Which of the following would lead the nurse to suspect that meningitis has lead to dissemination coagulation?

PGIMS Rohtak NO - 2017

Medical & Surgical Nursing

Medium

Appeared in: PGIMS Rohtak NO - 2017

Explanation

Meningitis, particularly when caused by bacteria like Neisseria meningitidis, can lead to sepsis.
Sepsis is a primary trigger for Disseminated Intravascular Coagulation (DIC), a complex disorder where the body's clotting system is overactivated.
This overactivation consumes platelets and clotting factors, paradoxically leading to widespread bleeding.
A hemorrhagic skin rash, presenting as petechiae (pinpoint spots) or purpura (larger patches), is a classic and often early sign of this bleeding tendency as blood leaks into the skin.
The appearance of this non-blanching rash in a patient with meningitis is a critical finding that suggests progression to meningococcemia and DIC.

Option B: Pulmonary edema (fluid in the lungs) is a sign of circulatory failure or Acute Respiratory Distress Syndrome (ARDS), which can be complications of sepsis, but it is not a primary sign of the clotting/bleeding disorder of DIC itself.
Option C: Pallor (paleness) is a very non-specific sign. It can be caused by shock, anemia, or simply a person's natural complexion. While a patient with sepsis and DIC may be pale due to shock, it is not a diagnostic sign of the coagulopathy.
Option D: Haemoptysis (coughing up blood) indicates pulmonary hemorrhage. While this can occur in very severe DIC, it is not as common or characteristic as bleeding from the skin (petechiae/purpura) or mucous membranes.

Clinical Relevance

Nursing practice connection: Knowing Complications of Meningitis: Disseminated Intravascular Coagulation (DIC) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The appearance of a non-blanching, hemorrhagic rash in a patient with fever and other signs of meningitis is a medical emergency. It signals meningococcal septicemia and DIC, which has a high mortality rate.
A nurse's rapid identification of this rash is crucial. It requires immediate notification of the healthcare provider and preparation for aggressive interventions, including high-dose IV antibiotics, fluid resuscitation, and potential blood product administration.
Patient safety involves implementing bleeding precautions: avoiding unnecessary punctures, applying prolonged pressure to sites, and using soft-bristled toothbrushes.

How to Approach the Question

First, identify the core concepts in the question: the primary disease is 'meningitis' and the complication is 'disseminated coagulation' (DIC).
Recall the pathophysiology of DIC. It's a two-part problem: 1) excessive clotting that consumes resources, followed by 2) severe bleeding because there are no clotting factors or platelets left.
The question asks what sign would make a nurse suspect this complication. You are looking for a key manifestation of the bleeding phase.
Evaluate the options based on this understanding.
A 'hemorrhagic skin rash' directly reflects bleeding under the skin, which is a hallmark of DIC's hemorrhagic phase.
Consider the other options: pulmonary edema, pallor, and haemoptysis are either less specific to DIC or less common than the characteristic skin rash.

Concept Tested & Keywords

Concept Tested: Complications of Meningitis: Disseminated Intravascular Coagulation (DIC)
Stem keywords: meningitis, dissemination coagulation, suspect
Lead-in keywords: Which of the following
Negative lead-in flag: false

QuoDwzw5Hiih3KBvLfdbKx

E6 Medicine Harrison 22e Part 1 pp. 1289-1291, 185-187

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 842-844