Colegio de San Antonio

de Padua
De La Salle Supervised
School
Guinsay, Danao City

CASE
PRESENTATION:
NEONATAL SEPSIS

Submitted by:

Abayon, Gretcin
Abogado, Kayne Iris
Baldwin, Kimberly
Benitez, Rosevie
Bolocano, Jieah Mae
Branzuela, Meriam
Candado, Dianne Dawn
Candano, Sweet Jenneth
Canga, Joanne
Cruz, Mill Jan

Submitted to:

Mrs. Monette Cañete

RN, M.A.N. TM1
 VISION
STATEMENT

CSAP is the premier professional institute of choice in Northern

Cebu, known for its high academic, technical and vocational
standards that ensure graduates’ success in competency- based
economy.

MISSION
STATEMENT

To produce well- rounded graduates through effective instruction

and supportive leaning environment that promote character
formation, academic excellence, research skill development and
community service to make them useful members of their
family, the community, the country and the world.

VISION
STATEMENT

The Colegio de San Antonio de Padua, College pf Nursing and

Diploma in Midwifery envisions to uphold the Institutional
mission to prepare nursing and midwifery students for global
competitiveness and to provide holistic care in order to develop
the full potential of a MAN.

MISSION
STATEMENT

It commits to produce globally competent Nurses and Midwives,

capable of providing holistic care, grounded on the core values
of the college in order to meet the demands of changing
environment of health care
 TABLE OF CONTENTS

I. Acknowledgement.............................................................................................4
II. Introduction..................................................................................................... 5
III. Objectives.......................................................................................................5
IV. Anatomy and Physiology ………………………….… …………………... 6
V. Psychosocial Profile ………………………………………………………. 9
▪ Patient’s Profile………………………………………………………….. 9
▪ Demographical Data ……………………………………………………… .9
▪ Genogram …………………………………………………………………. 10
▪ Growth and Development…………………………………………………...10
VI. Pathophysiology ....................................................................................... .11
VII. Physical Assessment................................................................................... 12
VIII. Gordons Functional Pattern ………………………………………….… 13
IX. Laboratory Results ………………………………………………………. 14
X. Nursing Care Plan ……………………………………………………..… 15
XI. Drug Study ……………………………………………………………… 16
XII. Discharge Plan ………………………………………………………..…19
 ACKNOWLEDGEMENT

Entering the world of nursing, one of the skills a nursing student must possess is
the skill in formulating case study. Making case study for the first time is not all
easy. However, everything has an end and we are thankful that we are able to
finish this case study. This won’t be possible without the support or help of the
following:

First of all, we would like to thank Almighty God for the opportunity to widen our
knowledge and for providing us with everything that we need as well as for the
healthy mind and soul as we get through this journey.

We would also like to thank Dr. Herminia O. Fernandez for allowing us to have
our case study and for letting us to do what we need to do as well as to our patient
who never think for a second in providing us with the informations needed in the
completion of this case study.

To Mrs. Monette Cañete, for allowing us to experience and for providing us with
knowledge on how to make the case study well as for giving us an idea that made
this task possible.
Lastly, we need extend our gratitude to our friend’s family or love ones who are
continuously support us with everything not just financially but as well as
emotionally.

TO GOD TO BE THE GLORY!

 INTRODUCTION:

NEONATAL SEPSIS is a systemic infection occurring in infants at less to equal to 28 days of

life and is an important cause of morbidity and mortality of newborns.
1. Early-onset neonatal sepsis has been variably defined based on the age of onset, with
bacteremia/ bacterial meningitis occurring at less to equal 72 h in infants hospitalized in the
NICU, vs. <7 days in term infants.

2-4. In preterm infants, EOS is most consistently defined as occurring in the first 3days of life
and is caused by bacterial pathogens transmitted vertically from mother to infant before or during
delivery.

3. Late-onset sepsis (LOS) is sepsis occurring after 72 h in NICU infants and 7 days of life in
term infants, has been variably defined as occurring up to the age of <90 or 120 days, and maybe
caused by vertically or horizontally acquired pathogens.
2,3,5- 7. Early-onset neonatal infections of viral or fungal etiology may also occur at >7 days of
life and must be distinguished from bacterial sepsis.

(Neonatal Sepsis is a blood infection that occurs in an infant younger than 90 days old. Early-
onset sepsis is seen in the first week of life. Late-onset sepsis occurs after 1week through
3months of age.)

Specific Objectives:

In this case study, We will be able to:

● Determine possible genetic problem to newborn

● Explain the pathophysiology of neonatal sepsis

● Formulate nursing care plan for Newborn

Gross Anatomy of the Lungs

The lungs are pyramid-shaped, paired organs that are connected to the trachea by the right and left
bronchi; on the inferior surface, the lungs are bordered by the diaphragm. The diaphragm is the flat,
dome-shaped muscle located at the base of the lungs and thoracic cavity. The lungs are enclosed by the
pleurae, which are attached to the mediastinum. The right lung is shorter and wider than the left lung, and
the left lung occupies a smaller volume than the right. The cardiac notch is an indentation on the surface
of the left lung, and it allows space for the heart. The apex of the lung is the superior region, whereas the
base is the opposite region near the diaphragm. The costal surface of the lung borders the ribs. The
mediastinal surface faces the midline.
Each lung is composed of smaller units called lobes. Fissures separate these lobes from each other. The
right lung consists of three lobes: the superior, middle, and inferior lobes. The left lung consists of two
lobes: the superior and inferior lobes. A bronchopulmonary segment is a division of a lobe, and each lobe
houses multiple bronchopulmonary segments. Each segment receives air from its own tertiary bronchus
and is supplied with blood by its own artery. Some diseases of the lungs typically affect one or more
bronchopulmonary segments, and in some cases, the diseased segments can be surgically removed with
little influence on neighboring segments. A pulmonary lobule is a subdivision formed as the bronchi
branch into bronchioles. Each lobule receives its own large bronchiole that has multiple branches. An
interlobular septum is a wall, composed of connective tissue, which separates lobules from one another.

– Blood Supply and Nervous Innervation of the Lungs

The blood supply of the lungs plays an important role in gas exchange and serves as a transport system
for gases throughout the body. In addition, innervation by the both the parasympathetic and sympathetic
nervous systems provide an important level of control through dilation and constriction of the airway.

– Blood Supply

The major function of the lungs is to perform gas exchange, which requires blood from the pulmonary
circulation. This blood supply contains deoxygenated blood and travels to the lungs where erythrocytes,
also known as red blood cells, pick up oxygen to be transported to tissues throughout the body.
The pulmonary artery is an artery that arises from the pulmonary trunk and carries deoxygenated,
 arterial blood to the alveoli. The pulmonary artery branches multiple times as it follows the bronchi, and
each branch becomes progressively smaller in diameter. One arteriole and an accompanying venule
supply and drain one pulmonary lobule. As they near the alveoli, the pulmonary arteries become the
pulmonary capillary network. The pulmonary capillary network consists of tiny vessels with very thin
walls that lack smooth muscle fibers. The capillaries branch and follow the bronchioles and structure of
the alveoli. It is at this point that the capillary wall meets the alveolar wall, creating the respiratory
membrane. Once the blood is oxygenated, it drains from the alveoli by way of multiple pulmonary veins,
which exit the lungs through the hilum.

– Nervous Innervation

Dilation and constriction of the airway are achieved through nervous control by the parasympathetic and
sympathetic nervous systems. The parasympathetic system causes bronchoconstriction, whereas the
sympathetic nervous system stimulates bronchodilation. Reflexes such as coughing, and the ability of
the lungs to regulate oxygen and carbon dioxide levels, also result from this autonomic nervous system
control. Sensory nerve fibers arise from the vagus nerve, and from the second to fifth thoracic ganglia.
The pulmonary plexus is a region on the lung root formed by the entrance of the nerves at the hilum. The
nerves then follow the bronchi in the lungs and branch to innervate muscle fibers, glands, and blood
vessels.

– Pleura of the Lungs

Each lung is enclosed within a cavity that is surrounded by the pleura. The pleura (plural = pleurae) is a
serous membrane that surrounds the lung. The right and left pleurae, which enclose the right and left
lungs, respectively, are separated by the mediastinum. The pleurae consist of two layers. The visceral
pleura is the layer that is superficial to the lungs, and extends into and lines the lung fissures. In contrast,
the parietal pleura is the outer layer that connects to the thoracic wall, the mediastinum, and the
diaphragm. The visceral and parietal pleurae connect to each other at the hilum. The pleural cavity is the
space between the visceral and parietal layers.

FETAL CIRCULATION

Super Duct
Lior us
L
u
vena 6 arteri – Oxygen delivery in the fetus
n 0 u
osus
cava
Pulm
g n
onar 2 5
g Oxygen delivery is related to CVO and the oxygen
Fora 5 0
y
men content of blood. Oxygen content of blood is
arter
Inferi
oval
yor 6 determined mainly by the quantity of haemoglobin
Duct
e 5 RL ve
vena
us
8
0 2 e nt
ig
A and its oxygen saturation. The fetus has a high
Li o
cava
vveno 5 fh ric
Ki haemoglobin concentration (16 g dl1 at term), with a
Por
sus tt lert
e
tal
U
da high percentage of haemoglobin F (HbF), which has a
r n
vei
mb
U
ar e
lower content of 2,3-diphosphoglycerate, thus
n
ilic
m
te
us
y
Coar shifting the oxygen dissociation curve to the left. This
bili
ri
Um
cal
mm te favours oxygen uptake in the placenta, where, if PO 2
es onri
bilic
iliac
values are similar in uterine and umbilical venous
al es
vein
blood, the oxygen saturation inumbilical venous,
Psychosocial Profile
I. Patient’s Profile
Patient name: Thristan Jay Tampadong
Contact number: N/A
Diagnosis: Neonatal sepsis
Religion: Roman Catholic
Name of hospital: VSMMC
Mother’s name: Jean Rose Tampadong
Birthdate: Jan 31,1997
Religion: Roman Catholic
Father’s name: Jayson Tampadong
Religion: Roman Catholic
Civil status: married
II. Demographic Information
Age: 21days (Newborn) Gender: male
Address: Yati Liloan, Cebu
Date of Admission: November 10,2019
Birth date: Nov. 7,2019
Civil status: Child
Age: 22 Gender: female
Address: Yati liloan, Cebu
Age: 32 Gender: male
Birthdate: October 9, 1987
III. GENOGRAM

LEGEND:
MALE

FEMALE

Miscarriage

IV. GROWTH AND DEVELOPMENT

Physical development
Watching your baby grow in size is part of the fun of being a new parent. Don't be
alarmed if your newborn loses some weight shortly after birth. This weight usually
is regained within 10 to 12 days. Most newborns gain about4 oz (113 g) to8 oz
(227 g) a week and grow about 1 in. (2.5 cm) to1.5 in. (3.5 cm).

Cognitive development
Cognition is the ability to think, learn, and remember. Your newborn's brain is
developing rapidly. You promote healthy brain growth every time you interact in a
positive way with your baby

Emotional and social development. 

Newborns quickly learn to communicate. They seek interaction with you and
express how they feel with sounds and facial expressions. At first, instinctual
behaviors, such as crying when uncomfortable, are your baby's ways to signal his
or her needs. Soon your newborn starts to subtly communicate and interact with
you. For example, your baby's eyes will track your movements. And his or her face
will brighten when you cuddle and talk soothingly. Even at a few days old, your
baby may try to mimic you sticking out your tongue.
Language development. 
Your newborn is listening to and absorbing the basic and distinct sounds of
language. This process forms the foundation for speech.

Sensory and motor skills development. 

Newborns have all five senses. Your newborn quickly learns to recognize your
face, the sound of your voice, and how you smell. Your newborn's sense of touch
is especially developed, particularly around the mouth. Your baby also has a strong
sense of smell. After a few days, your newborn hears fairly well and responds most
noticeably to high-pitched and loud sounds. Your baby recognizes and prefers
sweet tastes to those that are sour, bitter, or salty. Vision is developing quickly but
is believed to be the weakest of the senses. Motor skills develop as your baby's
muscles and nerves work together. Movements are mostly controlled by reflexes,
such as the rooting reflex, which is when a newborn's head turns and his or her
mouth "reaches" toward a touch. Hands are tightly fisted when the baby is alert.
PATHOPHYSIOLOGY

Physical Examination

I. VITAL SIGNS
HR: 153bpmRR: 4cpm TEMP: 38.8 WT: 2.5kg
II. SKIN
Skin temp: Warm
Turgor: Good
Lesions: None
Nails: Normal
III. HEAD/EYES/ EARS/NECK/THROAT
Head Shape: Round
 Head Scalp: Normal
Head Fontanels: Sunken
Hair/Eyes: Normal
EARS
Pinna: Normal
External canal: Normal
Tympanic membrane: Intact
Hearing: No tested
NOSE
Turbinates: Normal
NECK
Normal
THYROID
Normal
GENITO-URINARY
Normal
BACK AND SPINE
Symmetric

EXTREMITIES
Normal
LABORATORY RESULTS

HEMATOLOGY SECTION TEST NAME RESULTS UNIT REFERENCE RANGE

COMPLETE BLOOD COUNT

WBC Count L 6.99 x10^9/L 9-1-34.0 RBC Count 3.53 x10^12/L 3.2-6.1
Hemoglobin L 119.00 g/L 150-240 Hematocrit L 34.00 % 44-70
MCV L 96.60 fl 99-115 MCH 33.70 pg/cell 33-39
MCHC 34.90 % 32-36
RDW-CV 14.30 %
Platelet Count L 104.00 x10^9/L 150-450
Differential Count Neutrophil L 31.30 % 54-62
Lymphocyte H 50.90 % 25-33
Monocyte H 12.20 % 3-11 Eosinophil H 5.00 % 1-3
Basophil 0.60 % 0.1

TEST RESULTS UNIT REFERENCE NUMBER

Sodium L 131.30 mmol/L 135.000-145.00

Potassium 4.07 mmol/L 3.50 -5.50
Chloride 101.60 mmol/L 98.00-108.00
Iodized Calcium 1.37 mmol/L 1.10-1.40

CHEMISTRY SECTION TEST

NAME RESULTS UNIT REFERENCE NUMBER

Sodium L 127.70 mmol/L 135.00-145.00

Potassium 4.51 mmol/L 3.50-5.50
Chloride 101.80 mmol/L 98.00-108.00
Iodized Calcium 1.38 mmol/L 1.10-1.40
Total bilirubin H 11.39 mg/dL 0.3-1.1
Direct Bilirubin 0.39 mg/dL 0.1-0.4
Indirect Bilirubin 11.01 mg/dL

CLINICAL MICROSCOPY SECTION CELL COUNT/BODY FLUIDS RESULT RESULT

UNIT BODY FLUIDS Specimen CEREBROSPINAL FLUID (LUMBAR PUNCTURE)

Color: LIGHT YELLOW

Transparency: CLEAR
Approximate Volume: 1.2 ML ml
CELL COUNT WBC 0 cells/Ul
RBC 10 cells/uL
DIFFERENIAL COUNT
Remarks : DIFFERENTIAL COUNT NOT DONE NO WBC SEEN

NURSING CARE PLAN

DRUG STUDY
GENERIC NAME: Ampicillin
BRAND NAME: Ampcillin tridyhate
CLASSIFICATION: Anti- infective, bactericidal
DOSAGE: 150mg IVP q6 ANST(-)

MECHANISM OF ACTION:
Inhibit cell-wall synthesis during bacterial multiplication

INDICATION:
is used to prevent and treat number of bacterial infections, such as respiratory
tract infections, urinary tract infections, meningitis, salmonellosis, and
endocarditis. It may also be used to prevent group B streptococcal infection in
newborns

CONTRAINDICATION:
Contraindicated in pts hypertensive to drug or other penicillin and cephalosporins
SIDE EFFECT/ ADVERSE REACTION:
nausea, vomiting, diarrhea, abdominal pain, fatigue, head ache, dysuria, urinary
retention, dizziness, agitation, confusion

NURSING RESPONSIBILITIES:
*Prior to administration, skin test is to be done to determine signs and symptoms
of hypersensitivity
*Monitor seizures when giving high doses.
*Instruct mother to not miss a dose unless ordered by physician *Instruct mother
to report signs and symptoms of super infection

DRUG NAME: Amikacin

BRAND NAME: Amikin
CLASSIFICATION: aminoglycosides
DOSAGE: 250g IV q12

MECHANISM OF ACTION:
inhibits protein synthesis by binding directly to 30S ribosomal sub unit;
bactericidal

INDICATION:
Primarily for short term treatment of serious infections of respiratory tract,
bones, joints, skin, and soft tissues, CNS( including meningitis) and peritonitis
burns CONTRAINDICATION: History of hypersensitivity or toxic reaction with an
aminoglycosides antibiotic.

ADVERSE EFFECTS:
CNS: neurotoxicity, drowsiness, unsteady gait, weakness, clumsiness,
paresthesias, tremors, convulsions, peripheral neuritis.
VESTIBULAR: dizziness, ataxia
GI: nausea, vomiting, hepatotoxicity
METABOLIC: hypokalemia, hypomagnesemia
SKIN: skin rash, urticaria, pruritis, redness
UROGENITAL: oliguria, urinary frequency, hematuria, tubular necrosis, azotemia
OTHER: superinfections

NURSING RESPONSIBILITIES:
before initial dose, C&S; renal function and vestibulocochlear nerve function
*monitor peak and trough amikacin blood levels:, Draw blood 1h after IM or
immediately after completion of IV ; draw trough levels immediate before the
next IM or IV dose

Brand name: Gentian violet

CLASSIFICATION: antiseptic, antibacterial, antifungals

MECHANISM OF ACTION:
is used to treat some type of fungus infections inside the mouth (trush) and of the
skin, it also has weak antibacterial effects and may used on minor cuts and
scraped to prevent infection
INDICATION:
is used for digestion problem such as loss of appetite, fullness ,intestinal gas,
diarrhea, gastritis, heartburn, and vomiting. Is also used for fever and diabetes.

CONTRAINDICATIONS: contraindicated to condition with cancer sores, vaginal

irritation and allergies( triphenylmethane analogues)

Dosage form: solution,

Gentian violet : crystal violet, methylrosaniline and hexamethylpararosaniline
Route: mouth Dosage: . 25% or .5% solution.
FREQUENCY: Apply to affected area of the skin 2-3 times a day

SIDE EFFECTS/ADVERSE REACTION:

redness, swelling, or irritation, nausea, vomiting ,diarhhea and abdominal pain.

NURSING RESPONSIBILITIES:
*In giving the medication make sure to read the prescription of the physician.
* Infants should be turned face downward after application to minimize ingestion
of this drug
* Inform the signs and symptoms that occurs in giving the medication
* Inform the mother the side effects of using this drug and is not hindrance of
parents who are in breastfeeding
*Inform the mother that the color of gentian does not will slowly disappear and is
not hazardous
*Slowly swab the infant's affected area
*Instruct to report for any signs and symptoms that may occur

DISCHARGE PLAN

A. Objectives
1) To maintain a patent airway
2) To maximize breathing capacity
3) To relieve patient's secretions

B.
I: Medications

GENERIC NAME: Ampicillin 150mg Q.D P.O.

DRUG NAME: Amikacin 250mg Q.D P.O
Brand name: Gentian violet .5%sol b.i.d P.O

II-Exercise/Activity
Type of activity allowed:
- Deep breathing exercises
- Light activities Procedure/steps

1) Sit up straight as you prepare to do these exercises. Keep your backbone fully
upright with your shoulders pulled back as you get into position.

2) Inhale slowly & deeply. Slowly fill your lungs with air. Think about how pure,
fresh and cleansing this "new" air is for your body.

3) Focus on how your lungs feel as they fill with air. Notice how they expand. Pay
attention to how your diaphragm moves to make room more air in your lungs.

4) Exhale slowly. Release the air from your lungs until they are completely empty.
Feel your lungs contracting as you expel all of the old air from your body

III-Treatment :
Comply with medications :
Increase fluid intake :
Utilize deep breathing exercise for at least twice a day
IV-Health teachings
( ) Clinic appointment schedules
( ) Follow-up laboratory examinations
( ) Understanding & knowing what to do with side effects of medications
( ) Others: Health teaching on deep breathing exercises