# A 6-year-old child with bacterial meningitis is receiving IV antibiotics and has been experiencing increased intracranial pressure (ICP). The child's Glasgow Coma Scale score has decreased from 12 to 8 over the past 2 hours. Which nursing intervention should be the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542427  
> language: ko  
> subject: Adult Health

## 문제

A 6-year-old child with bacterial meningitis is receiving IV antibiotics and has been experiencing increased intracranial pressure (ICP). The child's Glasgow Coma Scale score has decreased from 12 to 8 over the past 2 hours. Which nursing intervention should be the priority?

## 보기

1. Administer prescribed acetaminophen for fever reduction
2. Increase the frequency of neurological assessments to every 15 minutes
3. Elevate the head of the bed to 45 degrees and maintain neck alignment
4. Notify the healthcare provider immediately and prepare for possible intubation **✔ 정답**

**정답: 4**

## 해설

A GCS drop from 12 to 8 indicates severe neurological deterioration and risk of herniation, requiring immediate notification and preparation for intubation to protect the airway. Other interventions like head elevation are secondary in this emergency.

## 심화 해설

Clinical Reasoning Analysis

The child’s Glasgow Coma Scale (GCS) score dropping from 12 to 8 over 2 hours represents a neurological emergency. A GCS of 8 or less is the critical threshold defining severe coma, at which point the patient can no longer reliably protect their airway. In the context of bacterial meningitis with already elevated intracranial pressure (ICP), this rapid deterioration signals impending brainstem herniation or loss of cerebral autoregulation. The immediate priority is to secure the airway to prevent hypoxia and hypercapnia, both of which act as potent cerebral vasodilators that further increase ICP. The 2025 Korean Guidelines for Pediatric Advanced Life Support emphasize that in in-hospital settings, advanced airway management including endotracheal intubation is a reasonable intervention when performed with minimal interruption and appropriate monitoring [2]. Notifying the healthcare provider immediately and preparing for possible intubation directly addresses this life-threatening decline in airway protective reflexes and allows for controlled ventilation to manage ICP.

Why the Other Options Are Not the Priority

**Option 1:** Administering prescribed acetaminophen for fever reduction is a supportive measure. While fever increases cerebral metabolic demand and can exacerbate ICP, this intervention does not address the immediate threat of airway compromise and respiratory failure indicated by a GCS of 8. In the hierarchy of resuscitation, airway and breathing always take precedence over temperature management.

**Option 2:** Increasing the frequency of neurological assessments to every 15 minutes is an important monitoring action, but it is a passive intervention. The clinical trajectory has already declared itself with a significant GCS decline. The nurse must act on the identified change rather than simply observe it more frequently. Delaying definitive airway management to perform more assessments places the child at risk for respiratory arrest.

**Option 3:** Elevating the head of the bed to 45 degrees and maintaining neck alignment is a beneficial nursing measure to promote cerebral venous outflow and reduce ICP. However, in a patient with a GCS of 8, airway protection overrides positioning. The risk of aspiration and hypoventilation in this position, without a secured airway, is high. This intervention is appropriate only after the airway has been definitively secured.

Pathophysiology and Clinical Correlation

Bacterial meningitis triggers an intense inflammatory response within the subarachnoid space, leading to cerebral edema, vasculitis, and obstruction of cerebrospinal fluid (CSF) flow, all of which contribute to increased ICP. As ICP rises, cerebral perfusion pressure (CPP), which is the difference between mean arterial pressure (MAP) and ICP, falls. The brain’s compensatory mechanisms eventually fail, causing a progressive decline in consciousness. The GCS drop from 12 to 8 signifies a transition from moderate to severe neurological depression. At this level, the gag and cough reflexes are often absent or profoundly diminished, meaning the child cannot clear secretions or protect the lower airway from aspiration. Furthermore, hypoventilation leads to carbon dioxide retention, causing cerebral vasodilation and a further dangerous rise in ICP, creating a vicious cycle. Endotracheal intubation breaks this cycle by enabling controlled ventilation to maintain a low-normal PaCO₂, which constricts cerebral vessels and rapidly reduces ICP. This principle of neuroprotection is highlighted in the pediatric life support guidelines, which stress the importance of physiologic resuscitation targets and neuroprotection in post-arrest and acute neurological injury care [2].References (research sources)

- [2]2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 8. Pediatric advanced life support.GuidelineKim DK, Kim JT, Na JY, Park B, Lee J, Jeong SI, Park JD, Chung SP, Kim TY, Sohn Y, Shim G, Jung YH, Oh Y, Youn CS, Lee MJ, Lee CH, Jang Y, Jang YS, Cho GC, Cha KC, Heo JS, Hwang SO. (2026) · DOI: 10.15441/ceem.26.103

## 임상 시나리오

Clinical Practice Guide: Pediatric GCS Decline in Meningitis

Priority Action for GCS Drop to 8 or Less

A drop in Glasgow Coma Scale (GCS) to 8 or below in a child with bacterial meningitis is a critical event signaling impending respiratory failure and brainstem herniation. The airway is the immediate priority. The nurse must activate the emergency response system, notify the provider, and prepare for rapid sequence intubation. Controlled ventilation after intubation allows for mild hyperventilation to temporarily reduce ICP while definitive treatments take effect.

Key Interventions During Preparation

- Keep head of bed elevated to 30 degrees (avoid 45 degrees to prevent jugular vein compression) and maintain neutral neck alignment to promote cerebral venous outflow.

- Avoid clustering care activities that can spike ICP, such as suctioning, unless absolutely necessary; pre-oxygenate with 100% oxygen before suctioning.

- Maintain normothermia with antipyretics as prescribed, as fever increases cerebral metabolic rate and oxygen consumption.

- Ensure all emergency airway equipment, including suction, bag-valve-mask, and endotracheal tubes, is at the bedside and functional.

Monitoring and Ongoing Care

Once the airway is secured, continuous monitoring of end-tidal CO2 is essential to maintain PaCO2 in the low-normal range (35-38 mmHg), avoiding aggressive hyperventilation that can cause cerebral ischemia. Neurological assessments, including pupil reactivity and motor responses, should continue every 15 minutes to detect further deterioration. Strict fluid management and administration of osmotic diuretics like mannitol may be ordered to control ICP.

## 핵심 개념

- **Bacterial Meningitis** — Bacterial meningitis. A bacterial infection of the meninges surrounding the brain and spinal cord, causing acute inflammation, cerebral edema, and increased intracranial pressure, which is a life-threatening condition.
- **Increased Intracranial Pressure** — Increased intracranial pressure. A condition in which the pressure inside the cranial cavity rises abnormally, compressing brain tissue, which can lead to brain herniation and impaired cerebral perfusion.
- **Glasgow Coma Scale** — Glasgow Coma Scale. It is a tool that objectively scores the level of consciousness (3–15 points) by evaluating eye opening, verbal response, and motor response. A score of 8 or below suggests severe brain injury.
- **Herniation Syndrome** — Brain herniation syndrome. A life-threatening emergency in which intracranial pressure rises extremely high, causing brain tissue to shift abnormally through partitions within the cranial cavity (e.g., the foramen magnum passing through the brainstem).
- **Intubation** — Endotracheal intubation. A procedure in which a tube is inserted into the trachea to secure the airway and provide mechanical ventilation for patients with respiratory failure or those requiring airway protection.

## 같은 주제 문제

- [A nurse is assessing a 28-year-old patient admitted with suspected bacterial meningitis. W…](https://mymerci.kr/pages/nclex_q.php?qn_id=541237)
- [A 28-year-old patient presents to the emergency department with a 12-hour history of sever…](https://mymerci.kr/pages/nclex_q.php?qn_id=541238)
- [A nurse is caring for a patient with bacterial meningitis who has been receiving antibioti…](https://mymerci.kr/pages/nclex_q.php?qn_id=541239)
- [A nurse is caring for a client with bacterial meningitis who has been receiving IV antibio…](https://mymerci.kr/pages/nclex_q.php?qn_id=541240)
- [A nurse is caring for a patient with bacterial meningitis who has been receiving IV antibi…](https://mymerci.kr/pages/nclex_q.php?qn_id=541241)
- [A 28-year-old patient presents to the emergency department with a 12-hour history of sever…](https://mymerci.kr/pages/nclex_q.php?qn_id=541242)
- [A 30-year-old healthcare worker is admitted to the emergency department with a 12-hour his…](https://mymerci.kr/pages/nclex_q.php?qn_id=541243)
- [A nurse is caring for a patient with suspected bacterial meningitis. Which nursing action …](https://mymerci.kr/pages/nclex_q.php?qn_id=541244)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._