A 6-year-old boy is admitted to the hospital with severe abdominal pain, bloody diarrhea, high fever, headache, and nuchal rigidity. Which condition would the nurse suspect for this child?
The correct answer and explanation is:
The condition the nurse would suspect in this case is bacterial meningitis with possible sepsis. This child presents with a combination of severe abdominal pain, bloody diarrhea, high fever, headache, and nuchal rigidity (stiff neck), all of which are concerning for an infectious process. The combination of gastrointestinal symptoms (abdominal pain and bloody diarrhea) and neurological signs (headache and nuchal rigidity) is highly suggestive of meningitis, specifically bacterial meningitis.
In bacterial meningitis, infection of the meninges (the protective membranes surrounding the brain and spinal cord) can result from bacteria entering the bloodstream and crossing the blood-brain barrier. Common bacterial causes include Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Neisseria meningitidis, in particular, is associated with meningococcemia, a condition that involves both septicemia (severe systemic infection) and meningitis. This can present with a combination of fever, headache, nuchal rigidity, and altered mental status.
The presence of gastrointestinal symptoms, such as abdominal pain and bloody diarrhea, raises suspicion for gastrointestinal-associated meningitis or sepsis caused by Shigella, Salmonella, or Escherichia coli (E. coli). These bacteria can cause severe gastroenteritis, and in some cases, they can lead to septicemia, which in turn can result in meningitis if the bacteria invade the bloodstream and spread to the central nervous system.
Other potential causes for this clinical presentation could include septic shock due to bacterial infection, as the child’s condition may deteriorate quickly, necessitating immediate treatment with antibiotics and other supportive measures. The nurse must assess the child’s vital signs, perform a thorough physical exam, and initiate appropriate diagnostic tests, such as lumbar puncture for cerebrospinal fluid analysis, blood cultures, and stool samples, to confirm the diagnosis and guide treatment.