April 2 Lecture Flashcards
a severe infection in
newly born infants
Neonatal Sepsis
SIRS
systemic
inflammatory response syndrome
Definition of neonatal sepsis
Clinical syndrome of
bacteremia with systemic signs &
symptoms of infection in the first
four weeks of life.
SIRS can be identified by the presence of which 2 or more
of the following signs
✔ Abnormal heart rate
✔ Respiratory distress
✔ Abnormal leukocyte count
✔ Abnormal temperature
Two types of neonatal sepsis
○ Early Onset
○ Late Onset
Neonatal sepsis affects how much in every birth?
approximately 2 infants per
1,000 births
Neonatal sepsis has a higher incidence in?
in premature & low birth weight infants
Cause of neonatal sepsis
○ Bacteria
○ Immature immune response
○ Genetic predisposition
An important cell in immunity against pathogens
Neutrophils
Why does neonate’s neutrophils have decreased chemotaxis?
Due to decreased chemoattractant.
a type of WBC that ingests pathogens
Monocytes
Opsonization
The coating of a pathogen with
antibodies that makes it susceptible to phagocytosis
The process of cells (phagocytes) engulfing, ingesting, & destroying pathogens.
Phagocytosis
antibodies that promote opsonization
Opsonins
Pathogen’s route in entering a neonate’s body
✔ Prenatal period
✔ Perinatal period
✔ Postnatal period
Classifications of neonatal sepsis
● Congenital Infection
● Early-Onset Sepsis
● Late-Onset Sepsis
Major risk factor is maternal infection
Congenital Infection
When does early onset sepsis occur?
Birth to 7 days
When does late onset sepsis occur?
8 to 28 days
Where does late-onset sepsis acquired?
Acquired in hospital, home, or community.
5 associated factors for early-onset sepsis
✔ Prolonged rupture of membranes > 12 hours
✔ Difficult or prolonged labor
✔ Birth asphyxia and difficult resuscitation
✔ Multiple per vaginal examination
✔ Very low birth weight or preterm baby
A type of sepsis caused by the organisms of the external environment of home or hospital and is often transmitted through the hands of the care provider.
Late onset sepsis
Gram negative organisms in late onset sepsis
e. Coli
klebsiella
enterobacter
serratia
pseudomona
proteus
citrobacter
Presentation of late onset sepsis
septicemia
pneumonia
meningitis
5 organisms identified in late onset sepsis
○ Escherichia coli
○ Group B Streptococci
○ Streptococcus pneumoniae
○ Acinobacter species
○ Candida
Symptoms of neonatal sepsis
✔ Tachypnea
✔ Feeding difficulties
✔ Difficulty breathing
✔ Irritability
✔ Heart rate changes
✔ Temperature instability
✔ Jaundice
Most common manifestations in neonatal sepsis
- Respiratory distress
- Altered feeding behavior
- Baby who was active, suddenly or gradually becomes lethargic, inactive or unresponsive & refuses to suckle.
- Temperature instability
- Skin
- Metabolic
Diagnostic tests in neonatal sepsis
A. Non-specific - WBC count & differential, Platelet count,
B. Definitive specific Cultures - Blood, CSF
C. Radiology - Chest X-Ray, Renal ultrasound, CT scan
Treatment for neonatal sepsis
antibiotics & supportive therapy
Antibiotics for neonatal sepsis
ampicillin & aminoglycoside
When is gentamicin effective?
within 10-14 days effective against most organisms responsible for early-onset sepsis.
An alternative method of
antibiotic treatment for late onset sepsis
combination of ampicillin and cefotaxime
Prevention for late onset sepsis
● Good prenatal care
● Materna infections diagnosed & treated early
● Babies should be breastfeed early
● Infection control policies applied
in the unit
Nursing diagnosis for late onset sepsis
- Fluid Volume Deficit
- Ineffective Tissue Perfusion r/t impaired transport of oxygen across alveolar & on capillary membrane
3 Nursing interventions for FVD
- Monitor & record v/s
- Provide oral care by moistening lips & providing daily bath
- Provide TSB if patient has fever
3 Nursing interventions for Ineffective Tissue Perfusion
- Note quality & strength of peripheral pulses
- Assess skin for changes in color, temp, & moisture
- Assess RR, depth, and quality
An acute inflammation of the meninges & CSF
Bacterial Meningitis
It remains a significant cause of illness in the pediatric age groups because of undiagnosed & untreated or inadequately treated cases
Bacterial Meningitis
Causes of Bacterial Meningitis
bacterial agents
○ H. influenza type B
○ S. pneumoniae & Neisseria meningitidis
○ B. hemolytic streptococci
○ E. Coli
5 routes organisms in bacterial meningitis also gain entry by:
○ Direct implantation after penetrating wounds
○ Skull fractures
○ Lumbar puncture
○ Surgical procedures
○ Anatomic abnormalities (Spina Bifida)
5 clinical manifestations of bacterial meningitis
✔ Fever, chills, headache, & vomiting
✔ Alteration in sensorium
✔ Seizure
✔ Irritable, agitated
✔ Confusion, hallucination
Diagnostic evaluation in bacterial meningitis
● Lumbar puncture
● Culture & sensitivity test of CSF
● CT Scan of the head
● CBC (increased WBC)
Therapeutic management in bacterial meningitis
● Inititation of antimicrobial therapy
● Maintenance of hydration
● Maintenance of ventilation
● Management of systemic shock
● Control of temperature
when one or more parts of the urinary system (kidneys, ureters, bladder, or urethra) become infected with a pathogen
Urinary Tract Infection
Most frequent pathogen in UTI
bacteria
3 Basic Forms of UTI
- Pyelonephritis
- Cystitis
- Asymptomatic Bacteriuria
The most common serious bacterial
infection in infants.
Pyelonephritis
A bacterial infection of the kidneys
Pyelonephritis
Cause of an acute or chronic pyelonephritis
Often due to ascending of bacteria from bladder up to ureters.
Clinical pyelonephritis is characterized by:
● Abdominal, back, or flank pain
● Fever (may be the only manifestation)
● Malaise
● Nausea
● Vomiting
● Diarrhea (occasionally)
What do you call the extreme overextension of the child’s neck?
opisthotonos
Newborns can show nonspecific symptoms in pyelonephritis such as:
● Poor feeding
● Irritability
● Jaundice
● Weight loss
It indicates that there is bladder involvement
Cystitis
Symptoms of cystitis
○ Dysuria
○ Urgency
○ Frequency
○ Suprapubic pain
○ Incontinence
○ Malodorous urine
Route of bacteria in UTI
bacteria arise from the fecal flora, colonize the
perineum, & enter the bladder via the urethra
In uncircumcised boys, where does the bacterial pathogens arise?
It arise from the flora beneath the prepuce.
In some cases, where does the bacteria causing cystitis ascend to?
It ascends to the kidney to cause pyelonephritis.
What happens when the urine sits at room
temperature for more than 60 min?
There will be overgrowth of a minor contaminant can suggest a UTI when the urine
might not be infected.
Diagnostic tests for UTI
- Based on symptoms or findings on urinalysis, or both.
- urine culture
- In toilet-trained children, a midstream urine sample
- In children who are not toilet trained, a catheterized urine sample should be obtained
It is a reliable method of storing the urine
until it can be cultured.
Refrigeration
What is the application after disinfection of the skin of the genitals
an adhesive, sealed, sterile collective bag
What is an unnecessary diagnostic test in UTI
suprapubic aspirate
If treatment is planned immediately after obtaining the urine culture, why is a bagged specimen should not be the method opted?
Because of a high rate of contamination often
with mixed organisms.
Signs & Symptoms of UTI
✔ Bedwetting
✔ Fever (occasionally the only symptom in babies)
✔ Foul-smelling, cloudy, or blood-tinged urine
✔ Fussiness
✔ Nausea, vomiting or loss of appetite
✔ Pain below your child’s belly button
✔ Pain or burning sensation when your child
urinates
✔ Waking at night to urinate
An inflammation of middle ear that most often occur in infant & young children but can occur at any age.
Otitis Media
What tube is associated in otitis media?
eustachian tube
Comparison of eustachian tube in infant & adult
The eustachian tube in an infant is shorter & wider than in the older child or adult. The tube is also straighter, thereby allowing nasopharyngeal secretions to enter the middle ear more easily.
Classification of Otitis Media
● Acute Otitis Media - usually lasting less than 6 weeks
● Chronic Otitis Media
Etiology of Otitis Media
○ Streptococcus pneumoniae
○ H. Influenza
○ Upper respiratory tract infection
○ Infection nasopharynx
6 causes of otitis media
- Immature immune system
- Genetic Predisposition
- Anatomic abnormality
- Physiologic dysfunction
- Bacterial pathogens
- Infant feeding methods
Children with anatomic abnormalities of the
______ have a higher risk for otitis media
palate & associated musculature
The most common bacterial pathogen in otitis media
Streptococcuspneumoniae, followed by
Haemophilus influenzae, & Moraxella catarrhalis.
signs & symptoms of otitis media
- Otalgia (Ear Pain)
- Otorrhea
- Headache
Otalgia
Ear pain
signs of otalgia
Pulling on the affected ear or ears or pulling on the hair.
When does otalgia apparently occurs more often?
When the child is lying down.
Discharge from the middle ear through a recently perforated tympanic membrane, or
through another perforation.
Otorrhea
Medical management for otitis media
Antibiotic Therapy
Myringotomy & TT Placement
Adenoidectomy
Incision of the eardrums
Myringotomy
Why is Myringotomy performed?
To establish drainage & to insert tiny tubes into the tympanic membrane to facilitate drainage.
Diagnostic tests for otitis media
● History taking
● Physical examination
● Otoscopic examination
● Culture
● Audiometry & Tympanometry
Complications of otitis media
● Chronic otitis media
● Hearing loss
● Perforation
● Poor speech development
A long standing infection of a part of whole of the middle ear characterized by ear discharge & permanent perforation.
Chronic Otitis Media
Duration of chronic otitis media
Lasts for morethan 6 weeks
Etiology of chronic otitis media
● Inappropriate treatment of acute otitis media
● URTI, Allergic rhinitis
● Eustachian tube deformity.
● Septal deviation, cleft palate, sinusitis
Symptoms of otitis media
● Ear discharge
● Deafness
● Itching & pain in the ear - with otitis externa
● Tinnitus & giddiness
Characteristic of ear discharges in chronic otitis media
Foul smelling
scanty
predominantly purulent
occasionally blood stained
Nursing diagnosis for chronic otitis media
✔ Acute pain r/t the inflammation of the middle ear.
✔ Anxiety r/t health status
✔ Impaired verbal communication r/t effects of hearing loss
✔ Disturbed sensory perception r/t obstruction, infection of the middle ear, or auditory nerve damage.
✔ Risk for injury r/t hearing loss, decreased visual acuity.
✔ Infection r/t presence of pathogens
Nursing management for chronic otitis media
- Positioning
- Heat application
- Diet
- Hygiene
- Monitor hearing loss
Position of the child in otitis media
Have the child sit up, raise head on pillows, or
lie on unaffected ear.
The most common bacterial skin infection in children.
Impetigo
Impetigo is highly contagious & normally appears around where?
The nose, mouth, & extremities.
Impetigo is characterized by?
By blisters with yellow fluid that rupture & leave a honey-colored crust
Impetigo is spread through?
Through direct contact with sores & scratching may cause the lesion to spread.
Impetigo is caused by
By common bacteria, usually Group A beta-hemolytic Streptococcus or Staphylococcus aureus that enters through breaks in the skin.
Impetigo is often accompanied by?
It often accompanies poor hygiene & is more
prevalent in warm temperatures
Types of Impetigo
- Bullous Impetigo (Blisters)
- Non - Bullous Impetigo
This form is caused by staph bacteria that produce a toxin that causes a break between the top layer (epidermis) & the lower levels of
skin forming a blister.
Bullous Impetigo (Blisters)
Medical term for blister
bulla
Blisters can appear especially in?
buttocks
Characteristics of blisters?
Fragile & often break & leave red, raw skin with raffed edge.
Subjective data for blisters
● Generalized weakness
● Malaise
● Itching (Pruritus)
Objective data for blisters
● Multiple lesions or bullae around the mouth and nose or extremities
● Honey-colored crust around lesions
● Fever
● Diarrhea
This is the common form, caused by both staph & strep bacteria. It appears as small blisters or scabs, which then form yellow or honey-colored crusts.
Non - Bullous Impetigo
Where does non - Bullous Impetigo start around?
Around the nose & on the face, they may also affect the arms & legs.
Diagnostic tests for impetigo
- Looking at the distinctive sores.
- Culture test
- Complete blood count
How can mild cases of impetigo be treated?
By gentle cleansing, removing crusts, & applying the prescription-strength antibiotic ointment mupirocin (bactroban).
Mupirocin
Bactroban
Complication of impetigo
Cellulitis
Antibiotics for impetigo
● Clindamycin
● Topical antibiotics, such as mupirocin & bacitracin
● Mupirocin ointment
Clindamycin
○ 150 - 300 mg orally every 8 to 8 hours; children 10 - 30 mg/kg per day in 3 - 4 divided doses.
○ The duration of the therapy is 7 - 10 days
○ Penicillin - allergic patients can be treated
Treatment for non-bullous impetigo
○ Topical antibiotics, such as mupirocin & bacitracin
Mupirocin ointment
○ Applied 3 times daily for 7 days
○ As effective as erythromycin
Ways impetigo can be transmitted
Through:
○ Towels
○ Toys
○ Clothing
○ Household items
5 nursing interventions for impetigo
✔ Assess vitals; note fever
✔ Maintain contact precautions
✔ Administer oral antibiotics
✔ Make sure patient’s fingernails are trimmed & clean
✔ Assess skin for lesions; note color & presence of crusting
Health teaching to prevent the spread of disease to others: (impetigo)
a. Infected child should use their own towels & linens which should be washed alone.
b. Ensure good handwashing habits
c. Avoid contact with others who may have depressed immune system
d. Avoid outside play, high temperatures that will make the sores worse
An itchy skin condition caused by a tiny
burrowing mite called Sarcopetes scabiei.
Scabies
Burrowing mite in scabies
Sarcopetes scabiei
Causes of scabies
● Close physical contact
● Dogs, cats, & humans all are affected by their own distinct species of mite.
How many days does the eggs
hatch in scabies?
3 - 4 days
Sites of infestation in scabies
a. Scalp
b. Face
c. Neck
d. Palms of the hands
e. Soles of the feet
Symptoms of scabies
● Itching, often severe & usually worse at night
● Thin, irregular burrow tracks made up of tiny
blisters or bumps on the skin
How does scabies spread?
- Through skin to skin contact
- By touching an infected person’s item
- Until the person is cured, they can continue to pass scabies on to others
Diagnostic tests for scabies
- Doctor examines the skin, looking for signs of mites, including the characteristic of burrows.
- Scraping from that area of skin to examine under a microscope.
Treatment for scabies
- creams and lotions
- usually apply the medication all over the body, from neck down, & leave the medication on for at least 8 hours.
- second treatment is needed if new burrows & rash appear
- Doctor may recommend treatment for all family members & other close contacts, even if
they show no signs of scabies infestation.
Prevention for scabies
● Try not to touch their skin
● Do not share clothes with an infected person
● Wash bedding in hot water & dry high temperatures for at least 20 minutes
● If unable to wash, sealing it in a plastic bag will kill the bugs.
Head Lice
Pediculosis Capitis
Common parasite in school-aged children
Pediculosis Capitis
When & where does female louse lay her eggs
Female lay her eggs at night at the junction of a hair shaft & close to the skin because the eggs need a warm environment.
Number of meals the louse requires
5 meals a day
Life span of louse
Adult louse lives only about 48 hours when away from human host, & the life span of the
female louse is 1 month.
Cancer of blood-forming tissues, it is the most
common form of childhood cancer.
Leukemia
Prevalence of leukemia
It occurs more frequently in boys than in girls, after age 1 & the peak onset is between 2 & 6 years of age.
What type of cancer is leukemia?
cancer of blood or bone marrow
Leukemia is characterized by?
By an abnormal increase of immature white blood cells called “blasts”
Leuka = ?, emia = ?
Leuka = white, emia = blood
Immature WBC
blasts
Two Forms of Leukemia
- Acute Lymphoblastic Leukemia (ALL)
- Acute Myelogenous Leukemia (AML)
Categories of Acute Lymphoblastic Leukemia (ALL)
lymphatic, lymphocytic, lymphoid, &
lymphoblastoid leukemia
Categories of Acute Myelogenous Leukemia (AML)
nonlymphoid cells
It is the soft, spongy tissue in the center
cavity of all bones.
Bone Marrow
Common stem cell
hemocytoblast
Hematopoiesis
Blood Cell Formation
