HOLY ANGEL UNIVERSITY

Angeles City

College of Nursing

Case Study Neonatal Sepsis

As a partial requirement in NCM 104 RLE

I.

INTRODUCTION

T e term !sepsis" as #een around sin$e an$ient times% modern definitions of !sepsis" &ere des$ri#ed in detail in t e early 1''0s( at a $onsensus $onferen$e $on)ened #y t e Ameri$an College of C est * ysi$ians and t e So$iety of Criti$al Care Medi$ine+ At t at time( !sepsis" &as des$ri#ed as a systemi$ response to a p ysiologi$ insult in$luding infe$tious and ot er etiologies t at lead to t e de)elopment of furt er organ in,ury( ultimately $ulminating in multiple organ dysfun$tion syndromes+ Neonatal sepsis( also termed Sepsis neonatorum( refers to a group of p ysi$al and la#oratory findings t at o$$ur in response to in)asi)e infe$tion &it in t e first -0 days of life+ As &ill #e dis$ussed #elo&( t ere are )arious infe$tious $auses of neonatal sepsis% o&e)er( t e pattern of presentation is quite similar in all $ases( as is t e approa$ to treatment+ T e importan$e of neonatal sepsis as a diagnosis is found in t e fa$t t at t is diagnosis o$$urs in #et&een 1 to . $ ildren per 1000 li)e #irt s in t e /nited States( and may #e asso$iated &it a fatality rate of up to -00+ As su$ ( it is essential t at $aregi)ers t at are in)ol)ed &it t e management of neonates a)e a relia#le approa$ to t e diagnosis and treatment of infants &it sepsis( and t at appropriate inter)ention #e instituted in a timely manner+ Neonatal Sepsis is an infe$tion in t e #lood t at spreads t roug out t e #ody and o$$urs in a neonate+ Neonatal Sepsis is also termed as Neonatal Septi$emia and Sepsis Neonatorum+ Neonatal Sepsis as 1 types2 T e one t at is seen in t e first &ee3 of life is termed as Early4 onset sepsis and most often appears in t e first 14 ours of life+ T e infe$tion is often a$quired from t e mot er+ T is $an #e $ause #y a #a$teria or infe$tion a$quired #y t e mot er during er pregnan$y( a *reterm deli)ery( Rupture of mem#ranes 5pla$enta tissue6 t at lasts longer t an 14 ours( 7nfe$tion of t e pla$enta tissues and amnioti$ fluid 5$ orioamnionitis6 and frequent )aginal e8aminations during la#or+ T e se$ond type or t e Late4onset Sepsis is a$quired after deli)ery+ T is $an #e $ause #y $ontaminated ospital equipment( e8posure to medi$ines t at lead to anti#ioti$ resistan$e( a)ing a $at eter in a #lood )essel for a long time( staying in t e ospital for an e8tended period of time+ Signs and symptoms of Neonatal Sepsis in$ludes #ut is not limited to2 #ody temperature $ anges( #reat ing pro#lems( diarr ea( lo& #lood sugar( redu$ed mo)ements( redu$ed su$3ing( sei9ures( slo& eart rate( s&ollen #elly area( )omiting( yello& s3in

and & ites of t e eyes 5,aundi$e6+ *ossi#le $ompli$ations are disa#ility and &orst is deat of t e neonate+ 5:reene( 100;6 Neonatal sepsis o$$urs at an estimated rate of 1 to 1 $ases per 1000 li)e #irt s in t e /+S+ T e ig est rates o$$ur in lo&4#irt 4&eig t 5L<=6 infants( t ose &it depressed respiratory fun$tion at #irt ( and t ose &it maternal perinatal ris3 fa$tors+ T e ris3 is greater in males 51216 and in neonates &it $ongenital anomalies 5Mer$3( 100>6+ A$$ording to t e * ilippine Mortality ?a$t S eet 100@ of t e =orld Aealt Brgani9ation( in 1000 li)e #irt s of neonates 1;0 of it died due to se)ere infe$tion t at in$ludes deat s from pneumonia( meningitis( sepsisCsepti$emia( and ot er infe$tions during t e neonatal period+ Neonatal sepsis $an o$$ur in any infant+ Ao&e)er( t e diagnosis is signifi$antly more $ommon in pre4term infants t an full term infants( and $an affe$t up to -0 to 1000 li)e #irt s in t e pre4term population+ Sepsis is also more $ommon in males t an females( and in de)eloping $ountries+ MORTALITY STATISTICS OF NEONATAL SEPSIS 2007 1. Pulmonary Tuberculosis 2. Pneumonia 3. CVA 4. Hy er!ension 5. Prema!uri!y 6. $eona!al %e sis 7. 'alaria 8. C$% (n)ec!ion 9. Ve"icular Acci#en! 10. ,iarr"ea Nurse Centered Objectives: At t e end of t is study( t e student nurse &ill #e a#le to2 D a)e $riti$al t in3ing s3ills ne$essary for pro)iding safe and effe$ti)e nursing $are+ D a)e a $ompre ensi)e assessment and implement $are #ase on our 3no&ledge and s3ills of t e $ondition D familiari9e t emsel)es &it effe$ti)e inter4personal s3ills to emp asi9e ealt promotion and illness pre)ention+ D 7mpart t e learning e8perien$e from dire$t patient $are+ No. 38 36 29 23 21 18 17 10 10 9 % 7.92 7.50 6.04 4.79 4.38 3.75 3.54 2.08 2.08 1.88 2008 1. CVA 2. Pneumonia 3. Pulmonary Tuberculosis 4. Hy er!ension 5. Ve"icular Acci#en! 6. Acu!e &as!roen!eri!is 7. %e sis $eona!orum 8. Con*es!i+e Hear! ,isease 9. 'alaria 10. ,iabe!es 'elli!us No. 46 43 27 23 12 11 11 10 9 9 % 9.83 9.19 5.77 4.91 2.56 2.35 2.35 2.14 1.92 1.92

&&&+& o+$om

Patient and a!i"# Centered Objectives: At t e end of t is study( t e patientCfamily &ill #e a#le to2 1+ 7dentify measures t at $ould minimi9e t e ris3 of o$$urren$e of t e disease+ 1+ 7dentify possi#le ris3 fa$tors t at may a)e $ontri#uted to t e de)elopment of Neonatal Sepsis+ -+ 7n$rease a&areness on t e ris3 fa$tors of Neonatal Sepsis+ 4+ Ee)elop t e familyFs support system and distinguis t eir respe$ti)e roles in impro)ing patientFs ealt status+ >+ 7n)ol)e t em in promoting t e ealt $are of t e patient+ II. Personal History Ms+ Sepsis is 1> years old and is of 7lo3ano des$ent #e$ause er mot er &as 7lo3ano+ S e &as #orn on Septem#er 1-( 1'.4 in Luna( La /nion+ S e ga)e #irt to er first #orn #ut s e is not yet married+ S e li)es in an apartment lo$ated in San Loren9o Street( Sto+ Eomingo( Angeles City+ S e &as admitted in a #irt ing ome last Septem#er .( 100' at 0-200 pm+ <a#y <oy S &as #orn on t e same date at Bur Lady of :ood <irt <irt ing Aome near AMC )ia Cesarean Se$tion 7 &it an Apgar s$ore of ; and .at 11210 pm+ T&o days after #irt ( Septem#er 10( 100'( t e #a#y &as admitted at AMC Main &ard #e$ause of reported $ontinuous )omiting+ Ms+ Sepsis &or3s as a lady guard in Angeles City Gail & erein s e inspe$ts t e &or3ers #efore entering t e )i$inity and s e earns 1-(000+00 per mont + S e spends 1(>00+00 for rental fee( &ater and ele$tri$ity( >(000+00 for food( and s e sends 4(000+00 to er parents in La /nion( in a mont ly #asis+ T en s e as a mont ly mo#ile #ill of .00+00 for :lo#e line and .0+00 for a smart line+ S e made a loan to A?*M7 in Manila for er gi)ing #irt % t is &as an agen$y & i$ is readily a)aila#le for poli$e offi$ers and &or3ers li3e t em+ Ms+ Sepsis finis ed tertiary edu$ation &it $ommer$e as er $ourse+ S e got t e &or3 in t e City Gail t roug er $ousin+ 7t &as offered to er & en s e &as still &or3ing as a $ler3 in an eig t ele$troni$ $ompany in <atangas+ S e de$ided to apply #ut s e did not pass t e NURSING HISTORY

requirement so s e &as not a$$epted+ T&o years after( s e applied again and got a$$epted+ No&

s e as #een &or3ing t ere for t&o years as of Septem#er 4( 100'+ <ut s e &or3ed for 1 years and > mont s for GM* in t eir main eadquarters+ Ms+ Sepsis and er family are under 7glesia Ni Cristo 57NC6+ <eing 7NC t ey a)e se)eral #eliefs su$ as if t ere &as someone & o is si$3 li3e a)ing $olds( flu( $oug ( t eir Ga$3ono 5offi$er6 &ould pray o)er im #e$ause if it &as se)ere &ould t ey #ring imC er to t e ospital+ T e mot er of Ms+ Sepsis told er to not &at$ tele)ision during er pregnan$y and to not ta3e $old #at after #irt #e$ause t ey &ill use steamed lea)es for #at ing+ S e also told Ms+ Sepsis to use a#dominal #inder & ile pregnant+ Fa ily!Healt" Illness History =it in Ms+ SepsisF family( only t e eldest son as ypertension+ No ot er ereditary disease &as identified #y er mot er+ <ut on er partnersF side( s e stated t at er partner ad prostate $an$er #ut &as already $ured t at one of is testes &as remo)ed+ History o# Past Illness Ms+ Sepsis ad $ i$3en po8% mumps at @ years old & i$ &as treated &it !tina" and mefenami$ a$id( and measles & erein er mot er told er to eat !#alot" for treatment+ S e ad urinary tra$t infe$tion #efore pregnan$y & i$ lasted for > days and &as treated &it Cefale8in and at er >t mont during pregnan$y & i$ lasted for a#out 1 &ee3 as &ell+ History o# Present Illness After #irt ( t e #a#y &as found to #e a)ing neonatal sepsis so e &as admitted at AMC Main =ard+ Ae &as #reastfed fe& ours after #irt t en &it &ater #y t e mot er and t e nurse t ereafter and e &as still fine+ T en e &as fed &it <ona( formula mil3( and t en e )omited+ T e family t oug t it &as fine and normal #ut it #e$ame $ontinuous so t ey notified er do$tor and t e #a#y &as admitted after+

 Fa

ily Healt" Illness History $%ia&ra

'

LEGENDS( Ee$eased =it ypertension

Aad prostate Can$er

Aad /T7

=it Neonatal Sepsis

O)STETRICAL HISTORY Ms+ Sepsis ad er menar$ e at t e age of 1- and lasted for a &ee3+ ?rom t en on( s e ad regular menstrual period e)ery mont &it > days to 1 &ee3 ma8imum of delay+ S e ga)e #irt to er first #a#y at t e age of 1>+ S e does not use BC* rat er s e uses &it dra&al met od as t eir $ontra$epti)e met od+ S e does not li)e toget er &it in different areas+
Maternal!O*stetri+ Re+or%

er partner #e$ause t ey are assigned

Ms+ Sepsis is not married to er #oyfriend yet and as no plan of getting married as of t e moment+ S e as an B#stetri$ re$ord of :ra)ida 1( *ara 1+ S e as a T*AL re$ord of 1404041+ Aer last menstrual period &as last Ee$em#er 1>( 100.+ So er estimated date of deli)ery &as supposedly on Septem#er 11( 100'+ S e ad gi)en #irt to er first #a#y( <a#y <oy S last Septem#er .( 100' t&o &ee3s a ead from er EEE+ S e &as #roug t earlier t an er estimated date of $onfinement #e$ause s e ad an early $ontra$tion and a#normal fetal position and attitude+ S e ad gi)en #irt )ia Cesarean Se$tion 7 in Bur Lady of :ood <irt <irt ing Aome( & i$ is a spe$iali9ed $lini$ solely for gi)ing #irt + Ante!,artal- Pre!natal Pre,aration A$$ording to Ms+ Sepsis s e ad a regular prenatal $ e$34up on er do$torFs $lini$+ S e goes on$e a mont during t e first trimester( t&i$e a mont during t e se$ond trimester( and e)ery &ee3 during t e t ird trimester+ S e re$ei)ed 1 dose of tetanus to8oid )a$$ine from er do$tor+ S e missed t e se$ond dose #ut er do$tor said it &as fine+ Si&ni#i+ant Tri estral C"an&es $.st / 0r% tri ester'

Bn t e $irst tri!ester of er first pregnan$y( s e did not e8perien$e mu$ $ ange+ S e narrated t at s e on$e ate !#agoong &it tomato" and )omited( sin$e t en s e ad not a)e t e appetite for it+ Bn t e sec%nd tri!ester of er pregnan$y( s e noti$ed dar3ening of er ne$3( underarm and inguinal area& T'ird tri!ester pregnan$y( s e noti$ed stret$ mar3s and e8perien$ed slig t it$ iness+ Slig t dis$omfort &as felt all t roug out t e pregnan$y period+ Euring er se$ond trimester of pregnan$y( Ms+ Sepsis ad urinary tra$t infe$tion+ 7t &as treated t roug oral anti#ioti$s su$ as Cefale8in and #y drin3ing lots of &ater

Last Septem#er ;( 100' s e felt $ontra$tions o$$urring at t e inter)al of > minutes+ At Septem#er .( 100' s e sa& #ro&n #lood and t en $lear se$retions of a#out t&o spoonfuls+ T en s e &as admitted at t e same date at 0-200 pm+ S e too3 )itamins during t e $ourse of er pregnan$y li3e ?errous sulfate for t e first trimester t en Mi$ron C for t e se$ond trimester t en Terraferon for t e last trimester+ S e dran3 Anmum #ut stopped at t e .t mont as ad)ised #y er o#4gyne #e$ause t e #a#y &as already >+1. pounds+ III. PHYSICAL ASSESSMENT $IPPA!Ce,"alo+a1%al A,,roa+"' September 10, 2009 (12:15 am) P.A. o# )a*y )oy S U,on a% T2 -@+>HC AR2 1-1 #pm =t2 1+' 3g 546 Cleft lip and palate Clear #reat sound% no rales Normal respiratory rate and r yt m 5NRRR6 No murmur Normal A#dominal <o&el Sound 5NA<S6 Soft full equal pulses ission $li#te% #ro t"e C"art' 2ital si&ns(

September 10, 2009 (04:00 pm) Initial Intera+tion P.A. o# )a*y )oy S 2ital si&ns( AR2 1@> #pm Temp2 -;+1 mmAg
RR: 53 bpm

CEPHALO!CAUDAL APPROACH SI7N 4 4 4 NA7LS 4 4 4 4 AEAE Aair and S$alp 4 4 4 4 4 4 4 4 4 EJES 4 4 4 4 4 4 4 4 Eye#ro&s are e)enly distri#uted and symmetri$ally aligned Equal mo)ements of eye#ro&s Eyelas es are equally distri#uted( $urled slig tly out&ard lids are edematous transient stra#ismus <ul#ar $on,un$ti)a are $lear *alpe#ral $on,un$ti)a are s iny( smoot and pin3 No edema or tearing of la$rimal sa$ Aair is #la$3 Aair is e)enly distri#uted Sil3y( resilient air No dandruff or fla3ing Normal s3ull $onfiguration( rounded( smoot s3ull $ontour Smoot s3ull $ontour A#sen$e of nodules or masses Symmetri$al fa$ial features and mo)ements ?lat anterior fontanel = en palpated( t e nail #ase is firm Tissue surrounding nails is inta$t Con)e8 $ur)e and pin3is nails <lan$ test2 prompt return of pin3 $olor less t an 1 se$onds Ruddy $omple8ion =it good s3in turgor 5negati)e tenting6 S3in is &arm to tou$

S3ull and ?a$e

4 4 4 4 4 EARS 4 4 4 4 4 4 4 4 4 4 4 4 4 NECI 4 4 4 4 4 4

Ani$teri$ s$lerae Cornea are transparent( s iny and smoot Corneal refle8 noted *upil are equally round and re$epti)e to lig t 7ris is #la$3 in $olor

Auri$les are symmetri$al Auri$les are firm( smoot ( free from lesions and pain Tip of t e ear is aligned &it t e outer $ant us of eye *inna re$oils after it is folded inta$t startle refle8 Symmetri$al nares No flaring Nose is lo$ated symmetri$ally( midline of t e fa$e inta$t gla#ellar refle8 Lips and #u$$al mu$osa are pin3 in $olor( moist and smoot te8ture Tongue pin3 in $olor( slig tly moist% )eins not prominent Sores and ul$eration are not e)ident+ inta$t rooting refle8 *resen$e of ead lag Equal in si9e Areola is lig t #ro&n in $olor No palpa#le lump <ilaterally t e same No pain and tenderness upon palpation

NBSE ANE S7N/SES

MB/TA ANE TARBAT

<REAST ANE AK7LLAE

 RES*7RATBRJ 4 4 4 4 4 4 4 4 4 4 4 4 4 Symmetri$ &it full $ est e8pansion $ylinder s aped slig t sternal retra$tions *alpa#le arterial pulse *ulses are strong Rounded =it #o&el sounds during aus$ultation No a#normal lumps and ardened areas in t e a#dominal area Rugated s$rotum /rinary meatus at tip of penis Symmetri$al in s ape E8tremities are &ell fle8ed inta$t palmar grasp and #a#ins3i refle8

CARE7BLASC/LAR

:ASTRB7NTEST7NAL

:EN7TAL

/**ER ANE LB=ER EKTREM7T7ES

I2. DIAGNOSTIC AND LA)ORATORY PROCEDURES Diagnostic/Laboratory Date Indications Results Normal Analysis and Procedures Ordered/ or Purposes Values Interpretation Date Results He!at%"%(# HCT )*+ E+B+ 4 To aid @-+0 40+04 T e emato$rit is 0'C0'C100' diagnosis of >4+0 in$reased E+R+ a#normal & i$ is a sign of 0'C0'C100' states of de ydration+ ydration( poly$yt emia and anemia and aids in $al$ulation of eryt ro$yte indi$es P"ate"et To e)aluate platelet produ$tion To determine for presen$e of for furt er tests su$ as =<C differential infe$tion and also for determination $ount -1. 1404440 T e platelet $ount is in normal amount+ =<C is in$reased & i$ indi$ates presen$e of infe$tion+

,-C ct )./01/+

1>+.

4+-410+0

Granu"%c#tes 5810C16 5810C'16

>. 14+' 10+'

44+14 .0+1 1+04.+. 1+14>+1441. Aemoglo#in is in$reased & i$ indi$ates de ydration+

HG- 5gCdL6

To measure t e emoglo#in

1.+4

N1rsin& Res,onsi*ilities( Patient Pre2arati%n:

E8plain to t e SB t e indi$ationCpurpose of t e test( t at t is test dete$ts presen$e of infe$tion and ot er a#normal $onditions of t e #lood E8plain to t e SB t e pro$edure t at t e test requires #lood sample( and & o &ill perform it+ Tell t e SB t at t e #a#y may feel dis$omfort from t e needle pun$ture and pressure on t e tourniquet+ T at t e #a#y may struggle and $ry+

Pr%cedure 3 P%st test care4 7f ematoma de)elops at t e site( apply &arm soa3s+ Ensure su# dermal #leeding as stopped #efore remo)ing pressure+ 7f ematoma is large monitor pulses distal to t e site+ 2. Anato THE PATIENT AND HIS ILLNESS

y an% P"ysiolo&y

T e immune system is a $omple8 array of organs( $ells and $ emi$als t at determine self from non4self identify potential dangers to t e #ody and eliminate t em #y mounting an immune response+ Most 5#ut not all6 infe$tions result in lifelong immunity+ Some infe$tions are inno$uous & ile ot ers $ause serious disease( permanent damage to t e ost and sometimes deat + Rat er t an ris3 serious illness it is possi#le to )a$$inate against a num#er of potentially serious diseases+ La$$ination is offered from a young age against a num#er of diseases as an alternati)e to e8perien$ing natural infe$tion and t e asso$iated ris3s+ 7t is important to immuni9e infants as soon as possi#le to prote$t against disease and t e infant immune system is 3no&n to #e effe$ti)e and responsi)e+ Ao&e)er( t eir immune system is naM)e i+e+ as not #een e8posed to any pat ogens+ T erefore t e infant needs to de)elop immunity to e)ery pat ogeni$ organism it en$ounters+ <y t e time of #irt t e #a#y &ill a)e large num#ers of $ir$ulating anti#ody passed a$ross t e pla$enta from t e mot er+ T is anti#ody &ill prote$t t e #a#y against some infe$tions initially( until t e #a#y forms its o&n immune response to pat ogens+

O3er3ie4 o# t"e i

1ne syste

Bur immune system prote$ts us against )iruses( #a$teria and parasites & i$ $an $ause infe$tious diseases+ T e immune system responds to antigens+ An antigen is a su#stan$e t at stimulates a spe$ifi$ immune response( espe$ially t e produ$tion of anti#odies+ <asi$ally t is in)ol)es s ape re$ognition+ Antigens are usually proteins or polysa$$ arides( #ut $an #e any type of mole$ule+ 7nfe$tious agents su$ as )iruses and #a$teria a)e antigens & i$ t e immune system responds to+ La$$ines $ontain antigens 5often purified parts of t e original organism6+ Ty,es o# I 1nity

T e & ite #lood $ells of t e immune system are produ$ed in t e marro& of our #ones+ T e $ells are $arried in t e #lood to spe$iali9ed organs su$ as lymp nodes( & ere t ey de)elop and $ommuni$ate to laun$ immune responses against infe$tions+ =e a)e t ree types of immunity2 1+ N%n5s2eci$ic i!!unit# is a first line of defense and generally 3eeps infe$tions from entering t e #ody+ E8amples of t is are s3in 5p ysi$al #arrier6( mu$us(tears( stoma$ a$id+ 1+ Innate i!!unit# is t e se$ond line of defense+ 7n t is situation $ertain & ite $ells engulf infe$tious agents+ T ese $ells are $apa#le of re$ognising antigens & i$ are non4 self 5ie from an infe$tious agent6( o&e)er t ey $annot re$ogni9e parti$ular pat ogens+ ?or e8ample( t ese $ells &ould not #e a#le to distinguis an influen9a )irus from a epatitis )irus( #ut t ey &ould #e a#le to distinguis t at t ere &as a )iral infe$tion o$$urring+ B)er '00 of infe$tions are $ontrolled #y t ese $ells+ Ao&e)er & en t e infe$tion #e$omes too great t ese $ells &ill alert t e spe$ifi$ arm of t e immune system+ -+ S2eci$ic %r ada2tive i!!unit# T is is t e t ird line of defense+ 7n t is situation & ite #lood $ell $alled lymp o$ytes identify ea$ antigen indi)idually #y re$ogni9ing different sequen$es of amino a$ids+ T is spe$ifi$ response initially ta3es longer to generate 544; days6 t an t e non4spe$ifi$ arm #ut results in a memory to t e spe$ifi$ antigen+ T e memory response #e$omes qui$3ly a$ti)ated+ T is means t at & en an indi)idual is re4 infe$ted &it t e pat ogen( t is memory response &ill remo)e t e infe$tious agent #efore it $an $ause disease 5i+e+ in 14- days6+ T is is t e response t at )a$$ination targets+

5"at is %i##erent a*o1t t"e in#ant i

1ne syste

T e infantsF immune system is inta$t #ut immature at #irt + Some )a$$ines su$ as <C: and Aepatitis < &or3 &ell & en t ey are administered at #irt & ereas ot ers do not generate as strong a response+ T e main pro#lem &it #a#iesF immunity is t at it is )ery naM)e+ At t e time of #irt #a#ies a)e not #een e8posed to any pat ogens+ T is means t at #a#ies a)e to generate a full immune response to e)ery pat ogen t ey en$ounter+ Ea$ immune response ta3es a#out 10 days to generate+ T is is & ere maternal anti#ody $an #e important & en present2 7t &ill elp to prote$t an infant if t ey are e8posed to a pat ogen in t ose first 10 days+ /nli3e ot er animals 5su$ as ruminants6 & i$ rely mainly on passi)e transfer of maternal anti#odies in #reast mil3( umans re$ei)e most of t eir maternal anti#odies t roug pla$ental transfer of 7g:+ Ao&e)er( t ere &ill still #e some anti#odies transferred in #reast mil3( #ut t e le)els are mu$ lo&er+ 7n addition uman #a#ies donFt a)e a porous stoma$ 5li3e $al)es do6 in order to a#sor# t e anti#ody+ T erefore most of t e anti#ody in #reast mil3 &ill &or3 in prote$ting pat ogens $rossing t e oral $a)ity+

F1n+tion Non Spe$ifi$ immunity

Cyto3ine produ$tion

Natural 3iller T $ytoto8i$ity 53illing6

Complement system

Di##eren+e %1rin& I ,li+ations in#an+y * ago$ytes $annot migrateSlo& response to infe$tion to&ards infe$tious sites( alt oug t eir #a$teri$idal 53illing6 a$ti)ity is normal+ *oor produ$tion of $yto3ines( in7mpaired responses of ot er $ell parti$ular T 1 $yto3ines su$ aspopulations t at rely on t eir interferon gamma #y T4$ells+ fun$tions su$ as natural 3iller $ells+ $ell 7s in$omplete+ T ese7neffi$ient 3illing of )iruses a#normalities are pro#a#ly $aused #y immaturity in $yto3ine produ$tion of T $ells and mono$ytes+ Ee)elops progressi)ely during7neffi$ient p ago$ytosis t e first year of life

Spe$ifi$ immunity 5T4$ells and Ee)elops early in prenatal life Relati)e nai)ety of T and < $ells <4$ells6 T and < $ells first appear in 3eymean primary immune response organs from an early point inis relati)ely ineffi$ient fetal de)elopment2 a$$ounting for t e parti$ular sus$epti#ility of ne&#orns( espe$ially premature #a#ies( to <one marro& 5.410 #a$terial and )iral infe$tions+ &ee3s6 Repeated antigeni$ stimulation T ymus 5. &ee3s6 leads to t e $omplete maturation Spleen 5. &ee3s6 Lymp nodes 511 &ee3s6 of spe$ifi$ immunity during t e first fe& years of life+ Appendi8 511 &ee3s6 + Tonsils 514 &ee3s Spe$ifi$ immune responses appear to #e possi#le after as little as 11 &ee3s of fetal de)elopment+ Ao&e)er( T and < $ells are Nnai)eN( en$ountering antigens for t e first time+ 7g: su# group not produ$ed until t e se$ond year of life 7mpaired produ$tion of some7na#ility to respond to isotypes+ Lo& serum 7gM( 7gApolysa$$ aride en$apsulated and 7gE+ 7g: mostly of maternal#a$teria su$ as meningo$o$$al origin+ and pneumo$o$$al until a#out 1 years of age+

7mmunoglo#ulin 57g or anti#ody6 produ$tion

7na#ility to respond to polysa$$ aride )a$$ines Maternal anti#ody prote$tion 7g: against some infe$tious:i)es prote$tion against some from pla$enta organismFs $rosses t e pla$enta+infe$tions t at mot er e8posed or =anes during first year of life+ immunised against in$luding measles and meningo$o$$al disease+ Can interfere &it )a$$ines su$ as MMR+ Little or no prote$tion against ot er diseases su$ as & ooping $oug + Maternal prote$tion from Mostly 7gA *ro)ides additional prote$tion #reast mil3 against gut mi$ro#es( less effe$ti)e against respiratory infe$tions

T"e %e3elo,in& i
Maternal

1ne syste

*e#ore an% a#ter *irt"

T e immune system is designed to re$ogni9e OselfF )ersus Onon selfF+ T is means our o&n immune system $an re$ogni9e our o&n $ells as #eing safe and anyt ing else as #eing a t reat+ B#)iously t is as impli$ations in pregnan$y( & ere a de)eloping fetus &ill #e e8pressing antigens from t e fat er+ T erefore during pregnan$y modifi$ations o$$ur in t e maternal immune system at many le)els+ T ese $ anges are ne$essary to ensure a su$$essful pregnan$y+ 7n t e a#sen$e of su$ $ anges t e mot erFs immune system &ould re$ogni9e t e fetus as foreign 5li3e a pat ogen6 and re,e$t it+ *otentially dangerous T4$ell responses are do&n regulated 5redu$ed6 and some aspe$ts of t e non4spe$ifi$ immune system are a$ti)ated+ As pre)iously mentioned( at t is time spe$ifi$ 7g: anti#ody passes from t e mot er t roug t e pla$enta to t e de)eloping fetus pro)iding it &it temporary prote$tion against some of t e infe$tions t at t e mot er as #een e8posed to or )a$$inated against+ T is gi)es opportunities to pro)ide ne&#orns &it transient prote$tion against some diseases+ In#ant T e infantFs immune system is relati)ely $omplete at #irt + 7t is $lear t at t e 7g: anti#odies re$ei)ed from mot er are important for t e prote$tion of t e infant during t e first fe& mont s of life & ile t e infant is starting to de)elop its o&n repertoire+ *assi)e transient prote$tion #y 7gA against many $ommon illnesses is also pro)ided to t e infant in #reast mil3+ Mot erFs mil3 pro)ides 7gA against a &ide range of mi$ro#es t at t e mot er as ad in er gut+ <reast mil3 as also #een s o&n to assist in t e de)elopment of t e infantFs o&n immune system+ T ere is some( alt oug &ea3( e)iden$e to s o& t at #reastfed infants respond #etter to some )a$$ines+ T e ma,or impetus o&e)er for t e e8pansion of lymp o$ytes 5< and T $ells6 is t e e8posure to mi$ro#es & i$ $oloni9e t e gut during #irt + *remature and lo& #irt &eig t infants are at in$reased ris3 of e8perien$ing $ompli$ations of )a$$ine pre)enta#le diseases and alt oug prote$ti)e+ 6 -OO75-ASE8 PATHOPHYSIOLOGY t e immunogeni$ity of some )a$$ines may #e de$reased in t e smallest preterm infants( t e anti#ody $on$entrations a$ ie)ed are usually

S+"e

ati+ Dia&ra

$Flo4 C"art'

- Pa!"o "ysiolo*y

-%ym !oms

-.ab !es!s

-Trea!men!

Synt"esis o# t"e Disease Neonatal sepsis may #e $ategori9ed as early or late onset+ Eig ty4fi)e per$ent of ne&#orns &it early4onset infe$tion present &it in 14 ours( >0 present at 1444. ours( and a smaller per$entage of patients present #et&een 4. ours and @ days of life+ Bnset is most rapid in premature neonates+ Early4onset sepsis syndrome is asso$iated &it a$quisition of mi$roorganisms from t e mot er+ Transpla$ental infe$tion or an as$ending infe$tion from t e $er)i8 may #e $aused #y organisms t at $oloni9e in t e mot erNs genitourinary tra$t( &it a$quisition of t e mi$ro#e #y passage t roug mi$roorganisms most $ommonly asso$iated &it a $oloni9ed #irt $anal at deli)ery+ T e early4onset infe$tion in$lude group <

Streptococcus 5:<S6( Escherichia coli, Haemophilus influenzae, and Listeria monocytogenes. Late4onset sepsis syndrome o$$urs at ;4'0 days of life and is a$quired from t e $aregi)ing en)ironment+ Brganisms t at a)e #een impli$ated in $ausing late4onset sepsis syndrome in$lude $oagulase4negati)e stap ylo$o$$i( Staphylococcus aureus, E coli, Klebsiella, Pseudomonas, Enterobacter, Candida, :<S( Serratia, Acinetobacter, and anaero#es+ T e infantNs s3in( respiratory tra$t( $on,un$ti)ae( gastrointestinal tra$t( and um#ili$us may #e$ome $oloni9ed from t e en)ironment( leading to t e possi#ility of late4onset sepsis from in)asi)e mi$roorganisms+ Le$tors for su$ $oloni9ation may in$lude )as$ular or urinary $at eters( ot er ind&elling lines( or $onta$t from $aregi)ers &it #a$terial $oloni9ation+ Ris9 act%rs T e most $ommon ris3 fa$tors asso$iated &it early4onset neonatal sepsis in$lude

maternal :<S $oloni9ation 5espe$ially if untreated during la#or6( premature rupture of mem#ranes 5*RBM6( preterm rupture of mem#ranes( prolonged rupture of mem#ranes( prematurity( maternal urinary tra$t infe$tion( and $ orioamnionitis+ Ris3 fa$tors also asso$iated &it early4onset neonatal sepsis in$lude lo& Apgar s$ore 5P@ at 1 or > min6( maternal fe)er greater t an -.HC( maternal urinary tra$t infe$tion( poor prenatal $are( poor maternal nutrition( lo& so$ioe$onomi$ status( re$urrent a#ortion( maternal su#stan$e a#use( lo& #irt &eig t( diffi$ult deli)ery( #irt asp y8ia( me$onium staining( and $ongenital anomalies+ Ris3 fa$tors impli$ated in neonatal sepsis refle$t t e stress and illness of t e fetus at deli)ery( as &ell as t e a9ardous uterine en)ironment surrounding t e fetus #efore deli)ery+

Late onset sepsis is asso$iated &it t e follo&ing ris3 fa$tors2 prematurity( $entral )enous $at eteri9ation 5duration of Q10 d6( nasal $annula $ontinuous positi)e air&ay pressure use( A1 #lo$3erCproton pump in i#itor use( and gastrointestinal tra$t pat ology+ Race4 <la$3 infants a)e an in$reased in$iden$e of :<S disease and late4onset sepsis+ T is is o#ser)ed e)en after $ontrolling for ris3 fa$tors of lo& #irt &eig t and de$reased maternal age+ Se.4 T e in$iden$e of #a$terial sepsis and meningitis( espe$ially for gram4negati)e enteri$ #a$illi( is ig er in males t an in females+ A(e4 *remature infants a)e an in$reased in$iden$e of sepsis+ T e in$iden$e of sepsis is

signifi$antly ig er in infants &it )ery lo& #irt &eig t 5P1000 g6( at 1@ per 1000 li)e #irt s( t an in infants &it a #irt &eig t of 100041000 g( at .4' per 1000 li)e #irt s+ T e ris3 for deat or meningitis from sepsis is ig er in infants &it lo& #irt &eig t t an in full4term neonates+ Si(ns and S#!2t%!s T e $lini$al signs of neonatal sepsis are nonspe$ifi$ and are asso$iated &it $ ara$teristi$s of t e $ausati)e organism and t e #odyNs response to t e in)asion+ T ese nonspe$ifi$ $lini$al signs of early sepsis syndrome are also asso$iated &it ot er neonatal diseases( su$ as respiratory distress syndrome 5RES6( meta#oli$ disorders( intra$ranial emorr age( and a traumati$ deli)ery+ :i)en t e nonspe$ifi$ nature of t ese signs( pro)iding treatment for suspe$ted neonatal sepsis & ile e8$luding ot er disease pro$esses is prudent+

Cardiac si(ns2 7n o)er& elming sepsis( an initial early p ase $ ara$teri9ed #y pulmonary ypertension( de$reased $ardia$ output( and ypo8emia may o$$ur+ T ese $ardiopulmonary distur#an$es may #e due to t e a$ti)ity of granulo$yte4deri)ed #io$ emi$al mediators( su$ as ydro8yl radi$als and t rom#o8ane <1( an ara$ idoni$ a$id meta#olite+ T ese #io$ emi$al agents a)e )aso$onstri$ti)e a$tions t at result in pulmonary ypertension & en released in pulmonary tissue+ A to8in deri)ed from t e polysa$$ aride $apsule of type 777 Streptococcus as also #een s o&n to $ause pulmonary ypertension+ T e early p ase of pulmonary ypertension is follo&ed #y furt er progressi)e de$reases in $ardia$ output &it #rady$ardia and systemi$ ypotension+ T e infant manifests o)ert s o$3 &it pallor( poor $apillary perfusion( and edema+ T ese late

signs of s o$3 are indi$ati)e of se)ere $ompromise and are mortality+

ig ly asso$iated &it

:etab%"ic si(ns2 Aypogly$emia( ypergly$emia( meta#oli$ a$idosis( and ,aundi$e all are meta#oli$ signs t at $ommonly a$$ompany neonatal sepsis syndrome+ T e infant as an in$reased glu$ose requirement #e$ause of sepsis+ T e infant may also a)e impaired nutrition from a diminis ed energy inta3e+ Meta#oli$ a$idosis is due to a $on)ersion to anaero#i$ meta#olism &it t e produ$tion of la$ti$ a$id+ = en infants are ypot ermi$ or t ey are not 3ept in a neutral t ermal en)ironment( efforts to regulate #ody temperature $an $ause meta#oli$ a$idosis+ Gaundi$e o$$urs in response to de$reased epati$ glu$uronidation $aused #y #ot destru$tion+ epati$ dysfun$tion and in$reased eryt ro$yte

Neur%"%(ic si(ns2 Meningitis is t e $ommon manifestation of infe$tion of t e CNS+ 7t is primarily asso$iated &it :<S 5-@06( E coli 5-106( and Listeria spe$ies 5>41006 infe$tions( alt oug ot er organisms su$ as S pneumoniae, S aureus, Staphylococcus epidermis, H influenzae( and spe$ies of Pseudomonas,

6 CLIENT5-ASE8 PATHOPHYSIOLOGY S+"e ati+ Dia&ra $Flo4 C"art'

- Pa!"o "ysiolo*y

-%ym !oms

-.ab !es!s

-Trea!men!

Synt"esis o# t"e Disease

As for <a#y <oy S( e ad an early4onset neonatal sepsis+ A type of sepsis a$quired from t e mot er andCor #efore deli)ery+ Early4onset neonatal sepsis most often appears &it in 14 ours of #irt + Ris9 act%rs %$ -ab# -%# S inc"udes Male4 it is said t at neonatal sepsis is $ommon to male infants t an female+ Maternal /T74 #a#y #oy SFs mot er ad /T7 during t e se$ond trimester Si(ns and S#!2t%!s T e patient e8perien$ed2 Continuous )omiting during t e first 14 ours of life Clini$al Signs in$ludes2 7n$reased =<C $ount of 1>+. gCL Results in 0'40'40' Normal )alue of 4+-410+0 gCL 7n$reased emato$rit $ount of @-+0 Results in 0'40'40' Normal )alue of 40+04>4+0 for males

2I. THE PATIENT AND HIS CARE .. Me%i+al Mana&e ent A& I2F IVF Date Ordered Date Performed Sept+ '( 100' 1121> a+m+ General Description T is medi$ation is a solution gi)en #y )ein 5t roug an 7L6+ 7t is used to supply &ater and $alories to t e #ody+ 7t is also used as a mi8ing solution 5diluent6 for ot er 7L medi$ations+ Ee8trose is a natural sugar found in t e #ody and ser)es as a Indications lient!s Response t e $lient ad ered &ell and did not manifest for any side effe$ts

E10= >00$$ 8 . ugttsCmin

7L solutions $ontaining de8trose are indi$ated for parenteral replenis ment of fluid and minimal $ar#o ydrate $alories as required #y t e $lini$al $ondition of t e patient+ 7t

ma,or energy sour$e+ = en used as an energy sour$e( de8trose allo&s t e #ody to preser)e its mus$le mass+

is also use as a mi8ing solution for ot er 7L medi$ation+

N1rsin& Res,onsi*ilities Pri%r: Lerify do$torFs order+ Ino& t e type( amount( and indi$ation of 7L t erapy *repare for t e 7L infusion set+ Clean t e insertion site+ 8urin(: Eo and &as ing Bpen and prepare t e infusion set Eo t e 7L insertion pro$edure Eress and la#el t e )enipun$tures site A$ter: La#el t e 7L tu#ing &it t e date and time of atta$ ment and initials of t e nurse+ Regulate 7L+ B#ser)e for potential $ompli$ation+ Eo$ument rele)ant data and re$ord t e start of t e infusion on t e $lientFs $ art+ 6 OGT "edical "anagement B:T Date Ordered Date Performed Sept+ 10( 100' 112-0 a+m+ General Description *assing a ru##erCplasti$ tu#e )ia mout Indications lient!s Response t e $lient ad ered &ell and did not manifest for any side effe$ts

To pre)ent )omiting &it resultant aspiration of gastri$ $ontents

N1rsin& Res,onsi*ilities Pri%r: Lerify do$torFs order+ 7nform t e SB+ E8plain t e purpose of B:T+ *ra$ti$e stri$t asepsis+ 8urin(: Eo and &as ing+ *repare t e materials needed for t e pro$edure+ A$ter: C e$3 for t e paten$y+ ). Generic Name Brand Name :eneri$ Name2 Ampi$illin <rand Name2 Ampi$in Generic Name Brand Name :eneri$ Name2 Ami3a$in Sulfate <rand Name2 Ami3in Date Ordered/ Date Taken !"te !# Genera) admini$trati!n (cti!n D!$a%e and #re&"enc' and (dmini$trati!n 7L 1>mg q 11 7n i#its protein synt esis #y #inding dire$tly to t e -0S ri#osomal su#unit% #a$teri$idal+ *)ient+$ re$p!n$e Dr1&s Date Ordered/ Date Taken !"te !# admini$trati!n D!$a%e and #re&"enc' and (dmini$trati!n 7L 100mg q 11 Genera) (cti!n *)ient+$ re$p!n$e

Sept+ '( 100'

7n i#its $ell &all synt esis during #a$terial multipli$ation+

Client responded &ell and ad no ad)erse rea$tion to drug+

Sept+ '( 100'

A redu$tion in neutrop ils as #een noted+

N1rsin& Res,onsi*ilities Pri%r: C e$3 for t e do$torFs order and medi$ation $ art *repare materials needed <efore gi)ing drug as3 t e patient a#out allergi$ rea$tions to $ertain drugs su$ as peni$illin+ A negati)e istory of t e drug allergy is not a guarantee against a future allergi$ rea$tion+ Eo s3in testing B#tain spe$imen for $ulture and sensiti)ity test #efore gi)ing first dose+ T erapy may #egin pending results+ 8urin(: Remem#er t e 10 RFs in gi)ing medi$ations+ A$ter: Tell t e patientC SB to ta3e t e entire quantity of t e drug e8a$tly as pres$ri#ed e)en after t e patient feels &ell+ En$ouraged patient to in$rease fluid inta3e T erapy $ontinuous for ; to 10 days+ 7f no response o$$ur after - to > days stop t e t erapy and o#tain ne& spe$imens for $ulture and sensiti)ity+ =at$ signs and symptoms of super infe$tion 5esp+ /pper Respiratory Tra$t6 su$ as $ontinued fe)er( $ ills and in$rease pulse rate+ 7nform patient to notify pres$ri#er if ras ( fe)er or $ ills de)elop+ A ras is a most $ommon allergi$ rea$tion+ C. Diet #ype of Diet N*B

Date Ordered Sept+ '( 100' 1121> p+m+

General Indication Description Restri$tion to To pre)ent ta3e food )ia oral aspiration+ route+

lient!s Response *atient did not re$ei)e anyt ing #y mout +

N1rsin& Res,onsi*ilities Pri%r: C e$3 t e do$torFs order+

 C e$3 t e rig t $lient+ Ma3e sure t at t e diet is properly instru$ted+ 8urin(: Monitor if t e SB $omplies &it t e diet gi)en for t e patient+ A$ter: Assess for t e patientFs $ondition+

2II. NURSING CARE PLAN Pro*le ($$e$$ment no.. NUTRITIONAL IM)ALANCE( LESS THAN )ODY RE7UIREMENTS N"r$in% Dia%n!$i$ 7m#alan$ed nutrition less t an #ody requirement related to ina#ility to ingest or digest food or nutrients Scienti#ic ,-p)anati!n T e patientFs inta3e of nutrients is insuffi$ient to meet t e #odyFs meta#oli$ demands+ T e #ody t en rea$ts to t e lo& nutrient synt esis t us $ompensatory me$ anisms are a$ti)ated su$ as de$rease in a$ti)ity( &eig t loss Ob.ecti/e$ N"r$in% 0nter/enti!n$ QMonitor and re$ord )ital signs QMonitor &eig t ati!na)e ,-pected O"tc!me After - ours of nursing inter)entions( t e SB &ill )er#ali9e understanding of $ausati)e fa$tors & en 3no&n and ne$essary inter)entions+

SQ R BQ *atient may manifest2 Q )omiting Q poor mus$le tone Q #ody &ea3ness Qloss of &eig t

After - ours of nursing inter)entions( t e SB &ill )er#ali9e understanding of $ausati)e fa$tors & en 3no&n and ne$essary inter)entions+

QTo pro)ide $omparati)e #aseline QTo monitor progression of $ondition QTo $orre$t or $ontrol underlying fa$tors

QAssist in de)eloping indi)iduali9ed regimen

Pro*le no. 8 HYPERTHERMIA ($$e$$ment N"r$in% Scienti#ic Dia%n!$i$ ,-p)anati!n SQ R Aypert ermia 7n sepsis( it implies t e presen$e of an BQ =<C is infe$tion of t e in$reased( a total #lood $aused of 1>+. & erein #y rapidly t e normal is 4+-4 multiplying 10+0 mi$roorganisms or to8ins & i$ Qs3in is &arm $an result to to tou$ ypert ermia as a defense me$ anism of t e #ody+

G!a)/,-pected O"tc!me After 1 our of nursing inter)entions( t e patientFs SB &ill #e a#le to identify underlying $auseC$ontri#uting fa$tors and importan$e of t e treatments( as &ell as signs and symptoms requiring furt er inter)ention+

0nter/enti!n$ Q7dentify underlying $ause

ati!na)e QTo 3no& & at are t e $auses of su$ $ondition+

,/a)"ati!n T e patientsF SB ad identified underlying $ause and $otri#uting fa$tors as &ell as t e importan$e of t e treatments+

Q Monitor sour$es QTo #e a#le to of fluid loss identify if t ere is de ydration and e8$essi)e fluid loss QMonitor la#oratory studies+ Q7dentify fa$tors t at t e SB $an $ontrol 5if any6 QTo monitor t e status of t e $lient QTo prote$t t e $liet from any fa$tor & i$ may #e a9ardous to t e $lient Q?or t e SB to 3no& t e importan$e of pre)enting de ydration to o$$ur and t e &ays on o& to treat t e $lient+

QEis$uss importan$e of adequate fluid inta3e and treatments+

Pro*le Assess S4 R

no. 0 INTERRUPTED )REAST FEEDING ent N1rsin& Dia&nosis 7nterrupted #reastfeeding related to neonateFs present illness as e)iden$ed #y separation of mot er to infant S+ienti#i+ E9,lanation Sin$e t e neonate is diagnosed for a)ing a neonatal sepsis( t e #a#y got separated from is mot er and pla$ed on a pri)ate room separate from er mot er+ 7nterrupted #reastfeeding de)elops sin$e t e mot er is una#le to #reast fed t e #a#y $ontinuously due to t eir separation+ Plannin& After 1 ours of nursing inter)ention and ealt tea$ ings t e mot er &ill identify and demonstrate te$ niques to sustain la$tation until #reastfeeding is initiated Inter3ention ;Assess mot erFs per$eption and 3no&ledge a#out #reastfeeding and e8tent of instru$tion t at as #een gi)en+ Q:i)e emotional support to mot er and a$$ept de$ision regarding $essationC $ontinuation of #reast feeding+ QEemonstrate use of manual piston4type #reast pump+ Rationale QTo 3no& & at t e mot er already 3no&s and needed to 3no&+ QTo assist mot er to maintain #reastfeeding as desired+ QAid in feeding t e neonate &it #reast mil3 &it out t e mot er #reastfeeding t e infant+ QTo pro)ide optimal nutrition and promote $ontinuation of #reastfeeding pro$ess E9,e+te% O1t+o e T e mot er &as a#le to identify and demonstrate te$ niques to sustain la$tation and identify te$ niques on o& to pro)ide t e ne&#orn &it #reast mil3+

B2 4T e ne&#orn is diagnosed &it a $ertain disease 5Sepsis6 4 T e ne&#orn &as separated from is mot er 4 T e mot er &as una#le to pro)ide #reast mil3 to er ne&#orn

QRe)ie& te$ niques for storageCuse of e8pressed #reast mil3

QEetermine if a routine )isiting s$ edule or ad)an$e &arning $an #e pro)ided Q*ro)ide pri)a$y( $alm surroundings & en mot er #reast feeds+ QRe$ommend for infant su$3ing on a regular #asis

QSo t at infant &ill #e ungryC ready to feed QTo promote su$$essful infant feeding QReinfor$es t at feeding time is pleasura#le and en an$es digestion+ QTo sustain adequate mil3 produ$tion and #reast feeding pro$ess

QEn$ourage mot er to o#tain adequate rest( maintain fluid and nutritional inta3e( and s$ edule #reast pumping e)ery - ours & ile a&a3e

no. : ;NO5LEDGE DEFICIT N"r$in% Scienti#ic ,-p)anati!n Dia%n!$i$ SQ!May Ino&ledge Neonatal sepsis is $aused #y 3inalaman #a defi$it an infe$tion dete$ted during ang laging related to or after t e deli)ery+ 7n t is pag4iya3 sa unfamiliarit $ase( t e patient &as 3ondisyon ng y &it t e identified to a)ing neonatal #a#y 3o information sepsis after t&o days+ ngayonS" resour$es+ Transpla$ental infe$tion or BQ an as$ending infe$tion from 4frequently t e $er)i8 may #e $aused #y as3 organisms t at $oloni9e in questions+ t e mot erNs genitourinary tra$t( &it a$quisition of t e mi$ro#e #y passage t roug a $oloni9ed #irt $anal at deli)ery+ T e mi$roorganisms most $ommonly asso$iated &it early4onset infe$tion in$lude group < Strepto$o$$us !"S#, Es$ eri$ ia $oli( Aaemop ilus influen9ae( and Listeria mono$ytogenes. = le t e depression fetl #y t e mot er &as $aused #y ormonal $ anges during t e pregnan$y+

Pro*le *"e$

Ob.ecti/e After 1 ours of N*7 t e patientsF SB &ill )er#ali9e understanding of t e $ondition( disease pro$ess and treatment+

N"r$in% 0nter/enti!n$ QEetermine $lientFs most urgent need from #ot $lientFs and nurseFs )ie&point+ Q*ro)ide situation rele)ant to t e situation+ QEis$uss $lientFs per$eption of need information related to $lientFs personal desires( needs( )alues( and #eliefs+ State o#,e$ti)es $learly in learnerFs term+ Q<egin &it t e information t e $lient already 3no&s and mo)e to & at t e $lient does not 3no& progressing to simple to $omple8+

ati!na)e QT is may differ and require ad,ustment in tea$ ing plan+ Q*re)ent o)erload+ Q7n order for t e $lient to feel $ompetent and respe$ted+

,/a)"ati!n T e patientsF SB )er#ali9ed understanding of t e disease pro$ess and &as a#le to $larify er $on$ern+

QCan arouse interestC limit sense of #eing o)er& elmed+

Pro*le

no. < RIS; FOR IMPAIRED PARENT-NEONATE ATTACHMENT

Assess S4 R

ent

B2 4T e ne&#orn is diagnosed &it a $ertain disease 5Sepsis6 4 t e ne&#orn is ospitali9ed 4 T e ne&#orn is separated from is parents

N1rsin& Dia&nosis Ris3 for 7mpaired parentC neonates Atta$ ment related to neonates p ysi$al illness and ospitali9ation+

S+ienti#i+ E9,lanation Eue to t e ne&#ornFs p ysi$al illness and ospitali9ation( t e parents may a)e fear on o& to andle t eir #a#y sin$e t e #a#y is on its fragile state and needed e8tra $are+ And sin$e e is t e 1st $ ild ospitali9ed in t eir family( t e parents mig t still #e unsure on o& to ta3e $are of t e #a#y+

Plannin& After - ours of nursing inter)ention and ealt tea$ ings t e mot er &ill identify and demonstrate te$ niques to en an$e #e a)ioral organi9ation of t e neonate +

Inter3ention Q7nter)ie& parents( noting t eir per$eption of situation and indi)idual $on$erns QEdu$ate parents regarding $ ild gro&t and de)elopment( addressing parental per$eptions Q 7n)ol)e parents in a$ti)ities &it t e ne&#orn t at t ey $an a$$omplis su$$essfully QRe$ogni9e and pro)ide positi)e feed#a$3 for nurturant and prote$ti)e parenting #e a)iors

Rationale QTo 3no& & at t e parents feelings a#out t e situation+ QAelps $larify realisti$ e8pe$tations

E9,e+te% O1t+o e T e parents &ill #e a#le to a)e a mutually satisfying intera$tions &it t eir ne&#orn+

QEn an$es self4$on$ept

QReinfor$es $ontinuation of desired #e a)iors

2III. DISCHARGE PLAN 6 :ETHO8 : 5 4 4 E T H 5 4 5 4 5 4 4 4 :edicati%n ampi$illin 100mg 7L q11 Ami3in SB4 1>mg 7L q11 E.ercise Stressed t at t e #a#y sleeps most often times Treat!ent Stressed importan$e of $omplying &it t e medi$ations Hea"t' Teac'in(s 7nstru$ted Mot er to #ring #a$3 t e #a#y in t e ospital for is medi$ation 7nstru$ted Mot er on t e time t e medi$ation &ill #e gi)en 7nstru$ted Mot er for t e drugFs side effe$t & i$ in$ludes $onstipation% diarr ea% di99iness% eada$ e% indigestion% nausea% pain( s&elling( or redness at t e in,e$tion site% sleeplessness% )omiting+ 4 4 4 4 4 4 4 8 5 4 7nstru$ted Mot er of t e importan$e of #reastfeeding 7nstru$ted Mot er on *roper <reastfeeding 7nstru$ted Mot er to e8pose t e #a#y to sunlig t at @200 am to 10200 am 7nstru$ted Mot er t at formula mil3 is only good for 4 ours 7nstru$ted Mot er on stri$t aspiration pre$aution 7nstru$ted Mot er to #urped t e #a#y after ea$ feedings 7nstru$ted Mot er to #at e daily t eir <a#y 8iet 7nstru$ted Mot er to feed t e #a#y as tolerated &it stri$t aspiration pre$aution

I<&

LEARNING 8ERIVE8 RO: THE STU8Y

At t e end( t e resear$ er reali9ed t at t ere is al&ays somet ing ne& to learn t at $ould elp you #e a #etter ealt $are pro)ider+ 7t is indeed true t at learning ne)er stops+ And &it t e $urrent trends t at &e a)e( it is part of t e nursesF responsi#ility to 3eep t emsel)es a#reast &it t e ne& trends+ =it t e study made #y t e resear$ er( s e ad a#le to identify & at neonatal sepsis is( its ris3 fa$tors( signs and symptoms of t e disease( diagnosti$ pro$edure t at $an #e done to diagnose t e disease( its medi$al treatment( pre)ention and nursing $are plan spe$ifi$ for t e disease+ =it t e 3no&ledge learned during t e study( t e resear$ er $an #e a#le to promote &ellness #y ealt tea$ ings to mot er and to persons unfamiliar &it t e disease and pre)ention of t e disease+ Euring t e $ourse of t e study( t e importan$e of proper infe$tion $ontrol and and &as ing &as found out for t e pre)ention in t e spread of infe$tion espe$ially in t e ospital+ T e resear$ er found out t at proper 3no&ledge of t e staff regarding t e disease $ondition of a patient &it neonatal sepsis is )ital for t e #etterment of er ser)i$e as one of t e pro)iders of $are on a ospital+ T is $ase study as also gi)en t e resear$ er t e great opportunity to s are is personal e8perien$e in t e $are of a patient &it neonatal sepsis+ CONCLUSIONS <ased on t e resear$ ers e8perien$e neonatal sepsis is not a )ery $ru$ial $ase alt oug t ere are lots of reported $ases &it se)ere neonatal sepsis+ Bnset $an #e pre)ented and #e treated espe$ially in t e $ase of Late4onset neonatal sepsis+ *rompt treatment and adequate 3no&ledge a#out t e disease pro$ess is needed so t at $ompli$ations &ill not arise+ Bn t e ot er and your $are is not only $onfined to t e patient #ut e8tends signifi$antly to t e family+ Ino&ledge and appropriate s3ills are part of t e tools of t e nurse in order to #e effe$ti)e in andling a patient &it neonatal sepsis+ Aa)ing a $lear understanding of t e disease and its pro$ess( &it $onsideration of t e feelings and #eliefs of t e parents( most espe$ially( &ill aid t e nurse in s3illfully meeting patientFs needs+

RECOMMENDATIONS At t e $ourse of t e study( t e resear$ er ad found out t at an in4dept 3no&ledge a#out t e disease pro$ess &ill #enefit not only t e patient and its family #ut also t e nurse and t e medi$al staff as &ell+ T e follo&ing is a list of re$ommendations made #y t e resear$ er2 ?or t e Nurses2 An in4dept 3no&ledge s ould #e a$quired regarding t e disease $ondition so Nurses must stress t e need for good prenatal $are and emp asi9e on parents( t e )alue of regular $ e$34ups at &ell4#a#y $lini$s+ *roper infe$tion $ontrol espe$ially stri$t and &as ing s ould #e implemented in t e ospital #e$ause it is t e most effe$ti)e met od in $ontrolling t e spread of infe$tion from staff to patient+ ?or t e ospital2 Sterility or $leanliness of ospital equipment s ould #e maintained Seminars a#out infe$tion $ontrol s ould #e $ondu$ted so t at 3no&ledgea#le in t e pre)ention of infe$tion from spreading+ ?or t e patients $are2 Supporti)e treatment s ould all #e gi)en and is needed in patients $are+ ospital staff &ill #e

t at proper treatment and pre)ention $an #e implemented+

=. REFERENCES ttp2CC&&&+immune+org+n9CStT.'' ttp2CC&&&+do +go)+p Cospitalngpala&anCinde8+p pS optionT$omU$ontentV)ie&Tarti$leVidT1.V7temidT14 Eoenges(M+E+et+al+NursesF po$3et guide+100.+?+A+ EAL7S CBM*ANJ Go nson( G+J+100.+ Te8t#oo3 of Medi$al4surgi$al nursing+ 11t edition+ Lippin$ott =illiams V =il3ins