Meningitis
A 4 year old patient presents to the ED with a temp of 38.7 and increased irritability. MOC states they live in a hotel room with another family. The patient was seen last week at the pediatrician for Otitis Media Which criteria are risk factors for meningitis?
Fever, Irritability, Otitis Media, Living Space
Which patient is at high risk for sepsis?
A) 4 month old with RSV
B) 2 year old with reoccurring otitis media infections
C) 3 day old premature neonate with hx of prolonged labor
D) 9 month old with failure to thrive and a PICC
C) prematurity and a history of a prolonged labor are both risk factors for sepsis the rest have only one risk factor
You are working in the ED when a 9 year old patient presents for general malaise and has a history of a respiratory infection a week ago and is unvaccinated. The patient is tachypneic, tachycardic, and has a temp of 37.9. The patient also has an elevated white blood cell count and low platelets. What are the SIRS criteria that are concerning in this patient?
Tachypnea, tachycardia, elevated white blood cell count
The others are concerning for sepsis but are not necessarily a criteria for SIRS
A 7 year old is being sent from the PCP office for suspected sepsis as a direct admit. In anticipation of the patient arriving the physician says to prepare to administer a fluid bolus on arrival based on the patient's reported blood pressure. What is the standard bolus volume you would expect to give?
20 mL/kilo
An exaggerated immune response that can lead to septic shock and multiple organ dysfunction/failure and death
SIRS
Which diagnostic would you expect a physician to order to rule out meningitis?
Spinal Tap/Lumbar Puncture
A 3 month old neonate is brought into the ED via ambulance MOC reports a BRUE episode in which the infant has recovered. What diagnostic would you not expect?
A) Lumbar Puncture
B) CBC
D) EEG
E) Urine Culture
F) None of the Above
F) None of the Above
All diagnostics are appropriate for a three month old neonate
You notify the provider you are concerned about sepsis in this patient. The provider has entered orders that follow your sepsis protocol. Which order should you complete first?
A) Administer Antibiotics
B) Obtain Cultures
C) Provide Tylenol
D) Administer a Fluid Bolus
B) Obtain Cultures Prior to Antibiotics
The patient has arrived on the floor and has been settled. In your assessment you would expect to hear ___ if the patient has pulmonary edema as a result of their sepsis diagnosis.
A) Crackles
B) Wheezing
C) Stridor
D) Absent Breath Sounds
A) Crackles
Hypertension with a wide pulse pressure, bradycardia and irregular respirations with apnea are the three characteristics of what neurological phenomenon?
Cushing's Triad
The CSF test has resulted with a high protein level and a low glucose level. Which kind of meningitis does this indicate?
Bacterial
The infant is admitted, and the CBC is first to result and has an elevated white blood cell count. The physician is concerned for sepsis and puts in orders which should the nurse do first.
A) Update and educate the family
B) Place an NG tube for Fluids/Feeds
C) Start Antibiotics
D) Administer Tylenol for Fever
What lab values would you expect to follow to monitor organ function in this patient?
A) CBC
B) CMP
C) Lactate
D) ALT vs AST
E) C reactive protein
F) Creatinine
G) Bilirubin
B, D, F, G
Metabolic Acidosis
This is also compensated based on the low CO2 and explains the tachypnea the patient is experiencing
Rhythmic movement or numbness of one side of the body with no loss of consciousness is an example of a:
A) Generalized Seizure
B) Focal Seizure
C) Absent Seizure
D) Complex Seizure
B) Focal
(One side of the body; One Hempsphere)
The patient has transferred to the floor for antibiotics and observation. When doing an assessment, the patient says my neck feels funny. Which sign would you expect the nurse to assess for nuchal rigidity:
A) Rebound Tenderness
B) Rovsing's Sign
C) Brudzinski's Sign
D) Papilledema
C) Brudzinski's Sign (occurs when passive flexion of the neck causes involuntary flexion of the knee)
The neonate is transferred to the floor to being antibiotic therapy. In the nurses assessment which are signs/symptoms of sepsis/septic shock?
A) Tachypnea
B) Tachycardia
C) Polyuria
D) Hyperthermia
E) Hypothermia
A, B, D, E, and F
Oliguria and anuria are the expected signs of sepsis/septic shock
In infants labile temperatures are signs of infection
You are monitoring your patient on the floor. If he weighs 35 kg. What is an appropriate urine output for the last four hours?
minimum of 140 mLs
=1 ml/kg/hour
The patient has been on the unit for 12 hours and the nurse is curious if the patient is responding to treatment. Which recent lab value would be the most appropriate in determining this?
A) CMP
B) CBC
C) Lactate
D) PT/INR
C) Lactate
The remaining values may appear improved
You are caring for a child with epilepsy. The patient begins to have a seizure with jerking movements observed in all four extremities you note the patient still appears well perfused. What is your priority nursing intervention?
A) Position the patient on their side
B) Apply Oxygen
C) Restrain the Patient
D) Run to Get Pads for the Bed
A) position the patient on their side
Not all patients require oxygen during a seizure only apply if necessary
Your patient has been resting comfortably with antibiotics running. You return to perform another assessment. Which of the following warrant a call to the provider?
A) Petechiae on Face and Trunk
B) Not Remembering the Day of the Week
C) Reported Headache and Light Sensitivity
D) Continued Neck Stiffness
A) Petechial Rash- Indicative of Meningococcal Infection and Possible Imminent Death
The neonate is transferred to the NICU to continue antibiotic therapy and for observation for septic shock. The nurse goes to perform her assessment which would be a late sign of cardiovascular compromise?
A) Tachycardia
B) Tachypnea
C) Decreased Activity
D) Hypotension
D) Hypotension
All are concerning signs for infection, but the remainder of the symptoms are early signs
Your patient had 100 ml out for the last four hours. Your provider has decided to give a fluid bolus for this patient what type of fluid would you expect them to order?
Normal Saline or Lactated Ringers
The patient acutely decompensated and has been transferred to the PICU. His blood pressure has dropped and isn't responding to fluid resuscitation. What would you expect the physician to order?
Vasopressor
You are caring for a newborn patient with spina bifida. You know that patients with this condition are at increased risk for other complications. Which of the following assessments would you expect to perform?
A) Daily Girths
B) Daily Weights
C) Daily Head Circumferences (OFC)
D) None of the Above
C) Daily OFC
the others are common assessments for all infants
babies with spina bifida have an 80 percent chance of developing hydrocephalus