The nurse has reviewed the Provider Prescriptions on the day of discharge.

Exhibits

The nurse has provided information regarding the adolescent's medication for home use to the guardian and the adolescent. Select the 2 statements that demonstrate the guardian's understanding of the adolescent's medication.

• Keep adolescent flat in bed for 24 hr post lumbar puncture: Extended flat bed rest is not recommended after lumbar puncture, as it does not prevent spinal headache and can increase discomfort. Instead, the adolescent may be kept supine only briefly for observation.

• Place the adolescent on a cooling blanket: While the adolescent has a fever of 39° C (102.2° F), a cooling blanket can cause the body to shiver, which can increase metabolic rate and raise the core temperature. A safer method is the administration of antipyretic medications like acetaminophen.

• Administer IV acyclovir: IV acyclovir is indicated for viral meningitis, particularly caused by herpes simplex virus. This adolescent’s presentation, CSF findings (low glucose, high protein, high WBC), and purpuric rash point toward bacterial meningitis, not viral etiology, making acyclovir inappropriate here.

• Place the adolescent on seizure precautions: The adolescent has developed seizure activity with tonic-clonic features, cyanosis, and pooling secretions. Seizure precautions are essential to protect from aspiration and injury, with measures such as padded side rails, suction readiness, and airway support.

• Administer IV cefotaxime: Cefotaxime is a broad-spectrum antibiotic effective against common bacterial meningitis pathogens. Given the cloudy CSF, elevated WBC, low glucose, and rapid deterioration, immediate administration of IV antibiotics is the standard, lifesaving intervention.

• Insert a peripheral IV catheter: IV access is necessary to administer fluids, antibiotics, and emergency medications. The adolescent is also showing signs of sepsis and hypotension (BP 88/50 mmHg), so fluid resuscitation and supportive therapy via IV are vital.

A. Prepare to give oral N-acetylcysteine: N-acetylcysteine is the antidote for acetaminophen toxicity and is most effective when given within 8 hours of ingestion. Since the child ingested a toxic dose 4 hours ago, administering this medication promptly helps prevent severe hepatic injury.

B. Send the child home on increased fluid intake: Simply encouraging fluids does not address acetaminophen toxicity. Without antidote therapy, the child is at significant risk for liver damage, so discharge with fluids would place the child in danger.

C. Perform gastric lavage with activated charcoal: Activated charcoal may be useful if given within 1 hour of ingestion to reduce absorption. At 4 hours post-ingestion, acetaminophen has already been absorbed, making this intervention ineffective.

D. Begin hemodialysis within the next 24 hr: Hemodialysis is rarely indicated in acetaminophen toxicity unless there is massive ingestion, severe liver failure, or extremely high serum levels. The standard and effective treatment at this stage is N-acetylcysteine.