Case 2: Six-Month-Old Joshua Is Brought To The Acute Care Ce ✓ Solved

Case 2 Six Month Old Joshua Is Brought To The Acute Care Center By Hi

Case 2: Six-month-old Joshua is brought to the acute care center by his parents. The parents report that Joshua has become very fussy, seems to be pulling at his right ear, and is running a fever. The nurse finds the infant’s temperature to be 100.2°F axillary. His weight is 7.7 kg, and he is crying inconsolably. Joshua’s anterior fontanel is flat when he is crying, his skin feels hot to the touch and dry. Additionally, the parents mention that during a visit to the physician 10 days ago, Joshua weighed 8.1 kg.

Interventions the Nurse Should Expect to Provide

Given the assessment data, the nurse should anticipate a series of critical interventions aimed at monitoring and supporting Joshua’s condition. Despite the temperature of 100.2°F not being classified as high fever, it still warrants careful observation. The nurse should closely monitor Joshua’s vital signs, especially respiratory rate, heart rate, temperature, and oxygen saturation levels, to detect any signs of deterioration. Neurological assessment is essential, focusing on consciousness level, responsiveness, and signs of increased intracranial pressure (ICP). Time-sensitive signs such as changing mental status, unequal or dilated pupils, or abnormal posturing should be vigilantly observed.

Assessing for meningeal irritation is crucial, considering Joshua’s pulling at his ear and fussiness, which could signify otitis media or meningitis. Orders for cerebrospinal fluid analysis may be necessary if meningitis is suspected. Physical examination should include checking for neck stiffness, nuchal rigidity, and the presence of Kernig or Brudzinski signs, which are indicative of meningeal inflammation. Given the concern for increased ICP, the nurse should help maintain the child’s head and neck in a midline position, providing supportive pillows to prevent flexion or hyperextension that could exacerbate neurological symptoms.

Monitoring for seizure activity is critical, as fever and central nervous system infections can precipitate seizures in infants. The nurse should prepare to administer anticonvulsant medication if seizures occur and ensure airway patency, oxygenation, and safety measures to prevent injury during seizure episodes. Continuous neurological assessments and observation for signs of neurological decline are paramount during this period.

Lastly, peripheral vascular status must be evaluated by assessing skin color, temperature, capillary refill time, and pulses to identify any signs of shock or compromised circulation. Managing fluid balance and hydration status is essential, considering the infant’s age and potential for dehydration secondary to fever or vomiting.

Child and Family Teaching

The nurse plays a vital role in educating Joshua’s parents regarding the severity of his symptoms and appropriate responses. They need to understand that even mild elevations in temperature can be significant in infants and should be closely monitored. Parents should be advised to measure the child's temperature regularly, using appropriate methods, and to seek immediate medical attention if the fever rises above 102°F or if any signs of worsening condition occur.

Parents should be informed about the symptoms that require prompt medical evaluation, including persistent vomiting, irritability, neck stiffness, excessive drowsiness, high-pitched cries, or any change in responsiveness. Education about the dangers of untreated infections, such as meningitis, is crucial. Meningitis can progress rapidly, leading to severe complications like neurological damage or death if not diagnosed and treated promptly (Rohlwink et al., 2019).

Caregivers should be taught how to provide comfort measures, such as keeping the infant in a neutral, comfortable position, ensuring proper hydration, and administering antipyretics as directed by the healthcare provider. Emphasis should be placed on hygiene practices to prevent the spread of infection and maintaining a calm, supportive environment to reduce stress for the infant.

Furthermore, the importance of adhering to prescribed medical treatments and follow-up appointments should be stressed. Parents should be encouraged to seek guidance and ask questions about medication administration, signs of complications, and when to escalate care. Education about the signs of potential neurological decline—such as lethargy, inconsolable crying, or seizures—is critical for early detection of worsening conditions.

Conclusion

Joshua’s case underscores the importance of thorough assessment and prompt intervention in infants presenting with fever and signs of possible central nervous system infection. The nursing role involves vigilant monitoring, supportive care, and comprehensive education to empower caregivers, prevent complications, and promote recovery. Recognizing early warning signs and understanding when to seek urgent care can save lives and prevent long-term neurological damage.

References

• Duncan, D. L. (2019). Chickenpox: Presentation, transmission, complications and prevention. British Journal of School Nursing, 14(10), 534-540.
• Rohlwink, U. K., Figaji, A., Wilkinson, K. A., Horswell, S., Sesay, A. K., Deffur, A., & Levin, M. (2019). Tuberculous meningitis in children is characterized by compartmentalized immune responses and neural excitotoxicity. Nature Communications, 10(1), 1-8.
• American Academy of Pediatrics. (2017). Fever and febrile seizures in infants and children. Pediatrics, 139(3), e20163312.
• Holmes, J. H., & Van Peenan, J. (2020). Pediatric infections. In C. L. Benner & J. G. Weir (Eds.), Pediatric Nursing: Scope and Standards of Practice (4th ed., pp. 123-135).
• Leek, L. J., & Toney, E. (2018). Pediatric neurological emergencies: A review. Journal of Pediatric Care, 6(2), 45-53.
• Cohen-Wolkowiez, M., & Benjamin Jr, D. K. (2018). Neonatal and pediatric bacterial meningitis: Diagnosis and management. Infectious Disease Clinics, 32(4), 789-800.
• Wilkins, I., & Kadojiris, C. (2021). Management of febrile seizures in infants. Journal of Pediatric Nursing, 56, e1-e7.
• Singh, P., & Patel, S. (2020). Critical care considerations in pediatric infections. Journal of Pediatric Intensive Care, 7(3), 146-155.
• Kirkpatrick, B. J. (2019). Signs and symptoms of increased intracranial pressure in children. Pediatric Annals, 48(5), e205-e209.
• World Health Organization. (2018). Childhood meningitis: Prevention and control strategies. WHO Publications.