meningitis in a 9yr old

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please help I cant decide. I need to pick the two most important nursing diagonisis for my case study.The chikld has a preliminary diagnosis of menengitis due to hib.

This child has impaired tissue perfusion- sepitis-seen by rr11 and purple rash, Dehydration- nil urine output for 12hrs plus dry lips membranes and tenting skin , Intra cranial pressure - meningitis- headache, sluggish pupils. I am unsure of the priorities. DRABC would address the tissue perfusion first but what is next?

Specializes in Med-Tele; ED; ICU.

I can't help you with the nursing diagnoses but practically speaking:

1) Empiric IV antibiotics - watch for results of CSF culture to ensure proper coverage.

2) Hydration... 12 hours of no output is critical and renal failure is right around the corner... or already there...

3) Regular labs

4) Frequent VS

Thank you for your reply it is very helpful.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
please help I cant decide. I need to pick the two most important nursing diagnosis for my case study.The child has a preliminary diagnosis of meningitis due to hib.

This child has impaired tissue perfusion- sepitis-seen by rr11 and purple rash, Dehydration- nil urine output for 12hrs plus dry lips membranes and tenting skin , Intra cranial pressure - meningitis- headache, sluggish pupils. I am unsure of the priorities. DRABC would address the tissue perfusion first but what is next?

Hi! Welcome to AN! The largest online nursing community!

What semester are you? What care plan resource are you using?

Care plans are ALL about the ASSESSMENT of the patient. Technically speaking there is not enough information for me to make an assessment of what would be a priority.

Priority is based on the ABC's and Maslows Hierarchy of Needs.

1. Biological and Physiological needs - air, food, drink, shelter, warmth, sex, sleep.

2. Safety needs - protection from elements, security, order, law, stability, freedom from fear.

3. Love and belongingness needs - friendship, intimacy, trust and acceptance, receiving and giving affection and love. Affiliating, being part of a group (family, friends, work).

4. Esteem needs - achievement, mastery, independence, status, dominance, prestige, self-respect, respect from others.

5. Self-Actualization needs - realizing personal potential, self-fulfillment, seeking personal growth and peak experiences.

My questions...Is this a real patient or just a written scenario? how old is the child? When was admission? What were the presenting symptoms/complaints? What is the present assessment? O2 Sat? Temp? LOC? DRABC: Danger Response Airway Breathing and Circulation (you are in NZ). Are you using NANDA-I for your care plans?

The child has a preliminary diagnosis of meningitis due to hib:

How do you know this? What labs have been done? Has a spinal tap been performed?

This child has impaired tissue perfusion- sepitis-seen by rr11 and purple rash...How does a rash reveal impaired tissue perfusion. A rash is not common in HiB but if it occurs it is an ominous sign of sepsis...or it is another source for the meningitis Now this child should/would have a poor capillary refill due to the severe dehydration AEB (as evidenced by) no urinary output....not a rash.

Dehydration- nil urine output for 12hrs plus dry lips membranes and tenting skin ....:eek: This is not good. Children (and adults) can, and will, die of dehydration. Dehydration in children is much more serious. Infants' and children's higher body water content, along with their higher metabolic rates and increased body surface area to mass index, contribute to their higher turnover of fluids and solute. The symptoms here is an emergency.

Intra cranial pressure - meningitis- headache, sluggish pupils...What else does the assessment show? Is the child alert? Sleepy? Irritable with a high pitched cry? Could these symptoms also be indicative of severe dehydration?

Which one of these assessments is the greatest concern at this time?

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