case study neonatal sepsis.doc

8/9/2019 case study neonatal sepsis.doc

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\CASE STUDY \



INTRODUCTION

Newborn infants are at much higher risk for developing sepsis than children and adults because of

their immature immune system—especially premature infants, where 1 out of every 250 will be

diagnosed with sepsis. epsis is one of the ma!or leading causes of death in the first few months of a

newborn"s life. #nfections can contribute up to 1$%15& of all deaths during the neonatal period with the

mortality rate reaching as high as 50& for infants who are not treated timely. 'he combination of an

immature and slow responding immune system increases the risk of infection in the neonate. (ne reason

for the increased risk is that antibodies, which help protect mothers from infections, do not cross through

the placenta to the fetus until appro)imately $0 weeks of gestation. 'he antibodies present at birth taketime to reach optimum levels, which also affects the protection provided.

Neonatal sepsis may be categori*ed as early or late onset. +ighty%five percent of

newborns with early%onset infection present within 2 hours, 5& present at 2%- hours, and a

smaller percentage of patients present between - hours and days of life. (nset is most rapid in

premature neonates. +arly%onset sepsis syndrome is associated with ac/uisition of microorganisms from the mother. 'ransplacental infection or an ascending infection from the

cervi) may be caused by organisms that coloni*e in the mothers genitourinary tract, withac/uisition of the microbe by passage through a coloni*ed birth canal at delivery. 'hemicroorganisms most commonly associated with early%onset infection include group

Streptococcus 34, Escherichia coli, Haemophilus influenzae, and Listeria monocytogenes.

ate%onset sepsis syndrome occurs at 6%70 days of life and is ac/uired from the



assessments. 'he assessment begins with a nurse"s innate knowledge of the many different risk factors for

newborn infection. 'he nurse needs to be observant for any sign that may indicate sepsis. #t cannot be

overemphasi*ed that prompt recognition, early diagnosis, and immediate treatment of sepsis candramatically improve the infant"s outcome and limit any potential disability.

OBJECTIVES

GENERAL OBJECTIVE:

This study aims to discuss a case where a nursing rocess is comrehensi!e"y

uti"i#ed in care o$ the atient ha!ing neonata" sesis ro!iding a thorough and c"ear

understanding o$ the c"ient%s history& hea"th condition& athohysio"ogy o$ the disease&

treatment and management' and to identi$y the drugs and its im"ications to de!e"o a

(etter medica" and nursing management o$ the disease)



ANATOMY AND PHYSIOLOGY

Fetal Circulation

<uring pregnancy, the fetal circulatory system works differently than after birth=

• 'he fetus is connected by the umbilical cord to the placenta, the organ that develops and

implants in the mothers uterus during pregnancy.

• 'hrough the blood vessels in the umbilical cord, the fetus receives all the necessary

nutrition, o)ygen, and life support from the mother through the placenta.

• >aste products and carbon dio)ide from the fetus are sent back through the umbilical

cord and placenta to the mothers circulation to be eliminated.



• @rom the aorta, blood is sent to the head and upper e)tremities. After circulating there,

the blood returns to the right atrium of the heart through the superior vena cava.

• About one%third of the blood entering the right atrium does not flow through the foramenovale, but, instead, stays in the right side of the heart, eventually flowing into the

pulmonary artery.

ecause the placenta does the work of e)changing o)ygen (24 and carbon dio)ide 8(24

through the mothers circulation, the fetal lungs are not used for breathing. #nstead of bloodflowing to the lungs to pick up o)ygen and then flowing to the rest of the body, the fetal

circulation shunts bypasses4 most of the blood away from the lungs. #n the fetus, blood is

shunted from the pulmonary artery to the aorta through a connecting blood vessel called theductus arteriosus.

Blood circulation after birth:

>ith the first breaths of air the baby takes at birth, the fetal circulation changes. A larger

amount of blood is sent to the lungs to pick up o)ygen.

• ecause the ductus arteriosus the normal connection between the aorta and the

pulmonary valve4 is no longer needed, it begins to wither and close off.

• 'he circulation in the lungs increases and more blood flows into the left atrium of the

heart. 'his increased pressure causes the foramen ovale to close and blood circulates



Neutrophils +levated numbers at birth, with impaired

functional ability

+levated numbers at birth, with impaired

functional ability

?onocytes Normal number at birth but have impaired

chemota)is

Normal number at birth but have impaired

chemota)is

?acrophages Normal number at birth but decreasedfunction

Normal number at birth but decreasedfunction

Natural Filler 8ells 8oncentration similar to adult level, but have

diminished cytoto)ic effects

8oncentration similar to adult level, but have

diminished cytoto)ic effects

I""une S%!te" h%!iolo&%

<espite the immune system and immune system components, early development during gestation the

newborn still remains vulnerable to infections after they are born because of the immaturity of their immune system.

A newborn has a poor response to invading pathogens. 'his immune response will gradually improve with

age. <uring the initial postpartum phase, the infant relies on maternal antibodies and the mother"s breast milk, which

is rich with immunoglobulins. >hen a pathogenic organism overcomes the infant"s defenses, infection and sepsis

result. epsis is defined as the presence of microorganisms or their to)ins in blood or other tissues. Newborn sepsisis still one of the most significant causes of neonatal disability and death today.

;eviewing the functions of the infant"s immune system will help provide a better understanding of the

interaction between the pathogenic organisms and the newborn"s susceptibility to infection. #nfections occur whenthe infant comes in contact with a pathogenic organism. 'he organism, whether it is a virus, fungus, or bacteria,

enters into the infant"s body system and begins to multiply.

'h i f " i i i di id d i h h 'h fi h i h



Educational Level: NA

Marital Status: *ing"e

Religion: NA

Birthdate: 0ecem(er .& .;;3

No. of Dependents:none

Birthplace: Bago City

Gender: ,ema"e

ccupation: NA

Nationalit!: ,i"iino

"erson ne#t to $in:7other

Source of histor!%relia&ilit!: *igni$icant other <mother= and atient%s charts

Date of Admission:0ecem(er 1& .;;3



(!pical Da! Activities

The mother usua""y do the househo"d chores taes care o$ the in$ant)

Nutritional * Meta&olic "attern

The mother eats nutritiona" $oods such as $ruits and !egeta("es with no tea& co$$e

or so$tdrin during regnancy) hi"e the (a(y is (reast$ed with asiration recaution)

The (a(y is with diaer and has a so$t stoo" due to (reast$eeding)

Activit! and E#ercise "atterns

The mother usua""y do househo"d chores and wa"s ear"y in the morning as a

$orm o$ e@ercise during regnancy) A$ter de"i!ery whi"e (oth mother and chi"d is in the

hosita"& the mother usua""y gi!es the chi"d sun (athing to e"iminate the ye""owish



The atient shares that raying and reading the Bi("e gi!es her strength and

he"s her $ace the stresses in "i$e a"though she does not go to church regu"ar"y) 8er

$ami"y and her re"ati!es show suort (y !isiting her in the hosita" and through te@ting

or ca""ing her to as how she and the (a(y is doing)

Se#ualit! "atterns

The atient is married and has a norma" se@ "i$e) *he cannot remem(er her L7+

and did not undergo any reroducti!e e@amination due to now"edge de$icit and

$inancia" insta(i"ity)

Social Support

Aside $rom her $ami"y& she is a"so grate$u" $or the suort and rayer that her



)istor! of "resent -llness:

a) ?sua" hea"th status: The atient has (een e@eriencing an on and o$$ $e!er with

coo"& c"ammy and Daundiced sin with uward ro""ing o$ eye(a""s& $e(ri"e sei#ure&

irrita(i"ity and oor $eeding)

() Chrono"ogic story:

-) Octo(er .;;. H 0uring the mother%s $irst regnancy <on the

.5th wee gestation= she e@erienced an accident & she

s"ied and $e"" whi"e in the (athroom and to manage the

ain she went to a Fmanoghi"ot and had her gra!id uterus

massaged to ee the (a(y sa$e) Then& she continued to

wor in the $arm and do the househo"d chores)

.) 0ecem(er .;;. H The mother e@erienced the same



resorted to 0A7A <discharge against medica" ad!ice= and

(rought the chi"d home)

1) Ari" .;;/ H 8er $irst (a(y acuired meas"es thought to

come $rom a neigh(oring in$ant& then e@erienced on and o$$

$e!er& chi""s and uward ro""ing o$ eyes) The mother (rought

her $irst (a(y to CL77R8 and the (a(y was diagnosed to

ha!e acuired German meas"es howe!er& due to "ac o$

$inancia" suort they went home and was not a("e to do

anything to aid the in$ant%s condition)

2) 7ay -4& .;;/ H The $irst (a(y died at $our months o"d a$ter

su$$ering $rom di$$erent re!ai"ing conditions "e$t unaided)

3) 0ecem(er .& .;;3 H The mother had her second de"i!ery



the in$ant so that the drugs can (e assed on to the in$ant

!ia (reastmi")

5) 0ecem(er 1& .;;3 H The mother (rought the c"ient to Bago

8ea"th Center $or BCG !accination and reorted the chi"d%s

case to the resident hysician) The hysician did not gi!e

the BCG immuni#ation and re$erred her to the Bago City

8osita" $or admission and $urther o(ser!ation)

c) Re"e!ant $ami"y history: NA

d) 0isa(i"ity assessment: NA

"ast )ealth )istor! /infant0:

Chi"dhood i""ness: uward ro""ing o$ eyes& chi""s& coo" and c"ammy sin& on and o$$



Nutritiona" atterns: Breast$eed with asiration recaution

Acti!itye@ercise atterns: +rimiti!e re$"e@es resent and strong

Recreation: none

*"eerest atterns: *"ees most o$ the time and on"y waes u when she urinates&

ass out stoo" or when hungry)

+ersona" ha(its: none

*ocioeconomic status: Be"ow o!erty "ine

En!ironmenta" hea"th atterns: +oor en!ironmenta" condition with dirty surroundings

and unsanitary ersona" hygiene)

Ro"es& Re"ationshis& *e"$concet <mother=: 7other has a ositi!e out"oo $or her

chi"d%s $uture gi!en that the chi"d%s "i$e wi"" (e

ro"onged) *he has a"so a good re"ationshi with her



*tresscoing atterns <mother and chi"d=: 7other coes u with stress through rayers

and $ami"y suort) 8er chi"d coes u with stress with the he" o$ her

mother through cudd"ing& $eeding and c"eaning her)

PHYSICAL ASSESSMENT

A) Genera" Aearance

?on assessment& the c"ient "oos unc"ean and untidy with ("ood tinged dress as

she is cudd"ed (y her mother) ?ward ro""ing o$ eyes is o(ser!ed (ut with good

rimiti!e re$"e@es resent) +seudomenstruation is resent as e!idenced (y white

secretions going out o$ the !agina) The um(i"ica" cord is dry and "oos !ery unc"ean

tied with a nonsteri"e thread <the usua" thread we use in sewing c"oths= and cord

c"am) The c"ient%s nai"s were "ong and uncut) C"ient was $e(ri"e and in



*he has a good cai""ary re$i"" K. seconds with strong and raid u"se and has a

heart rate o$ -5; (eats er minute)

,) Gastrointestina" Tract *ystem

The atient has a normoacti!e (owe" sounds at $our uadrants o$ the a(domen)

*he is on (reast$eeding with asiration recaution and was a("e to de$ecate to a so$t

green mushy stoo" aro@imate"y 5; cc)

G) Genitourinary Tract *ystem

The c"ient !oided $ree"y to a c"ear urine aro@imate"y -2 cc with diaer) 8er

erineum is unc"ean with seudomenstruation as e!idenced (y resence o$ ("ood

secretions going out o$ the !agina)



U#IN'LYSIS

Earameter Eatient Normal 9alue #nterpretation #mplication8((; EA+ #3B' ';A> AN(;?A #ndicates

diluted urine

arge fluid

intake4

';ANEA;+N8G #3B' BAJG 8+A; AN(;?A ?ay indicate

bacteruria

E+8#@#8

3;A9#'G

1.010 1.001% 1.020 N(;?A N(;?A

pB .0 5%6 N(;?A N(;?A

;8 1%$ hpf 0%2 hpf ++9A'+< ?ay indicate

renal failure problems

EH 8+ 1% hpf N(N+ ++9A'+< #ndicates

genitourinarytract infection:

contamination



PATOPHISIOLOGY

Home bir! !ro"#! !e !e$% o& ' (%'$er'(

U)*')i'r+ ,o)-iio)* ')- ")*eri$e e."i%me)* "*e-

I),re'*e- $i/e$i!oo- o& b',eri'$ #ro0!

I)*",ie) /)o0$e-#e o& !e #"'r-i')* '* o %ro%er ,or-,'re

I - b i $ ! - i & i



A**e**me)D''

N"r*i)#Di'#)o*i*

R'io)'$e De*ire- O",ome N"r*i)#I)er2e)io)*

J"*i3,'io)

A,"'$4

Ab)orm'$Fi)-i)#*5'he client looksunclean and untidywith blood tinged dress#ntermittent fever @ebrile sei*ure,irritability and poorfeedingGellowishdiscoloration in theskin, eyes and tongue Nails were long and

uncut'he umbilical cord is

dry and looks veryunclean tied with

thread and cord clampEseudomenstruation is present>8 8ountK 1.$ )

10:

#p$ard rolling of

eyesT /4)4C& 8R -5; (m and RR

.; cm

Ri*/4 Re$'e-

'is% for &nfection

( progression ofsepsis to septicshock,development ofopportunisticinfections)related tocompromisedimmune system,environmentalexposure,invasive

procedures,failure toexercise properpreventivemeasures,improperhygiene

*enition+

S,!em'i,

Di'#r'mPre-i*%o*i)#F',or*inancialinstability

-oorenvironmental

sanitationnowledge

*ecit#uperstitious

/eliefs

∪

*eliveredthrough home

birth by a0paltera1

∪

non2 sterileprocedures and

environment

∪

improperumbilical cordcare by using aordinary thread

to tie theremaining cord

After 3 hours of

nursingintervention theclient will be ableto+ Achieve

timelyhealing, befree ofpurulentsecretions 4drainage orerythema,

and beafebrile

&ndependent+

Monitor 5#closely

-rovideisolation4monitor visitorsas indicated

6ash handsbefore4 aftereach care

activity, even ifsterile glovesare used.

To monitor increase ordecrease in 5# thatwould suggestpotentially fatalcomplications

/ody substanceisolation should beemployed for allinfectious patients.7mbilical $ord4 linenisolation andhandwashing may be all

that is re8uired forumbilical cord care.-atients with diseasestransmitted through airmay also needrespiratory precautions.'everse isolation4restriction of visitorsmay be needed toprotect theimmunosuppressedpatient

'educes ris% of cross2contamination

9o

clierelhypafethe b

decr

ND65 RIS7 FOR INFECTION

NURSING CARE PLAN



F',or*5*ecreasedenergy4 fatigue#eptic #hoc%#epticemia

Sre)#!*48e$$)e**5#trong amily#upport

'is% forinfection2 atincreased riskfor beinginvaded by pathogenicorganisms

∪

yellowishdiscoloration,

upward rolling of eyes, febrilesei>ures and

intermittent fever

∪

N?ONATA@#?-#&#

∪

'is% for

infection( progression of sepsisto septic shock,development of

opportunisticinfections)

#ource+ Nurses

-oc%et9uide,+*oenges

Medical2#urgicalNursing+#melt>er

N$-+*oenges

?ncourage4providefre8uentpositionchanges

@imit use ofinvasivedevices4procedureswhen possible

Maintain steriletechni8ue whenputting invasivedevices

Monitortemperaturetrends

Observe forsha%ing chillsand profusediaphoresis

$ollaborative+ Obtain

specimens ofurine, blood,sputum, wound

9ood pulmonary toiletmay reduce respiratorycompromise

'educes number ofsites of entry ofopportunisticorganisms

-revents introductionof bacteria, reducingris% of nosocomialinfection

ever ;3.B= $2 C== isthe result of endotoxineect on the

hypothalamus andpyrogen releasedendorphins

$hills often precedetemperature spi%es inpresence ofgenerali>ed infection.

&dentication of theportal of entry andorganism causing thesepsis



Assessment *ata Nursing *iagnosis 'ationale *esired Outcome Nursing&nterventions

Dustication ?valuat

'ctual( 'bnor"al

Findin&!:

'he first baby of themother was deliveredthrough home birth

also, died by fourmonths old due tounaided and notintervened conditionssuch as meningitis and3erman measles 'he mother believesthe old beliefs andsuperstitious beliefs'he mother resorts to aLpalteraM or

LmanoghilotM if thereis an arising problem

both to her and her baby and would seekadmission in thehospital if thecondition is no longermanageableoth parents of ourclient are elementarygraduateHNA>A;+ that thereare institutions whocan cater the needs ofthe people for free like

lying in clinics

E#&N$? O7'$@&?NT &# AN&NANT &N 6F&$F TF? $O9N&T&5?*?5?@O-M?NT &#

NOT G?T-'?5A&@&N9 6?A##?##?* TF?MOTF?' O O7'$@&?NTH

nowledge *ecit(learning need)regarding illness,prognosis,treatment, self2care anddischarge needs

related to lac% ofexposure4recall!informationmisinterpretation!cognitivelimitation asevidenced by&naccurate follow2through ofinstructions4development ofpreventablecomplications!

inattentiveness!statement ofmisconception

Sche"atic Dia&ra"

-'?*&#-O#&N9A$TO'#

IH inancial#tatus

∪inished

elementary levelonly

JH &naccessibilityto resources and

institutions

∪

7naware of thepresent help inthe community,

ignorancetowards the

society due toisolation

;H 9enerativity

∪

-assed on beliefswhich are

believed to be afallacy and may

at timesendanger lives

∪

The mothertrusts the

capability of a0paltera1 and a

After - hours of nursingintervention the clientwill be able to 9erbali*e

understanding of

disease processand prognosis 8orrectly

performnecessary procedures ande)plain reasonsfor actions

#nitiate necessarylifestyle changes

Earticipate in

treatmentregimen

#ndependent= ;eview disease

process andfuturee)pectations.

;eviewindividual riskfactors and modeof transmission: portal of entry ofinfections

Erovide

informationabout drug

therapy,interactions, sideeffects, andimportance ofadherence toregimen

#e)ie* nece!!it%

of $er!onal

h%&iene and

en)iron"ental

cleanline!!

<iscuss need forgood nutritionalintake: balanced

Erovideknowledge baseon which the patient can make

informed choices Awareness ofmeans ofinfectiontransmission providesopportunity to plan for:institute protectivemeasures

Eromotes

understanding ofand enhances

cooperation intreatment: prophyla)is andreduces risk ofrecurrence andcomplications.

+el$! to control

en)iron"ental

e,$o!ure b%

di"ini!hin& the

nu"ber of

$atho&en!

$re!ent

Necessary foroptimal healingand general well%

3oal partially 'he client wasverbali*e her ounderstandingclient was mad

participate in ttreatment regithe client showsigns that she improve her liand that her pehygiene andenvironment aleft unattended



Ri*/4 Re$'e-F',or*5*ecreasedenergy4 fatigue#eptic #hoc%#epticemia

Sre)#!*48e$$)e**5#trong amily#upport

*enition+nowledge *ecit2Absence ordeciency ofcognitive

informationrelated to specictopic (@ac% ofspecicinformationnecessary for clients4 #OEsH toma%e informed

0manoghilot1 intimes of distressboth to her and

her baby

∪

The mother hadan accident while

pregnant see% forthe manoghilotshelp

∪

The 0manoghilot1manipulated thegravid uterus of

the motherthin%ing it wouldsalvage the life

of the baby

∪

The mother gave

birth to her babythrough home

birth by a0paltera1

∪

&mproper cordcare by the0-altera1

∪

/aby was indistress themother was

advised by the0paltera1 to ta%eseveral

diet #dentify signs and

symptomsre/uiring medicalevaluation, e.g. persistenttemperature

elevation,tachycardia,syncope, rashesof unknownorigin etc.

being of the baby @or early

recognition ofdeveloping:recurringinfection allowsfor timely

intervention andreduces risk for progression tolife threateningsituation.



medications sothat this will be

passed on to thebaby via

breastfeeding

∪

Neonatal #epsis

and the baby wasadmitted to thehospital

∪

Mother still didnot ta%e a bath

for the belief thatshe and her babymust ta%e a bath

together

∪

&nformationmisinterpretation

∪

&naccurate followthrough of

instructions!inattentivenessand shows no

signs of interest

∪

nowledge decit(learning needs)

ource= Nurse"s

Eocket3uide,=



<oenges ?edical%

urgical Nursing=melt*er

N8E=<oenges



'ctual( 'bnor"al Findin&!:

'he client looks unclean and

untidy with blood tinged dress#ntermittent fever @ebrile sei*ure, irritability and poor feedingGellowish discoloration in theskin, eyes and tongue Nails were long and uncut'he umbilical cord is dry andlooks very unclean tied withthread and cord clampEseudomenstruation is present>8 8ountK 1.$ ) 10:#p$ard rolling of eyesT /4)4C& 8R -5; (mand RR .; cm

Ri*/4 Re$'e- F',or*5*ecreased energy4fatigue#eptic #hoc%#epticemia

Sre)#!*4 8e$$)e**5#trong amily #upport

#neffectivethermoregulation

related tonewborn"stransition toe)trauterineenvironment asevidenced byintermittent fever, prevailing illness

%efinition&#neffectivethermoregulationis the inability tomaintain a steady body temperatureregardless ofchanges in theenvironment

Sche"atic Dia&ra"

Newborns &mmature/ody #ystems

∪ Adaptation to warm

uterine environment

∪

upon delivery exposureto a dierent climate

∪

maladaptation toextrauterineenvironment

∪

-lus the new bornexperienced N?ONATA@

#?-#&# at ; days old

∪

reoccurring fever,presence of febrile

sei>ures, occasionallythe new born is cool totouch, chills, upward

rolling of eyeballs

∪

&neectivethermoregulation

ource=

Nurse"s Eocket 3uide,=<oenges

?edical%urgical Nursing=Source& Eillitteri, Adele

?aternal and 8hild

After a week thenewborn client will beable to maintain bodytemperature withinnormal limits

ndependent&

'ake vitalsigns /15mins. 2Bthen / $0 mins) 2h then /hourly untilstable.

Assist withmeasures toidentifycausativefactorsunderlying thecondition

Administerfluids and

electrolytes ,andmedications asindicated

Collaborati'e&

As physicians order= Elace double

droplight.

'o monitor iftemperaturereached thenormal value between $.5%$6.508.

'o be able todeterminewhatinterventionsmay be givento the clientand the precautionsthat may comealong with it

'o restore or

maintain body: organ

function

'o maintainnormal bodytemperature

(oal )et&

Newbmaina)illatemp$608



Bealth Nursing th +d.ippincott >illiams

C>ilkins. 8opyright200$



.ENE#IC N'ME(B#'ND

N'ME(CL'SSIFIC'TION

MODE OF

'CTION

DOS'.E /

F#E0UENCY(

#OUTE OF

'DMINIST#'TION

INDIC'TIONS CONT#'INDIC'TIONS'DVE#SE

EFFECTS

NU#SIN.

CONSIDE#'TION

3eneric=

3entamicin ulfate

rand=8idomycin, 3aramycin

8lassification=

Anti%infectives,

Aminoglycosides

#nhibiots protein

synthesis by binding

directly to the $0

ribosomal subunitP bactericidal

17mg #9'' (< • erious infections

caused by

sensitive strains of

Eseudomonasaeruginosa, +.

8oli, Eroteus,

Flebsiella, or

taphyloccocus

• 8ontraindicated in

patients hypersensitive

to drug or other

aminoglycosides• Hse cautiously in

neonates.

• 8N= fever,

sei*ures, vertigo,

di**iness

• ++N'= ototo)icity, blurred vision,

tinnitus

• 3#= Nausea and

vomiting

• 3H= nephroto)icity

• Bematologic=

anemia, leucopenia,

thrombocytopenia,

agranulocytosis

• ;espiratory= apnea

• <o skin testing

• +valuate patient"s

hearing before and

during therapy, reporthere are alterations

the hearing process

• >eigh patient and

review renal function

studies before therap

begins.

• (btain blood peak

gentamicin level 1 h

after #.? in!ection

• >atch signs and

symptoms of

superinfection

• 'herapy usually

continues for 6 to 10

stop therapy and obt

new specimens for

culture and sensitivit

testing!h



.ENE#IC N'ME(B#'ND

N'ME(CL'SSIFIC'TION

MODE OF

'CTION

DOS'.E /

F#E0UENCY(

#OUTE OF

'DMINIST#'TION

INDIC'TIONS CONT#'INDIC'TIONS'DVE#SE

EFFECTS

NU#SIN.

INTE#VENTION

3eneric=

'etanus 'o)oid, @luid

rand=

8lassification=

Anti%ulcer agent

Eromotes immunity to

tetanus by inducing anti

to)in production

5ml #? Q the left thigh • Erimary

immuni*ation to

prevent tetanus

• Eoste)posure prevention of

tetanus

• 8ontraindicated in

immunosuppressed

patients, in those with

immunoglobulinabnormalities, and in

those with severe

hypersensitivity or

neurologic reactions to

to)oid or its ingredients.

8ontraindicated with

patients with

thrombocytopenia or

other coagulation

disorders that would

contraindicate #?

in!ection unless benefits

outweigh risks.

• Hse adsorbed formcautiously in infants or

children with cerebral

damage, neurologic

disorders, or history of

febrile sei*ures

• Eostpone vaccination in

patients with acute illness

and during polio

outbreaks, e)cept in

emergencies

• 8N= slight fever,

headache, sei*ures,

malaise,

encephalopathy• 89= tachycardia,

hypotension,

flushing

• ?usculoskeletal=

aches, pains

• kin= erythema,

induration, nodule at

in!ection site,

urticaria, pruritus

• (ther= chills,

anaphyla)is

• (btain history of

allergies nad

reaction to

immuni*ation.• Feep epinephrine

1,000 available to

treat anaphyla)is

• Adsorbed from

produces longer

immunity. @luid

form provides

/uicker booster

effect in patients

actively immuni*

previously.



M E T H O D

K&nform the motherof the patient about

the medication, itseects, dosage andcorrect timing.

K&nstruct theguardian to followthe therapeuticregimen religiouslyso as not to exceedthe recommendeddosage.

K&nstruct theguardian to increase

the infantLsambulation and4ormovement so as toprevent theaccumulation ofpulmonarysecretions.

K &nstruct theguardians as to

proper s%in care+

2 /athe the infant atleast once a day inlu%ewarmwater and mild babysoap or shampoo

2 $lean theumbilical, genital andperineal area afterurination and4or

defecation.

2 -ractice fre8uenthandwashing beforehandling the infantand after havingcontact with soiledthings of the baby.

2 The guardian andthe infant shouldwear as much as

possible clean andwell2washed clothesto minimi>e

K?mphasi>e theimportance of proper

grooming, care of the nails, hair, oraland wound care toboth theguardians and theinfant

K#tress that thee8uipments used forthe infant shouldbe sterili>ed or cleanenough so as to

preventbacteria to come incontact with the baby

K#tress the importantrole of fre8uenthandwashing inthe prevention ofbacterial infestationand growth

K&nstruct theguardians to follow

the O-* scheduleasinstructed

K&nstruct theguardian to ma%esure that theinfantreceives all therecommendedimmuni>ations

KTeach theguardians self2careand continuity ofcare to ensure thepromotion of homeand community2based care.

KMa%e sure thatthe bottles are

sterili>ed beforeusing or thenipples to becleaned beforeletting the babysuc%.

Keed the infant odemand, fewamount only andonlyincrease it if the

baby is still hungryand le thebaby burp everyafter feeding.

K&nstruct theguardian to consutheir pediatricianonce the infantshows symptomsof allergy to mil%so that the pedia

can give theappropriate mil%

case study neonatal sepsis.doc

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