Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Angeles City
Presented to:
Presented By:
Pia Baluyut
Shelley Cayanan
Mervin Tuazon
BSNIV-8
GROUP 32
INTRODUCTION
The disease can be classified as: congenital, early-onset and late-onset. Congenital
neonatal sepsis is when the child is infected during pregnancy before birth. The baby
can be infected by virus through placenta or birth canal. HIV (Human Immunodeficiency
Virus), syphilis is some of the viruses that can infect the child before delivery. Early-
onset neonatal sepsis is when the infant is infected, while taking birth or soon after the
delivery. Group B streptococcus (GBS) and Escherichia coli (E. coli) are considered as
chief viruses that infect the baby, while birth. Early-onset neonatal sepsis is a result of
asymptomatic colonization in the intestinal or genital tract of the mother. Colonization is
existence of bacteria’s/viruses in a body part. An infant is said to be affected by late-
onset neonatal sepsis, when it is infected a few days after delivery. This infection can be
due to the organisms present in the environment of the hospital. After getting discharged
from hospital, babies can get infected due to the bacteria’s present in the environment at
home. GBS and E. coli are also responsible for late-onset neonatal sepsis. Symptoms of
early-onset neonatal sepsis are observed mostly within 24 hours of delivery, while that of
late-onset neonatal sepsis can be observed between 8th-89th days of delivery.
Symptoms observed in infants suffering from neonatal sepsis are unstable body
temperature, unable to suck breast milk properly, apnea, fever in rare cases, vomiting
and diarrhea, respiratory distress, reduced heart rate, jaundice, belly area may be
swollen.
WHO as of 2009, an estimated 82,000 children die every year before their fifth birthday
in the Philippines. Half of these deaths are related to common infectious diseases such
as diarrhea, pneumonia, neonatal sepsis and measles. In fact, half of neonatal deaths
occur during the first two days of life. Progress to curtail neonatal deaths is miserable,
with death rates among this age group showing only the barest decline over the past 20
years.
Infections are the most common cause of death in premature infants and a major threat
for poor outcomes," the authors write. Late-onset sepsis, i.e., infections arising after the
perinatal period (immediately before and after birth), mainly occur in the hospital and
affect 21 percent of very low birth-weight (VLBW; less than 3.3 lbs) neonates according
to background information in the article. Bovine lactoferrin (BLF; a milk glycoprotein)
inhibits the growth of a wide variety of bacteria, fungi, and viruses and has been shown
to exhibit even higher in vitro antimicrobial activity than human lactoferrin. Whether
lactoferrin can reduce the incidence of sepsis is unknown. In animal tests, the probiotic
Lactobacillus rhamnosus GG (LGG) improved the activity of lactoferrin but has not been
studied in infants.
Forty-five infants had a first episode of late-onset sepsis. The researchers found that
overall, late-onset sepsis occurred less frequently in the BLF and BLF plus LGG groups
(9/153 [5.9 percent] and 7/151 [4.6 percent], respectively) than in the control group
(29/168 [17.3 percent]). The decrease occurred for bacterial as well as fungal episodes.
The sepsis-attributable risk of death was significantly lower in the two treatment groups.
No adverse effects to treatment occurred. The researchers recommend this study
confirming the safety and efficacy of lactoferrin in VLBW infants, including more
extremely preterm infants, because they potentially will benefit the most from lactoferrin.
Combination strategies, such as the use of BLF plus LGG in the study should be
pursued, and substances that might affect lactoferrin activity, such as iron
supplementation, should be investigated. The effect of lactoferrin on hematocrit [the
proportion of blood that consists of packed red blood cells should be monitored, and the
effects of lactoferrin on neurodevelopmental outcome, hospital length of stay, and costs
should be studied.
An in-depth study about Neonatal Sepsis is extensively important for a nurse most
especially if the nurse is working in the pediatric ward or neonatal Intensive Care Unit or
the NICU department. A nurse should be properly educated regarding the cause of the
neonatal sepsis, how it is acquired and prevented, and its complications to prevent the
occurrence of late-onset neonatal sepsis. Being able to obtain knowledge about
neonatal sepsis can give the student nurses information that could help them in their
health teachings to patients about factors that could predispose an individual to this
disease. Being the health care provider of the patient means that student nurses have
the responsibility to prevent, treat and help in the rehabilitation of patients affected by the
disease.
Shall have an appropriate management and treatment to the patient and utilize it.
1. Personal Data
Baby Sepsis is a 2 days old baby boy who weighs 2.6kg, he is a catholic,
a Filipino, and lives in Angeles City. He was born on July 9, 2010 in their house
via NSD; he weighed 2.6 lbs, and was born full term. 1 day after his birth he had
jaundice, he was then rushed in one of the hospitals in Angeles City and there he
was confined with a diagnosis, T/C Neonatal Sepsis.
Baby Sepsis is only two days old when he was admitted, and since then he has
not experienced any illnesses.
When Baby Sepsis was only 2 days old, he began to had jaundice and had a
fever of 39oC he was then rushed in one of the hospitals in Angeles City.
Developmental task is to form a sense of trust versus mistrust. Child learns to love and
be loved. This was exhibited by Baby Sepsis when the student nurse was holding him,
he kept fidgeting and started to cry, while whenever his mother touches him, he keeps
calm. This proves that he can differentiate between his mother’s touch and a stranger’s
touch, he cries because he is unfamiliar with the student nurse and so has not yet
established trust. It would be important for the student nurse to provide a primary care
giver, provide experiences that add to security, such as soft sound and touch, provide
visual stimulation for active child involvement.
The child explores the world by using his mouth especially the tongue. Baby Sepsis
manifested this through his eagerness to suck on his pacifier and his instant reaction of
calming down once he begins sucking on a pacifier. It would do good to provide oral
stimulation by giving pacifiers, not discouraging thumb sucking.
Babies relate to the world through their senses, using only reflex behaviour. Stimuli are
assimilated into beginning mental images. This was evident from Baby Sepsis when his
reflexes were tested such as rooting reflex, sucking reflex, swallowing reflex, plantar
grasp reflex, babinski reflex, and magnet reflex.
Physical Examination
VS
T= 35.2oC
P= 102 bpm
R= 34 bpm
Head: dry lips with lesions around the mouth; yellow sclera; yellow conjunctiva;
without scars; without periorbital edema.
Skin: yellow in color ; with purple bruises on Right arm and leg;; poor skin turgor;
skin warm to touch; soft skin; no lesions; no scars.
Nails: capillary refill of <3sec; smooth pail nail beds; complete set of fingers and toes; no
scars; no wounds; no discolorations; no edema.
Neck: midline; no distention; no swelling lymph nodes; no lesions; no scars; no
tenderness; no edema.
Extremities (Upper and Lower):; IV insertion wounds on both arms; purple bruises
on upper and lower extremities.
V. The Patient and his Care
A. Medical Management
Date
Performed:
July 18 - 19
2010
Date Changed:
D10 W 500 cc x 7-
8ugtts/ min. # 3 Date
Performed: July
20 - 21, 2010
PNSS 500 cc x Date Ordered: Hypotonic It is used for BT. The client didn’t experience any
KVO solution allergic reaction.
July 19. 2010 containing a low
concentration of
solute relative to
Date another solution.
Performed: When a cell is
placed in a
July 19, 2010 hypotonic
solution, the
water diffuses
Date changed: into the cell,
causing the cell
to swell and
possibly
explode.
Date
Performed:
Date Changed:
Before:
After:
Oxygen Therapy Date Ordered Oxygen therapy Oxygen therapy is indicated to the The client was well oxygenated
and Performed: is used to treat patient to provide adequate without signs of hypoxia and
Via nasal cannula hypoxia. It can oxygenation and relieve respiratory distress
regulated 2-3 LPM July `13 - 21, be dispensed respiratory difficulty.
2010 from a cylinder,
piped-in-system,
liquid O2
reservoir or O2
concentration.
Nursing Responsibilities:
Before:
Phototherapy Phototherapy is Phototherapy was indicated to the The client still has jaundice and
the use of light patient because of observed icteric sclera after phototherapy
Date ordered
to icteric sclera and jaundice which
and performed:
photoisomerize the doctor diagnosed as
July 13, 2010 unconjugated hyperbilirubinemia.
bilirubin into
forms that are
more water-
soluble and can
be excreted
rapidly by the
liver and kidney
without
glucuronidation.
It provides
definitive
treatment of
neonatal
hyperbilirubinem
ia and
prevention of
kernicterus.
Nursing responsibilities
Before:
Oro-gastric tube OGT is the A oro-gastric tube is direct ito the The client was able to tolerate OGT
insertion process of stomach which enable gastric when giving feeding. The patient
Date ordered
placing a soft lavage. On the days of nurse didn’t experience aspiration.
and performed:
plastic tube patient interaction OGT is used to
July 16, 2010 through a deliver milk formulas to the baby’s
patient's mouth, stomach
past the pharynx
and down the
esophagus into
a
patient's stomac
h.
Oro- gastric
tubes are
inserted to
deliver
substances
directly into the
stomach, or to
remove
substances from
the stomach or
as a means of
testing stomach
function or
contents.
Nursing responsibilities
Before:
DATE
CHANGED
Blood Transfusion 40 cc DO: A blood transfusion is a To solve the problem The student nurses didn’t
(blood type B+) safe, common procedure regarding the abnormal results see the client during this
July 18, 2010 in Hematology like anemia, procedure.
in which blood is given to
luekopenia and
you through an thrombocytooenia.
intravenous (IV) line in
DP:
one of your blood
July 19, 2010 vessels.
During a blood
transfusion, a small
needle is used to insert
an IV line into one of
your blood vessels.
Through this line, you
receive healthy blood.
The procedure usually
takes 1 to 4 hours,
depending on how much
blood you need.
Nursing Responsibilities
Prior:
Vital signs must be checked after 15 minutes, then 30 minutes from then, then at one hour. then vital signs must be checked every
hour.
Taka note any reaction of the blood
If any reaction, STOP THE INFUSION OF BLOOD, maintain infusion of NSS and notify physician
Start the saline solution, attach the blood tubing primed with NSS to the intravenous catheter
Invert the blood bag gently several times to mix cells with the plasma, pull the tab and spike the Y set
Infuse slowly for 1st 15 minutes at 10gtts/m
Maintain aseptic technique.
After:
After transfusion, open normal saline and infuse ubtil tubing is clear
Proper Documentation
Wash hands.
DRUGS
Name of Date Route of General Action Indication(s Client’s Response to the
Drugs; Generic Ordered Administrati ) Medication with actual side
Name on, Dosage Functional effects
Date & Frequency Classification or
Brand Name Taken/ of
Given Mechanism of Purpose(s)
Administrati Action
on
Date
Changed/
D/C
Generic name: Date 30 mg IV q4 Anti pyretic Fever The client didn’t experience
Paracetamol 30Ordered: for 37.8 fever or temp of 37.8C.
mg IV q4 for July 16, Reduces fever
37.8 2010 by acting
directly on the
Brand Name: hypothalamic
Acetaminophen heat –
regulating
center to cause
vasodilation
and sweating,
which helps
dissipate heat.
Generic name: Date 30 mg IV q12 Antibiotic Septicemia The client didn’t experience
Ceftriaxone Ordered: caused by E. any allergic reaction.
Sodium July 16, Bactericidal: coli,
2010 Inhibits The drug is sensitive to the
Brand Name synthesis of microorganism found on his
Date bacterial cell
culture, making it effective as
Rocephin: Performed: wall, causing Meningitis
cell death. a treatment for his condition.
July 16 – Caused by
21, 2010 H.
influenxzae/
Cephalosporin some cases
rd
(3 generation). caused by S.
pnuemoniae
NURSING RESPONSIBILITIES FOR DRUG THERAPY:
NPO Date Ordered and No food and fluid is Food is prohibited None The client received
(Nothing Per Orem) Started passed through the after every lumbar nothing per orem
July 11, 2010 alimentary canal puncture to prevent and did not
spinal headache experience
Date Changed and vomiting. episodes of
July 13, 2010 vomiting.
Date started:
July 17 , 2010
*Back to MILK
feeding
Date started:
July 19, 2010 (BT)
MILK FORMULA Date Ordered and It is designed to It used when The client able to
WITH STRICT Started: simulate human breastfeeding is tolerate her milk
ASPIRATION July 13, 2010 milk. It is contraindicated, and didn’t
PRECAUTION individualized for mothers employed experience
Date Changed: the infant and is outside the home, aspiration.
July 17, 2010 determined in breast milk
specific amounts by production is
*Back to NPO considering the inadequate, sickly
requirements for mother, inborn
calories, CHON, errors of
Date started: vitamins and metabolism wherein
July 18 , 2010 minerals. It is babies lack
prepared in the necessary enzymes
*Back to NPO most sterile manner to digest or utilize
possible and fed to milk and for some
the baby depending personal reasons
on his hunger.
Nursing Responsibilities:
Before:
Dependent
5. aids in lowering
5. Administer down temperature
Anti-pyretics as
ordered
PROBLEM 2: Ineffective Thermoregulation r/t Immaturity and Illness
July 21 2010
S=
O=Received baby on bassinette under bililight with ongoing IVF #3 D10W 500cc @ 40
cc level draining via soluset @ 54 cc level regulated @ 4 ugtts/min infusing well on left
hand with 02 therapy via nasal cannula @ 2 LPM with OGT open draining minimal
coffee ground secretions, jaundice noted, icteric bulbar conjunctiva, pinkish palpebral
conjunctiva, with dried blood seen on lips with hematoma observed over baby’s
extremities and buttocks, with absence of apneic episodes and seizure attacks patient
remain free from signs of cyanosis with good strong cry, with good skin turgor, with
presence of milia on his nose with CRT of 2 sec with good cry with presence of babinski,
rooting, and mori reflex, with presence of dried blood on the umbilical cord with edema
present on his penis and scrotum. With VS taken and recorded as follows T-35.2 C CR-
102 bpm RR- 34 cpm
A=Ineffective tissue perfusion r/t abnormal blood profile AEB platelet count 60 x 109 and
decrease O2 sat 86.7%
P= after 3 hours of Ni the baby will demonstrate absence of signs of injury AEB absence
of bleeding episodes.
>kept thermoregulated
>kept OGTopen
>needs attended
7am seen on rounds by dra. Cadiz with orderts made and carried out
>cont meds
>cont bililight
>refer
E= Goal met AEB the baby demonstrated absence of signs of injury AEB absence of
bleeding episodes.
VI. 1.Client’s Daily Progress Chart
Vital Signs
T ---- 35.2oC
P --- 102 bpm
R --- 34 bpm
Medical Management
1. OGT
2. O2
3.D10 water
5.PNSS
Drugs
1. Cefuroxime
2. Gentamicin
3. Ceftriaxone
4. Vitamin K
5.Furosemide
Diet: NPO
VII. Conclusion and Recommendation
Learning Derived
As future nurses, our duty is to provide care to our patients and help them to
recover from their illness. In order to do this, we should have enough knowledge and
skills. We have to utilize these knowledge and skills to provide them with health
teachings to prevent diseases.
As a student nurse, the group came up with realizations essential to the future
practice of our profession. The knowledge, skills and attitudes we possess should be
enhanced and improved accordingly to properly address the medical and nursing needs
of the client. We are endowed with responsibility of providing the best possible care to
our patient and assisting them attain towards the achievement of optimum health.
Sufficient understanding of the disease condition and the therapeutic regimen involve in
the course of treatment will allow us to perform our duties and responsibilities within the
maximum criteria. Comprehension of the patient’s distinct needs will furnish the quality
of care for our patient and will enable us to apply individualized nursing care to our
patient and will strengthen for professional relation to our patient. But to top it all, the
best part conducting a case study is the sense of fulfilment we felt knowing that in one
way or the other we have touch one’s life by extending a hand and a heart when they
needed it most.
This case study helps our group in understanding the disease process of the patient.
By identifying the primary needs of the patient with Neonatal sepsis. It will help our group
to further learn the current trends to the disease condition, the right nursing intervention,
proper drug administration, the preventive aspects for the purpose of health teaching to
patients and the rationale behind the clinical manifestations. Effective management of
the problems identified will help the patient to recover faster and maintain a holistic
sense of wellness even while in the hospital. This case study had also equipped the
group with knowledge, skill and attitude on how to manage future patients with the same
or similar disease. And gave us an overview of the concepts we’ve studied before so we
could apply it to our day to day exposure to different individuals and to the hospitals and
communities.
During the course of making this requirement in RLE the group has learned a lot
about the disease sepsis which could affect neonates due to their weak immune system
and bodily response to infection. The case gave us an opportunity to study more about
the certain factors that lead to the occurrence of the disease the manifestations that it
would show and also the possible outcomes if it would not be treated immediately. The
human body has unique ways to fight of any foreign material in the circulation and
through the help of this case study not only us the researchers would benefit from it but
also to others who may make this presentation as a basis in further understanding the
disease condition. The encounter or handling of this certain patient would help us nurses
in the pursuit of the profession to be able to apply our knowledge to the succeeding
patients having the same condition and be able to provide necessary measures to
control or manage the problem.
Recommendations:
To the Philippine Government, that they may know the latest studies and research
being done in order to improve the quality of life of every people. They should put more
attention to public health to improve the output a citizen can provide this country, none
the less it would also be better and beneficial if they the government would also the
education standards of the Filipino citizens so that in any occurrence of crisis they opt to
find solution and remedies that would help to alleviate their problem.
To the Health Care Providers, particularly physician and nurses, that they may
impart their knowledge to the public in order to prevent the occurrence of further
complications, and the group would also recommend to them that they would opt to do
their duties with outmost perfection in the way that they can to alleviate the circumstance
of their patients and clients.
To the Medical Interns and Student Nurses, that they may become aware of the
current trends, studies, researchers and issues in both medicine and nursing fields, and
they opt to practice their duties to the best that they can so that in the future they would
be practicing the outmost care to their patients and clients.
To the Filipino people specifically to the patient, that they may have the
background regarding the latest studies being done to improve quality of life. The patient
should also watch for factors that could again aggravate their health. Their health is in
their hands so they should try to practice ways and techniques on how to avoid
complications such as this disease in our case study.