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Prepared By:

Divinia Joy C. Tuzon, RN


SEPSIS
SEPSIS or SEPTICEMIA

 Refers to a generalized
bacterial infection in the
bloodstream.

 Neonates are highly susceptible to


infection.
 Neonates and infants have poor
response to pathogenic agents.
SEPSIS or SEPTICEMIA

 Can be acquired prenatally or during


labor.

 Transplacental transfer can occur


with:
 Cytomegaloviruses
 Toxoplasmosis
 Treponema pallidum
SEPSIS or SEPTICEMIA

 EARLY SEPSIS

 Less than 3 days after birth


 Acquired in the perinatal period
 Infection can occur from direct contact with
organisms from maternal GIT and GUT
 Group B streptococcus (GBS)
 Escherichia coli
SEPSIS or SEPTICEMIA
 LATE SEPSIS

 1 to 3 weeks after birth


 Primarily nosocomial
 Staphylococci
 Klebsiella
 Pseudomonas
 Coagulase negative staphylococcus – ELBW &
VLBW
SEPSIS or SEPTICEMIA
 Postnatal infection – acquired by
cross-contamination from other
infants, personnel, or objects in the
environment.
 “water-bugs”
DIAGNOSTIC EVALUATION

 Laboratory and radiographic


examination
 Cultures of blood, urine and CSF
 Blood studies may show:
 Anemia
 Leukocytosis
 Leukopenia – ominous sign
 Elevated number of immature neutrophils,
decreased or increased total neutrophils,
and changes in neutrophil morphology
LUMBAR PUNCTURE or SPINAL
TAP
Therapeutic Management
 Early recognition and diagnosis are essential.
 Antibiotic therapy – initiated before lab results
are available; positive and negative cultures
 Circulatory support
 Respiratory support
 Immunotherapy
 Supportive therapy
 Oxygen
 Fluids
 Electrolyte and acid-base balance
 BT
Nursing Considerations

 Observation and assessment


 Potential modes of infection transmission
 Knowledge of side effects, proper
regulation and administration of drugs
 Decrease additional physiologic or
environmental stress
 Proper handwashing, use of disposable
equipments, disposal of excretions, and
adequate housekeeping
 Observation for signs of complications
B. Common Health Problems
That Develop During Infancy
 Sudden infant death syndrome
 Colic
 Failure to thrive
 Trisomy 21
 Autism/ADHD
 Intussusception
 Cleft palate
 Imperforated anus
 Hirchsprung's disease
 Spina bifida
 Hydrocephalus
 Otitis Media
 Meningitis
 Febrile seizures
PROTEIN AND
ENERGY
MALNUTRITION
(PEM)
KWASHIORKOR

MARASMUS
KWASHIORKOR
MARASMUS
FEEDING
DIFFICULTIES
REGURGITATION
AND
“SPITTING UP”
REGURGITATION
AND “SPITTING UP”
 REGURGITATION – return of
undigested food from the
stomach, usually accompanied
by burping
 SPITTING UP – dribbling of
unswallowed formula from the
infant’s mouth immediately
after a feeding
REGURGITATION

 Frequent burping
 Minimum handling
 Positioning the child
“SPITTING UP”

 Absorbent bibs
 Protective cloths

 Excoriation
You need to suspect there
is a problem:
• when he or she has difficulty gaining weight
• if he is frequently irritable
• if he chokes often when he eats or has
difficulty breathing or wheezing
• if he has a chronic cough
• if he is hoarse when he cries
• if he refuses to eat or cries after each
feeding
• if he arches his back during or after
feedings
• if he has a large volume of reflux
• if the vomit is bloodstained
• if he or she fails to thrive
Paroxysmal
Abdominal
Pain
COLIC
 Paroxysmal abdominal pain or
cramping manifested by loud
crying and drawing the legs up to
the abdomen.
COLIC
 Duration of cry greater than 3
hours a day, occurring more than 3
days per week, and parental
dissatisfaction with the child’s

 More common in young infants


under the age of 3 months and
infants with “difficult”
temperament
Potential Causes
 Too rapid feeding
 Overeating
 Swallowing excessive air
 Improper feeding technique
 Emotional stress or tension
 *Cow’s milk allergy or intolerance
 *Parental smoking
Management
 Begin with an investigation of
diagnosable causes
 Drugs such as sedatives,
antispasmodics, antihistamines,
antiflatulents
Nursing
Considerations
Thorough, detailed history

Infant’s diet
Diet of the breastfeeding mother
Time of day when crying occurs
Relationship of the crying to feeding time
Presence of specific family members
Activity of the mother or caregiver
Characteristics of the cry
Measures used and effectiveness
Infant’s stooling, voiding, sleeping patterns
Nursing
Considerations
 Milk-free diet for a minimum of 3 to
5 days
 *Need for calcium supplements
 Need to understand the infant’s
crying behavior and modifying
parent interventions
Family home care:
reliving colic
 Place infant prone over a covered
warm-water bottle, heated towel, or
covered heating pad
 Massage infant’s abdomen
 Respond immediately to the crying
 Change infant’s position frequently
 Provide smaller, frequent feedings
 Burp infant during and after feeding
FAILURE TO
THRIVE
Failure To Thrive (FTT)

 A sign of inadequate growth


resulting from inability to obtain
and/or use calories required for
growth.

 No universal definition, common


parameter is weight (sometimes
height) that falls below the 5th
percentile for the child’s age.
CLINICAL MANIFESTATIONS OF
NFTT
Growth failure
Developmental retardation
Apathy
Poor hygiene
Withdrawn behavior
Feeding or eating disorders
No fear of strangers
Avoidance of eye contact
Wide-eyed gaze and continual scan of the environment
Stiff and unyielding or flaccid and unresponsive
Minimal smiling
3 General Categories of
Failure To Thrive (FTT)
 ORGANIC FAILURE TO THRIVE (OFTT)
 Result of a physical cause

 NONORGANIC FAILURE TO THRIVE (NFTT)


 Has a definable cause that is unrelated to disease.
 Result from psychosocial factors

 IDIOPATHIC FAILURE TO THRIVE


 Unexplained by the usual organic and
environmental etiologies but may also be
classified as NFTT.
Failure To Thrive (FTT)

 Many other factors can lead to inadequate


feeding of the infant, such as:

 Poverty
 Health and/or childrearing beliefs
 Inadequate nutritional knowledge
 Family stress
 Feeding resistance
 Insufficient breast milk
Failure To Thrive (FTT)
 Initially made from evidence of growth
retardation
 Recent FTT – weight is below accepted standards
 Long-standing – both weight and height are depressed

 Health and dietary history


 Physical assessment
 Developmental assessment
 Family assessment

 *growth delay or failure


Therapeutic Management

 Treatment is directed at
reversing the malnutrition
 Provide calories to support
“catch-up” growth
 Prognosis is related to the
cause
Nursing Consideration

 Accurate assessment of initial


weight and height and daily
weight
 Recording of all food intake is
mandatory
 Feeding behavior is documented,
as well as the parent-child
interaction
Guidelines: Feeding children
with NFTT
 Provide a primary core of staff to feed the child
 Provide a quiet, unstimulating atmosphere
 Maintain a calm, even temperament throughout
the meal
 Talk to the child by giving directions about
eating
 Be persistent
 “Strictly encouraged” feeding, not forced feeding
 Maintain a face-to-face posture with the child
when possible
 Introduce new foods slowly
 Follow the child’s rhythm of feeding
 Develop a structured routine
AUTISM
AUTISM

 A complex developmental disorder of brain


function accompanied by a broad range and
severity of intellectual and behavioral
deficits.

 Manifested during infancy and early


childhood primarily from 18 to 30 months.
 More common in males
 Not related to socioeconomic level, race, or
parenting style
AUTISM

 Etiology is unknown.
 Evidence supports multiple biologic
causes
 Abnormal EEG
 Epileptic seizures
 Delayed development of hand dominance
 Persistence of primitive reflexes
 Metabolic abnormalities
AUTISM
SOCIAL RELATIONS AND BEHAVIOR
Extreme interpersonal isolation
Intense, abnormal concern for preservation of
sameness
Unyielding to cuddling and holding
Do not respond to verbal stimulation
Bizarre attachment to mechanical objects
Odd repetitive behaviors, such as flicking a light
switch on and off
Difficult to manage; passive or irritable
Frequent temper tantrums and/or self-destructive
behavior
DEVELOPMENT
Mental retardation, usually severe
May have advanced gross motor skills
Normal to hyperactive
May have exceptional ability (eg. memory)
Poor suck and feeding responses
AUTISM

LANGUAGE
Echolalia or parrot speech
Pronominal reversal (tendency to use
“you” for “I”)
Literal, concrete use of words
SENSORY/PERCEPTUAL PROCESSES
Sensory deficits even though vision and hearing
intact
Act as if deaf, yet may be overly sensitive to
sound
Hyposensitive or hypersensitive to pain
Have aversion to touch