I.

Introduction Neonatal Sepsis on the other hand is an infection in the blood that spreads throughout the body and o c c u r s i n a n e o n a t e . N e o n a t a l S e p s i s i s a l s o t e r me d a s Neonatal Septicemia and Sepsis Neonatorum. Neonatal Sepsis has 2 types: The one that is seen in the first week of life is termed as Early- onset 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 24hours, Infection of the placenta tissues and amniotic fluid (chorioamnionitis) and frequent vaginal examinations during labor. The second type or the Late-onset Sepsis is acquired after delivery. This can be cause by contaminated hospital equipment, exposure to medicines that lead to antibiotic resistance, having a catheter in a blood vessel for a longt i me , s t a y i n g i n t h e h o s p i t a l f o r a n e x t e n d e d p e r i o d o f t i me . S i g n s a n d s y mp t o ms o f Neonatal Sepsis includes but is not limited to: body temperature changes, breathing problems, diarrhea, low blood sugar, reduced movements, reduced sucking, seizures, s l o w h e a r t r a t e , s w o l l e n b e l l y ar e a , v o mi t i n g , y e l l o w skin and whites of the e y e s ( j a u n d i c e ) . Po s s i b l e c o m p l i c a t i o n s ar e d i s a b i l i t y a n d w o r s t i s d e a t h o f t h e n e o n a t e . (Greene, 2007) Neonatal sepsis occurs at an estimated rate of 1 to 2 cases per 1000 live births i n t h e U. S . T h e h i g h e s t r a t e s o c c u r in low- birth- weight (LBW) infants, those with depressed respiratory function at birth, and those with maternal perinatal risk factors.The risk is greater in males (2:1) and in neonates with congenital anomalies (Merck,2 0 0 5 ) . A c c o r d i n g t o t h e P h i l i p p i n e Mo r t a l i t y F a c t S h e e t 2 0 0 6 o f t h e W o r l d He a l t h Organization, in 1000 live births of neonates 17% of it died due to severe

infection thatincludes deaths from pneumonia, meningitis, sepsis/septicemia, and other i nfectionsduring the neonatal period. (www.merck.com)Looking at the table below, according to world health statistics done in the year 2 0 0 4 N e o n a t a l Infection rank as no 11 as a leading cause of death it w a s f u r t h e r compared to the mortality statistics of the year 2030. In the year 2030 it was projectedthat in the year 2030 Neonatal Infection will be lower down to rank 21 as a leading causeof death. Updated mortality projections are based on historically observed relationshipsbetween trends in economic and social development and cause-specific mortality.

N U R S I N G A S S E S S M E N T A.Personal History 1.Demographic Data Baby Boy V is a neonate born last June 24, 2008,9:47 in the morning at OLMCMC. They resides somewherein Angeles City. Based on his ballard score of maturationalassessment of his gestational age, he is in between 36 to37 weeks of age. He has a birth weight of 2.5 kg, a lengtho f 5 1 c m , h e a d c i r c u m f e r e n c e o f 3 0 c m , c h e s t circumference of 28cm and abdominal circumference of 2 5 c m . H e w a s b o r n f r o m a 3 1 y e a r s o l d G 2 P 1 w i t h a TPAL of 1001 mother via normal spontaneous delivery.His f a t h e r i s 3 4 y e a r s o f a g e . I n i t i a l l y a f t e r b i r t h h e w a s place in the nursery unit of the hospital for observation andwas transferred to NICU a day after he was born June 25,2008. CBC with PC and Blood typing was ordered on thesame date when he was born. He was discharged fromthe hospital last July 02, 2008 with a diagnosis of NeonatalSepsis, Culture positive (Enterobacter cloacae) Socio- Economic and Cultural Factors Baby Boy Vs family is an extended type of family.Other than his father, mother and 1 sibling who is 5 yearsolder than him his grandmother is staying with them. Theyare all Roman Catholics and are native kapampangans.Baby Boy Vs father owns a jeepney and is working as a jeepney driver while his mother is a plain housewife.A c c o r d i n g t o h i s m o t h e r t h e i r m o n t h l y i n c o m e i s approximate ly P10, 000 per month and this income wasb e i n g u s e d i n b u d g e t i n g f o r f o o d s a n d d a i l y n e e d s , el ectricity and water bills, some extras were being used for t h e i r j e e p n e y s

m a i n t e n a n c e . W i t h t h i s e x p e n s e s h i s mother said that their way of living is just enough for themto pass by.Baby Boy Vs mother said that it is his mother whoc o o k s f o r t h e m b u t u s u a l l y t h e y e a t i n s t a n t f o o d a n d c a n n e d g o o d s b e c a u s e i t s t h e o n l y f o o d t h a t c a n b e bought with their little budget. But nonetheless, they stilleat 3 times a day. And as for what they use when their cooking they do have a gas stove but they still sometimesuse charcoal when cooking.During his mothers pregnancy, his mother is fondof eating salty and sweet foods, usually fond of drinkingcoffee at least 3 cups per day and drinks water of about 8-10 glasses daily.Baby Boy Vs father is a high school graduate whilehis mother was an undergraduate whos supposedly takingup education as a course. But due to financial constraintwas unable to finish her education; she just then startedw o r k i n g a s a s a l e s l a d y . A n d w h e n s h e got married shestopped from work and was satisfied for being a p l a i n housewife.With their grandmother living with them, their familyu s u a l l y b e l i e v e s i n h e r b o l a r y o s a n d a l b u l a r y o w h e n s e e k i n g f o r h e a l t h a d v i c e . T h e y a l s o b e l i e v e i n superstit i o n s d u e t o t h e i n f l u e n c e o f t h e i r g r a n d m o t h e r . One saying that his mother believes in is when his mother is menstruating his mother usually does not take a bathd u r i n g h e r f i r s t d a y o f m e n s t r u a t i o n b e l i e v i n g t h a t t h i s would cause her to be insane. 3.Environmental Factors Baby Boy Vs family resides somewhere in AngelesC i t y . T h e y l i v e d n e a r b u s i n e s s e s t a b l i s h m e n t s a n d jeepney station; they have to endure the noisy and busyenvironment marred by pollution. According to his mother the place is also congested and establishments are built almost close to each other. Their house is a bungalow type which is made-up of hollow blocks and wood D.History of Present Illness Baby Boy V was born last June 24, 2008, 9:47 am at OLOMCMC. Prior t o d e l i v e r y her mother had a Premature Rupture of Membrane and e a r l y contraction, the reason why his mother was brought early in the hospital. It isalso said by the mother that she had a difficult labor because the baby did notcome-out immediately. A lot of straining and pushing during delivery wasdone as said by the midwife in the hospital, who was also present during her delivery. Stress of the fetus during delivery is evident by him having a caputs u c c e d a n e u m . R o u t i n e N e w b o r n c a r e w a s d o n e i n c l u d i n g v i t a m i n K administration and giving of eye prophylaxis. His pediatrician then orderedCBC typing and platelet count. He was not immediately brought to the NICUunit but stayed first in the Nursery unit for further assessment. His initial CBCcount was as follows: WBC 11.5, Hgb. 213, Hct. 0.64, platelet count 130,RBC 7.5. Though the results were slightly elevated Baby Boy V was not yettransferred to their NICU unit. He was transferred to NICU because of poor s u c k

and edema in his upper and lower extremities. He has an i n i t i a l diagnosis of T/C neonatal sepsis. E . P h y s i c a l E x a m i n a t i o n June 24, 2008 (Lifted from the chart)Vital Signs: RR-43 bpmCR-135 bpmTemp- 36.7 o C Measurements: Length- 51 cmHead Circumference- 50 cmChest Circumference- 28 cmAbdominal Circumference- 25 cmWeight- 2,5 kgs Apgar Score- 8-9 Physical Examination of the NewbornSkin: (+) acrocyanosis, (+) thinning lanugo Head : (+) caput, with soft, firm and flat fontanels Eyes: (+) PERRLA, with pale palpebral conjunctiva Ears: symmetrical, no discharge or lesions, well curved pinna; soft but ready recoil Nose : no discharge Chest: symmetrical lung expansion, stippled areola 12mm bud Abdomen : (-) tenderness Male genitalia: testes down, good rugae, with adequate urine output Back: intact spine, (-) mass Rectum: with patent anal opening, (+) passage of stool Extremities: anterior transverse crease only June 26, 2008 (Done by the researcher)Vital Signs: RR-63 bpmCR-175 bpmTemp- 38.5 o C