Sepsis NeonatorumNewborn HyperbilirubinemiaPrepared by:Carmela Mae S. Pis-anLorraine Salva

INTRODUCTIONNeonatal Sepsis 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:1. Early- onset sepsis

The onset hat is seen in the first week of life and most often appears in the first 24 hours of life2. Late-onset Sepsis

Is acquired after delivery. occurs at 7-90 days of life and is acquired from the caregiving environment.

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 24hours, Infection of the placenta tissues and amniotic fluid (chorioamnionitis) and frequent vaginal examinations during labor. Early- onset sepsis

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 longtime, staying in the hospital for an extended period of time.Late-onset Sepsis

Demographic Data

Name: Apenas, Frankie May Ajelado Sex: FemaleAge: 5 days oldAddress: Liptong, Valencia, Negros Oriental Civil Status: SingleEducational Attainment: N/AReligion: Roman CatholicOccupation: N/ANationality: Filipino

Date of admission: September 12, 2014; 7:56 p.m.Room: AB-PEDDoctor in charge: Dr. Venus C. Borromeo Chief complaints: Inflammation and foul smelling of the umbilicusDiagnosis: sepsis neonatorum with hyperbilirubinemia

Nursing History

Our patient is 5 days old upon admission, she was born last September 07, 2014 at 07:27 p.m in Diagcare Lying - In Clinic in Piapi Dumageute, Negros Oriental.Via NSVD in cephalic presentation, weighing 3500 grams with an apgar score of 9,9.

Erythromycin ophthalmic ointment 0.5% applied in both eyes Hepatitis B 0.5ml injected intramuscularly at right vastus lateralis Vitamin K 0.1 ml injected in the left vastus lateralis of the clientAfter delivery patient was given: Newborn Screening DONE

After 2 days they were discharged in the lying-in and went home.

Mother verbalized that the only instruction given was to let their child have vacinne in the baranggay health center and clean the umbilicus.On the 5th day of the babyThey went to Valencia's Health Center to let the patient's umbilicus cleaned.but the nurse told them that they have to consult a doctor because the patient's umbilicus is swelling with foul odor.

Then they went immediately in NOPH to seek for futher assessment and evaluation on the patients umbilicus.They were admitted on September 12, 2014 at around 7:56 p.m. at AB-PEDChief of complaint:Inflammation and foul smelling of umbilicus.Under the care of:Dr. Venus C. BorromeoDiagnosis: sepsis neonatorum with hyperbilirubinemiaClient was given STAT:IVFD5IMB 500 cc @ 10cc/hr (soluset)Cefotaxime 200mg IVTT q 8H (-ANST)Laboratory ordered was:CBC, Urinalysis and Bilirubin testThe doctor ordered dressing of umbilicus daily and continues breastfeeding.

On September 13, 2014phototherapy exposure was ordered and the clientgiven Amikacin 50mg IVTT ODgiven Cefotaxime 200mg IVTT q 8H (-ANST)On September 14, 2014phototherapy was continued, medications and IVF of D5IMB 500 cc @10vv/hr (soluset)On September 15, 2014phototherapy was continued, medications and IVF of D5IMB 500 cc @10vv/hr (soluset)

Received lying in bed sleeping with IVF soluset D5IMB 500cc flowing at 10 mcgtts/min at the left metacarpal vein, no inflammation, no swelling and no infiltration noted in the insertion site. IVF infusing well. Well groomed.On September 16, 2014

Upon Assessment: The mother verbalized that she had regular prenatal check ups in their health care center, then during her 7th month of pregnancy she transferred her prenatal check up in diagcare and gave birth there. the mother told us that before she was brought to the lying in her bag of water raptured. She said there were a lot of water that came out with a little bloods, she was still in 2 cm that time. She said she was induced because of the raptured bag of water. She said that she did had labor because the bag of water just raptured then she was brought in the lying and was told that she should be induced and she was still in 2cm because there are already a lot of water and it maybe dangerous.

Mother verbalized that maybe the patient was infected because she just gave birth in the lying in and if only we know i should have gave birth here in the hospital. The mother also said that the umbillical clamp was keep on touching the clothes of the patient maybe that is the reason of the infection. The mother also told us that she had a UTI during her pregnancy with the patient at 5 months. She said that she went for a check and was given medications. (she forgot what medication she drink that time) The father also told us that after 2 days of delivery to the patient they noticed that the baby was a little yellow in near her eyes but they just ignored it.

Patient response in the different reflexes:Palmar reflexes presentPlantar reflexes presentTonic neck reflex presentHeel reflex presentMoro reflex presentBabinski reflex present Urinalysis:Color: light yellowTransparency: clearSp. Gravity: 1.010Ph: 6.0Pus cells: 0-2/hpfRBC: 0-1/hpfEpith cells: fewAmorp urates: rareBacteria: rare CBCRBC: 3.80 LMCV: 106 highMCH: 36.3 highLYM: 47 highBAS: 6 high Billirubin testTotal bilirubin: 22.9 mg/dlDirect bilirubin: 0 mg/dlIndirect bilirubin: 22.9 mg/dlLaboratory Result

On September 17, 2014 They were instructed to let the baby go out early in the morning and have the sunlight touch her skin.

The following are the medications that they have to secure for the patient:Cefuroxime 200 mg IVTT x 2 times a day (8AM - 3PM) for 5 daysAmikacn 50 mg IVTT once a day (8AM) for 5 daysMultivitamins + Zinc drops 0.5ml once a day (8AM) to start if baby is 3 weeks oldThe patient was on HEPLOCK and the parents told us that they are going to have the medication injected in the health center.

They were also instructed to have a follow up check up after 5 days September 23,2013Patient was for discharged

Nursing Care Plan

List of NCP1. Knowledge deficit related to Unfamiliarity with information resources

2. Risk for fluid volume deficit related to phototherapy

3. Ineffective tissue perfusion related to impaired transport of oxygen across alveolar and on capillary membrane

4. Impaired skin integrity related to hyperbilirubinea

5. Anxiety (Child and Parent) related to hospitalization of child

6. Risk for Infection [progression of sepsis to septic shock, development of opportunistic infections] related to compromised immune system and improper hygiene

Cont.7. Interrupted breastfeeding related to neonates present illness as evidenced by separation of mother to infant

8. Risk for Impaired parent/ neonates Attachment related to neonates physical illness and hospitalization

9. Ineffective thermoregulation related to newborns transition to extrauterine environment

10. Diarrhea related to Phototherapy

NCP # 1Knowledge deficit

related to Unfamiliarity with information resources

CUES/EVIDENCESOBJECTIVES Subjective: >Mother verbalized that we are worried to what happened to our daughter. >Mother verbalized that maybe the patient was infected because she just gave birth in the lying in and if only we know i should have gave birth here in the hospital. >The mother also said that the umbillical clamp was keep on touching the clothes of the patient maybe that is the reason of the infection. Objective >Patients mother wondering what is the real cause of infection to her baby > Mother asking information about the disease > Patients mother keep on asking questions about the disease condition After our nursing intervention: > Mother will verbalized understanding on the disease, it treatment and how to prevent it. > Mothers anxiety will be reduced as verbalized > Mothers question about what may be the causes of infection will be answered

NCP # 2 Risk for fluid volume deficit

related to phototherapy

NCP # 3Ineffective tissue perfusion

related to impaired transport of oxygen across alveolar and on capillary membrane

CUES/EVIDENCESOBJECTIVESINTERVENTIONSRATIONALEEVALUATION Subjective:> Mother verbalized hat the patient defecated 3 times with black stool with yellowish color > Mother said that the patient minimally use her accessory muscles

> Mother verbalized that the patient was yellow in color (jaundice) all over the body and eyes and the patients umbellical cord was wet, swelling and have a foul odor that is why they are admitted.

Objective:

> The patient manifested change in skin color skin yellowish (Jaundice) After our nursing intervention:

> Patient will demonstrate increased perfusion as evidenced by warm and dry skin, strong peripheral pulses, normal vital signs, adequate urine output and absence jaundice

> Patient will have proper circulation as evidence by no redness or sores noted.

> Patient will be done and successful treatment in its phototherapy.

1. Monitor neonates condition.

2. Monitor Vital signs

3. Note quality and strength of peripheral pulses

4. Assess respiratory rate, depth, and quality - To determine the need for intervention and the effectiveness of therapy. - To have a baseline data - To asses pulse that may become weak or thready, because of sustained hypoxemia - To note for an increased respiration that occurs in response to direct effects of endotoxins on the respiratory center in the brain, as well as developing hypoxia, stress.

- Respirations can become shallow as respiratory insufficiency develops creating risk of acute respiratory failure. After our nursing intervention:

> Patient was warm to touch and had a dry skin with no redness and sores. > Patient has a proper circulation as evidence by no redness and sores noted.

> Patient was done with her phototherapy treatment and was MGH

> Patients umbilical cord was dry, no swelling and no foul odor.

NCP # 4Impaired skin integrity

related to hyperbilirubinea

THANK YOU

Our patient is in the early onset sepsis, the jaundice was seen by the parents in her 2nd day of life but disregarded it. Rupture of membranes (placenta tissue) that lasts longer than 24hours is one of the cause we the researcher considered. it the next slides we are going to see as to what maybe the reasons why the patient developed sepsis neonatorumWe are also looking into consideration where the patient gave birth, contaminated hospital equipment may also be a reasons why the patient had sepsis. Appearance (skin color) Pulse (heart rate) Grimace response (reflexes) Activity (muscle tone) Respiration (breathing rate and effort)

Newborn weight range (grams)2500-4000 gramsErythromycin prevent blindness. The blindness in question results from infection STD.Hepatitis B This shot acts as a safety net, reducing the risk of getting the disease from moms or family members who may not know they are infected with hepatitis B.Vitamin K To provide administration of prophylactic Vitamin K1 to prevent Vitamin K1 deficiency bleeding in the newborn (VKDB). The colonisation of the intestine by bacteria required to synthesis vitamin K does not occur until milk feeding is established.Blood clotting factors 11, V11, 1X and X require vitamin K to convert into active clotting factors, and because Vitamin K is poorly transferred across the placenta any stores are quickly depleted after birth