A 2-year-old child is brought to the emergency room with high fever, irritability, and a rash. The nurse suspects bacterial meningitis. What is the appropriate intervention?
A Administer an antipyretic and observe
B Perform a lumbar puncture and start antibiotics
C Administer an antihistamine and monitor
D Order a head CT scan and observe
The Correct Answer and Explanation is:
The correct intervention is:
B. Perform a lumbar puncture and start antibiotics
Explanation:
Bacterial Meningitis in young children, particularly under 2 years old, is a serious condition that requires prompt intervention to avoid severe complications or death. The symptoms presented—high fever, irritability, and rash—are characteristic of bacterial meningitis, which is an infection of the protective membranes covering the brain and spinal cord.
Performing a lumbar puncture (LP) is critical for diagnosing bacterial meningitis. The LP allows for the collection of cerebrospinal fluid (CSF), which is then analyzed to identify the presence of bacteria, elevated white blood cell count, and other changes indicative of infection. This diagnostic procedure helps in confirming the diagnosis of bacterial meningitis and differentiating it from other types of meningitis or conditions with similar symptoms.
Starting antibiotics immediately after obtaining CSF is essential because bacterial meningitis can progress rapidly. Delaying treatment can lead to severe complications such as brain damage, hearing loss, or death. Broad-spectrum antibiotics are typically administered initially to cover the most common pathogens, such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b (Hib). Antibiotic therapy is then adjusted based on the specific bacteria identified from the CSF culture.
In contrast, the other options are not appropriate for the initial management of suspected bacterial meningitis:
- A. Administer an antipyretic and observe: While antipyretics can help manage fever, they do not address the underlying infection. Observation without further diagnostic or therapeutic action could lead to deterioration.
- C. Administer an antihistamine and monitor: Antihistamines are used for allergic reactions and would not be effective in treating or diagnosing bacterial meningitis.
- D. Order a head CT scan and observe: While a CT scan can be useful in assessing for complications such as brain abscess or increased intracranial pressure, it should not delay the diagnostic lumbar puncture and initiation of antibiotics. Observing without initiating appropriate treatment can be harmful.
In summary, performing a lumbar puncture to confirm the diagnosis and starting antibiotics to treat bacterial meningitis are the crucial steps in managing this potentially life-threatening condition.