A child is brought to the emergency room with a high fever, photophobia, and a headache. What important sign would a nurse use to check for meningeal irritation?
Explanation
•Meningeal irritability is assessed by eliciting positive Brudzinski’s and Kernig’s signs, as well as an inability to flex the neck forward (nuchal rigidity).
•Brudzinski’s sign: After forced flexion of the neck there is a reflex flexion of the hip and knee and abduction of the leg.
•Kernig’s sign: When the nurse flexes patient's hip and knee at 90-degree angles, pain and resistance are noted.
•Incorrect: Cullen's sign is the presence of superficial edema and bruising around the umbilicus. It is suggestive of acute pancreatitis or an intra-abdominal bleed.
•Incorrect: Ortolani's sign is a distinctive "clunk" heard after flexing and abducting a newborn's hips. This is indicative of hip dysplasia.
•Incorrect: McBurney's sign is deep tenderness or pain at McBurney's point, one-third the distance from the right anterior iliac spine and the navel. This is indicative of acute appendicitis.