DAILY NURSE GAMES

Diagnose It Answer — April 3, 2026

PUZZLE #3
TODAY'S DIAGNOSIS
Meningitis

ALL CLUES

Clue 1 — Chief Complaint

22-year-old college student brought in by roommate with severe headache described as 'the worst of my life,' fever, and neck stiffness.

Clue 2 — History

Symptoms developed rapidly over 6 hours. Lives in a college dormitory. No recent travel. Vaccination history unknown.

Clue 3 — Vitals

Temp 39.8°C, HR 124, BP 88/54, RR 22. Patient is photophobic and phonophobic. GCS 13.

Clue 4 — Assessment

Positive Kernig's sign and Brudzinski's sign. Non-blanching petechial rash noted on trunk and lower extremities.

Clue 5 — Labs

WBC 22,000 with left shift. LP shows cloudy CSF, elevated protein, low glucose, WBC 850 (predominantly neutrophils). Gram stain pending.

CLINICAL NOTE

Bacterial meningitis is a life-threatening infection of the meninges requiring immediate antibiotic administration — nurses must not delay treatment waiting for LP results if the patient is deteriorating. The classic triad is fever, neck stiffness, and altered mental status, with a CSF WBC count above 1,000 cells/mcL strongly suggesting bacterial etiology. Non-blanching petechiae suggest meningococcal disease and indicate septicemia; nursing priority includes droplet isolation precautions and close neurological monitoring.

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