Case Analysis
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Case Analysis
LOCATES Mnemonic
According to Dains, Baumann & Scheibel, (2016), LOCATES mnemonic in diagnosis and obtaining the patient history looks at exacerbating and leveling factors that worsened or made the symptoms relieve. It also looks at pain severity, for instance, what makes the pain worse or reduce. The health practitioner also confirms the remedies taken, for example, the use of medication to relieve the symptoms and the last changes experienced after the treatments given.
Obtaining History
It is fundamental first to obtain a family history to rule out neurological disorders such as migraines, respiratory conditions, genetic diseases, or even a problem with the musculoskeletal system(Burns et al., 2020). One needs to get a history of the baby’s vaccination to rule out bacteria or viruses that may cause meningitis in children. such as the pneumococcal vaccine for hepatitis B. the LOCATES mnemonic in diagnosis and obtaining
Physical Assessment and Diagnostic Tests.
The detailed physical assessment focusses on the respiratory conditions as well as neurological functions such as kerning’s signs to get the specific medical diagnosis. However, the nurse is unable to get through with neurological diagnosis due to the baby’s noncompliance. This calls for conduction of other motor and cognitive functions only. Diagnostic tests like complete blood count and laboratory test to get the specific pathogen causing the condition like fever and irritability are done(Burns et al., 2020). The diagnosis for the case is based on history, which includes fever, vomiting, marked irritability, and refusal to comply with heading and neck examination give speculations for infant meningitis. Confirmation of the diagnosis of the disease involves carrying out blood tests, including blood culture, full blood count, and the analysis of polymerase serology reactions, C-reactive proteins are carried out. The gold standard for microbial testing to confirm meningitis in cerebrospinal fluid obtained by lumbar puncture. It is then taken for laboratory tests to get the causative agent.
Differential Diagnoses
The differential diagnoses for Trevor, a pediatric with conditions such as high fever, irritability, and decreased peroral intake following respiratory diseases, can be encephalitis, acute bacterial meningitis, and viral meningitis (Burns et al., 2020). Bacterial meningitis has a rapid onset and needs a lab test to make a conclusive diagnosis. It is caused by bacteria such as Haemophilus influenza B, Neisseria meningitides, and Streptococcus pneumonia. In our case, Trevon’s condition has an acute onset lethargy, nausea and vomiting are confirmatory symptoms of acute bacterial meningitis(Zhang et al. 2019). This condition is a pediatric emergency and has had high mortality and morbidity rates. Trevon’s case rules out viral meningitis, there is no history of a missed vaccination or exposure to Herpes simplex virus and non-polio enteroviruses.
Treatment and Management of Acute Bacterial Meningitis
The urgent treatment includes admission into the pediatrics ward as an in-patient. The nursing management involves pain-relieving, and respiratory conditions management by maintaining the airway patency and thermoregulation due to high fever. Chaudhary et al. (2018) note the pharmacological treatment of acute respiratory meningitis includes immediate starting of antibiotic therapy with ceftriaxone according to prescription, corticosteroids, and fluids are administered to cater for fever and compensation of loss through vomiting and reduced oral intake.
Parent Education on Meningitis
The parent should be advised on ensuring Trevon receives the remaining vaccines, such as the measles vaccine, according to the recommended schedule for vaccination of infants. The parent education on infant meningitis help in early identification of signs and prompt seeking of medical services. The parents and families of the affected infants should be educated on the presenting symptoms of possible meningitis, such as gas stiffens neck, fever, and vomiting, with less intake of oral fluids. The parents should be educated on fever management and advised to provide large amounts of fluids to counteract the fluid loss from vomiting (Hu 2019). The parents should also be trained on how to administer the prescribed medications if the child is discharged for home-based care.
Follow Up Visit
The discharging healthcare should instruct the mother to return to the clinic for the next clinic visit in the child welfare clinic in 2 weeks. During the revisit, the baby will be ready to receive meningococcal and Diptheria Pertussis and Tetanus vaccines booster dose (Chaudhary et al., 2018). The baby may also receive a neurological assessment from a neurologist during the same day
References
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., Davidson, M. R., … & Wieland Ladewig, P. A. (2020). AAP.
Chaudhary, S., Bhatta, N. K., Lamsal, M., Chaudhari, R. K., & Khanal, B. (2018). Serum procalcitonin in bacterial & non-bacterial meningitis in children. BMC pediatrics, 18(1), 342.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2018). Advanced Health Assessment & Clinical Diagnosis in Primary Care E-Book. Elsevier Health Sciences.
Hu, L. (2019). Patient education: Lyme disease treatment (Beyond the Basics).
Zhang, X. X., Guo, L. Y., Liu, L. L., Shen, A., Feng, W. Y., Huang, W. H., … & Chen, H. Y. (2019). The diagnostic value of metagenomic next-generation sequencing for identifying Streptococcus pneumoniae in pediatric bacterial meningitis. BMC infectious diseases, 19(1), 495.