Case 1 A six month old male presents to the emergency depart

Case 1 A six month old male presents to the emergency department… Case 1A six month old male presents to the emergency department with a history of lethargy. He was seen 3 days ago with fever and URI symptoms, diagnosed with otitis media and treated with oral amoxicillin. Per mother, “this morning he had become irritable and was less active than usual. He has vomited three times and his urine output is noticeably decreased. He has no diarrhea. Mother states she “is anxious and wants to speak with a doctor ASAP.” Per mom, cannot recall if patient is “up to date on all vaccines or not.”Exam: VS T 40.0, P 90, R 30 (irregular), BP 120/90, weight 8kg. He is lethargic and arousable only to painful stimuli. His anterior fontanel is full and tense, and he has able neck rigidity. His pupils are reactive, but his eyes do not focus well on his parents. His heart, lungs and abdomen are normal. His color and perfusion are good. He has no petechiae. He moves all his extremities weakly and his DTRs are hyperactive.A CBC, blood culture and chemistry panel are drawn. An IV is started. Since an increased ICP (intracranial pressure) is suspected, a lumbar puncture (LP) is initially delayed and he is immediately given 500 mg of ceftriaxone IV. A stat CT scan of the brain is normal, so an LP is done and the CSF (cerebrospinal fluid) is visibly hazy. An infectious disease consultant is called to inquire about IV dexamethasone and vancomycin. Both are recommended and given. The CSF results return 1 hour later showing 450 WBCs, 95% segs, 5% monos, total protein 75, glucose 25 mg/dl. Gram stain of the CSF shows many WBCs with few gram positive cocci. He is admitted to the pediatric ICU.    Which of the following assessment findings are a concern and why? Infection is the main concern  Based on these findings what will most likely occur regarding surgery?  What are the clinical decisions for this patient?   What is the rationale behind these clinical decisions?    Health Science Science Nursing PEDS N317

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