sepsis neon at or um case study

8/9/2019 Sepsis Neon at or Um Case Study

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1. PATIENT ASSESSMENT

A. GENERAL DATA

1. Patient’s Name: B.D.2. Address: Tarlac3. Sex: Male4. Birth Date: 07-26-20105. Rank in the family: 7th.6. Nationality: Filipino7. Civil Status: Newborn8. Date of Admission: 07-26-20109. Attending Physician: Dr.Guide

B. CHIEF COMPLIANT:PREMATURITYD. HISTORY OF PRESENT ILLNESS:

SEPSIS NEONATARUM DUE TO PREMATURITYE. FAMILY ASSESSMENT

NAME RELATION AGE SEX OCCUPATION EDUC’L ATTAINMENT

M.D HUSBAND 52 MALE DRIVER HIGH SCHOOL GRADUATEK.D WIFE 40 FEMALE HOUSE WIFE HIGH SCHOOL GRADUATEK.D BROTHER 25 MALE VENDOR HIGH SCHOOL GRADUATEN.D BROTHER 22 MALE VENDOR HIGH SCHOOL GRADUATEL.D SISTER 20 FEMALE NONE HIGH SCHOOL GRADUATER.D BROTHER 19 MALE VENDOR HIGH SCHOOL GRADUATEA.D SISTER 15 FEMALE STUDENT STUDENTB.D SISTER 09 FEMALE STUDENT STUDENTB.D PATIENT 0 MALE NEWBORN NEWBORN



1. NUTRITIONAL – METABOLIC PATTERN

Usual Daily Menumother

Food - meat and vegetablesWater - 5-6 glasses per dayBeverages – juice, cola

2. Elimination Pattern:

Bowel habits note for any frequency of defecation, characteristics of stoolColor - greenishOdor - good smellConsistency -Laxative use if any – none

Bladder frequency of urination, characteristics of urineColor - yellowishOdor -Alterations if any - none

3. Activity – Exercise PatternSelf-care ability

_IV_Feeding _IV_Dressing _IV_Grooming_IV_Bathing _IV_Toileting ___Cooking_IV_Bed mobility ___Home maintenance ___others



Legend0 - full careI - requires use of equipment

II - requires assistance or supervision from othersIII - requires assistance or supervision from another, and equipment a

deviceIV - dependent; doesn’t participate

SLEEP – REST PATTERN

Sleep habits:Special sleeping problems: irritabilityHours of sleep: 2-3 hoursSleeping aids: none

4. Role Relationship PatternPerception of major roles and responsibilities in the family

Perception of major roles and responsibilities at work

Perception of major social roles and responsibilities



5. SEXUALITY-REPRODUCTIVE PATTERN

Menstrual History

Age of onset of menarche - 5Number of menstrual days - 5 daysNumber of pads every menstruation – 3 pads

Obstetric History

TPALOperation - none

F. Developmental History

Theories Age Sex Patient DescriptionFreud 0 male Mouth is the center of pleasureSecurity is the primary needfeeding procedure,pleasure and sense of comfort andsafety feeding should bepleasurableand provided the when required.

Regional Exam1. Hair, head and face2. Eyes –3. Nose -4. Ears – soft slow recoil5. Mouth and Throat –6. Skin – smooth, pinkish, visible veins



7. Nails –8. Thorax and lungs –9. Breast and axilla – perceptible

10.Abdomen –11.Extremities –12.Genitals – testes and upper canal rugea

13. Rank in the family – 7th 14.Educational attainment – new born

Pediatric History

a. Maternal and birth historyDate of birthBirth weightType of deliveryCondition after birthHospital

b. motherComplications of deliveryAnesthesia – epidural anesthesiaExposure to teratogens – no such exposure to teratogens

c. neonatesNeonatal history - prematurityFeeding history – Nothing per oremType of feeding – strict aspiration precautions



Laboratory and Diagnostic ExamDate: January 26, 2010Type of Examination:

Test Results normal values significance

WBC 20.3 GL 4.1 – 10.9 g/L - The result denotes thatThe client has infection

LYM 17.2 RO 84.7/L*MID 0.9-4.3%MGRAN 2.2 R3 11.0 %G

RBC 4.43 T/L 4.3 – 5.9 mill/mm3

HGB 176. G/L 125-175 g/dL - This denotes that theClient high altitudes

HCT 521 L/L 0.40 – 0.52 g/LMCV 117.5 PG 80 – 100 cu/µm

MCH 39.7 PG 25.4 – 34.6 pg/cell

CHC 338 G/L

PLT 70 GL 140 – 440 g/L



Generic Name: oxacillinBrand Name: bactocill

Dosage: Infants and Children: I.M., I.V.: 100-200 mg/kg/day in divided doses every 6hours (maximum: 12 g/day)Indication: treatment of infections caused by penicillinase-producing staphyloccicci;initial therapy of suspected staphylococcal infection.

Mechanism ofaction

Side effects Contraindication Adverse reaction Nursingconsideration

Interferes withcell wallreplication of

susceptibleorganisms;osmoticallyunstable cellwall swells,bursts fromosmotic pressure

- Milddiarrhea

- Nausea

- Swelling attheinjectionsite

- Chest pain- Mouth

irritration

Before usingoxacillin, tellyour doctor if

you are allergictocephalosporinssuch as Ceclor,Ceftin, Duricef,Keflex, andothers, or ifyou have asthma,liver disease,kidney disease,or a history ofany type ofallergy.

- fever- rash- diarrhea

- nausea- neutropenia

- hepatotoxicity

• Assessresult ofculture and

sensitivitytest.

• Patientshould bemonitoredclosely.

• Evaluateresults oflaboratotytest.

Assessbowelpatterneveryday.

• Assess forovergrowthof



infection.

Generic Name: ranitidine

Brand Name: zantacDosage: dosage for babies is typically 2 mg to 4 mg per kg (a little less than 1 mg to 2mg per pound) once a day, but no more than 150 mg per day.Indication: used In the management of various gastrointestinal (GI) disorders such asdyspepsia, gastro-esophageal reflux disease (GERD),peptic ulcer and Zollinger-Ellisonsyndrome. Prophylaxis of GI hemorrhage from stress ulceration and in patients at risk ofdeveloping acid aspiration during general anesthesia; prophylaxis of Mendelson syndrome.

Mechanism ofaction

Side effects Contraindication Adverse reaction Nursingconsideration

Inhibitshistamine at H2

receptor site inthe gastricparietal cells,which inihibitsgastric acidsecretion.

- Sometimesbabies canbecome abit sleepy

- Diarrhea

- Blurred vision

- Constipation

- Dizziness

- headache

- feeling of a

whirling motion- general body

discomfort

- nausea

- stomach pain

- vomiting

- any patienthypersensitive to thedrug or itscomponents

- should beusedcautiouslyin thosepatientswith renaldisease,specifically in thosewith renalimpairmentor renalfailure

- dizziness- abdominalpain

- delirium- constipation- myalgia- sinus

tachycardia- insomnia- jaundice- bradycardia- alopecia

• Use cautionin presenceof renal orhepaticimpairment.

• Evaluateresults oflaboratorytest.

• Assess

potentialforinteractionwith otherpharmacological agentsmaybetaking.



ANATOMY AND PHYSIOLOGY

Lymphatic SystemThe lymphatic system consists of organs,

ducts, and nodes. It transports a watery clear fluidcalled lymph. This fluid distributes immune cellsand other factors throughout the body. It alsointeracts with the blood circulatory system todrain fluid from cells and tissues. The lymphaticsystem contains immune cells called lymphocytes,which protect the body against antigens (viruses,bacteria, etc.) that invade the body. See more on

lymphocytes below.

Main Functions of Lymphatic System

• To collect and return interstitial fluid,including plasma protein to the blood, and thus

help maintain fluid balance,

• To defend the body against disease by producing

lymphocytes,

• To absorb lipids from the intestine and transport them

to the blood.

Lymph organs include the bone marrow, lymphnodes, spleen, and thymus. Precursor cells in thebone marrow produce lymphocytes. B-lymphocytes (B-cells) mature in the bone marrow.

T-lymphocytes (T-cells) mature in the thymusgland.

Lymph Nodes - A lymph node is an organized

collection of lymphoid tissue, through which thelymph passes on its way to returning to the blood.Lymph nodes are located at intervals along thelymphatic system. Several afferent lymph vesselsbring in lymph, which percolates through thesubstance of the lymph node, and is drained outby an efferent lymph vessel



The Cardiovascular System

The heart and circulatory system make upthe cardiovascular system. The heart works as a

pump that pushes blood to the organs, tissues,and cells of the body. Blood delivers oxygen andnutrients to every cell and removes the carbondioxide and waste products made by those cells.Blood is carried from the heart to the rest of thebody through a complex network of arteries,



arterioles, and capillaries. Blood is returned to theheart through venules and veins.

The one-way circulatory system carries

blood to all parts of the body. This process of blood flow within the body is called circulation.Arteries carry oxygen-rich blood away from theheart, and veins carry oxygen-poor blood back tothe heart. In pulmonary circulation, though, theroles are switched. It is the pulmonary artery thatbrings oxygen-poor blood into the lungs and thepulmonary vein that brings oxygen-rich bloodback to the heart.

Twenty major arteries make a path through

the tissues, where they branch into smallervessels called arterioles. Arterioles further branchinto capillaries, the true deliverers of oxygen andnutrients to the cells. Most capillaries are thinnerthan a hair. In fact, many are so tiny, only oneblood cell can move through them at a time. Oncethe capillaries deliver oxygen and nutrients andpick up carbon dioxide and other waste, theymove the blood back through wider vessels calledvenules. Venules eventually join to form veins,

which deliver the blood back to the heart to pickup oxygen. Vasoconstrictionor the spasm of smooth muscles around the bloodvessels causes and decrease in blood flow but anincrease in pressure. In vasodilation, the lumen of the blood vessel increase in diameter therebyallowing increase in blood flow. There is no

tension on the walls of the vessels therefore,there is lower pressure.

Various external factors also cause

changes in blood pressure and pulse rate. Anelevation or decline may be detrimental to health.Changes may also be caused or aggravated byother disease conditions existing in other parts of the body. The blood is part of the circulatory system. Whole

blood contains three types of blood cells, including: red bloodcells, white blood cells and platelets.

These three types of blood cells are mostlymanufactured in the bone marrow of thevertebrae, ribs, pelvis, skull, and sternum. These

cells travel through the circulatory systemsuspended in a yellowish fluid called plasma.Plasma is 90% water and contains nutrients,proteins, hormones, and waste products. Wholeblood is a mixture of blood cells and plasma.

Red blood cells (also called erythrocytes)are shaped like slightly indented, flattened disks.Red blood cells contain an iron-rich protein calledhemoglobin. Blood gets its bright red color whenhemoglobin in red blood cells picks up oxygen in

the lungs. As the blood travels through the body,the hemoglobin releases oxygen to the tissues.

The body contains more red blood cells than anyother type of cell, and each red blood cell has alife span of about 4 months. Each day, the bodyproduces new red blood cells to replace those thatdie or are lost from the body.



White blood cells (also called leukocytes) are akey part of the body's system for defending itself against infection. They can move in and out of the

bloodstream to reach affected tissues. The bloodcontains far fewer white blood cells than red cells;although the body can increase production of white blood cells to fight infection. There areseveral types of white blood cells, and their lifespans vary from a few days to months.

Certain types of white blood cells produceantibodies, special proteins that recognize foreignmaterials and help the body destroy or neutralizethem. When a person has an infection, his or her

white cell count often is higher than when he orshe is well because more white blood cells arebeing produced or are entering the blood streamto battle the infection.

Platelets (also called thrombocytes) aretiny oval-shaped cells made in the bone marrow.

They help in the clotting process. When a bloodvessel breaks, platelets gathering the area andhelp seal off the leak. Platelets survive only about

9 days in the bloodstream and are constantlybeing replaced by new cells.

Blood also contains important proteinscalled clotting factors, which are critical to theclotting process. Although platelets alone can plugsmall blood vessel leaks and temporarily stop orslow bleeding, the action of clotting factors isneeded to produce a strong, stable clot.

Platelets and clotting factors work togetherto form solid lumps to seal leaks, wounds, cuts,

and scratches and to prevent bleeding inside andon the surfaces of our bodies. The process of clotting is like a puzzle with interlocking parts.When the last part is in place, the clot is formed.



IMMUNE SYSTEM

An immune system is a collection ofbiological processes within an organismthat protects against disease byidentifying and killing pathogens and

tumour cells. It detects a wide variety ofagents, from viruses to parasitic worms,and needs to distinguish them from the

organism's own healthy cells and tissuesin order to function properly. Detectionis complicated as pathogens can evolverapidly; producing adaptations that avoidthe immune systemand allow the pathogens to successfullyinfect their hosts.To survive this challenge, multiplemechanisms evolved that recognize andneutralize pathogens. Even simpleunicellular organisms such as bacteriapossess enzyme systems that protectagainst viral infections. Other basicimmune mechanisms evolved in ancienteukaryotes and remain in their moderndescendants, such as plants, fish,reptiles, and insects. These mechanismsinclude antimicrobial peptides calleddefensins, phagocytosis, and thecomplement system. Vertebrates such ashumans have even more sophisticated

defense mechanisms.The immune systems of vertebrates

consist of many types of proteins, cells,organs, and tissues, which interact in anelaborate and dynamic network. As part ofthis more complex immune response, thehuman immune system adapts over time



torecognise specific pathogens moreefficiently. This adaptation process isreferred to as "adaptive immunity" or

"acquired immunity" and createsimmunological memory.

Immunological memory created from aprimary response to a specific pathogen,provides an enhanced response to secondaryencounters with that same, specificpathogen. This process of acquiredimmunity is the basis of vaccination.

Disorders in the immune system canresult in disease. Immunodeficiencydiseases occur when the immune system isless active than normal, resulting inrecurring and life-threatening infections.Immunodeficiency can either be the resultof a genetic disease, such as severe

combined immunodeficiency, or be producedby pharmaceuticals or an infection, suchas the acquired immune deficiency syndrome

(AIDS) that is caused by the retrovirusHIV. In contrast, autoimmune diseasesresult from a hyperactive immune systemattacking normal tissues as if they wereforeign organisms. Common autoimmunediseases include rheumatoid arthritis,diabetes mellitus type 1 and lupuserythematosus. Immunology covers the studyof all aspects of the immune system whichhas significant relevance to human healthand diseases. Further investigation inthis field is expected to play a seriousrole in promotion of health and treatmentof disease



INTRODUCTION

Sepsis in a newborn (sepsis neonatorum) is an infection that spreads throughout the

baby’s body. Sepsis occurs in less than 1 percent of newborns (1 out of every 100), but

accounts for up to 30 percent of deaths in the first few weeks of life. Infection is 5-10

times more common in premature newborns and in babies weighing less than 5½ pounds than

in normal-weight, full-term newborns. Complications experienced during birth, such as

premature or prolonged rupture of the membranes or infection in the mother, put the

newborn at increased risk of infection. Sepsis is a term for severe infection that is

present in the blood and spreads throughout the body. In newborns, it is also called

sepsis neonatorum or neonatal septicemia.



Case Study(sepsis neonatorum)

Submitted by:Roxanne J. Saplala

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sepsis neon at or um case study

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