Definition
Neonatal sepsis (neonatal septicemia or sepsis neonatorum) is an infection in the blood that spreads throughout the body and occurs in a neonate. Neonatal Sepsis has two types:
Early-onset Sepsis
Onset of 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.
Late-onset Sepsis
The second type or the Late-onset Sepsis is acquired after delivery. This can be caused 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
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,
- yellowish skin and whites of the eyes (jaundice).
Possible complications are disability and worst is death of the neonate.
Nursing Care Plans
Hyperthermia
Due to the presence of an infectious agents, stimulation of the monocytes triggers the release of the pyrogenic cytokines that stimulate anterior hypothalamus which results in elevated thermoregulatory set point that leads to an increased heat conservation (Vasoconstriction) and increased heat production which results to fever.
Assessment
Patient may manifest
- Irritability
- Weakness
- Temperature above normal level (36 oC)
- Skin warm to touch
- Presence of tachycardia (above 160 bpm)
- Presence of tachypnea (above 60 bpm)
- WBC elevated
Nursing Diagnosis
- Hyperthermia related to inflammatory process/ hypermetabolic state as evidenced by an increase in body temperature, warm skin and tachycardia
Outcomes
- Patient will maintain normal core temperature as evidenced by vital signs within normal limits and normal WBC level
- Patient will still maintain normal core temperature as evidenced by normal vital signs and normal laboratory results.
| Nursing Interventions | Rationale |
|---|---|
| Monitor neonate’s condition. | To determine the need for intervention and the effectiveness of therapy. |
| Monitor vital signs | To have a baseline data |
| Provide TSB | Helps in lowering down the temperature |
| Ensure that all equipment used for infant is sterile, scrupulously clean. Do not share equipment with other infants | Prevents the spread of pathogens to the infant from equipment |
| Administer antipyretics as ordered | Aids in lowering down temperature |
Fluid Volume Deficit
Fluid volume deficit, or hypovolemia, occurs from a loss of body fluid or the shift of fluids into the third space one factor includes a failure of the regulatory mechanism of the newborn specifically hyperthermia
Assessment
Patient may manifest
- Decreased urine output
- Increased urine concentration
- Increased pulse rate (above 160 bpm)
- Decreased body temperature (above 36 oC)
- Decreased skin turgor
- Dry skin/ mucous membranes
- Elevated hct
Nursing Diagnosis
- Fluid volume deficit related to failure of regulatory mechanism
Outcomes
- 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.
| Nursing Interventions | Rationale |
|---|---|
| Monitor and record vital signs | To note for the alterations in V/S (decreased BP, Increased in PR and temp) |
| Note for the causative factors that contribute to fluid volume deficit | To assess what factor contributes to fluid volume deficit that may be given prompt intervention. |
| Provide TSB if patient has fever | To decrease temperature and provide comfort |
| Provide oral care by moistening lips & skin care by providing daily bath | To prevent injury from dryness |
| Administer IV fluid replacement as ordered | Replaces fluid losses |
| Administer antipyretic drugs if patient has fever as ordered | To reduce body temperature |
Ineffective Tissue Perfusion
Since the body of the newborn is unable to compensate to the imbalances of the inflammatory response related to his condition the body tends to “hyperdrive” causing an inadequate oxygen in the tissues or capillary membrane leading to poor perfusion.
Assessment
Patient may manifest
- Skin or temperature changes
- Weak pulses
- Edema
- Inadequate urine output
Nursing Diagnosis
- Ineffective tissue perfusion related to impaired transport of oxygen across alveolar and on capillary membrane
Outcomes
- 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
| Nursing Interventions | Rationale |
|---|---|
| Note quality and strength of peripheral pulses | To asses pulse that may become weak or thready, because of sustained hypoxemia |
| Assess respiratory rate, depth, and quality | 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. |
| Assess respiratory rate, depth, and quality | To assess for compensatory mechanisms of vasodilation |
| Assess skin for changes in color, temperature and moisture | To promote circulation /venous drainage |
| Elevate affected extremities with edema once in a while | Conserves energy and lowers O2 demand |
| Provide a quiet, restful atmosphere | To maximize O2availability for cellular uptake |
Interrupted Breastfeeding
Since the neonate is diagnosed for having a neonatal sepsis, the baby got separated from his mother and placed on a Neonatal Intensive Care Unit for better management and care. Interrupted breastfeeding develops since the mother is unable to breastfeed the baby continuously due to their separation.
Assessment
- The newborn is diagnosed with a certain disease (Sepsis)
- The newborn is separated from his mother
- The mother unable to provide breast milk to newborn continuously
Nursing Diagnosis
- Interrupted breastfeeding related to neonate’s present illness as evidenced by separation of mother to infant
Outcomes
- The mother will identify and demonstrate techniques to sustain lactation until breastfeeding is initiated
- The mother shall still be able to identify and demonstrate techniques to sustain lactation and identify techniques on how to provide the newborn with breast milk.
| Nursing Interventions | Rationale |
|---|---|
| Assess mother’s perception and knowledge about breastfeeding and extent of instruction that has been given. | To know what the mother already knows and needed to know. |
| Give emotional support to mother and accept decision regarding cessation/ continuation of breast feeding. | To assist mother to maintain breastfeeding as desired. |
| Demonstrate use of manual piston-type breast pump. | Aid in feeding the neonate with breast milk without the mother breastfeeding the infant. |
| Review techniques for storage/use of expressed breast milk | To provide optimal nutrition and promote continuation of breastfeeding process |
| Determine if a routine visiting schedule or advance warning can be provided | So that infant will be hungry/ ready to feed |
| Provide privacy, calm surroundings when mother breast feeds. | To promote successful infant feeding |
| Recommend for infant sucking on a regular basis | Reinforces that feeding time is pleasurable and enhances digestion. |
| Encourage mother to obtain adequate rest, maintain fluid and nutritional intake, and schedule breast pumping every 3 hours while awake | To sustain adequate milk production and breast feeding process |
Risk for Impaired Parent/Infant Attachment
Due to the newborn’s physical illness and hospitalization, the parents may have fear on how to handle their baby since the baby is on its fragile state and needed extra care. And since he is the 1st child hospitalized in their family, the parents might still be unsure on how to take care of the baby.
Assessment
- The newborn is diagnosed with a certain disease (Sepsis)
- The newborn is separated from his mother
- The mother unable to provide breast milk to newborn continuously
Nursing Diagnosis
- Risk for Impaired parent/neonates Attachment related to neonates physical illness and hospitalization.
Outcomes
- The mother will identify and demonstrate techniques to enhance behavioral organization of the neonate
- After discharge the parents will be able to have a mutually satisfying interactions with their newborn.
| Nursing Interventions | Rationale |
|---|---|
| Interview parents, noting their perception of situational and individual concerns | To know what the parents feelings about the situation. |
| Educate parents regarding child growth and development, addressing parental perceptions | Helps clarify realistic expectations |
| Involve parents in activities with the newborn that they can accomplish successfully | Enhances self-concept |
| Recognize and provide positive feedback for nurturing and protective parenting behaviors | Reinforces continuation of desired behaviors |