Neonatal Sepsis

I.
INTRODUCTION
“Neonatal sepsis deaths at Ospital ng Makati due to neglect – DOH”
For the past few weeks, headlines about Neonatal Sepsis that take place at
Ospital ng Makati were all featured on almost all of the newspaper, news bulletin and
news on the television in the Philippines. It had made a huge impact in the Philippines
concerning health issues. The news is about the outbreak of neonatal sepsis that
happens at OSMAK causing 23 neonatal deaths. According to the investigation, poor
infection control practices and overcrowding are the reasons for the outbreak that has
lead to Makati’s legal department to consider filing administrative cases against five
hospital staff whose negligence reportedly caused the babies’ deaths.
This issue is most important to nurses working on a hospital especially to those
who are assigned in a Neonatal Intensive Care Unit or NICU department. Proper
infection control and management should be well-implemented in the hospital in order to
avoid what had happen on the affected hospital.
Neonatal Sepsis on the other hand is an infection in the blood that spreads
throughout the body and occurs in a neonate. Neonatal Sepsis is also termed as
Neonatal Septicemia and Sepsis Neonatorum. Neonatal Sepsis has 2 types: The one
that is seen in the first week of life is termed as Early- onset sepsis and most often
appears in the first 24 hours of life. The infection is often acquired from the mother. This
can be cause by a bacteria or infection acquired by the mother during her pregnancy, a
Preterm delivery, Rupture of membranes (placenta tissue) that lasts longer than 24
hours, Infection of the placenta tissues and amniotic fluid (chorioamnionitis) and frequent
vaginal examinations during labor. The second type or the Late-onset Sepsis is acquired
after delivery. This can be cause by contaminated hospital equipment, exposure to
medicines that lead to antibiotic resistance, having a catheter in a blood vessel for a long
time, staying in the hospital for an extended period of time. Signs and symptoms of
Neonatal Sepsis includes but is not limited to: body temperature changes, breathing
problems, diarrhea, low blood sugar, reduced movements, reduced sucking, seizures,
slow heart rate, swollen belly area, vomiting, yellow skin and whites of the eyes
(jaundice). Possible complications are disability and worst is death of the neonate.
(Greene, 2007)
Neonatal sepsis occurs at an estimated rate of 1 to 2 cases per 1000 live births
in the U.S. The highest rates occur in low-birth-weight (LBW) infants, those with
depressed respiratory function at birth, and those with maternal perinatal risk factors.
The risk is greater in males (2:1) and in neonates with congenital anomalies (Merck,
2005). According to the Philippine Mortality Fact Sheet 2006 of the World Health
Organization, in 1000 live births of neonates 17% of it died due to severe infection that
includes deaths from pneumonia, meningitis, sepsis/septicemia, and other infections
during the neonatal period. (www.merck.com)
Looking at the table below, according to world health statistics done in the year
2004 Neonatal Infection rank as no 11 as a leading cause of death it was further
compared to the mortality statistics of the year 2030. In the year 2030 it was projected
that in the year 2030 Neonatal Infection will be lower down to rank 21 as a leading cause
of death. Updated mortality projections are based on historically observed relationships
between trends in economic and social development and cause-specific mortality.
www.who.com
Current Issues and Trends in Neonatal Sepsis
One of the most common causes of early-onset neonatal sepsis is the Group B
Streptococcal infection. On a journal published last April 02, 2008 entitled “Stricter
Adherence to Maternal Antibiotics Is Needed to Curb GBS Neonatal Sepsis” highlighted
that adequate intrapartum prophylaxis need to be improved especially on mothers with
GBS. They also added that to improve the prevention of these proven or probable GBS
infections, not only is strict adherence to prophylaxis recommendations needed but also
sensitive and faster testing of the carrier GBS status of the mother at delivery.
"To assess the effectiveness of GBS prophylaxis and to obtain reliable data about
the results of GBS prevention, the incidence of both culture-positive and culture-negative
GBS neonatal infection should be considered after removal from the analysis those
newborns with known intrauterine GBS infection, in whom prophylaxis is less effective,"
the researchers add. (www.medscape.com)
Another study was made entitled “Safety and Impact of Chlorhexidine Antisepsis
Interventions for Improving Neonatal Health in Developing Countries”. It is said in the
study that affordable, efficacious, and safe interventions to prevent infections and
improve neonatal survival in low-resource settings are needed. Chlorhexidine is a broad-
spectrum antiseptic that has been used extensively for many decades in hospital and
other clinical settings. It has also been given as maternal vaginal lavage, full-body
newborn skin cleansing, and/or umbilical cord cleansing to prevent infection in neonates.
Recent evidence suggests that these chlorhexidine interventions may have significant
public health impact on the burden of neonatal infection and mortality in developing
countries. This review examines the available data from randomized and nonrandomized
studies of chlorhexidine cleansing, with a primary focus on potential uses in low-
resource settings. Safety issues related to chlorhexidine use in newborns are reviewed,
and future research priorities for chlorhexidine interventions for neonatal health in
developing countries are discussed. It is concluded in the study that chlorhexidine-based
antisepsis interventions have the potential for significant reduction of the burden of
neonatal morbidity and mortality in developing countries, yet further information is
needed before policy recommendations can be made. (www.medscape.com)
An in-depth study about Neonatal Sepsis is so important for a nurse most
especially if the nurse is working in a 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, its complications, and etc. to prevent the
occurrence of late-onset neonatal sepsis that can possibly lead to legal cases like what
had happen in the case of Neonatal Sepsis in OSMAK.
After the completion of the study, a nurse shall be able to:

 Identify and differentiate the types of Neonatal Sepsis
 Be updated with the latest trends in the treatment of Neonatal Sepsis
 Perform a comprehensive assessment of Neonatal Sepsis
 Enumerate the different signs and symptoms of Neonatal Sepsis
 List down the different diagnostic procedures that would help in the diagnosis of
Neonatal Sepsis.
 Identify and understand different types of medical treatment necessary for the
treatment of Neonatal Sepsis.
 Formulate nursing care plans utilizing the nursing process
 Formulate conclusions based on the findings and enumerated a
recommendations concerning Neonatal Sepsis.
Nurse Centered Objectives:
♦ have critical thinking skills necessary for providing safe and effective nursing care.
♦ have a comprehensive assessment and implement care base on our knowledge
and skills of the condition
♦ familiarize ourselves with effective inter-personal skills to emphasized health
promotion and illness prevention.
♦ Impart the learning experience from direct patient care.
Patient and Family Centered Objectives:
At the end of this study, the patient/family will be able to:

1. Identify measures that could minimize the risk of occurrence of the disease.
2. Identify possible risk factors that may have contributed to the development of
Neonatal Sepsis.
3. Increase awareness on the risk factors of Neonatal Sepsis.
4. Develop the family’s support system and distinguish their respective roles in
improving patient’s health status.
5. Involve them in promoting the health care of the patient.
II. NURSING ASSESSMENT
A. Personal History
1. Demographic Data
Baby Boy V is a neonate born last June 24, 2008,
9:47 in the morning at OLMCMC. They resides somewhere
in Angeles City. Based on his ballard score of maturational
assessment of his gestational age, he is in between 36 to
37 weeks of age. He has a birth weight of 2.5 kg, a length
of 51 cm, head circumference of 30 cm, chest
circumference of 28cm and abdominal circumference of
25cm. He was born from a 31 years old G2P1 with a TPAL
of 1001 mother via normal spontaneous delivery. His
father is 34 years of age. Initially after birth he was place in
the nursery unit of the hospital for observation and was
transferred to NICU a day after he was born June 25,
2008. CBC with PC and Blood typing was ordered on the
same date when he was born. He was discharged from
the hospital last July 02, 2008 with a diagnosis of Neonatal
Sepsis, Culture positive (Enterobacter cloacae).
2. Socio- Economic and Cultural Factors

Baby Boy V’s family is an extended type of family.
Other than his father, mother and 1 sibling who is 5 years
older than him his grandmother is staying with them. They
are all Roman Catholics and are native kapampangans.
Baby Boy V’s father owns a jeepney and is working as a
jeepney driver while his mother is a plain housewife.
According to his mother their monthly income is
approximately P10, 000 per month and this income was
being used in budgeting for foods and daily needs,
electricity and water bills, some extras were being used for
their jeepney’s maintenance. With this expenses his
mother said that their way of living is just enough for them
to pass by.
Baby Boy V’s mother said that it is his mother who
cooks for them but usually they eat instant food and
canned goods because it’s the only food that can be
bought with their little budget. But nonetheless, they still
eat 3 times a day. And as for what they use when their
cooking they do have a gas stove but they still sometimes
use charcoal when cooking.
During his mother’s pregnancy, his mother is fond
of eating salty and sweet foods, usually fond of drinking
coffee at least 3 cups per day and drinks water of about 8-
10 glasses daily.
Baby Boy V’s father is a high school graduate while
his mother was an undergraduate who’s supposedly taking
up education as a course. But due to financial constraint
was unable to finish her education; she just then started
working as a saleslady. And when she got married she
stopped from work and was satisfied for being a plain
housewife.
With their grandmother living with them, their family
usually believes in “herbolaryos” and “albularyo” when
seeking for health advice. They also believe in
superstitions due to the influence of their grandmother.
One saying that his mother believes in is when his mother
is menstruating his mother usually does not take a bath
during her first day of menstruation believing that this
would cause her to be “insane”.
3. Environmental Factors
Baby Boy V’s family resides somewhere in Angeles
City. They lived near business establishments and
jeepney station; they have to endure the noisy and busy
environment marred by pollution. According to his mother
the place is also congested and establishments are built
almost close to each other. Their house is a bungalow type
which is made-up of hollow blocks and wood.
B. Obstetrical History
Her mother had her menarche at the age of 15 years old and
lasted for a week. From then on, she had regular menstrual period every
month and each period lasted for 5-7 days. She also experience
premenstrual dysmenorrhea and has heavy menstrual flow on the first 2
days of onset. She gave birth to her first baby at the age of 26.
1. Maternal-Obstetric Record
Baby Boy V’s mother got married when she was 25

years of age. She has an Obstetric record of Gravida 2,
Partum 2. She has a TPAL record of 2002. His mother
last menstrual period was last October 1, 2007. So her
estimated date of delivery was supposedly on July 8, 2008.
She had given birth to Baby Boy V last June 24, 2008 two
weeks ahead from her EDD. She was brought earlier than
her estimated date of confinement because she had an
early contraction and premature rupture of membrane.
She had given birth via NSD with the aid of an OB doctor
on a tertiary level hospital. She was diagnosed by her
doctor for having a Chronic Hypertension, she has a BP of
140/90 mmHg upon admission.
Baby Boy V has 1 sibling. His sibling was born via
NSD on the same hospital as a term healthy baby girl.
2. Ante-partal/ Pre-natal Preparation
According to Baby Boy V’s mother she had a

regular prenatal check-up on her doctor’s clinic. She goes
once a month during the first trimester, twice a month
during the second trimester, and every week during the
third trimester. She received 3 doses tetanus toxoid
vaccine from her doctor. It also said by the mother that she
really does have a BP of 140/90 mmHg but nothing is done
to manage it.
3. Significant Trimestral Changes (1st – 3rd trimester)
On the first trimester of the latest pregnancy, she

experienced episodes of nausea and vomiting. She is
knowledgeable that nausea and vomiting is a natural
discomfort of pregnancy. She neither did nor performed
any home remedy/management in order to relieve the
discomfort. She also felt early fatigability and manage it
through rest. Straining to defecate or constipation is also
experienced by the mother on the third month. This was a
result of the compression of the large intestine, restricting
normal bowel movement. She was advised to drink an
ample amount of liquid (8-10 glasses of water) and high
fiber food such as papaya in order to relieve the
discomfort. She accepted and followed the said advice
and constipation was gradually relieved.
On the second trimester of her pregnancy, she had
complained of frequent episodes of backache which was
caused by the weight of the developing babies. She also
experience early fatigability and headache which is a result
of hindered maternal blood flow caused by the fetal growth
and development. These second trimester discomforts
were managed by the patient through bed rest.
Third trimester pregnancy discomforts the patient
experienced shortness of breath and manage it by rest and
proper ventilation.
During her second and third trimester pregnancy
the mother had urinary tract infection. It was remedied
through oral antibiotics such as amoxicillin tablet, and by
drinking lots of water and by doing perineal hygiene.
C. Family- Health Illness History
The family
health illness history of
here indicates that the
familial illness history of Legend
Baby Boy V is a heart
disease that came from - Heart Dse.
his grandmother on the - Hypertension
father side, hypertension - UTI
from his maternal
grandfather and mother.
And the disease that is
associated to his current
illness is UTI that came
from his mother.
D. History of Present Illness
Baby Boy V was born last June 24, 2008, 9:47 am at OLOMCMC. Prior
to delivery her mother had a Premature Rupture of Membrane and early
contraction, the reason why his mother was brought early in the hospital. It is
also said by the mother that she had a difficult labor because the baby did not
come-out immediately. A lot of straining and pushing during delivery was
done as said by the midwife in the hospital, who was also present during her
delivery. Stress of the fetus during delivery is evident by him having a caput
succedaneum. Routine Newborn care was done including vitamin K
administration and giving of eye prophylaxis. His pediatrician then ordered
CBC typing and platelet count. He was not immediately brought to the NICU
unit but stayed first in the Nursery unit for further assessment. His initial CBC
count was as follows: WBC 11.5, Hgb. 213, Hct. 0.64, platelet count 130,
RBC 7.5. Though the results were slightly elevated Baby Boy V was not yet
transferred to their NICU unit. He was transferred to NICU because of poor
suck and edema in his upper and lower extremities. He has an initial
diagnosis of T/C neonatal sepsis.
E. Physical Examination
June 24, 2008 (Lifted from the chart)
Vital Signs:
RR-43 bpm
CR-135 bpm
Temp- 36.7oC
Measurements:
Length- 51 cm
Head Circumference- 50 cm
Chest Circumference- 28 cm
Abdominal Circumference- 25 cm
Weight - 2,5 kgs.
Apgar Score- 8-9
Physical Examination of the Newborn
Skin: (+) acrocyanosis, (+) thinning lanugo
Head: (+) caput, with soft, firm and flat fontanels
Eyes: (+) PERRLA, with pale palpebral conjunctiva
Ears: symmetrical, no discharge or lesions, well curved pinna; soft but ready recoil
Nose: no discharge
Chest: symmetrical lung expansion, stippled areola 12mm bud
Abdomen: (-) tenderness
Male genitalia: testes down, good rugae, with adequate urine output
Back: intact spine, (-) mass
Rectum: with patent anal opening, (+) passage of stool
Extremities: anterior transverse crease only
June 26, 2008 (Done by the researcher)
Vital Signs:
RR-63 bpm
CR-175 bpm
Temp- 38.5oC
Measurements:
Length- 51 cm
Head Circumference- 50 cm
Chest Circumference- 28 cm
Abdominal Circumference- 25 cm
Weight - 2,5 kgs.
General A ppearance: Seen baby in crib with ongoing IVF of D10W at 6-7 ugtts/min
via umbicath. He is less active and febrile. He has good cry and good suck but
does not demand feeding. He is well-flexed, with full range of motion and with
spontaneous movement.
Skin: with good turgor, nipples present and on expected locations, (-) cyanosis, skin
warm to touch.
Head: (-) Lacerations, (+) caput succedaneum, (-) bruising and swelling, with diamond-
shaped anterior fonatanel, with triangular-shaped posterior fontanel, fontanels
soft, firm and flat
Eyes: (-) tears when crying, (-) redness and purulent discharge, (+) edema around the
eyelids, (+) PERRLA, (+) blink reflex
Ears: pinna tends to bend easily, with startle reflex.
Nose: obligate nasal breathers, with bilateral patent nostrils, (-) nasal discharges, (-)
nasal flaring
Mouth: mucosa moist, tongue moves freely and does not protrude, (+) sucking and
rooting reflex
Neck: short and thick, turns easily side to side, able to raise head slightly when lying in
prone position
Chest: with evident xiphoid process, with symmetrical nipples, with symmetrical chest
movements, (-) retractions,(-) murmur
Abdomen: with (+) abdominal respirations, soft, cord dry at base, (+) bowel sounds, (+)
passage of stool, (-) mass
Male genitalia: Urinary meatus at tip of penis, with palpable testes, urine output 5gms
in an hour
Extremities: (+) edema on both extremities, (-) syndactyly, (-) polydactyly, with weak
peripheral pulses.
June 29, 2008 (Done by the researcher)
Vital Signs:
RR-48 bpm
CR-132 bpm
Temp- 36oC
General A ppearance: Seen baby in crib with ongoing IVF of D5IMB 113 cc via soluset
at 9-10 ugtts/min infusing well on his left hand. He is less active and afebrile. He has
good cry and good suck but less demand feedings. He is well-flexed, with full range of
motion and with spontaneous movement.
Skin: with good turgor, nipples present and on expected locations, (-) cyanosis, with
cold, clammy skin especially on the extremities part., (+) jaundice
Head: (-) Lacerations, (+)caput succedaneum, (-) bruising and swelling, with diamond-
soft, firm and flat
Eyes: (-) tears when crying, (-) redness and purulent discharge, (-) edema around the
nasal flaring
rooting reflex
prone position
Male genitalia: Urinary meatus at tip of penis, with palpable testes, with adequate u.o
Extremities: (+) edema on lower extremities, (-) syndactyly, (-) polydactyly, with weak
peripheral pulses.
July 01, 2008 (Done by the researcher)
Vital Signs:
RR-45 bpm
CR-135 bpm
Temp- 36.8oC
General Appearance: Seen baby in crib with ongoing IVF of D5IMB 98 cc via soluset at
7-8 ugtts/min infusing well on his left hand. He is active and afebrile. He has good cry,
good suck and demands feedings. He is well-flexed, with full range of motion and with
spontaneous movement.
Skin: with good turgor, nipples present and on expected locations, (-) cyanosis, warm
and dry.
Head: (-) Lacerations, (+)caput succedaneum, (-) bruising and swelling, with diamond-
soft, firm and flat
Eyes: (-) tears when crying, (-) redness and purulent discharge, (-) edema around the
nasal flaring
rooting reflex
prone position
Male genitalia: Urinary meatus at tip of penis, with palpable testes, with adequate u.o
Extremities: (-) edema on extremities, (-) syndactyly, (-) polydactyly, cold clammy skin
F. DIAGNOSTIC AND LABORATORY PROCEDURES
DIAGNOSTIC/ DATE INDICATION(S) OR RESULTS NORMAL ANALYSIS AND

LABORATORY ORDERED PURPOSE(S) VALUES INTERPRETATION OR
PROCEDURES DATE RESULTS
RESULT(S) IN
Complete Blood 06-24-08- ♦ CBC is done with the patient WBC- 11.5 5-10 x10 9/L The results indicates the
Count (CBC) 08:30 am for the purpose of identifying the presence of infection as
06-24-08- need for BT, effectiveness of BT Segmenter- 0.50-0.70 manifested by an increase in
12:00 nn and if there is a presence of 0.02 WBC count
infection: The CBC includes the -RBC, hemoglobin and
RBC count, hemoglobin, Lymphocyte- 0.20-0.40 hematocrit are elevated and
hematocrit, RBC indices, WBC 0.27 may probably indicates
count and platelet count. Blood presence of dehydration.
test done to the patient includes: Monocyte- 0.07 0.01-0.06 - thrombocytopenia may occur
(a) Hct which measures the in neonatal sepsis in response
concentration of RBC within the to the cellular products of the
blood volume, the blood test Eosinophil- 0.01 0.01-0.05 microorganisms. These
evaluates blood loss, anemia, cellular products cause
blood replacement and fluid Hgb- 213 M 140-180 platelet clumping and
balance and screens RBC g/L adherence leading to platelet
status; (b) Hgb is an important destruction.
component of RBC that carries Hct- 0.64 N 0.4-0.54
O2 and CO2 to and from tissue,
this test evaluates blood loss, PC- 130 150-350 x
erythropoietic ability, anemia 10 g/L
amd response to therapy;
(c)WBC is use to evaluate RBC- 7.5 M 5.5-6.5 x
number of conditions and 10 12/L
differentiates causes of -The results are within the
alterations in the total WBC normal limit except for the
06-28-08- count including infection, WBC- 6.6 platelet which has below
09:00 am inflammation and tissue Segmenter- normal result.
06-28-08- necrosis. Neutrophils and 0.55
12:00 nn Lymphocytes are components of Lymphocyte-
WBC; (d) Platelet count 0.36
evaluates platelet production Monocyte- 0.09
and use as screening test to Hgb- 187
platelet function Hct- 0.56
Pt. Centered Indication- PC- 120
st
1 CBC- determines presence of RBC- 6.5
infection obtained from the
mother and as part of his -The results are considered to
newborn assessment be in the normal level except
nd
07-01-08- 2 CBC- determines if there is a WBC- 10.3 for the platelet count.
08:50 am progress from his condition Segmenter-
07-01-08- 3rd CBC- determines if the baby 0.43
12:00 nn is ready to be discharged Lymphocyte-
0.52
Monocyte- 0.03
Eosinophil- 0.02
Hgb- 193
Hct- 0.58
PC- 120
RBC- 6.8
 Nursing Responsibilities 
Prior:
 Explain to the mother the purpose of the test.
 Inform them that the test requires a blood sample and that the patient may experience discomfort/pain from the needle
puncture.
 Inform them that there are no food or fluid restrictions.
 Lists drugs being taken by the client to detect any effect on results.
During:
 Inform the mother that venous blood is to be collected.
 Venipuncture should be performed in an aseptic technique as well as the collection of the sample.
 Handle the specimen gently to avoid hemolysis.
After:
 Make sure that the specimen bottles are labeled correctly.
 Put pressure over the puncture site.
 Inform them that the results will be out as soon as the specimen is interpreted in the laboratory.
DIAGNOSTIC/ DATE ORDERED INDICATION(S) OR RESULTS NORMAL VALUES ANALYSIS AND
LABORATORY DATE RESULT(S) PURPOSE(S) INTERPRETATION
PROCEDURES IN OR RESULTS
URINALYSIS 06-24-08- 08:30 This was done to Color: Color: The color,
am the patient as a Yellow Yellow appearance, and
06-24-08- 12:00 screening for specific gravity are
nn abnormalities within Appearance: Appearance: within normal limits.
the urinary system Clear Clear Presence of Pus
as well as for cells, Red cells,
system problems Specific Gravity: Specific Gravity: epithelial cells and
that may manifest 1.005 1.005-1.030 mucus threads
through the urinary indicates presence
tract. Pus Cells: Pus Cells: of infection.
0-2/HPF None
Red Cells: Red Cells:

0-1/HPF None
Epithelial Cells: Epithelial Cells:

Few None
Mucus Threads: Mucus Threads:
Light None
Albumin: Negative Albumin: Negative

Glucose: Negative Glucose: Negative
Prior:
 Inform the mother that there are no food or fluid restrictions before the test.
 Advise the mother of the procedure and the reason for the test.
During:
 The specimen should be sent to the laboratory within 1 hour after collection or if the specimen cannot be processed
immediately, refrigerate it.
 If a 24 – hour urine collection is requested the specimen should be refrigerated or preserved within formalin during the
collection time.
After:
 Record data.
 Relay result to the doctor
DIAGNOSTIC/ DATE INDICATION(S) OR PURPOSE(S) RESULTS NORMAL VALUES ANALYSIS AND
LABORATORY ORDERED INTERPRETATION
PROCEDURES DATE OR RESULTS
RESULT(S)
IN
Blood Urea 06-25-08 Blood urea nitrogen (BUN) 8.1 mg/dl 7-18 mg/dl The result is within
Nitrogen (BUN) 08:30 am measures the amount of urea the normal limit
nitrogen, a waste product of
06-25-08 protein metabolism, in the blood.
12:00 nn Urea is formed by the liver and
carried by the blood to the kidneys
for excretion. Because urea is
cleared from the bloodstream by
the kidneys, a test measuring how
much urea nitrogen remains in the
blood can be used as a test of
renal function. However, there are
many factors besides renal
disease that can cause BUN
alterations, including protein
breakdown, hydration status, and
liver failure.
Pt. centered indication
- to check how the kidneys are
functioning before starting to take
certain drug therapies.
Prior:
 Select vein for venipuncture (usually antecubital space).
 Apply tourniquet several inches above intended venipuncture site
 Clean venipuncture site (with povidone iodine or alcohol, allow area to dry).
During:
 Perform venipuncture by entering the skin with needle at approximately a 15-degree angle to the skin, needle bevel up.
 If using a Vacutainer, ease tube forward in holder once in the vein. If using a syringe, pull back on the barrel with slow, even
tension as blood fills the syringe.
 Release tourniquet when the blood begins to flow.
After:
 After the blood is drawn, place cotton ball over site; withdraw the needle and exert pressure. Apply bandage if needed.
 Properly dispose contaminated materials.
 Record the date and time of blood collection. Attach a label to each blood tube.
 Relay results to the doctor.
* Note: Do not use a vein site proximal to an IV infusion.

DIAGNOSTIC/ DATE INDICATION(S) OR PURPOSE(S) RESULTS NORMAL ANALYSIS AND
LABORATORY ORDERED VALUES INTERPRETATION
RESULT(S) IN
Creatinine 06-25-08 Creatinine has been found to be a fairly 0.68 mg/dl 0.4-1.4 mg/gl The result is within
08:30 am reliable indicator of kidney function. As the normal limit
the kidneys become impaired the
06-25-08 creatinine level in the blood will rise.
12:00 nn Abnormally high levels of creatinine
thus warn of possible malfunction or
failure of the kidneys
*** Nursing Responsibilities same from BUN

RESULT(S)
IN
Bilirubin 06-28-08 Within the first 24 hours of life, up to 50% Total 0.2-1.2 mg/dl The results are above
08:30 am of full-term newborns, and an even greater Bilirubin: normal. The results
percentage of pre-term babies, may have a 5.35 mg/dl can be caused by his
06-28-08 high bilirubin level. After birth, newborns Direct 0.0-0.05 mg/dl disease perse.
12:00 nn begin breaking down the excess red blood Bilirubin: Though results are
cells (RBCs) they are born with and, since 2.58 mg/dl high no intervention
the newborn’s liver is not fully mature, it is was done to cure the
unable to process the extra bilirubin, Indirect symptom,
causing the infant's bilirubin levels to rise in Bilirubin: intervention such as
the blood and other body tissues. This 2.77 mg/dl phototherapy via blue
situation usually resolves itself within a few light.
days.
Pt. centered indication

bilirubin diagnostic exam was ordered
when he shows evidence of jaundice
*** Nursing Responsibilities same from BUN

RESULT(S) IN
Hemogluco Test 06-25-08 The blood glucose test is ordered 45 mg/dl 40-60 mg/dl The result is within
(HGT) 08:30 am to measure the amount of glucose the normal limit
in the blood right at the time of
06-25-08 sample collection.
08:30 am
Prior:
 Determine for what purpose is the procedure ordered
 Maintain sterile technique
During:
 Gently extract blood specimen from the patient.
 Apply cotton on the punctured site.
After
 Document results
 Relay results to the doctor

RESULT(S) IN
Blood gram stain/ 06-25-08 Gram stain is a differential stain No definite Negative The result is normal
culture sensitivity 08:30 am used to demonstrate the staining Microorganism
test properties of bacteria seen
06-27-08 The result shows a
12:00 nn Your doctor may order blood heavy growth bacteria
cultures when you are having Culture positive Negative identified as
symptoms of septicemia or sepsis, With aerobic, enterobacter cloacae
which indicates that bacteria or heavy growth which indicates the
their products are causing harm in enterobacter diagnosis of
your body. Sensitivity testing cloacae septicemia. The result
report indicates on what antibiotics also shows sensitive
can be used that is sensitive to the Sensitive drugs and resistant drugs
microorganisms shown in blood that can be used applicable to the
culture exam. Amikacin bacterial growth found
Ampicillin- in blood culture. It is
Sulbactam also indicated that
Cefepime ampicillin and claforan
Chloramphenico is resistant to the
l organism.
Ciprofolaxacin
Imipenem
Levofloxacin
Meropenem
Norfloxacin
Piperacilin-
tazobactam
Sulbactam-
cefoperazon
Tigecycline
Tetracycline
(Obtaining of Blood GS/CS uses stricter aseptic method in obtaining blood samples than the other blood procedure to have a more
reliable and accurate results)
Prior:
 Select vein for venipuncture (usually antecubital space).
 Apply tourniquet several inches above intended venipuncture site
 Clean venipuncture site (with povidone iodine or alcohol, allow area to dry).
During:
 Perform venipuncture by entering the skin with needle at approximately a 15-degree angle to the skin, needle bevel up.
 If using a Vacutainer, ease tube forward in holder once in the vein. If using a syringe, pull back on the barrel with slow, even
tension as blood fills the syringe.
 Release tourniquet when the blood begins to flow.
After:
 After the blood is drawn, place cotton ball over site; withdraw the needle and exert pressure. Apply bandage if needed.
 Properly dispose contaminated materials.
 Record the date and time of blood collection. Attach a label to each blood tube.
 Relay results to the doctor.
RESULT(S) IN
Chest X-ray/ Baby Chest X-ray X-rays - a diagnostic test which Normal chest Normal The result is just
Gram APL uses invisible electromagnetic and baby gram normal.
06-25-08 energy beams to produce images findings.
06-25-08 of internal tissues, bones, and
organs onto film. Chest Baby gram- the
Baby Gram radiographs may depict segmental visualized
06-26-08 or lobar infiltrate but they more osseous
06-26-08 commonly reveal a diffuse, fine, structures are
reticulogranular pattern, much like not remarkable.
what is observed in RDS. Pleural Lungs are clear.
effusions may also be observed. The intestinal
gas pattern is
Pt. centered indication within normal
To determine for some evidence of
diffuse infiltrates and poor overall Chest APL-
aeration Both lung
parenchyma
are clear.
Cardiac shadow
is not enlarged.
The diaphragm
and bony thorax
are not unusual.
Prior:
 Explain the purpose of the CXR to the mother.

 Inform the mother whether they will be transported to the radiology department or have the x-ray done at bedside (portable
CXR).
 Tell the mother that the test will take only a few minutes and is painless
During:
 Provide a lead apron for any person who must hold the patient during the procedure.
 Provide extra blankets for patient chilled from exposure during CXR.
After:
 Assess respiratory status of patient.
III. ANATOMY AND PHYSIOLOGY
Immunology is the study of our protection from foreign macromolecules or

invading organisms and our responses to them. These invaders include viruses,
bacteria, protozoa or even larger parasites. In addition, we develop immune responses
against our own proteins (and other molecules) in autoimmunity and against our own
aberrant cells in tumor immunity.
Our first line of defense against foreign organisms are barrier tissues such as the
skin that stop the entry of organism into our bodies. If, however, these barrier layers are
penetrated, the body contains cells that respond rapidly to the presence of the invader.
These cells include macrophages and neutrophils that engulf foreign organisms and kill
them without the need for antibodies. Immediate challenge also comes from soluble
molecules that deprive the invading organism of essential nutrients (such as iron) and
from certain molecules that are found on the surfaces of epithelia, in secretions (such as
tears and saliva) and in the blood stream. This form of immunity is the innate or non-
specific immune system that is continually ready to respond to invasion.
A second line of defense is the specific or adaptive immune system which may
take days to respond to a primary invasion (that is infection by an organism that has not
hitherto been seen). In the specific immune system, we see the production of antibodies
(soluble proteins that bind to foreign antigens) and cell-mediated responses in which
specific cells recognize foreign pathogens and destroy them. In the case of viruses or
tumors, this response is also vital to the recognition and destruction of virally-infected or
tumorigenic cells. The response to a second round of infection is often more rapid than
to the primary infection because of the activation of memory B and T cells. We shall see
how cells of the immune system interact with one another by a variety of signal
molecules so that a coordinated response may be mounted. These signals may be
proteins such as lymphokines which are produced by cells of the lymphoid system,
cytokines and chemokines that are produced by other cells in an immune response, and
which stimulate cells of the immune system. The immune system is composed of two
major subdivisions, the innate or nonspecific immune system and the adaptive or
specific immune system (Figure 1). The innate immune system is our first line of defense
against invading organisms while the adaptive immune system acts as a second line of
defense and also affords protection against re-exposure to the same pathogen. Each of
the major subdivisions of the immune system has both cellular and humoral components
by which they carry out their protective function (Figure 1). In addition, the innate
immune system also has anatomical features that function as barriers to infection.
Although these two arms of the immune system have distinct functions, there is interplay
between these systems (i.e., components of the innate immune system influence the
adaptive immune system and vice versa).
Although the innate and adaptive immune systems both function to protect
against invading organisms, they differ in a number of ways. The adaptive immune
system requires some time to react to an invading organism, whereas the innate
immune system includes defenses that, for the most part, are constitutively present and
ready to be mobilized upon infection. Second, the adaptive immune system is antigen
specific and reacts only with the organism that induced the response. In contrast, the
innate system is not antigen specific and reacts equally well to a variety of organisms.
Finally, the adaptive immune system demonstrates immunological memory. It
“remembers” that it has encountered an invading organism and reacts more rapidly on
subsequent exposure to the same organism. In contrast, the innate immune system
does not demonstrate immunological memory.
All cells of the immune system have their origin in the bone marrow and they
include myeloid (neutrophils, basophils, eosinpophils, macrophages and dendritic cells)
and lymphoid (B lymphocyte, T lymphocyte and Natural Killer) cells (Figure 2), which
differentiate along distinct pathways (Figure 3). The myeloid progenitor (stem) cell in the
bone marrow gives rise to erythrocytes, platelets, neutrophils, monocytes/macrophages
and dendritic cells whereas the lymphoid progenitor (stem) cell gives rise to the NK, T
cells and B cells. For T cell development the precursor T cells must migrate to the
thymus where they undergo differentiation into two distinct types of T cells, the CD4+ T
helper cell and the CD8+ pre-cytotoxic T cell. Two types of T helper cells are produced in
the thymus the TH1 cells, which help the CD8+ pre-cytotoxic cells to differentiate into
cytotoxic T cells, and TH2 cells, which help B cells, differentiate into plasma cells, which
secrete antibodies.
The main function of the immune system is self/non-self discrimination. This

ability to distinguish between self and non-self is necessary to protect the organism from
invading pathogens and to eliminate modified or altered cells (e.g. malignant cells).
Since pathogens may replicate intracellularly (viruses and some bacteria and parasites)
or extracellularly (most bacteria, fungi and parasites), different components of the
immune system have evolved to protect against these different types of pathogens. It is
important to remember that infection with an organism does not necessarily mean
diseases, since the immune system in most cases will be able to eliminate the infection
before disease occurs. Disease occurs only when the bolus of infection is high, when the
virulence of the invading organism is great or when immunity is compromised. Although
the immune system, for the most part, has beneficial effects, there can be detrimental
effects as well. During inflammation, which is the response to an invading organism,
there may be local discomfort and collateral damage to healthy tissue as a result of the
toxic products produced by the immune response. In addition, in some cases the
immune response can be directed toward self tissues resulting in autoimmune disease.
NON-SPECIFIC IMMUNITY
The elements of the non-specific (innate) immune system (Table 2) include

anatomical barriers, secretory molecules and cellular components. Among the
mechanical anatomical barriers are the skin and internal epithelial layers, the movement
of the intestines and the oscillation of broncho-pulmonary cilia. Associated with these
protective surfaces are chemical and biological agents.
A. Anatomical barriers to infections
1. Mechanical factors
The epithelial surfaces form a physical barrier that is very impermeable to most
infectious agents. Thus, the skin acts as our first line of defense against invading
organisms. The desquamation of skin epithelium also helps remove bacteria and other
infectious agents that have adhered to the epithelial surfaces. Movement due to cilia or
peristalsis helps to keep air passages and the gastrointestinal tract free from
microorganisms. The flushing action of tears and saliva helps prevent infection of the
eyes and mouth. The trapping effect of mucus that lines the respiratory and
gastrointestinal tract helps protect the lungs and digestive systems from infection.
2. Chemical factors
Fatty acids in sweat inhibit the growth of bacteria. Lysozyme and phospholipase
found in tears, saliva and nasal secretions can breakdown the cell wall of bacteria and
destabilize bacterial membranes. The low pH of sweat and gastric secretions prevents
growth of bacteria. Defensins (low molecular weight proteins) found in the lung and
gastrointestinal tract have antimicrobial activity. Surfactants in the lung act as opsonins
(substances that promote phagocytosis of particles by phagocytic cells).
3. Biological factors
The normal flora of the skin and in the gastrointestinal tract can prevent the
colonization of pathogenic bacteria by secreting toxic substances or by competing with
pathogenic bacteria for nutrients or attachment to cell surfaces.
B. Humoral barriers to infection
The anatomical barriers are very effective in preventing colonization of tissues by

microorganisms. However, when there is damage to tissues the anatomical barriers are
breached and infection may occur. Once infectious agents have penetrated tissues,
another innate defense mechanism comes into play, namely acute inflammation.
Humoral factors play an important role in inflammation, which is characterized by edema
and the recruitment of phagocytic cells. These humoral factors are found in serum or
they are formed at the site of infection.
1. Complement system – The complement system is the major humoral non-specific

defense mechanism (see complement chapter). Once activated complement can lead to
increased vascular permeability, recruitment of phagocytic cells, and lysis and
opsonization of bacteria.
2. Coagulation system – Depending on the severity of the tissue injury, the coagulation
system may or may not be activated. Some products of the coagulation system can
contribute to the non-specific defenses because of their ability to increase vascular
permeability and act as chemotactic agents for phagocytic cells. In addition, some of the
products of the coagulation system are directly antimicrobial. For example, beta-lysin, a
protein produced by platelets during coagulation can lyse many Gram positive bacteria
by acting as a cationic detergent.
3. Lactoferrin and transferrin – By binding iron, an essential nutrient for bacteria, these
proteins limit bacterial growth.
4. Interferons – Interferons are proteins that can limit virus replication in cells.
5. Lysozyme – Lysozyme breaks down the cell wall of bacteria.

6. Interleukin-1 – Il-1 induces fever and the production of acute phase proteins, some of
which are antimicrobial because they can opsonize bacteria.
Cellular barriers to infection
Part of the inflammatory response is the recruitment of polymorphonuclear eosinophiles

and macrophages to sites of infection. These cells are the main line of defense in the
non-specific immune system.
1. Neutrophils – Polymorphonuclear cells (PMNs, figure 4) are recruited to the site of

infection where they phagocytose invading organisms and kill them intracellularly. In
addition, PMNs contribute to collateral tissue damage that occurs during inflammation.
2. Macrophages – Tissue macrophages (figure 5, 6, 7) and newly recruited monocytes

(figure 4 and 8), which differentiate into macrophages, also function in phagocytosis and
intracellular killing of microorganisms. In addition, macrophages are capable of
extracellular killing of infected or altered self target cells. Furthermore, macrophages
contribute to tissue repair and act as antigen-presenting cells, which are required for the
induction of specific immune responses.
3. Natural killer (NK) and lymphokine activated killer (LAK) cells – NK and LAK cells can
nonspecifically kill virus infected and tumor cells. These cells are not part of the
inflammatory response but they are important in nonspecific immunity to viral infections
and tumor surveillance.
4. Eosinophils – Eosinophils (figure 6a and b) have proteins in granules that are effective
in killing certain parasites.
PHAGOCYTOSIS AND INTRACELLULAR KILLING
A. Phagocytic cells
1. Neutrophiles/Polymorphonuclear cells
PMNs are motile phagocytic cells that have lobed nuclei. They can be identified
by their characteristic nucleus or by an antigen present on the cell surface called CD66.
They contain two kinds of granules the contents of which are involved in the
antimicrobial properties of these cells. The primary or azurophilic granules, which are
abundant in young newly formed PMNs, contain cationic proteins and defensins that can
kill bacteria, proteolytic enzymes like elastase, and cathepsin G to breakdown proteins,
lysozyme to break down bacterial cell walls, and characteristically, myeloperoxidase,
which is involved in the generation of bacteriocidal compounds. The second type of
granule found in more mature PMNs is the secondary or specific granule. These contain
lysozyme, NADPH oxidase components, which are involved in the generation of toxic
oxygen products, and characteristically lactoferrin, an iron chelating protein and B12-
binding protein.
2. Monocytes/Macrophages
Macrophages are phagocytic cells that have a characteristic kidney-shaped

nucleus. They can be identified morphologically or by the presence of the CD14 cell
surface marker. Unlike PMNs they do not contain granules but they have numerous
lysosomes which have contents similar to the PNM granules.
B. Response of phagocytes to infection
Circulating PMNs and monocytes respond to danger (SOS) signals generated at

the site of an infection. SOS signals include N-formyl-methionine containing peptides
released by bacteria, clotting system peptides, complement products and cytokines
released from tissue macrophages that have encountered bacteria in tissue. Some of
the SOS signals stimulate endothelial cells near the site of the infection to express cell
adhesion molecules such as ICAM-1 and selectins which bind to components on the
surface of phagocytic cells and cause the phagocytes to adhere to the endothelium.
Vasodilators produced at the site of infection cause the junctions between endothelial
cells to loosen and the phagocytes then cross the endothelial barrier by “squeezing”
between the endothelial cells in a process called diapedesis.
Once in the tissue spaces some of the SOS signals attract phagocytes to the
infection site by chemotaxis (movement toward an increasing chemical gradient). The
SOS signals also activate the phagocytes, which results in increased phagocytosis and
intracellular killing of the invading organisms.
Initiation of Phagocytosis
Phagocytic cells have a variety of receptors on their cell membranes through which
infectious agents bind to the cells. These include:
1. Fc receptors – Bacteria with IgG antibody on their surface have the Fc region
exposed and this part of the Ig molecule can bind to the receptor on phagocytes.
Binding to the Fc receptor requires prior interaction of the antibody with an
antigen. Binding of IgG-coated bacteria to Fc receptors results in enhanced
phagocytosis and activation of the metabolic activity of phagocytes (respiratory
burst).
2. Complement receptors – Phagocytic cells have a receptor for the 3rd component
of complement, C3b. Binding of C3b-coated bacteria to this receptor also results
in enhanced phagocytosis and stimulation of the respiratory burst.
3. Scavenger receptors – Scavenger receptors bind a wide variety of polyanions on
bacterial surfaces resulting in phagocytosis of bacteria.
4. Toll-like receptors – Phagocytes have a variety of Toll-like receptors (Pattern

Recognition Receptors or PRRs) which recognize broad molecular patterns
called PAMPs (pathogen associated molecular patterns) on infectious agents.
Binding of infectious agents via Toll-like receptors results in phagocytosis and the
release of inflammatory cytokines (IL-1, TNF-alpha and IL-6) by the phagocytes.
D. Phagocytosis
After attachment of a bacterium, the phagocyte begins to extend pseudopods

around the bacterium. The pseudopods eventually surround the bacterium and
engulf it, and the bacterium is enclosed in a phagosome. During phagocytosis the
granules or lysosomes of the phagocyte fuse with the phagosome and empty their
contents. The result is a bacterium engulfed in a phagolysosome which contains the
contents of the granules or lysosomes.
IV. THE PATIENT AND HIS ILLNESS (BOOK-BASED)
Synthesis of the Disease

Lifted from emedicine.com
General Description
Neonatal sepsis may be categorized as early or late onset. Eighty-five percent of

newborns with early-onset infection present within 24 hours, 5% present at 24-48 hours,
and a smaller percentage of patients present between 48 hours and 6 days of life. Onset
is most rapid in premature neonates. Early-onset sepsis syndrome is associated with
acquisition of microorganisms from the mother. Transplacental infection or an ascending
infection from the cervix may be caused by organisms that colonize in the mother's
genitourinary tract, with acquisition of the microbe by passage through a colonized birth
canal at delivery. The microorganisms most commonly associated with early-onset
infection include group B Streptococcus (GBS), Escherichia coli, Haemophilus
influenzae, and Listeria monocytogenes.(emedicine.com)
Late-onset sepsis syndrome occurs at 7-90 days of life and is acquired from the
caregiving environment. Organisms that have been implicated in causing late-onset
sepsis syndrome include coagulase-negative staphylococci, Staphylococcus aureus, E
coli, Klebsiella, Pseudomonas, Enterobacter, Candida, GBS, Serratia, Acinetobacter,
and anaerobes. The infant's skin, respiratory tract, conjunctivae, gastrointestinal tract,
and umbilicus may become colonized from the environment, leading to the possibility of
late-onset sepsis from invasive microorganisms. Vectors for such colonization may
include vascular or urinary catheters, other indwelling lines, or contact from caregivers
with bacterial colonization.(emedicine.com)
Risk Factors
The most common risk factors associated with early-onset neonatal sepsis
include maternal GBS colonization (especially if untreated during labor), premature
rupture of membranes (PROM), preterm rupture of membranes, prolonged rupture of
membranes, prematurity, maternal urinary tract infection, and chorioamnionitis.
Risk factors also associated with early-onset neonatal sepsis include low Apgar
score (<6 at 1 or 5 min), maternal fever greater than 38°C, maternal urinary tract
infection, poor prenatal care, poor maternal nutrition, low socioeconomic status,
recurrent abortion, maternal substance abuse, low birth weight, difficult delivery, birth
asphyxia, meconium staining, and congenital anomalies. Risk factors implicated in
neonatal sepsis reflect the stress and illness of the fetus at delivery, as well as the
hazardous uterine environment surrounding the fetus before delivery.
Late onset sepsis is associated with the following risk factors: prematurity, central
venous catheterization (duration of >10 d), nasal cannula continuous positive airway
pressure use, H2 blocker/proton pump inhibitor use, and gastrointestinal tract pathology.
Race- Black infants have an increased incidence of GBS disease and late-onset sepsis.
This is observed even after controlling for risk factors of low birth weight and decreased
maternal age.
Sex- The incidence of bacterial sepsis and meningitis, especially for gram-negative
enteric bacilli, is higher in males than in females.
Age- Premature infants have an increased incidence of sepsis. The incidence of sepsis
is significantly higher in infants with very low birth weight (<1000 g), at 26 per 1000 live
births, than in infants with a birth weight of 1000-2000 g, at 8-9 per 1000 live births. The
risk for death or meningitis from sepsis is higher in infants with low birth weight than in
full-term neonates.
Signs and Symptoms
The clinical signs of neonatal sepsis are nonspecific and are associated with
characteristics of the causative organism and the body's response to the invasion. These
nonspecific clinical signs of early sepsis syndrome are also associated with other
neonatal diseases, such as respiratory distress syndrome (RDS), metabolic disorders,
intracranial hemorrhage, and a traumatic delivery. Given the nonspecific nature of these
signs, providing treatment for suspected neonatal sepsis while excluding other disease
processes is prudent.
• Cardiac signs: In overwhelming sepsis, an initial early phase characterized by

pulmonary hypertension, decreased cardiac output, and hypoxemia may occur.
These cardiopulmonary disturbances may be due to the activity of granulocyte-
derived biochemical mediators, such as hydroxyl radicals and thromboxane B2,
an arachidonic acid metabolite. These biochemical agents have vasoconstrictive
actions that result in pulmonary hypertension when released in pulmonary tissue.
A toxin derived from the polysaccharide capsule of type III Streptococcus has
also been shown to cause pulmonary hypertension. The early phase of
pulmonary hypertension is followed by further progressive decreases in cardiac
output with bradycardia and systemic hypotension. The infant manifests overt
shock with pallor, poor capillary perfusion, and edema. These late signs of shock
are indicative of severe compromise and are highly associated with mortality.
• Metabolic signs: Hypoglycemia, hyperglycemia, metabolic acidosis, and jaundice
all are metabolic signs that commonly accompany neonatal sepsis syndrome.
The infant has an increased glucose requirement because of sepsis. The infant
may also have impaired nutrition from a diminished energy intake. Metabolic
acidosis is due to a conversion to anaerobic metabolism with the production of
lactic acid. When infants are hypothermic or they are not kept in a neutral thermal
environment, efforts to regulate body temperature can cause metabolic acidosis.
Jaundice occurs in response to decreased hepatic glucuronidation caused by
both hepatic dysfunction and increased erythrocyte destruction.
Neurologic signs: Meningitis is the common manifestation of infection of the CNS. It is

primarily associated with GBS (36%), E coli (31%), and Listeria species (5-10%)
infections, although other organisms such as S pneumoniae, S aureus, Staphylococcus
epidermis, H influenzae, and species of Pseudomonas,
IV. The patient and His Illness (Client-Centered)
General Description
As for Baby Boy V, he had an early-onset neonatal sepsis. A type of sepsis
acquired from the mother and/or before delivery. Early-onset neonatal sepsis most
often appears within 24 hours of birth
.
Risk Factors of Baby Boy V includes
 Male- it is said that neonatal sepsis is common to male infants than female.
 Maternal UTI- baby boy V’s mother had UTI during the third trimester
 Enterobacter Cloacae Infection- the organism was found in his blood culture
 Poor maternal nutrition- his mother likes eating sweet and salty foods during her
pregnancy.
 Low socio-economic status- it is said by his mother that their were just passing
by in their life as evidence by their monthly income of P10,000.
 Difficult delivery- his mother verbalized of having a difficult labor.
 Stress and illness of the fetus at delivery- as evidenced by the presence of caput
succedaneum.
Signs and Symptoms
The patient experienced:
 edema on extremities- experienced from 06-24-08 to 06-28-08
 Poor suck and demand
 Instability in thermoregulation
 Less active
Clinical Signs includes:
 (+) blood culture- result was positive of enterobacter cloacae
Results in 06-27-08
 Increased WBC count of 10.3 g/L
Results in 06-24-08
 Decreased Platelet Count of 120 g/L
Results in 06-24-08
 Increased B1B2 increased
Results in 06-28-08
PATHOPHYSIOLOGY (BOOK-CENTERED)
Precipitating Factor Predisposing Factor

Early-Onset
Gender
- Maternal Pyrexia - Recurrent Abortion
Race
- Infection - Maternal Substance Abuse
Bacteria- S. Aureus, E. Coli, - Low birth Weight Age- <35 wks. AOG
Chlamydia, Enterobacter - Difficult Delivery
Virus- Enterovirus, adenovirus, - Meconium Staining
Viral dses. - Stress and illness of the fetus
- Prolonged ROM at delivery
- PROM - hazardous uterine environment
- Maternal UTI
- Chorioamnionitis
- Poor prenatal care
- Poor maternal nutrition
- Low socio-economic status
Late-Onset
- Prolonged Hospitalization
- Presence of foreign body
- Cross infection
- Birth weight
- H2 blocker/ proton pump inhibitor use
- GI pathology
Initial Insult (Bacteria, viral, traumatic, thermal
Antibiotic Infection
s
Immune Body will respond
Pathogens enters the body Systemic Reaction
Neutrophils move in WBC
Chemotaxic occurs
Opsonization causes
phagocytosis
Monocytes kills pathogens

Systemic Reaction
Pro-Inflammatory Response Anti-Inflammatory Response

(Cytokines) (IL-10)
TNF
Balance Imbalance
Production of Thrombi
Coagulation Promotes Clot

Formation
Homeostasis
Increase activity of Fibrinolysis MARS

Inhibitors
Sepsis
Decrease fibrinolysis
Platelet destruction
Decrease PC
Sepsis
Initial Phase (1-3 days) Late Phase
Cool extremities,
Body compensates poor peripheral Hyperdrive
pulses,
hypotension
Slow things down Poor perfusion
Inadequate o2 delivery O2
Decrease Hypometabolism and nutrients to tse. therap
systemic vascular y
resistance
Decreased energy Tse. hypoxia
expenditure
Warm, bounding Lactic acidosis shock

pulses, with brisk Decrease CO
capillary refill, Fluid
edema Decrease o2 Metabolic acidosis therap
consumption MODS y
Diminished energy intake

Vasoconstriction
Impaired nutrition
- Pathophysiology
Impaired Acute renal Hepatic DIC
Symptoms pulmonary failure dysfunction
function
Lab tests
Bilirubi
Treatment BUN n
Crea
DEATH
PATHOPHYSIOLOGY (CLIENT-CENTERED)
Precipitating Factor Predisposing Factor

Early-Onset Gender-Male
 Maternal Pyrexia (38 oC)
 Infection
Bacteria- Enterobacter Cloacae culture positive
 Difficult Delivery
 Stress and illness of the fetus at delivery
 PROM
 Maternal UTI
 Poor maternal nutrition
 Low socio-economic status
 hazardous uterine environment
Initial Insult (Bacteria)
Antibiotic Infection
s
Immune Body will respond
Pathogens enters the body Systemic Reaction
Neutrophils move in WBC-

10.3
(06-24-
Chemotaxic occurs
Opsonization causes
phagocytosis
Monocytes kills pathogens

Systemic Reaction
Pro-Inflammatory Response Anti-Inflammatory Response

(Cytokines) (IL-10)
TNF
Imbalance
Increase activity of MARS

Fibrinolysis Inhibitors
Sepsis
Decrease fibrinolysis
Platelet destruction
Decrease PC
130g/L -- 06-24-08
120g/L—06-28-08
120g/L—07-02-08
Antibiotics
Tazobactam
Sepsis and
amikacin
Initial Phase (1-3 days) Late Phase
Cool
Body compensates extremities, Hyperdrive
poor peripheral
pulses,
Slow things down Poor perfusion
Inadequate o2 delivery and O2

Decrease systemic Hypometabolism nutrients to tse. therap
vascular y
resistance
Decreased energy Tse. hypoxia
expenditure
Warm, bounding Lactic acidosis shock

Decrease CO
pulses, with brisk
capillary refill, Fluid
edema (06-24-08 Decrease o2 Metabolic acidosis thera
to 06-28-08) consumption MODS py
Diminished energy intake

Vasoconstriction
Impaired nutrition
Poor suck and
demand to
- Pathophysiology feedings
Acute renal Hepatic
Symptoms failure dysfunction
Lab tests
06-28-08
06-25-08 Total Bili 5.35 mg/gl
Treatment BUN 8.1 mg/dl Direct Bili 2.58 mg/dl
Crea 0.68 Indirect Bili 2.77
mg/dl
V. THE PATIENT AND HIS CARE
A. Medical Management
a. IVFs
MEDICAL DATE ORDERED GENERAL INDICATION(S)/ CLIENT’S RESPONSE

MANAGEMENT/ DATE PERFORMED DESCRIPTION PURPOSE(S) TO THE TREATMENT
TREATMENT DATE CHANGED
Dextrose 10% in Water DO: 06-25-08 This medication is a Intravenous solutions The fluid was given
(D10W) DP: 06-25-08 solution given by vein containing dextrose are through an umbicath.
D10W—75cc in soluset DC: 06-27-08 (through an IV). It is used indicated for parenteral The patient adhered well
at 6-7 ugtts/min to supply water and replenishment of fluid on his treatment by not
calories to the body. It is and minimal showing any signs of
also used as a mixing carbohydrate calories as dehydration or any side
solution (diluent) for other required by the clinical effects of the said fluid.
IV medications. Dextrose condition of the patient.
is a natural sugar found in It is also use as a mixing
the body and serves as a solution for other IV
major energy source. medication. D10W is
When used as an energy used for patients >1500
source, dextrose allows kgs of weight.
the body to preserve its
muscle mass.
MEDICAL DATE ORDERED GENERAL INDICATION(S)/ CLIENT’S RESPONSE
MANAGEMENT/ DATE PERFORMED DESCRIPTION PURPOSE(S) TO THE TREATMENT
TREATMENT DATE CHANGED
D5IMB—94.4 cc via DO: 06-27-08 This solution is used to The patient was able to
It was given to the
soluset @ 8-9 DP: 06-27-08 provide lost nutrients in maintain body fluid and
patient to maintain fluid
ugtts/min Till discharged the body. has not manifested any
balance in the body and
signs and symptoms of
to prevent dehydration.
dehydration. He had also
not experienced any side
effects or any untoward
reaction on his IV site.
Nursing Responsibilities
Prior:
 Verify with the doctor’s order.
 Explain the indication to the mother.
During:
 Label the IVF bottle and tubings indicating the date and time it was started with the ordered regulation.
 Maintain and regulate at the rate prescribed.
 Handle IVF site aseptically.
 Change solution and IVF tubings as per hospital policy.

After:
 Check the site for any signs/symptoms of infection.
b. Drugs
Name of Drug Date Ordered Route of General Action and Client’s Response to
Generic and Brand Date Taken or given Administration Indication/ purpose medication with actual
Name Date Changed Dosage and side effects
Frequency
Ampicillin 06-25-08 125 mg, IV every 12o Penicillin, - The patient did not
(Sodampen) 06-25-08/ 10:00am Anti-infective Drug manifest any allergic or
06-27-08/ 10:00 pm - indicated for untoward reaction of the
septicemia drug
- Did not develop any
side effects
- Base on the result of
the blood culture,
ampicillin is resistant to
the organism found in the
culture, the reason why
the drug was changed.
Frequency
Cefotaxime 06-25-08 125 mg, IV every 12o Cephalosphorin - The patient did not
(Claforan) 06-25-08/ 12:00 NN Anti-infective manifest any allergic or
06-27-08/ 12:00 MN - for septicemia caused untoward reaction of the
by a susceptible drug
microorganism - Did not develop any
side effects
- Base on the result of
the blood culture,
Claforan is also resistant
to the organism found in
the culture, the reason
why the drug was also
changed.
Frequency
Piperacillin-Tazobactam 06-27-08 125 mg, IV every 12o Antibiotic - The patient did not
(Tazocin) 06-27-08/ 06:00 am - piperacillin/tazobactam manifest any allergic or
consists of a semi- untoward reaction of the
synthetic penicillin and a
drug
beta-lactamase inhibitor.
- Did not develop any
Tazobactam enhances and
side effects
extends the antibiotic
- The drug is sensitive to
spectrum of piperacillin to
include beta-lactamase the microorganism found
producing bacteria on his culture, making it
normally resistant to effective as a treatment
piperacillin for his condition.
- indicated for the - WBC is normal prior to
treatment of moderate to discharged
severe infections caused
by susceptible strains of
bacteria
Frequency
Amikacin Sulfate 06-27-08 38 mg, IV, OD Aminoglycoside - The patient did not
(Amikin) 06-27-08/ 08:00 pm Antibiotic manifest any allergic or
- treatment of serious untoward reaction of the
infections caused by drug
susceptible strains of - Did not develop any
gram-negative bacteria side effects
- The drug is sensitive to
the microorganism found
on his culture, making it
effective as a treatment
for his condition.
- WBC is normal prior to
discharged
Prior:
 Check for any hypersensitivity reaction (Skin testing was not indicated because it is believed that a neonate would not develop any
hypersensitivity reaction to a certain drug until 6 months of age due to his/her natural antibody.)
 Check for the patency of the IV site
 Check for the 10 R’s
 Check for its expiration date
 Maintain sterility during the preparation
During:
 Give the drug slow IV
 Maintain sterile technique during the administration
After:
 Monitor for any untoward reaction
 Document the time or any reaction in the chart
c. Diet
TYPES OF DATE ORDERED GENERAL INDICATION(S)/ SPECIFIC CLIENT’S
DIET DATE STARTED DESCRIPTION PURPOSE(S) FOODS TAKEN RESPONSE AND/
DATE CHANGED OR REACTION TO
DIET
Nothing Per
Orem 06-24-08 Restriction to take Nothing per orem is a None Patient did not
(NPO) 06-24-08 x 4 hours food via mouth or standard order in NICU receive anything by
(10:00am- 02:00 pm) oral route. for a new born neonate. mouth. No untoward
06-24-08 It is usually ordered for reaction was noted.
four hours. NPO was
done to prevent
aspiration since on the
first hours of life the
neonate still has lots of
secretions.
DIET
1/4th oz. of 06-24-08 The patient is only Cooled boiled water Cooled boiled Patient’s diet was
cooled 06-24-08 x 2 doses allowed to take was ordered to test if water well tolerated. The
boiled every 3 hours cooled boiled water the newborn can patient did not vomit,
water 06-24-08 by mouth. tolerate his feedings. but it is also noted
that the baby has a
fair to good suck.
DIET
Feeding as 06-24-08 The patient is This diet is ordered to Milk The diet is well
Tolerated 06-24-08 allowed to take the prevent further tolerated; however,
(FAT) Till discharged prescribed milk as nutritional imbalances the patient does not
tolerated. and maintain patient’s always demand for
health his feedings and has
fair to good suck at
first. But before
discharged the
patient already has a
good suck and
demanded feedings
Prior:
 Check for the doctors order
 Assess client’s need
 Before prepare the appropriate diet for the patient be sure that proper hand washing is maintained
During:
 Give feedings with strict aspiration precaution
After:
 Burped after each feedings
 Place the baby on side-lying position after each feedings
 Monitor if the feeding is well-tolerated
 Note and document any untoward reaction.
d. Activity/Exercise
*** no activity or exercise was ordered for the patient
C. Nursing Management
1. Nursing Care Plans
a. Problem #1 Hyperthermia
Assessment Nursing Scientific Planning Intervention Rationale Expected

Diagnosis Explanation Outcome
Hyperthermia Due to the Short-term: Independent
S- related to presence of an The patient shall
 inflammatory infectious agens, After 30 minutes 1. Monitor 1. To determine maintain normal
process/ stimulation of the of nursing neonate’s the need for core temperature
hypermetabolic monocytes intervention the condition. intervention and as evidenced by
O- state as triggers the patient will the effectiveness normal vital signs
The patient may evidenced by an release of the maintain normal of therapy. and normal
manifest one or increase in body pyrogenic core laboratory results.
more of the temperature, cytokines that temperature as 2. To have a
following: warm skin and stimulate anterior evidenced by 2. Monitor Vital baseline data
- Temperature tachycardia hypothalamus vital signs within signs
above which results in normal limits and
elevated normal WBC 3. Helps in
normal level thermoregulatory level 3. Provide TSB lowering down
(36 oC) set point that the temperature
- Skin warm leads to an Long Term:
to touch increased heat
- Presence of conservation After 3 days of Interdependent
tachycardia (Vasoconstriction) NI, pt will still 4. this would
(above 160 and increased maintain normal 4. Ensure that all prevent the
bpm) heat production core equipment used spread of
- Presence of which results to temperature as for infant is pathogens to the
tachypnea Fever. evidenced by sterile, infant from
(above 60 normal vital scrupulously equipment
bpm) signs and clean. Do not
- WBC normal share equipment
elevated laboratory with other infants
results.
Dependent
5. Administer 5. aids in
Anti-pyretics as lowering down
ordered temperature
b. Problem #2 Fluid volume deficit

Fluid volume Fluid volume Short-term:
S- deficit related to deficit, or 1. Monitor and 1. To note for the The patient shall
 failure of hypovolemia, After 3 hours of record vital signs alterations in V/S be able to
regulatory occurs from a nursing (decreased BP, maintain fluid
mechanism loss of body fluid intervention the Increased in PR volume at a
O- or the shift of patient will be and temp) functional level as
The patient may fluids into the able to maintain evidenced by
manifest: third space one fluid volume at a 2. Note for the 2. To assess individually
- decreased factor includes a functional level causative factors what factor adequate urinary
urine output failure of the as evidenced by that contribute to contributes to output with
- increased urine regulatory individually fluid volume fluid volume normal specific
concentration mechanism of adequate urinary deficit deficit that may gravity, stable
- increased the newborn output with be given prompt vital signs, moist
pulse rate specifically normal specific intervention. mucous
(above 160 bpm) hyperthermia gravity, stable membranes,
- increased body vital signs, moist good skin turgor
temperature mucous and prompt
(above 36 oC) membranes, 3. Provide TSB if 3. To decrease capillary refill and
- decreased skin good skin turgor patient has fever temperature and resolution of
turgor and prompt provide comfort edema.
- dry skin/ capillary refill
mucous and resolution of
membranes edema. 4. Provide oral 4. To prevent
- elevated hct care by injury from
Long Term: moistening lips & dryness
skin care by
After a couple of providing daily
days the patient bath
will still be able 5. Administer IV 5. replaces fluid
to maintain fluid fluid losses
volume at a replacement as
functional level ordered
as evidenced by
individually
adequate urinary 6. Administer 6. to reduce
output with antipyretic drugs body
normal specific if patient has temperature
gravity, stable fever as ordered
vital signs, moist
mucous
membranes,
good skin turgor
and prompt
capillary refill
and resolution of
edema.
c. Problem #3 Ineffective Tissue Perfusion

Ineffective tissue Since the body Short-term: Independent
S- perfusion related of the newborn The patient shall
 to impaired is unable to After 3 hours of 1. Monitor 1. To determine demonstrate
transport of compensate to nursing neonate’s the need for increased
oxygen across the imbalances intervention the condition. intervention and perfusion as
O- alveolar and on of the patient will the effectiveness evidenced by
The patient may capillary inflammatory demonstrate of therapy. warm and dry
manifest one or membrane response related increased skin, strong
more of the to his condition perfusion as 2. To have a peripheral pulses,
following: the body tends evidenced by 2. Monitor Vital baseline data normal vital
- skin or to “hyperdrive” warm and dry signs signs, adequate
temperatur causing an skin, strong 3. To asses urine output and
e changes inadequate peripheral 3. Note quality pulse that may absence of
- Weak oxygen in the pulses, normal and strength of become weak or edema
pulses tissues or vital signs, peripheral thready,
- Edema capillary adequate urine pulses because of
- Inadequate membrane output and sustained
urine leading to poor absence of hypoxemia
output perfusion edema
4. To note for an
Long Term: 4. Assess increased
respiratory rate, respiration that
After 3 days of depth, and occurs in
NI, pt will quality response to
maintain direct effects of
adequate endotoxins on
perfusion AEB the respiratory
stable VS, warm center in the
and dry skin, brain, as well as
absence of developing
edema, hypoxia, stress.
adequate urine Respirations can
output and become shallow
strong peripheral as respiratory
pulses. insufficiency
develops
creating risk of
acute respiratory
failure.
5. To assess for
5. Assess skin compensatory
for changes in mechanisms of
color, vasodilation
temperature and
moisture
6. To promote
6. Elevate Head circulation
of Bead /venous
drainage
7. To reduce
7. Elevate edema
affected
extremities with
edema once in a
while
Interdependent
8. Conserves
8. Provide a energy and
quiet, restful lowers O2
atmosphere demand
Dependent
9. To maximize
9. Administer O2 availability for
oxygen as cellular uptake
ordered
d. Problem #4 Interrupted Breast Feeding

Interrupted Since the Short-term:
S- breastfeeding neonate is The mother shall
 related to diagnosed for After 3 hours of 1. Assess 1. To know what be able to identify
neonate’s having a nursing mother’s the mother and demonstrate
present illness neonatal sepsis, intervention and perception and already knows techniques to
O- as evidenced by the baby got health teachings knowledge about and needed to sustain lactation
The newborn is separation of separated from the mother will breastfeeding know. and identify
diagnosed with a mother to infant his mother and identify and and extent of techniques on
certain disease placed on a demonstrate instruction that how to provide
(Sepsis) Neonatal techniques to has been given. the newborn with
- The newborn is Intensive Care sustain lactation breast milk.
separated from Unit for better until 2. Give 2. To assist
his mother management breastfeeding is emotional mother to
- The mother and care. initiated support to maintain
unable to Interrupted mother and breastfeeding as
provide breast breastfeeding Long Term: accept decision desired.
milk to newborn develops since regarding
continuously the mother is After 3 days of cessation/
unable to breast NI, the mother continuation of
fed the baby shall still be able breast feeding.
continuously due to identify and
to their demonstrate 3. Demonstrate 3. aid in feeding
separation. techniques to use of manual the neonate with
sustain lactation piston-type breast milk
and identify breast pump. without the
techniques on mother
how to provide breastfeeding
the newborn with the infant.
breast milk. 4. Review 4. To provide
techniques for optimal nutrition
storage/use of and promote
expressed continuation of
breast milk breastfeeding
process
5. Determine if 5. So that infant

a routine visiting will be hungry/
schedule or ready to feed
advance warning
can be provided
6. Provide 6. To promote
privacy, calm successful infant
surroundings feeding
when mother
breast feeds.
7. Recommend 7. Reinforces
for infant sucking that feeding time
on a regular is pleasurable
basis and enhances
digestion.
8. Encourage 8. to sustain
mother to obtain adequate milk
adequate rest, production and
maintain fluid and breast feeding
nutritional intake,
process
and schedule
breast pumping
every 3 hours
while awake
e. Problem # 5 Risk for impaired parent/ infant attachment

Risk for Impaired Due to the Short-term:
S- parent/ neonates newborn’s 1. Interview 1. To know what the parents shall
 Attachment physical illness After 3 hours of parents, noting the parents be able to have a
related to and nursing their perception feelings about mutually
neonates hospitalization, intervention and of situation and the situation. satisfying
O- physical illness the parents may health teachings individual interactions with
The newborn is and have fear on the mother will concerns their newborn.
diagnosed with a hospitalization. how to handle identify and
certain disease their baby since demonstrate
(Sepsis) the baby is on its techniques to 2. Educate 2. Helps clarify
- the newborn is fragile state and enhance parents realistic
hospitalized needed extra behavioral regarding child expectations
- The newborn is care. And since organization of growth and
separated from he is the 1st child the neonate development,
his parents hospitalized in addressing
their family, the Long Term: parental
parents might perceptions
still be unsure on After discharge
how to take care the parents will 3. Involve 3. Enhances
of the baby. be able to have parents in self-concept
a mutually activities with the
satisfying newborn that
interactions with they can
their newborn. accomplish
successfully
4. Recognize 4. Reinforces
and provide continuation of
positive desired
feedback for behaviors
nurturant and
protective
parenting
behaviors
2. ACTUAL SOAPIERS
June 26, 2008

S - Ø
O - Seen baby on crib with ongoing IVF of D10W at 6-7 ugtts/min

via umbicath. He is less active and febrile, warm to touch, (+)
tachycardia and tachypnea, latest WBC result 11.5 g/L. Vital signs
taken and recorded are as follows:
RR-63 bpm
CR-175 bpm
Temp- 38.5oC
A - Hyperthermia related to inflammatory process/ hypermetabolic

state as evidenced by an increase in body temperature, warm skin
and tachycardia
P - After 1 hour of nursing interventions, the patient’s
temperature will decrease by 1 degree centigrade.
I - Assessed body temperature every hour until temperature

normalized.
- Assessed IV site, increased pulse and respirations.
- Monitored laboratory results.
- Performed tepid sponge bath.
- Washed hands before and after giving care.
- Used sterile technique for IV maintenance.
- Stretched bed linens.
E - Goal met after an hour the newborn’s temperature subsides to

37. 5 oC
June 26, 2008
S - Ø
O - warm to touch, (+) tachycardia and tachypnea, (+) edema on

extremities latest Hct result 0.64%. Urine output 5 grams in an
hour (diaper’s weight). Vital signs taken and recorded are as
follows:
RR-63 bpm
CR-175 bpm
Temp- 38.5oC
A - Fluid volume deficit related to failure of regulatory mechanism

P - After 3 hours of nursing intervention the patient will be able to
maintain fluid volume at a functional level as evidenced by
individually adequate urinary output with normal specific gravity,
stable vital signs, moist mucous membranes, good skin turgor and
prompt capillary refill and resolution of edema.
I - Monitored and recorded vital signs
- Noted for the causative factors that contribute to fluid volume
deficit
- Provided TSB
- Provided oral care by moistening lips & skin care by providing
daily bath
- Administered IV fluid replacement as ordered
- Monitored laboratory results.
- Washed hands before and after giving care.
- Stretched bed linens.
E - Goal partially met, after 3 hours the patient has stable vital signs
but still has edema and inadequate urine output. The edema
disappears on the 3rd day of interaction.
June 29, 2008
S - Ø
O - Seen baby in crib with ongoing IVF of D5IMB 113 cc via soluset
at 9-10 ugtts/min infusing well on his left hand. He is less active
and afebrile. With weak peripheral pulses and (+) edema. Vital
signs taken and recorded are as follows:
RR-48 bpm
CR-132 bpm
Temp- 36oC
A - Ineffective tissue perfusion related to impaired transport of oxygen

across alveolar and on capillary membrane
P - After 3 hours of nursing intervention the patient will demonstrate

increased perfusion as evidenced by warm and dry skin, strong
peripheral pulses, normal vital signs, adequate urine output and
absence of edema
I - Monitor neonate’s condition.

- Monitor Vital signs
- Note quality and strength of peripheral pulses
- Assess respiratory rate, depth, and quality
- Assess skin for changes in color, temperature and moisture
- Elevate Head of Bead
- Elevate affected extremities with edema once in a while
- Provide a quiet, restful atmosphere
E - Goal partially met, after 3 hours the patient has stable vital signs
and adequate urine output but still has edema. The edema
disappears on the 3rd day of interaction.
July 01, 2008
S - Ø
O - Seen baby in crib with ongoing IVF of D5IMB 98 cc via soluset at

7-8 ugtts/min infusing well on his left hand. He is active and
afebrile. He has good cry, good suck and demanded feedings.
Vital signs taken and recorded are as follows:
RR-45 bpm
CR-135 bpm
Temp- 36.8oC
A - Interrupted breastfeeding related to neonate’s present illness as
evidenced by separation of mother to infant
P - After 3 hours of nursing intervention and health teachings the

mother will identify and demonstrate techniques to sustain
lactation until breastfeeding is initiated
I - Assessed mother’s perception and knowledge about

breast feeding and extent of instruction that has been given.
- Gave emotional support to mother
- Encouraged use of manual piston-type breast pump.
- Reviewed techniques for storage/use of expressed breast milk
- Determined if a routine visiting schedule or advance warning can
be provided
- Provided privacy, calm surroundings when mother breast feeds.
- Recommended infant sucking on a regular basis
- Encouraged mother to obtain adequate rest, maintain fluid and
nutritional intake, and schedule breast pumping every 3 hours
while awake
E - Goal met after 3 hours of nursing intervention the mother had

identified and demonstrated techniques to sustain lactation and
identified techniques on how to provide the newborn with breast
milk.
VI. CLIENT'S DAILY PROGRESS
ADMISSIO DISCHA
DAYS N DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 RGE
6/25/200 6/26/200 6/27/200 6/28/200 6/29/200 6/30/200 7/1/200
6/24/2008 8 8 8 8 8 8 8 7/2/2008
Nursing Problems
1. Hyperthermia *
2. Fluid volume deficit * * * *
3. Ineffective Tissue Perfusion * * * *
4. Interrupted Breast Feeding * * * * * * * * *
5. Risk for impaired parent/ infant
attachment * * * * * * * * *
Vital Signs
175 132 135
PR 135 bpm 133 bpm bpm 143 bpm 138 bpm bpm 148 bpm bpm 128 bpm
RR 43 bpm 44 bpm 63 bpm 35 bpm 42 bpm 48 bpm 38 bpm 45 bpm 42 bpm
Temp 36.7oC 36.2oC 38.5oC 36.7oC 36.5oC 36oC 36.3oC 36.8oC 36.2oC
Diagnostic & Laboratory Procedure
CBC with PC * * *
U/A *
BUN, Crea *
B1B2 *
HGT *
Blood GS/CS *
CXRAY *
Baby gram *
Medical Management
D10W * * *
D5IMB * * * * * *
Drugs
Ampicillin * * *
Cefotaxime * * *
Piperacillin-Tazobactam * * * * * *
Amikacin Sulfate * * * * * *
Diet
NPO *
CBW *
FAT * * * * * * * * *
Activity/Exercise N/A N/A N/A N/A N/A N/A N/A N/A N/A
Surgical Management N/A N/A N/A N/A N/A N/A N/A N/A N/A
VII. DISCHARGE PLANNING
a. General Condition of Client upon Discharge

Baby Boy V, one day prior to discharge, is active and afebrile. He already
demands for his feedings and has good suck and well-tolerated feedings. He has
negative edema on his extremities. He is also not ill-looking unlike before. But since
that they were not that financially stable Baby Boy V is discharged with a heplock for the
continuation of his antibiotics. He is well-flexed, with full range of motion and with
spontaneous movement. His overall health condition is generally good.
b. METHOD
M - Medication
- Piperacillin-Tazobactam 125 mg/IV every 12 hours (7am- 7pm)
- Amikacin 38 mg, IV once a day (10 am)
E - Exercise
- Stressed that the baby sleeps most often times
T - Treatment
- Stressed importance of complying with the medications
H - Health Teachings
- Instructed Mother to bring back the baby in the hospital for his medication
- Instructed Mother on the time the medication will be given
- Instructed Mother for the drug’s side effect which includes constipation;
diarrhea; dizziness; headache; indigestion; nausea; pain, swelling, or
redness at the injection site; sleeplessness; vomiting.
- Instructed Mother of the importance of breastfeeding
- Instructed Mother on Proper Breastfeeding
- Instructed Mother to expose the baby to sunlight at 6:00 am to 10:00 am
- Instructed Mother that formula milk is only good for 4 hours
- Instructed Mother on strict aspiration precaution
- Instructed Mother to burped the baby after each feedings
- Instructed Mother to bathe daily their aby
D - Diet
- Instructed Mother to feed the baby as tolerated with strict aspiration
precaution
VIII. SUMMARY OF FINDINGS
The researcher has personally handled a case with an early onset neonatal
sepsis. With the information gathered and observed about Neonatal Sepsis, the
researcher was able to accomplish the objectives made.
Neonatal Sepsis is a neonatal infection of the blood that usually spreads
throughout the body. It has 2 types: the early-onset neonatal sepsis which was cause
by maternal factors and was usually brought by an infection develop before delivery.
Late-onset neonatal sepsis on the other hand was cause by unsterilility, be it from the
medical equipment, and or directly from the medical staff. Clinical signs and symptoms
of neonatal sepsis includes: body temperature changes, breathing problems, diarrhea,
low blood sugar, reduced movements, reduced sucking, seizures, slow heart rate,
swollen belly area, vomiting, yellow skin and whites of the eyes (jaundice). Diagnostic
procedures includes but not limited to: CBC, Blood GS/CS, X-ray, and UA. The most
effective method in the diagnosis of neonatal sepsis is by blood GS/CS. The main
treatment of neonatal sepsis is by administration of antibiotics and IV fluids, treatments
are also directed towards physical signs and symptoms. Different nursing care plans
can be obtained from Neonatal sepsis; it includes but is not limited to Hyperthermia,
Fluid volume deficit, Ineffective Tissue Perfusion, Interrupted Breast Feeding, Risk for
impaired parent/ infant attachment. During the process, the family is also included in the
plan of care. The researcher has also involved the family especially the mother in the
patients plan of care.
IX. CONCLUSIONS
Based on the researchers experience neonatal sepsis is not a very crucial case
although there are lots of reported cases with severe neonatal sepsis. Onset can be
prevented and be treated especially in the case of Late-onset neonatal sepsis. Prompt
treatment and adequate knowledge about the disease process is needed so that
complications won’t arise. On the other hand your care is not only confined to the
patient but extends significantly to the family. Knowledge and appropriate skills are part
of the tools of the nurse in order to be effective in handling a patient with neonatal
sepsis. Having a clear understanding of the disease and its process, with consideration
of the feelings and beliefs of the parents, most especially, will aid the nurse in skillfully
meeting patient’s needs.
X. RECOMMENDATIONS
At the course of the study, the researcher had found out that an in-depth
knowledge about the disease process will benefit not only the patient and its family but
also the nurse and the medical staff as well. The following is a list of recommendations
made by the researcher:
For the Nurses:
 An in-depth knowledge should be acquired regarding the disease

condition so that proper treatment and prevention can be implemented.
 Nurses must stress the need for good prenatal care and emphasize on
parents, the value of regular check-ups at well-baby clinics.
 Proper infection control especially strict hand washing should be
implemented in the hospital because it is the most effective method in
controlling the spread of infection from staff to patient.
For the hospital:
 sterility or cleanliness of hospital equipment should be maintained

 Seminars about infection control should be conducted so that hospital
staff will be knowledgeable in the prevention of infection from
spreading.
For the patients care:
 It was observed by the researcher that not all treatments was given
and ordered for the patient which includes using of phototherapy or bili
lights. The patient manifested yellowish discoloration of the skin or
jaundice and above normal results of bilirubin, yet phototherapy was
not ordered. Supportive treatment should all be given and is needed in
patients care.
XI. LEARNING DERIVED
At the end, the researcher realized that there is always something new to learn
that could help you be a better healthcare provider. It is indeed true that learning never
stops. And with the current trends that we have, it is part of the nurses’ responsibility to
keep themselves abreast with the new trends.
With the study made by the researcher, she had able to identify what neonatal
sepsis is, its risk factors, signs and symptoms of the disease, diagnostic procedure that
can be done to diagnose the disease, its medical treatment, prevention and nursing care
plan specific for the disease. With the knowledge learned during the study, the
researcher can be able to promote wellness by health teachings to mother and to
persons unfamiliar with the disease and prevention of the disease.
During the course of the study, the importance of proper infection control and
hand washing was found out for the prevention in the spread of infection especially in
the hospital.
The researcher found out that proper knowledge of the staff regarding the
disease condition of a patient with neonatal sepsis is vital for the betterment of her
service as one of the providers of care on a hospital.
This case study has also given the researcher the great opportunity to share his
personal experience in the care of a patient with neonatal sepsis.
XI. BIBLIOGRAPHY
Books:
• Nelson Textbook of Pediatric. 17th edition. By Behrman.
• Nurse’s Pocket Guide Diagnoses, Prioritized Intervention and Rationale. By

Doenges and et.al. 10th edition.2006
• Nursing 2006 Drug Handbook. By Schilling, J. 26th edition. 2003
• Laboratory and Diagnostic Test Handbook, M.K. Gaedeke, Addison – Wesley

Publishing Company, 2000
• Care of the High – Risk Neonate, 7 th Edition, Klaus and Fanaroff, W. B. Saunders
Company, 2000
Websites:
• http://adam.about.com/encyclopedia/infectiousdiseases/Neonatal-sepsis.htm
• http://www.childrenshospital.org/az/Site1574/mainpageS1574P0.html
• http://www.bio-medicine.org/q/neonatorum/
• http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=737031
• http://www.medscape.com/viewarticle/483474
• http://www.wrongdiagnosis.com/n/neonatal_sepsis/signs.htm
• http://infectious-diseases.jwatch.org/cgi/content/full/2000/301/4
• http://www.who.int/whosis/whostat/2008/en/index.html
• http://www.health.state.mn.us/divs/idepc/dtopics/neosep/index.html
• http://www.co-infectiousdiseases.com/pt/re/coinfdis/abstract.00001432-
200808000-
00004.htm;jsessionid=L6tFbjhs45SMLlp1Gr38dXvNQmG53dBWyvnHQfdTCMw
P2NyNjpYT!536197444!181195628!8091!-1
• http://www.gmanews.tv/largevideo/latest/25531/Neonatal-sepsis-deaths-at-
Ospital-ng-Makati-due-to-neglect---DOH
• http://allnurses.com/forums/f205/nursing-care-plan-sepsis-neonatorum-
274406.html

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I.

“Neonatal sepsis deaths at Ospital ng Makati due to neglect – DOH”

After the completion of the study, a nurse shall be able to:

Nurse Centered Objectives:

Patient and Family Centered Objectives:

At the end of this study, the patient/family will be able to:

2. Socio- Economic and Cultural Factors

Baby Boy V’s mother got married when she was 25

2. Ante-partal/ Pre-natal Preparation

According to Baby Boy V’s mother she had a

3. Significant Trimestral Changes (1st – 3rd trimester)

On the first trimester of the latest pregnancy, she

June 24, 2008 (Lifted from the chart)

Physical Examination of the Newborn

Skin: (+) acrocyanosis, (+) thinning lanugo

Head: (+) caput, with soft, firm and flat fontanels

Eyes: (+) PERRLA, with pale palpebral conjunctiva

Chest: symmetrical lung expansion, stippled areola 12mm bud

Abdomen: (-) tenderness

Back: intact spine, (-) mass

Rectum: with patent anal opening, (+) passage of stool

Extremities: anterior transverse crease only

June 26, 2008 (Done by the researcher)

Physical Examination of the Newborn

Ears: pinna tends to bend easily, with startle reflex.

Back: intact spine, (-) mass

Rectum: with patent anal opening, (+) passage of stool

June 29, 2008 (Done by the researcher)

Physical Examination of the Newborn

Ears: pinna tends to bend easily, with startle reflex.

Back: intact spine, (-) mass

Rectum: with patent anal opening, (+) passage of stool

Physical Examination of the Newborn

Ears: pinna tends to bend easily, with startle reflex.

Back: intact spine, (-) mass

Rectum: with patent anal opening, (+) passage of stool

DIAGNOSTIC/ DATE INDICATION(S) OR RESULTS NORMAL ANALYSIS AND

 Explain to the mother the purpose of the test.

 Inform them that there are no food or fluid restrictions.

 Inform the mother that venous blood is to be collected.

 Handle the specimen gently to avoid hemolysis.

 Make sure that the specimen bottles are labeled correctly.

 Put pressure over the puncture site.

Red Cells: Red Cells:

Epithelial Cells: Epithelial Cells:

Albumin: Negative Albumin: Negative

* Note: Do not use a vein site proximal to an IV infusion.

DIAGNOSTIC/ DATE INDICATION(S) OR PURPOSE(S) RESULTS NORMAL ANALYSIS AND

Pt. centered indication

DIAGNOSTIC/ DATE INDICATION(S) OR PURPOSE(S) RESULTS NORMAL ANALYSIS AND

DIAGNOSTIC/ DATE INDICATION(S) OR PURPOSE(S) RESULTS NORMAL ANALYSIS AND

 Explain the purpose of the CXR to the mother.

Immunology is the study of our protection from foreign macromolecules or

The main function of the immune system is self/non-self discrimination. This

The elements of the non-specific (innate) immune system (Table 2) include

A. Anatomical barriers to infections

B. Humoral barriers to infection

The anatomical barriers are very effective in preventing colonization of tissues by

1. Complement system – The complement system is the major humoral non-specific

5. Lysozyme – Lysozyme breaks down the cell wall of bacteria.

Cellular barriers to infection

Part of the inflammatory response is the recruitment of polymorphonuclear eosinophiles

1. Neutrophils – Polymorphonuclear cells (PMNs, figure 4) are recruited to the site of

2. Macrophages – Tissue macrophages (figure 5, 6, 7) and newly recruited monocytes