# A 6-month-old infant is admitted to the pediatric unit with suspected bacterial meningitis. The infant presents with fever, bulging fontanelle, and high-pitched cry. Which nursing action should be the HIGHEST priority?

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> subject: Adult Health

## 문제

A 6-month-old infant is admitted to the pediatric unit with suspected bacterial meningitis. The infant presents with fever, bulging fontanelle, and high-pitched cry. Which nursing action should be the HIGHEST priority?

## 보기

1. Administer prescribed antibiotics immediately
2. Obtain blood cultures before antibiotic administration
3. Implement droplet precautions immediately **✔ 정답**
4. Perform a complete neurological assessment

**정답: 3**

## 해설

Implementing droplet precautions immediately is highest priority to prevent transmission of infectious organisms to others. Antibiotics, blood cultures, and neurological assessment are important but secondary to infection control.

## 심화 해설

Clinical Priority Setting for Suspected Bacterial Meningitis in an Infant

The correct answer is to implement droplet precautions immediately. In the hierarchy of nursing actions for a patient with a suspected highly contagious and life-threatening infection, protecting healthcare workers, other patients, and visitors from exposure is the foundational first step before any direct diagnostic or therapeutic intervention occurs. This principle is rooted in infection control standards and the chain of infection.

Rationale for Prioritizing Droplet Precautions

Bacterial meningitis is primarily transmitted through respiratory droplets. The organisms Neisseria meningitidis and Haemophilus influenzae type b are classic examples. An infant with a high-pitched cry, fever, and a bulging fontanelle presents a high index of suspicion. Implementing droplet precautions requires a private room and the use of a surgical mask for anyone entering within 3 feet of the patient. This action must be taken immediately upon suspicion to break the chain of infection, as it does not depend on a confirmed diagnosis. Delaying this step, even to obtain cultures or administer the first dose of antibiotics, exposes the healthcare team and other vulnerable children on the unit to a significant risk of acquiring the infection.

Analysis of Other Options in the Clinical Sequence

While the other listed actions are critical components of care, they are secondary to the immediate safety measure of isolation.

- Administer prescribed antibiotics immediately (Option 1): While time-sensitive, antibiotic administration is not the highest priority nursing action. The nurse must first ensure the environment is safe (precautions in place) and then proceed with treatment. A brief delay to establish isolation does not significantly alter the patient's outcome, whereas failing to isolate first has immediate population health risks.

- Obtain blood cultures before antibiotic administration (Option 2): This is a standard of care to identify the causative organism, as highlighted in the reference material which notes that cerebrospinal fluid (CSF) analysis and culture remain the gold standard for diagnosis [1]. However, cultures are a diagnostic step that follows the establishment of safety precautions. The sequence is: isolate first, then collect specimens, then administer antibiotics.

- Perform a complete neurological assessment (Option 4): A comprehensive assessment is vital for monitoring complications like increased intracranial pressure, which manifests as a bulging fontanelle. However, this is an ongoing, detailed evaluation that occurs after immediate safety and critical interventions are initiated. The initial presentation of fever and a bulging fontanelle already provides enough data to suspect meningitis and trigger the isolation protocol.

Connecting Clinical Presentation to the Underlying Pathophysiology

The infant's symptoms reflect the inflammatory process within the central nervous system. The reference material indicates that while fever is a potential symptom, other signs are not as easily identifiable in infants as in older children [1]. The bulging fontanelle is a direct result of increased intracranial pressure from meningeal inflammation and cerebral edema. The high-pitched cry is a neurological manifestation of meningeal irritation and pain. These classic signs in a 6-month-old create a presumptive diagnosis that mandates immediate isolation, as the patient is potentially infectious before the definitive CSF culture results are available. The nurse's clinical judgment must prioritize actions that protect the broader patient population from this highly transmissible pathogen.References (research sources)

- [1]Evaluation of Fever of Unknown Origin in an Infant: Can a Case Be Made for Ultrasound of the Head as a Second-Tier Test for Meningitis?Case reportOsborne AF, Jordan MA, Perdigon O, Byrd AN, Rathore M. (2025) · DOI: 10.7759/cureus.96850

## 임상 시나리오

Priority Action: Suspected MeningitisInfection Control Before All Else
Upon initial suspicion of bacterial meningitis, immediately place the patient on Droplet Precautions in a private room. This is the foundational safety step to break the chain of infection before any diagnostic or therapeutic tasks.

A surgical mask is required for all healthcare personnel and visitors entering within 3 feet of the patient. The classic triad in an infant includes fever, high-pitched cry, and a bulging fontanelle.

CautionDo not delay isolation to obtain blood cultures or administer antibiotics. The risk of exposing other vulnerable patients and staff to Neisseria meningitidis or Haemophilus influenzae type b outweighs the brief delay in these interventions.

## 핵심 개념

- **Droplet Precautions** — Infection control measures for pathogens transmitted via respiratory droplets, requiring a private room and a surgical mask for anyone within 3 feet of the patient.
- **Bacterial Meningitis** — An acute inflammation of the meninges caused by bacteria such as Neisseria meningitidis, presenting with fever, bulging fontanelle, and high-pitched cry in infants.
- **Chain of Infection** — A model illustrating the six components needed for infection transmission, which nursing actions aim to break at the portal of exit or mode of transmission.
- **Bulging Fontanelle** — A tense, outward curving of an infant's soft spot on the skull, a classic sign of increased intracranial pressure often seen in meningitis.

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