Date post: | 20-Dec-2015 |
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Objectives: Define neonatal sepsis.1. List the causes make neonates susceptible
to infection.2. State the modes of transmission.3. Write common predisposing factors to
neonatal sepsis.4. Discuss the assessment criteria for each
body systems.5. Describe the management of neonatal
sepsis.6. Design plan of nursing care for baby has
neonatal sepsis.
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Definition
• Sepsis or "septicemia" refers to a generalized bacterial infection in the blood–stream.
• Neonatal sepsis occurs when bacteria or their poisonous products, known as endotoxins,
• gain access to the blood–stream, causing systemic signs and symptoms.
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Why neonates are susceptible to infection?
They have immature immune system. Poor response to infectious agents. There is usually no local inflammatory
reaction at the portal of entry to signal an infection and the resulting symptoms tend to be vague and nonspecific
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• Modes of Transmission
during:
- The prenatal period from maternal blood stream through the placenta.
• The natal period from infected amniotic fluid,
• or infection from birth canal (vagina or cervix).
The postnatal period through
contamination from:- other infants, personnel, - or subjects in the environment, such as,
mechanical ventilators and venous and arterial catheters used for infusions, blood sampling.
Common Predisposing Factors to Neonatal Sepsis:Maternal Factors: early sepsis less than 3 days after birth:
Premature rupture of membranes.
Intrapartum fever more than 38oC.
Premature labor.
Antenatal or antepartum asphyxia.
Maternal urinary tract infection.
Prolonged rupture of membrane more than 18 hours.
Neonatal Factors causing late sepsis 1-3 weeks after birth:
Prematurity.
Neonates with Endotracheal tubes, central lines,
I.V. catheters,… etc.
Neonates who are formula fed.
Prolonged hyper alimentation.
Current neonatal diseases.
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• Assessment Criteria
(Clinical Manifestations)
General signs:
"Failure to do well", "does not look right".
Unexplained respiratory distress.
Refuse to suckle.
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• Respiratory distress:
Tachypnea or apnea.
Irregular grunting respiration
Flaring nostrils.
Chest retractions.
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Gastric distress:
Vomiting (vomitus may be bile stained).
Diarrhea.
Abdominal distention.
Absent stool as a result of paralytic
ileus.
Poor sucking and feeding.
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Skin manifestations may include:
Cyanosis or pallor.
Mottling.
Purpura.
Jaundice.
Lesions associated with specific
organisms.
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• N.B.
Fever frequently absent, body
temperature commonly normal or
subnormal.
Indication of local inflammatory response
is rare.
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Diagnostic Tests:
Diagnostic tests should be obtained before initiating the antibiotic therapy, such as,
•Blood.
•Urine.
• Tracheal.
•Cerebrospinal fluid culture.
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Therapeutic Management:• Initiating therapy even before reassuring the
results:
• A. Aggressive Administration of Antibiotics:
• Before antibiotic administration, culture
should be carefully obtained.
• The recommended antibiotics are
ampicillin, gentamycin and penicillin.
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• B. Supportive Therapy If respiratory distress or cyanosis is evident,
oxygen administration or intubation and
mechanical ventilator will be required.
Adequate hydration with intravenous fluid and
electrolytes.
Blood transfusion may be needed to correct
anemia or shock.
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Nursing ManagementNursing Diagnoses:
Risk for injury related to effect of sepsis on all body systems
Risk for fluid volume deficit related to
increased metabolic rate, and insensible
fluid loss.
Risk for thermoregulation alteration
related to stress of infection, unstable
central temperature control.
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Ineffective breathing pattern related to
pulmonary and neuromuscular immaturity
and decreased energy and fatigue.
Risk for altered nutrition less than body
requirement related to feeding intolerance
(poor sucking and feeding, vomiting and
diarrhea).
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• Planning
• The goals of nursing management are the
same as for any high- risk neonate with
special emphasis on respiratory needs to:
• Minimize the harmful effect of sepsis on
neonate and prevent complications.
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Implementation
Nursing care of the infant with sepsis is similar
to the care of any high risk infant.
The nurse's awareness of the potential modes of
transmission allows her to identify those infants
more at risk for developing sepsis.
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The nurse should:
– Observe closely the neonates who are at risk for
developing sepsis to ensure early detection as
early diagnosis and treatment can prevent
complications.
– Decrease muscle tone, activity, lack of interest
intolerance of feeding and unstable body
temperature.