Sophia is a nine year old girl brought to the local emergency department by her mother, Jane. Jane reports that Sophia has been lethargic for the past 3 hours, has had little interest in eating or...

Sophia is a nine year old girl brought to the local emergency department by her mother, Jane. Jane reports that Sophia has been lethargic for the past 3 hours, has had little interest in eating or drinking and is complaining of a headache that appears to be getting worse despite being given oral paracetamol and ibuprofen at home. Sophia has a visible purpuric rash on her trunk, is pale and peripherally cool, dislikes the light and appears irritated and sleepy. The assessment records the following data:
 temperature (axillary), 39.7 degrees C, heart rate 70 beats per minute (apical)
 respiratory rate, 11 breaths per minute, no marked work of breathing, blood pressure 120/60 (left upper arm)
 SpO2, 97% in room air
 Unimmunised, vegan organic diet
purpuric rash over trunk
 lips pink with dry mouth
 tacky mucous membranes
 gastrointestinal/genitourinary: abdomen soft, no tenderness or distension; normal bowel sounds, no scars
 musculoskeletal/skin: cool, pale; range of motion reduced; tenting skin turgor; no deformities, central capillary refill

 neurological: irritable; PERL and sluggish; responds to voice; increased tone, reluctant to move extremities or neck.  nutrition: decreased eating and drinking for 1 day.  elimination: bowels usually open once a day, normal appearance. urine output has diminished, Jane reports “Sophia has not passed urine all day”  height and weight are all at the 70th percentile.  Social history: Sophia lives with her family being her mother, father and 2 brothers in the city.
Sophia is given a provisional diagnosis of Meningitis being Haemophilus influenzae type b (Hib)
Specific guidelines (use the additional guidelines in the Unit Plan and marking guide to help you with your structure) 1. What do the physical assessment details indicate and explain why. (Holistic assessment and overview of the child’s immediate physical, emotional, social, psychological and cultural needs) 2. Identify two key problems, justify why you have prioritised them and discuss the planning, implementation and evaluation of care with a rationale. (Identification of 2 key problems with justification for choice. Why have you prioritised them? What is the associated altered anatomy and physiology? For example if you choose shock explain the underlying pathophysiology) 3. What does the literature suggest is best practice and why? 4. What are the family and child centred care considerations including the need to treat close contacts or family in the community. Why is this important?