Introduction
Neonatal sepsis is an infection of the blood that affects infants who are below ninety days of age. There exist two categories of neonatal sepsis, namely: early-onset as well as late-onset sepsis (Belleza, 2021). Early-onset occurs within the first week of birth, while late-onset affects infants who are between one week and three months old. Additionally, in early-onset sepsis, the newborn baby either transmits this infection before or while the mother gives birth. Factors increasing the occurrence of early-onset sepsis include preterm delivery, placenta, and amniotic fluid infection, and in case water breaks more than eighteen hours before birth (Belleza, 2021). Moreover, an extension of hospital stay and the presence of the catheter in the blood vessels contribute to late-onset sepsis in infants. The major bacteria causing sepsis in newborn babies is Group B streptococcus. Other bacteria that cause neonatal sepsis include Escherichia coli, certain streptococcus strains, and Listeria. However, these cases are not rampant in current years due to the introduction of screening technology for pregnant women. This essay critically reflects the care given to a preterm baby on optiflow with sepsis in the neonatal unit during my shift.
Description
The name of the preterm baby was Simon, born at twenty-seven plus two weeks of pregnancy. Simon was delivered through a cesarean section and weighed 779g. After delivery, Simon could not breathe normally, and therefore, he was incubated after forty-five minutes of birth for ventilation breaths. Simon was transferred to the neonatal unit, where he was ventilated for three days. Afterward, a continuous positive airway pressure (CPAP) machine provided him with steady air pressure to assist him in breathing. The last alternative was optiflow which is more comfortable than dry or standard oxygen. Optiflow, also known as Nasal high flow oxygen, provides high-flowing, humidified, and warmed oxygen to patients (Belleza, 2021). Simon was twenty-six days old during the reflection period and was on an eight-liter optiflow. Additionally, the oxygen requirement was between twenty-five and thirty percent.
All safety checks were conducted after handover, and after assessment, it was discovered that Simon had desaturation and frequent bradycardia, which required oxygen stimulation. I also noticed that Simon had a rapid rate of breathing, irritability, and tachypnea. I immediately informed the doctor in charge and the nurse on duty. A partial septic screen (blood cultures, CRP, FBC) was conducted, and began on antibiotics. An x-ray of the chest was done, and respiratory distress was revealed. Lastly, 3.0 lactate was detected through blood gas, and an assessment of pain was administered. Simon looked lethargic, in distress, and unwell. Seeing his condition, I felt sympathy and concern for him. Nurses and other healthcare practitioners need to have the ability to determine and provide care to such infants to increase long-term outcomes.
Nursing Assessment
One of the major responsibilities of nurses is an assessment which should be practiced with utmost diligence and preciseness. A physical assessment was done on Simon to determine any changes in his behavior or condition. The nurse on duty also inspected Simon for any visible distress symptoms, including lethargy, poor tone, and stimuli response. The nurse also watched from baseline the trends in his vital signs such as pulse, pressure, and temperature. In addition, the nurse assessed the pain Simon was going through, measuring some indicators of behavior.
These behavior indicators included: facial expressions, considering contextual indicators like the gestational period at birth and his sleep rate. Some physiological indicators included the level of oxygen in the blood and checking his heartbeat rate. Furthermore, input and output monitoring, also known as body fluid management, was done on Simon. This process is vital as it permits the normal functioning of metabolic activities in the body of the patient. The fluid input was assessed by determining the rate at which Simon became hungry and thirsty, while output was measured by checking stools and urine from their body of Simon.
Hand Hygiene and Aseptic Technique
Adhering to the cleanliness of hands, using individual protective equipment, and an aseptic technique by nurses are crucial in preventing more infections and spreading harmful bacteria and organisms to other patients and workers in a health institution. Depending on the type and effects of the bacteria or organism, practices of controlling these infections might require isolation. In this incident, the nurse wore gloves and rubbed her hands with alcohol when attending to Simon. The purpose of alcohol was to assist in minimizing the occurrence of late-onset sepsis, especially since Simon was a preterm baby.
The nurse insisted that using hand hygiene protocols such as washing hands, hand rubbing, and wearing gloves is important as it significantly minimized the length of stay (LOS) occurrence in preterm babies. This hygiene technique is also important in producing a sustained refinement in the rate of infection. The aseptic technique involves using procedures and practices to curb pathogens and microbes contamination. The septic technique used on baby Simon was the use of sterile masks and gloves. The nurse used an autoclave to sterilize her gloves and mask and also made sure of disposing of all the used equipment.
Maintaining a Neutral Thermal Environment
Instability of temperature is a very common condition in sepsis patients, especially preterm infants. The disadvantage of an unstable temperature is that it minimizes the strength and energy essential to the growth and ability of the body to fight certain infections (Belleza, 2021). This temperature instability was the reason why Simon was moved to an incubator where the nurse regularly monitored his temperature. Humidified oxygen in the incubator also helped prevent Simon from nasal obstruction usually caused by incorrectly positioned prongs and excess nasal secretions. When newborn babies experience unstable body temperature, it can lead to hypothermia, which is associated with higher mortality and morbidity rate. Therefore, body temperature regulation should be considered a basic detail of infant care. There are various reasons why newborn babies are prone to thermoregulation at birth. These reasons include a relatively high rate of metabolism, a large surface area to volume ratio, and a large head compared to the body, which accounts for almost twenty-five percent loss of heat.
Maintaining Fluids and Electrolytes
The nurse made sure that Simon had a balanced intake of fluids and nutrients. Additionally, Simon was given nothing by mouth as a result of an increase in necrotizing enterocolitis, paralytic ileus, and aspiration risks. Management of nutrition, electrolyte, and fluid is essential in preterm infants since most babies in NICU (Neonatal Intensive Care Unit) need IFVs (Intravenous Fluids). These infants also have fluid shifts between extracellular, vascular, and intracellular compartments. The only fluid Simon fed on was breast milk from his mother. Breast milk is highly rich in nutrients required by the baby for his development and growth. Although various commercial milk formulas are designed for use in place of breast milk, most of these formulas contain cow milk. In the NICU, Simon was fed intravenously, that is, using a feeding tube. Here, Simon received three types of nutrition: breast milk, infant formula for preterm babies, and TPN (Total Parenteral Nutrition). Moreover, intravenous access was required after a few minutes of birth, mostly because Simon was a premature baby. The purpose of intravenous access was to administer fluids, nutrients, and medications in the course of postnatal maintenance.
Provision of Adequate Ventilation and Oxygenation
Hypoxemia is regularly associated with sepsis and refers to the insufficient oxygen level in the blood. Therefore, uninterrupted pulse oximetry was required, and subsidiary oxygen was necessary to keep oxygen saturation easy to reach. Simon had a severe sepsis condition, and therefore, he required mechanical ventilation or Continuous Positive Airway Pressure (CPAP). The choice of a clinician on ventilator modes to a serious degree is restricted to the available equipment in the NICU. Although many current ventilators can provide necessary synchronized ventilation modes, many hybrid combinations or modes are unique to each device and manufacturer.
For example, several ventilators can combine Pressure Support Ventilation (PSV) as well as Synchronised Intermittent Mandatory Ventilation (SIMV). In contrast, others only use PSV as an isolated mode with a rate of backup similar to AC (Assist/Control). Even though PSV eliminates the hold of inspiration, thus better synchronization and effective time of inspiration, it was not appropriate for use in the case of Simon. PSV was not ideal because he was a premature infant therefore, the constant in his breathing time was very short: could be below 0.25 seconds. This inspirational duration is not adequate for gas combination and could lead to overly fast rates of respiration.
Maintaining Perfusion
Septic and hypovolemic shock are both types of sepsis complications. Therefore it is essential to monitor blood pressure as well as use inotropes or volume expanders for blood pressure maintenance. An inotrope is a type of drug used to increase the contraction force of the heart while pumping. Since his heart was pumping a very low amount of blood, leading to low blood pressure, an inotrope was required to maintain his blood pressure (Carbone et al., 2020). This assessment was primarily based on clinical signs, and significant advances in technology have provided a thorough comprehension of perfusion. These technologies have also permitted pathophysiology therapy instead of targeting and monitoring blood pressure. This approach was guided by the knowledge that disorders caused by perfusion have diverse causes, and thus using one management viewpoint might cause more harm.
Monitoring Laboratory Results
Laboratory results include CBC (Complete Blood Count), electrolytes, aerial blood gases, and blood cultures. A CBC evaluates the entire health of a patient and detects a variety of disorders such as leukemia, anemia, and infection. Moreover, a CBC test is used to measure distinct features and components of blood such as platelets, white blood cells, hematocrit, and red blood cells, which transport oxygen. The nurse carried out a CBC test on Simon to determine the amount of hemoglobin in his blood and also evaluate any disorders. Overall, these results are essential in determining the rate at which the conditions of infants progress. Another example of a sepsis complication is hypoglycemia which also requires monitoring of blood glucose. Treatment of hypoglycemia includes providing the baby with a rapid-acting glucose source. Generally, glucose in the body of an infant acts as a source of energy for both the body and brain.
Parental Support
Both caregivers and parents of sepsis infants need emotional support throughout the illness period of their child. They should have the appropriate knowledge of the pathophysiology of neonatal sepsis, such as treatments, risk factors, need for isolation, and regular hand hygiene. Nurses and doctors encourage these parents to participate in bonding and care with their infants. When parents are discharged from the hospital, they should be aware of the symptoms and signs of sepsis. These signs include fast breathing, pale or clammy skin, fast heart rate, low temperature or fever, and breath shortness (Belleza, 2021). It is also important to note that these symptoms do not always illustrate sepsis: most of the time, it is not the case. However, if more than one of the signs mentioned above and symptoms occur simultaneously, or the child falls sick often, parents are advised to seek medical attention.
In conclusion, how neonatal sepsis manifests are not specific. A great suspicion index with or without laboratory infection evidence is the only effective method of diagnosing the illness early. Additionally, immediate antibiotic therapy institutions as well as nurturing care will help save a large percentage of neonatal sepsis cases. Various parameters found in the laboratory can also help screen neonates having neonatal sepsis. However, none of these parameters are specific enough to be used alone. The diagnostic technique focuses on reviewing and history of symptoms and signs that are none specific. On the other hand, antibiotic treatment is termed the mainstay treatment of neonatal sepsis, with care and support equally essential.
References List
Belleza, M., 2021. Sepsis and Septic Shock. Nurseslabs. Web.
Carbone, F., Montecucco, F. and Sahebkar, A. (2020) Current and emerging treatments for neonatal sepsis. Expert opinion on pharmacotherapy, 21(5), pp.549-556.