anxiety associated with IV placement. This is especially helpful for young children like preschoolers and is recommended for pain management.

D. Explain the procedure to the child in detail: Preschoolers benefit from simple, age-appropriate explanations rather than detailed medical descriptions. Using clear, brief explanations or play-based preparation is more effective for their developmental level.