CASE #2: FOUL SMELLING CORD STUMP

Setting: Health Center

Chief Complaint: “My baby’s cord stump smells bad”

Vital Signs: Temperature: 37.0oC, HR: 120bpm; RR: 40bpm

Birth weight: 3.00kgs

History Present Illness: The mother states that she gave birth at home 5 days ago. Her pregnancy, labor and birth were did not
have any complications. The mother stated that she noticed that her baby’s cord stump had an offensive smell. She brought her
baby to the health center for the first time today because she is concerned that the cord might be infected.

Case Study Questions:

(Q1-4: 1 person each question)

1. Before beginning your assessment, what should you do and ask the mother?

● Biographical data of the Client

 ● Reason for seeking Health Care
● Personal Health History
● Family History
● Lifestyle and Health Practices
- SPECIFIC QUESTIONS:
● When did the foul smell start?
● Do you clean the cord stump?
● How do you clean the cord stump?
● When and how often do you clean the cord stump?
● What are the things you use to clean the cord stump?
● Is there any bleeding that occurs in the umbilical cord stump?
● Do you have any infections upon giving birth?

2. What will you include on your assessment, and why?

● Taking Vital signs

➢ Taking the baby’s vital signs may give information about the child’s overall health.
● Physical Assessment
➢ Assessment of the baby’s overall physical well-being.
➢ Observation of other signs (e.g redness, swelling, tenderness of skin) that may affect the smell of the cord stump.

3. What physical examination will you include in your assessment, and why?

Head to Toe Physical Examination - Since it is the baby’s first time in the health center, a thorough checkup is needed to know if the
baby’s first medical exam is within normal range after 5 days from birth.

● Head - Checking the soft spots (fontanels) on the baby’s head to confirm if bone formation is not yet complete.
● Ears - Using an otoscope to check for infection in the baby’s ears.
● Eyes - Inspecting the baby’s eyes with an ophthalmoscope to know the baby’s eye movements.
● Mouth - Checking the roof of the baby’s mouth for an opening and to reveal signs of infection that is common such as yeast
infection.
● Skin - Identifying various skin conditions including birthmarks and rashes.
● Heart and Lungs - Using a stethoscope to detect any abnormal heart sounds or breathing difficulties from the baby.
 ● Abdomen - Pressing gently the baby’s belly to detect tenderness and enlarged organs/unusual masses.
● Hips and Legs - Moving the baby’s legs to check for dislocation and other problems with the hip joints.
● Genitalia - Inspecting the baby’s genitalia for tenderness, lumps, and signs of infection. For boys, checking if both testes of
the baby have descended into the scrotum is needed and making sure that the penis is healing properly after circumcision.

4. What laboratory test will you include, and why?

Complete Blood Count - to identify if there is an increase in the levels of WBC which would indicate an infection.

You have completed your assessment and the baby shows no danger signs or other significant findings except for the foul-smelling
on the cord stump. All other aspects of the baby’s physical examination are within normal range. No need for resuscitation as well.
Upon interview, the mother denied putting any substance on the cord stump. The mother stated also that her baby is breastfeeding
well.

Physical Examination:

· General: Awake, alert,

· Skin around the cord stump: (-) redness and swelling

· Cord stump: (-) draining pus, (-) redness and swelling

· Abdomen: non-distended

5. Based on these findings; what seems to be the baby’s problem (diagnosis), and why?

Possible Diagnosis:
 ● Risk for Infection - The stump has a foul odor which can be a sign of infection. If it is not infected now, it is not impossible for it
to be infected later on.
● Inadequate knowledge of the mother - The foul odor of the stump may be a result of improper hygiene or care done by the
parent because of a lack of knowledge regarding what should be done.

6. Based on the problem (diagnosis), what is your plan of care, and why?

● Health teaching for the mother or the other primary caregiver of the baby about:

- Proper and hygienic cord stump care to prevent infection.

-Importance of good hygiene (proper handwashing)

-Disinfecting and sterilizing items used in the baby.

-Importance and benefits of complete immunization.

The mother and the baby returned to the health center the next day because her mother-in-law instructed her to stop doing the
treatment regimen advised, not wash the cord stump, and keep the cord bound with a piece of cloth. Upon assessment, you find
that the cord stump and umbilicus have slightly improved. There are no other significant findings or signs of sepsis. The baby
continues to feed well and have normal temperature.

· Skin around the cord stump: (-) redness and swelling

· Cord stump: (-) draining pus, (-) redness and swelling

· Abdomen: non-distended

7. Based on these findings, what is your continuing plan of care, and why?

● Teach the mother the proper cord and hygienic method of cleaning the remaining umbilical cord of the baby.
 ● Brief vaccines to the mother that her child can receive to prevent possible infections and particular diseases.

8. Make at least 3 possible NCPs for this patient

● 1. Knowledge deficit related to improper umbilical cord care evidenced by the foul odor of cord stump
● 2. Risk for infection due to inadequate primary defenses
● 3. Risk for infection due to lack of immunization

PROBLEM NURSING PLANNING IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS

A mother ● Knowledge After Nursing 1. Ask the mother how 1. Knowing how the After 2 hours of
complained of a deficit related to implementation The she cleans the cord mother cleans the health teaching,
foul smell improper mother will be stump of her baby. cord stump will help the mother was
coming from the umbilical cord educated and us determine what able to
baby’s cord care evidenced expected to was not done or was demonstrate the
stump. by the foul odor demonstrate the done wrong which proper care for the
of cord stump proper umbilical may have caused the umbilical cord.
Subjective: cord care and foul odor.
The mother lessen the foul After 3 days of
stated that her smell in the baby’s 2. Demonstrate how to nursing
baby is cord stump. properly clean the 2. Showing the mother intervention
breastfeeding cord stump. how to do it will help (proper umbilical
well and denied her know certain cord care), the foul
putting any techniques that smell coming from
substance on should be done. the baby’s cord
the cord stump stump had
lessened.
Objective: 3. Let the mother do the 3. Letting her do the
Vital Signs cleaning of the care we taught will
Temperature - baby’s cord stump. enable her to master
37.0oC the care she should
Heart rate - 120 give to her baby.
bpm
Respiratory rate 4. Provide feedback 4. Providing feedback
- 40 bpm upon the mother’s
Birth weight - 3 performance of the
kgs care.
5. Inform mother to use 5. Alcohol was used
water when cleaning
the cord stump and
the skin around it,
and mild soap can be
used if it was stained
with urine or stool.
will enable the mother
to correct whatever
she has to correct.
Complimenting her
can motivate her and
make her more
confident in providing
the care.
before but was
stopped being
advised because it
kills the good bacteria
that will help the cord
stump dry.

6. Educate the mother 6. Covering the cord

to fold the diaper so it stump with the diaper
would not cover the will stop it from being
cord stump. air-dried and may
irritate the cord stump.

7. Educate the mother 7. Dressing the baby

to not dress the baby
with clothes too tight
around the belly
where the cord stump
is.
with clothes too tight
around the belly will
prevent it from being
exposed to the air
which may slow the
drying of the cord
stump.

8. Encouraging the
8. Encourage the mother to ask
 mother to ask questions will enable
questions if ever she us to clarify
has any. information the
mother is confused
with.

PROBLEM NURSING PLANNING IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS

A mother ● Risk for The mother will After one hour of

complained of a Infection due to be able to give a 1. Monitor the vital signs 1. A temperature above the nursing intervention,
foul smell coming inadequate proper and of the baby normal range (36.5 to 37.5 the mother was able
from the baby’s primary hygienic method oC) would indicate to understand and
cord stump. defenses of cleaning the hyperthermia which is a sign demonstrate the
(broken skin remaining of infection. A heart rate proper and hygienic
SUBJECTIVE: specifically umbilical cord of outside the normal range cord care for the
The mother stated referring to the the baby after (120-160 bpm) can also baby.
that she noticed exposed one hour of indicate an infection.
that her baby’s umbilical cord) nursing
cord stump had an intervention.
offensive smell. 2. Note signs and
She brought her symptoms of fever 2. The presence of fever may
baby to the health indicate infection.
center for the first
time today
because she is
concerned that the
cord might be
infected.

Objective:
Foul odor coming
from the cord 3. Note risk factors for 3. The cord stump is an
stump the occurrence of excellent medium for
infection bacterial growth. Therefore,
Cord is still not dry. without proper cord care,
the baby is susceptible to
cord infection. Identifying
the area of which serves as
a beneficial environment for
bacterial growth will help the
mother recognize the areas
that will need a thorough
cleaning
4. Assess and 4. Assessing the skin
document skin conditions around the base
conditions around the of the umbilical cord will
base of the umbilical enable the mother to check
cord if there are unusual findings
like pus or discoloration that
may indicate infection.

5. Stress proper 5. Hand washing before

handwashing touching the cord stump is a
techniques to the vital part of keeping the
mother baby away from bacteria
that may cause infections.

6. Demonstrate to the 6. Avoiding the stump from

mother the sponge getting wet will help in
bath to keep the making it fall off and heal
stump dry faster
 7. Instruct the mother 7. Skin being a primary
on how to protect the defense organ will protect
integrity of the skin the baby from bacteria that
and prevent the may cause infections.
spread of infection
around the base of
the umbilical cord.

8. Schedule a follow-up 8. A follow-up check will

checkup for the enable the health care
patient provider to determine if the
treatment regimen was
effective, and if not, it can
be changed.

PROBLEM NURSING PLANNING IMPLEMENTATION RATIONALE EVALUATION

DIAGNOSIS
A mother ● Risk for The foul smell After 2 hours of
complained of a Infection related coming from the 1. Examine for the 1. Re-infection could have nursing
foul smell to Lack of baby’s cord presence, existence, happened, causing the foul intervention, the
coming from the Immunization. stump will lessen and history of odor of the cord stump. mother was able to
baby’s cord and early signs of infection. know the vaccines
stump. infection may be that her baby can
given treatment receive.
Subjective: immediately. 2. A temperature above the
The mother 2. Monitor the normal range (36 to 37 oC) After 4 hours, the
stated that her temperature and heart would indicate fever which mother was
baby is rate of the patient. is a sign of infection. A convinced to let
breastfeeding heart rate outside the her baby be
well and denied normal range (120-160 vaccinated with
putting any bpm) can also indicate an vaccines that can
substance on infection. help her baby be
the cord stump safe from certain
infections.
Objective: 3. Other signs of infection
Vital Signs 3. Observe the patient's together with a foul odor After 12 months,
Temperature - behavior. would be redness, the baby was able
37.0oC swelling, discharge, or to receive the
Heart rate - 120 secretions. vaccinations such
bpm as Hepatitis B
Respiratory rate vaccine,
- 40 bpm pentavalent
Birth weight - 3 4. A cloudy or vaccine, polio
kgs yellow-greenish discharge vaccines (oral and
4. Monitor and document
coming from the cord inactivated), PCV,
any redness, swelling,
stump may indicate and MMR vaccine.
discharge, or
infection.
secretions in the cord
stump accompanying
the foul odor.
5. Assess and monitor 5. A change in the baby’s
the nutritional status of appetite can be a sign of
the baby. infection

.
6. Check the 6. Demonstrating the proper
immunization status of way to clean the cord
the baby. stump would help the
parent take care of the
stump, preventing
infections.

7. Demonstrate the 7. One way to prevent

proper way of washing infection is to use sterile
the baby’s cord stump. equipment.

8. Make sure the mother 8. Hand washing before

disinfects and touching the cord stump is
sterilizes any items a vital part of keeping the
used in the baby. baby away from bacteria
that may cause infections.

9. Emphasize the
importance of proper 9. Having the immunizations
hand hygiene. introduced to babies upon
birth can help them prevent
certain infections.
 10. Monitor white blood 10. An increase in levels of
cells with the use of a white blood cells would
Complete Blood Count indicate an infection.
(CBC).

9. Make PDAR/FDAR from the NCPs

PROBLEM DATA ACTION RESPONSE

Poor hygiene due to
inadequate knowledge Subjective:
“I gave birth at home 5 days
ago. My pregnancy, labor,
and birth did not have any
complications. I noticed that
my baby’s cord stump had an
offensive smell. I brought my
baby to the health center for
the first time today because I
am concerned that the cord
might be infected.
Objective:
Vital Signs:
● Temperature: 37.0oC
● HR: 120bpm
● RR: 40bpm
● Birth weight: 3 kgs
● Knowing and asking the After 4 hours of nursing
details of how the mother action, the mother will be able
keeps the baby’s cord to demonstrate the proper
stump clean way of cleaning the baby’s
● Educating the mother cord stump
about the proper way of
cleaning a baby’s cord
stump like the sponge
bath. After 2-3 days of nursing
● Letting the mother know action, the baby’s cord stump
to keep the cord stump condition will improve and
dry as much as possible have less swelling
in order to prevent
infection
● Providing honest After a week of nursing
feedback about how the action, the mother will be able
mother cleans the baby’s to promote proper hygiene
cord stump and the not only to her family but also
possible questions that her friends who are mothers
she may ask taking care of newborns as
● Recommending to the well
mother to be aware of
the factors that may

PROBLEM
Risk for Infection related to
inadequate primary defenses
Physical Examination:
● General: Awake, alert
● Skin around the cord
stump: (-) redness
and swelling
● Cord stump: (-)
draining pus, (-)
redness and swelling
● Abdomen:
non-distended
DATA
Subjective:
“I gave birth at home 5 days
ago. My pregnancy, labor,
and birth did not have any
complications. I noticed that
my baby’s cord stump had an
offensive smell. I brought my
baby to the health center for
the first time today because I
am concerned that the cord
might be infected.
Objective:
Vital Signs:
● Temperature: 37.0oC
● HR: 120bpm
● RR: 40bpm
● Birth weight: 3 kgs
affect the baby’s cord
stump such as the
environment, clothes that
the baby wears and etc.
● Promoting proper hand
hygiene before initiating
physical contact with the
baby’s cord stump
ACTION RESPONSE
● Monitor the vital signs of After the nursing action, the
the baby cord stump and umbilicus of
● Note signs and the baby have slightly
symptoms of fever improved and the mother
● Assess and document stated “I noticed that the
skin conditions around smell has lessened and
the base of the umbilical improved after two days”
cord
● Stress proper Vital Signs:
handwashing techniques ● Temperature: 36.9oC
to the mother ● HR: 119bpm
● Demonstrate to the ● RR: 43bpm
mother the sponge bath ● Weight: 3.1 kgs
to keep the stump dry
● Instruct the mother on Physical Examination:
how to protect the
integrity of the skin and ● General: Awake, alert
prevent the spread of
infection around the base
 Physical Examination:
● General: Awake, alert
● Skin around the cord
stump: (-) redness
and swelling
● Cord stump: (-)
draining pus, (-)
redness and swelling
● Abdomen:
non-distended
PROBLEM DATA
Lack of Immunizations related
to risk for infection Subjective:
“I gave birth at home 5 days
ago. My pregnancy, labor,
and birth did not have any
complications. I noticed that
my baby’s cord stump had an
offensive smell. I brought my
baby to the health center for
the first time today because I
am concerned that the cord
might be infected.
Objective:
Vital Signs:
of the umbilical cord.
● Schedule a follow-up
checkup for the patient
ACTION
● Assess and document
baby’s vital signs
● Perform physical
examination around the
baby’s cord stump.
● Monitor White blood cells
by doing a Complete
blood count (CBC).
● Perform health teaching
to the mother about;
*How to properly wash and
care for the baby's umbilical
cord.
*Disinfecting and sterilizing
items that are used in taking
care of the baby.
*Proper handwashing.
*Importance of complete
Immunization to infants.
● Skin around the cord
stump: (-) redness
and swelling
● Cord stump: (-)
draining pus, (-)
redness and swelling
● Abdomen:
non-distended
RESPONSE
● The mother
verbalized, “My baby
was fully vaccinated
with every vaccine
that he should have. I
feel assured that he
will not get sick that
easily because of
this.”
● Baby was able to
receive every vaccine
discussed with the
mother, without
missing a dose
required for his age.
 *What immunization can be
● Temperature: 37.0oC given to the baby.
● HR: 120bpm
● RR: 40bpm ● Give Immunization to the
● Birth weight: 3 kgs
Physical Examination:
● General: Awake, alert
● Skin around the cord
stump: (-) redness
and swelling
● Cord stump: (-)
draining pus, (-)
redness and swelling
● Abdomen:
non-distended
baby.
-HepatitisB (1st dose after
birth & 2nd dose after
2months, 3rd dose
around 6-18 months)
-Diphtheria, tetanus, &
acellular pertussis (1st
dose in 2months & 2nd
dose in 4months, 3rd
dose in 6 months & 4th
dose around 15 months)
-Haemophilus influenzae
type b (1st dose in
2months & 2nd dose in
4months, 3rd & 4th dose
around 12-15 months)
-Pneumococcal conjugate
(1st dose in 2months &
2nd dose in 4months,
3rd dose in 6months &
4th dose around 12-15
months)
-Inactive Poliovirus (1st
dose in 2months & 2nd
dose in 4months, 3rd
dose around 6-15
months)
-Influenza (IIV) OR
(LAIV4) annual
vaccination 1 or 2 doses
12-15 months of baby.
 -Measles (MMR) &
Varicella (VAR) (1ST
dose around 12-15
months of age)

10. Make discharge instructions/health teachings for this case using the acronym METHODS.

METHODS PATIENT DISCHARGE PLANNING

Medication Based on the given data, there is no need to prescribe medication regarding the foul smell cord stump

Environment
Make sure that the baby will not be exposed to a dirty environment. Make the room where the baby
spends most of his time well-cleaned and disinfected. If it cannot be helped, cover the belly of the baby
with sterile gauze or a clean cloth to prevent the cord stump from being dirty.

Treatment
Proper cleaning of the cord stump would be advised as the treatment for the patient. This is to prevent
infections and lessen the odor coming from the stump.

Health Teaching The mother of the patient is advised to remember to expose the cord stump to air to let it heal faster. If
soiled, it should be washed with water and mild soap, and exposed to air for air drying. It is advisable
to go to the health center again if the mother notices signs of infections that arose after the initial
check-up as soon as possible.

Out-Patient Follow-up
The patient is advised to go back to the health care center for a follow-up check-up after 3 days to
check if the care taught was effective to lessen the foul odor of the cord stump. It can also be a way to
check if other signs or symptoms of infection arose.
 Diet Continue breastfeeding to boost the immune system of the baby.

Spirituality Share positivity with the mother through praying.

Sexual Activity Advise mother that she must wait 4--6 weeks after delivery before engaging in sexual intercourse. This
is to let the body heal from labor.

References:

https://www.seattlechildrens.org/conditions/a-z/umbilical-cord-symptoms/
https://www.medicalnewstoday.com/articles/infected-umbilical-cord
https://www.childrens.health.qld.gov.au/fact-sheet-caring-for-your-babys-umbilical-cord-stump-and-belly-button/
https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/healthy-baby/art-20044767
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
https://www.medicalnewstoday.com/articles/308480