UNIVERSITY OF THE CORDILLERAS

College of Nursing
Governor Pack Road, Baguio City, Philippines 2600
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
E-mail: webmaster@bcf.edu.ph
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NEONATAL SEPSIS;NEONATAL JAUNDICE

A Case Presented to the

College of Nursing

In Partial Fulfillment of the requirements in the Course

Nursing Care Management 107

Submitted By:

ABAD, Arianne Yules

ABAD, Keena Rainzelle
BAÑAGO, Rhea Jean
BANGTUAN, Neil Cyrus Gian
CAWITAN, Sarah Mae
GALANG, Mark Glendyl
GALLARDO, Mayumi Elle Chloe
NGALES, Senley
OCSILLOS, Edberg Jann
ORIBELLO, Alley Thea
ORIBELLO, Athenna Jae

(Date: 03-DECEMBER-2023 )

Noted and Approved for Presentation:

Name of Case Presentation Adviser or Panel/s

________________________
Signature of Adviser / Date
 ABSTRACT

TITLE: NEONATAL SEPSIS;NEONATAL JAUNDICE

AUTHOR INFORMATION: Arianne Yules Abad, Keena Rainzelle Abad, Rhea Jean Banago,
Neil Cyrus Gian Bangtuan, Sarah Mae Cawitan, Mark Glendyl Galang, Mayumi Elle Chloe
Gallardo, Senley Ngalles, Edberg Jann Ocsillos, Alley Thea Oribello, Athenna Jae Oribello
(BSN- 2B A UNIVERSITY OF THE CORDILLERAS)

BACKGROUND:

One of the main causes of newborn mortality and morbidity globally is neonatal sepsis,
particularly in cases where the baby is delivered prematurely. Neonatal sepsis progresses
rapidly and has no visible signs, therefore if appropriate treatment and management are
not received in a timely manner, the newborn could face death. Many factors cause
neonatal sepsis such as the instance of Home delivery where the equipment used in the
procedure of cord cutting and clamping is not sterilized which could be a reason for
bacterial transmission. If not treated immediately it could lead to complications such as
Jaundice which is the increase of bilirubin count in the body that causes yellowish
discoloration on the skin. Previous studies have shown that strengthening nursing care for
neonatal sepsis can effectively improve the clinical treatment effects. (Boettiger M. et.al,
2017) Therefore, proper and active nursing care is also the key to improving the well-being
of infants.
CASE DESCRIPTION:

Patient P, a 14-day-old, female infant was born at 36 weeks and by means of home
delivery, to a mother, gravida 9 para 7. The patient is admitted with a chief complaint of
neonatal jaundice. The yellowish discoloration was noted from the face down to the lower
extremities and poor sucking. The final diagnosis of the patient was Neonatal Sepsis and
neonatal Jaundice. The following tests were performed: Complete Blood Count, Electrolyte
Serum Test, Serum bilirubin test, and Capillary Blood Glucose.

During the physical examination, the patient mostly is asleep and cuddled by the
mother. Mild jaundice was noted on the body and poor sucking reflex was compliant.
Patients’ body temperature elevated to 38. 0 C. However, after the two-day shift, there
were improvement in sucking during breastfeeding done by the mother. Improvement was
also noted in the appearance since the patient’s yellowish skin tone was diminished.

CONCLUSION:

Neonatal Sepsis can be prevented if the delivery was done in the hospital instead of
home delivery. The transmission of the bacteria will be prevented because of the usage of
sterilized equipment in the hospital vicinity. Hospital admission is really important to
completely assess a patient with neonatal sepsis resulting in complications, through hospital
admission the patient will be given immediately the care and interventions needed to
alleviate her suffering and make the healing process faster.

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 TABLE OF CONTENTS

I. Introduction............................................................................................................................ 3

II. Statement of Objectives........................................................................................................3

A. General Objectives................................................................................................................3

B. Specific Objectives................................................................................................................ 3

III. Patient’s Profile........................................................................................................................3

IV. Chief Complaint..................................................................................................................... 4

V. Present History of Illness.........................................................................................................4

VI. Past History of Illness.............................................................................................................. 4

VII. Family Health History..............................................................................................................4

VIII. Developmental History....................................................................................................... 4-5

IX. Social and Environmental History......................................................................................... 5

X. Lifestyle and Health Practices...............................................................................................5

XI. Health Assessment................................................................................................................. 5

A. General Survey.......................................................................................................................5

B. Head to Toe Assessment....................................................................................................... 6

C. 13 Areas of Assessment......................................................................................................7-9

XII. Diagnostics...................................................................................................................... 10-13

XIII. Comprehensive Pathophysiology...................................................................................... 14

XIV. Treatment/Management..................................................................................................... 15

A. Drugs.............................................................................................................................15-22

B. IV Fluids........................................................................................................................ 22-26

XV. Nursing Care Plans............................................................................................................... 27

A. Prioritization of Problems.....................................................................................................27

a.1. List of Problems..............................................................................................................27

a.2. Basis for Prioritization............................................................................................... 27-28

B. Nursing Care Plans............................................................................................................. 29

NCP 1.........................................................................................................................................29

NCP 2....................................................................................................................................30-31

NCP 3....................................................................................................................................31-32

NCP 4....................................................................................................................................33-34

NCP 5....................................................................................................................................34-35

C. Discharged Plan................................................................................................................... 36

XVI. Learning Insights..............................................................................................................37-39

XVII. List of References.................................................................................................................. 40

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I. Introduction
Neonatal sepsis is an invasive infection, usually bacterial, occurring during the
neonatal period (Tesini, 2022). It refers to an infection involving the bloodstream in
newborn infants less than 28 days old. Is a severe systemic inflammatory syndrome
resulting from infection (Singh, M., Alsaleem, M., et. al. 2022). This condition’s signs and
symptoms include multiple, nonspecific, and include diminished spontaneous activity,
poor sucking reflexes, apnea, bradycardia, unstable temperature, respiratory distress,
abdominal distention, GI problems (such as diarrhea, and vomiting), seizures, and
jaundice. This condition is diagnosed clinically and is also based on culture tests and
results.
Neonatal sepsis is a primary cause of neonatal mortality and is a concern
worldwide, especially in low and middle-income countries. According to the World
Health Organization (year of pub), states the major direct cause of newborn deaths
globally is neonatal infection, or sepsis, which is responsible for about 33% of newborn
deaths.

Furthermore in an article from World Data Atlas in 2017, deaths due to neonatal
sepsis and other infectious conditions for the Philippines was 0.06 %. Deaths due to
neonatal sepsis and other infectious conditions in the Philippines increased from 0.05 % in
2003 to 0.06 % in 2017 growing at an average annual rate of 1.66%.

II. Statement of Objectives

A. General Objectives
This case analysis aims to increase the understanding and knowledge
of student nurses on how to care for patients with neonatal sepsis and
neonatal jaundice effectively and efficiently.

B. Specific Objectives
Specifically, this case analysis aims to:
1. define neonatal sepsis and its effects on the body as a whole;
2. illustrate the pathophysiology of neonatal sepsis and in relation to the
signs and symptoms specifically observed in the patient;
3. discuss the interventions for the management of neonatal sepsis
4. formulate appropriate nursing care plans suited for the patient based
on the assessment findings;
5. identify care measures to be given to the patient and family to
promote continuity of care and independence after discharge.
III. Patient’s Profile
Name : Patient P
Ethnic Background : Ibaloi
Civil Status : Single
Religion : Roman Catholic
Occupation : N/A
Admitting Diagnosis : Neonatal Sepsis; Neonatal Jaundice
Final/Principal Diagnosis : Neonatal Sepsis; Neonatal Jaundice
Date and Time Admitted : November 06, 2023 at 11:50 am

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IV. Chief Complaint
Neonatal Jaundice

V. Present History of Illness

The patient was delivered via normal spontaneous delivery at their home, preterm
with yellowish skin discoloration noted. The delivery of the neonate was done by the father
so as the cord-cutting and clamping procedure using unsterile scissors and a thread of rice
sack. The parents did not seek hospital or medical consultation. Four days after birth, the
mother observed that the yellowish discoloration of the neonate’s skin progressed and
became more visually visible, but medical consultation was still not considered. Twelve days
after the patient’s birth, the neonate illustrated signs of poor sucking reflex. Yellowish skin
discoloration was still observed. The baby was then brought to Itogon District Hospital and
was given Fusidic acid on the umbilical stump. Upon admission to Benguet General
Hospital, the patient’s temperature was noted to be 38 °C.

VI. Past History of Illness

Four days after birth, the mother noted yellowish discoloration at the face down to
the lower extremities but no associated signs and symptoms. The patient was experiencing
on-and-off fever and poor feeding, as verbalized by the mother. Two (2) weeks after birth,
the baby was brought to Itogon District Hospital, and vitamin K was administered on the
vastus lateralis intramuscularly and Fusidic acid was topically given on the umbilical stump.
In addition, the patient has no previous allergies, accidents, or injuries.

VII. Family Health History

The patient’s significant others stated that both the maternal and paternal sides
have no known history of diseases or medical conditions. Within the immediate household,
all nine siblings, including the current two-week-old newborn, have suffered from neonatal
jaundice and neonatal sepsis during infancy. Given the absence of a hereditary health
legacy on either side of the family, the similarity of health issues among siblings points
towards the shared environment.

VIII. Developmental History

The patient was the last daughter out of the other nine (9) siblings, which are
composed of 7 females and 2 males but 2 siblings died - one male and one female. She is a
2 week and 5 days old baby. During our shift, the newborn's sucking reflex is present and is
able to breastfeed. According to the Oral stage of Freud's psychosexual development that
begins at birth to 1 year old, a newborn to infant should have a sucking reflex as their
source of pleasure. But the mother states that prior to their newborn being admitted to the
hospital five (5) days ago, their newborn has a weak sucking reflex. According to Erik
Erickson's Psychosocial Stage of Development — Trust vs Mistrust, the newborn trusts and
clings to her mother during breastfeeding where nourishment and affection are met, which
improves the bonding between mother and child. In the Sensorimotor Stage of Jean
Piaget's Stages of Cognitive Development which includes the ages ranging from birth to
two (2) years old, the newborn is usually asleep during vital signs monitoring but easily
aroused even with soft noises, can grasp upon placing a finger on the newborn's palm, able
to feel the pulse oximeter on her feet upon placing it on her toes and can feel pain.
However, the newborn's eyes were closed due to the medication that was administered

4
which is Erythromycin Eye Ointment. Throughout the shift, the newborn mostly sleeps and
wakes up only during breastfeeding and monitoring of the vital signs.

IX. Social and Environmental History

The patient belongs to a family of nine (9) with her parents and siblings. They belong
to the community of Itogon but are not active in community gatherings and celebrations.
The mother has bonded with the patient, taking the main responsibility of care and feeding.
The patient has yet to bond with siblings due to hospitalization and lack of time spent
together. The patient resides at Sitio Petican Barangay Tinongdan in the municipality of
Itogon Benguet. Itogon is situated 4½ km west of Tinongdan. Their home is one of the group
of houses on the higher reaches of the mountains near streams, where they get their
primary source of water. Their house is allocated near areas with underground mines. Their
house has windows that are easily accessible, which allows for sufficient air ventilation
within. Their means of garbage disposal is through burning and recycling their waste. The
only mode of transportation accessible in the area is the public jeepney, which only runs
every two hours. The family's main source of income is farming, which they do from their
fertilized (mostly with manure) garden outside their home.

X. Lifestyle and Health Practices

During pregnancy, the mother stated that she was used to drinking soft drinks and
eating junk foods occasionally. Aside from taking care of her other children and doing
household chores, she did not have any other personal habits. Her diet mostly includes
bitter gourd since it was available on their farm. She also receives vitamins and minerals
from supplements she takes such as iron, folate, calcium, vitamin C, and B-complex. Due to
those unhealthy practices of the mother during pregnancy, it affected the nourishment,
health, and development of the neonate.

XI. Health Assessment

A. General Survey
The patient was received asleep, cuddled by the mother. The patient has an
ongoing IVF of D5IMB 150mL x 8° via a volumetric chamber infusing well over the left
metacarpal vein. Initial vital signs were noted normal having a temperature of 37.5,
respiration of 52, and heart rate of 144. However, the patient has an oxygen saturation of
94%. The patient weighs 2.3 kg and height of 43 cm. The patient’s body build is ectomorph.

The patient is asleep but easily aroused, is alert, and responds to the voice of the
mother by moving towards the sound of the voice. She wears a loose onesie paired with a
bonnet, mittens, and socks to protect her from the cold. Proper hygiene is observed through
frequent changes of clothes and diapers, no foul body and breath odor noted upon
assessment.

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B. Head-to-Toe Assessment

1. Head Normocephalic, hair is well distributed, no signs of oiliness

and flaking noted, lanugo present, no bumps, and lesions
noted, no presence of tenderness noted upon palpation,
symmetrical facial movements.
2. Eyes Pupils are equally round, irises are equal and black in
color, mucous membranes are moist, hint of yellow
discoloration in conjunctiva
3. Ears Ears are aligned with eyes, no excess cerumen or
discharge seen in the external canal, no lesions or any
abnormalities
4. Nose and sinuses Nasal congestion noted, nares patent, no deviations
noted, septum is located midline
5. Mouth Oral mucosa is moist, no lesions, tongue with white
coating from milk residue, no difficulty swallowing, poor
sucking reflex
6. Neck Neck with no tenderness, no glandular or nodal
enlargement noted upon palpation, able to move neck
from side-to-side and up and down without difficulty
7. Chest Symmetrical thoracic expansion; respiration of 52, regular,
use of accessory muscle noted, no tenderness noted
upon palpation
8. Cardiac Regular heart sounds, S1, S2, no extra heart sounds,
apical pulse normal, no abnormal heart rhythms noted,
no murmurs noted upon auscultation
9. Breast/Chest No presence of enlarged or engorged breasts upon
palpation, no mass noted upon palpation
10. Abdomen Abdomen globular in shape, normoactive bowel sounds,
no tenderness noted upon palpation, umbilicus dry and
intact
11. Genitals No signs of infestation noted, no lesions, no swelling, no
excoriation, no discharge noted
12. Musculoskeletal Extremities without deformity, spine straight, Babinsky
reflex present, full range of motion of neck, arms, and legs
13. Integumentary Skin color is brown with hints of yellow discoloration, warm
to touch, no lesions, skin texture is dry, presence of skin
folds noted, umbilicus dry and intact with no discharges,
no presence of heat, swelling, and nodules in ankles and
feet, poor skin turgor, body hair is evenly distributed
throughout the whole body. Nails are soft, pale with a hint
of yellowish discoloration, and short, capillary refill of 2-3
seconds.

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 C. 13 Areas of Assessment

1. Psychosocial and Psychological Status

Patient P is a 2-week-old female. She lives with her parents and siblings and presently
resides at Barangay Tinongdan Sitio Petican, Itogon Benguet. Her religious affiliation is
Roman Catholic. According to Erik Erikson’s Psychosocial Developmental Theory, the
patient falls under Trust vs Mistrust. The first stage occurs in childhood during the infancy
period from birth to 18 months, wherein the infant must first form a loving, trusting
relationship with a caregiver, or develop a sense of mistrust. According to the mother, the
infant calms to the mother’s touch especially during breastfeeding.

2. Mental and Emotional Status

No data supports the mental status of the infant. Patient finds comfort around the
mother's arms.

3. Environmental Status
Patient P was admitted to the pediatric ward at the Benguet General Hospital. Her
room is located approximately 2 meters from the nurse’s station which can accommodate
4 patients. The room is well-ventilated, has an accessible window, has adequate lighting,
and has enough space for the patients and watchers. The floors are regularly swept and
kept dry to avoid accidents. Lights are not overpowering and the bed is at a comfortable
height, with side rails working, and a bedside table easily accessible for their needs. The
mother reported that the patient frequently has trouble falling asleep because of the
ambient noise and the cries of other patients who share the same room during their stay.

4. Sensory Status
a. Visual Status
Eyes are sensitive to bright light. Irises are equal and black in color. The conjunctiva is
moist and with a hint of yellow discoloration. The caregiver applies Erythromycin eye
ointment to the patient’s eyes before sleeping.
b. Auditory
The patient is able to hear and react to soft noises during vital signs monitoring.
c. Olfactory Status
The patient is able to distinguish the smell of mother from another person.
d. Gustatory Status
The patient has poor sucking and rooting reflex as observed within the 2-day shift.
e. Tactile Status
Responsive to touch as the patient was startled upon pinching for skin turgor test.

5. Motor Status
The patient was fully dependent on her mother. The patient can move her arms and legs
freely without difficulty and is able to grasp upon placing our index finger on her palm.

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6. Thermoregulatory Status

Date Time Temperature

6 pm 37. 5°C
November 09, 2023
10 pm 38. 0 °C

6 pm 37. 1 °C
November 10, 2023
10 pm 36. 7 °C

Temperature was taken using a digital thermometer in her axilla. The patient has a
temperature ranging from 36.7 to 38°C.

7. Respiratory Status

Date Time RR SPO2

6 pm 52 cpm 94 %
November 09, 2023 10 pm 51 cpm 92 %

6 pm 53 cpm 96 %
November 10, 2023 10 pm 52 cpm 98 %

The patient’s respiratory rate is within the normal range of 30-60 bpm throughout the
two-day shift. On the first day of the shift, the patient's oxygen saturation significantly
decreased in the evening, falling to 92%.

8. Circulatory Status

Date Time CR Capillary

6 pm 144 bpm 2 seconds

November 09, 2023
10 pm 146 bpm 2 seconds

6 pm 145 bpm 3 seconds

November 10, 2023
10 pm 139 bpm 2 seconds

The patient’s heart rate ranges from 139-146 bpm which is within the normal range of
100–150 bpm. Her capillary refill usually takes 2-3 seconds which is within the normal range
for an infant’s capillary refill time.

9. Nutritional Status
Despite the frequent and prolonged feeding sessions, the patient is breastfed four to
six times a day for twelve hours. The patient has difficulty breastfeeding, as shown by a poor
sucking reflex, but the mother tries to breastfeed her frequently in an effort to meet her
nutritional needs.

10. Elimination Status

When asked about the patient’s elimination status, the mother changes diapers once

8
every 5 to 6 hours, or as often as needed. The patient usually defecates mustard yellow or
darker-colored stools.
11. Sleep, Rest, and Comfort Status
The patient was mostly seen cuddled by her mother or lying in bed. The mother
verbalized that the patient takes naps that last for about 1 to 2 hours and is able to sleep 10
hours or longer at night. The patient is mostly asleep.

12. Fluids and Electrolytes Status

IVF of D5IMB 150mL x 8° via a volumetric chamber infusing well over the left
metacarpal vein.

13. Integumentary Status

The patient’s skin is warm to the touch, with no pallor, no edema, no skin rashes
noted upon assessment, and with a hint of yellowish discoloration. Her capillary refill returns
after 2-3 seconds. Her hair is black and evenly distributed, lanugo present, and does not
have any foul smell. Nails are soft, pale in color, well trimmed and with no signs of blisters.
Umbilicus dry and intact with no discharges or lesions noted upon assessment.

9
XII. Diagnostics
Diagnostic procedure Significance/ Purpose of the
Description of procedure Significant findings Nursing Implications
and date done procedure

Complete Blood Count The blood test known as a It helps in observing/evaluating Hemoglobin Indicates that the patients’ blood
November 06, 2023 complete blood count, or CBC, for any unusual increase and normal range: have trouble carrying oxygen
counts red blood cells, which are decrease in blood cells such as 120-160 g/L throughout your body and getting rid
responsible for transferring oxygen anemia and leukemia which may result: of carbon dioxide.

from your lungs to the rest of your be a sign of infection. 110-Low

body. White blood cells, which
fight infections and other diseases. Hematocrit Indicates anemia
normal range:
0.37-0.47
result:
0.33-low

WBC Count A high white blood cell count

Normal Range: indicates that the patient has a
4.5 to 11.0 × 109/L bacterial or viral infection.
Result:
12.25- High

Differential Count
Neutrophils Indicates neutropenia, causing
Normal Range: swelling and repeated infections
0.51-0.67
Result:
0.34- Low

10
 Indicates the body is dealing with an
Lymphocytes infection or other inflammatory
Normal Range: condition.
0.25-0.40
Result:
0.45-high

Basophils No result
Normal Range:
0.00-0.01
Result:
Not included on the test

Monocytes Within the normal range.

Normal Range:
0.02-0.08
Result:
0.08-normal

Platelet count Indicates Thrombocytosis

Normal Range:
150-450X10 9L
Result: 724 –high

ABO Typing
result: A
Rh Typing
result: Positive

11
 Serum Bilirubin Test It measures bilirubin levels in the This test checks the newborn’s Total bilirubin Indicates patient has Jaundice
November 06,2023 blood. Blood samples are taken for liver health by measuring the Normal range:
this test and the most common bilirubin level. 1.7-20.5
method is to break the skin of the Result: 382.6 -high
heel with a sharp lancet. It is called
a heel stick. After puncturing, a Direct Bilirubin Indicates that liver is not clearing
slight bruise may appear at the normal Range: bilirubin properly
puncture site and the blood 0.00-5.10
sample will then be sent to a result: 19.05-high
laboratory for analysis.
Indirect bilirubin Indicates that liver is not clearing
normal range: bilirubin properly
1.7-5.1 μmol/L
result:
363.55-High
Serum Electrolyte Test A blood test that determines To check the electrolytes which Chloride Indicates high chloride in blood
November 06, 2023 whether the body is experiencing are the salt and minerals in the normal range:
an electrolyte imbalance. body. 98- 107 mmol/L
It is a component of a standard result:
blood test or a thorough medical 108.90-high
examination and can also be used
to identify an acid-base imbalance sodium Within normal range
or fluid imbalance in the body. normal range:
135-148 mmol/L
result:
144.70 -normal

potassium Within normal range

12
 normal range:
3.50-5.30 mmol/L
result:
4.46 -normal

CBG Using a blood glucose meter, also Used to measure and assess the normal range: Indicates a low blood sugar
November 06, 2023 known as a glucometer, CBG glucose level of the patient. 91 - 151 mg/dl
obtains a blood glucose reading result:
from a finger prick sample. 68 mg/dl-low

13
XIII. Comprehensive Pathophysiology

14
XIV. Treatment/Management

A. Drugs

Drugs Dose Route Frequency

Penicillin G Sodium 140,000 units IV Q8 Hours

Amikacin 42 mg IV OD

Mupirocin Ointment 20mg/g Topical BIDx7days

Erythromycin Eye Ointment 30g Ophthalmic TID

INDICATION /
DRUG NAME MECHANISM OF ACTION ADVERSE EFFECT NURSING RESPONSIBILITIES
CONTRAINDICATION
Generic: Inhibits cell-wall synthesis, INDICATION: CV: phlebitis from IV site BEFORE:
Penicillin G Sodium during bacterial Serious infection Hematologic: anemia Dx:
Brand: multiplication. CONTRAINDICATION: Other: hypersensitivity ● Check the history to
Benzylpenicillin sodium ● Contraindicated in reactions determine previous use of

Therapeutic Class: patients hypersensitive and reactions to penicillins.

Antibiotics to the drug or other Tx:

penicillins and in those ● Administer only the
Pharmacologic Class:
on sodium-restricted prescribed dose for the
Natural penicillins
diets patient.

15
Dosage: 140,000 units every ● Use cautiously in
8 hours patients with renal EDx:
Route: impairment ● Educate significant others
IV ● Use cautiously in about the benefits and risks
patients with other of medication.
drug allergies,
especially to
DURING:
cephalosporins.
Dx:
● The drug may cause
renal tubular damage, ● Observe 12 rights of

interstitial nephritis, HF, administration.

and electrolyte Tx:

imbalance when given ● For patients that are
high doses. unconscious or infants,
inform the significant others
about the procedure and
medication you're going to
do or give before
administering.
EDx:
● Encourage significant
others to verbalize feelings
and concerns.

16
 AFTER:
Dx:
● Monitor and note for any
adverse effects.
Tx:
● Ensure safety by raising the
side rail.
EDx:
● Document medication
administration correctly
and accordingly.

Generic: Inhibits protein synthesis by INDICATION: Respiratory: apnea BEFORE:

Amikacin binding directly to the 30s Serious infection Dx:
Brand: ribosomal subunit; CONTRAINDICATION: ● Check the physician's
bactericidal order.
Amikin ● Contraindicated with
Therapeutic Class: patients hypersensitive Tx:

Antibiotics to drug and other ● Prepare medication as

aminoglycosides ordered.
Pharmacologic Class:
● Use cautiously in EDx:
Aminoglycosides
patients with sulfite
Dosage: 42 mg once a day ● Educate significant others
sensitivity
about the benefits and risks
Route: ● Use cautiously in
of medication.
IV patients with impaired
renal function,
DURING:
hypocalcemia,

17
neuromuscular Dx:
disorders (myasthenia ● Observe 12 rights of
gravis, parkinsonism), administration.
or hearing impairment;
neonates and infants;
Tx:
and older adults.
● Administer medication as
ordered.
EDx:
● Educate significant others
about the given
medication.

AFTER:
Dx:
● Monitor and note for any
adverse effects observed.
Tx:
● Provide comfort and safety
measures.
EDx:
● Document medication
administration correctly
and accordingly.

18
Generic: Inhibits proliferative responses INDICATION: Respiratory: cough. AFTER:
Mupirocin Ointment of T and B lymphocytes, Impetigo in umbilicus Dx:
Brand: suppresses antibody ● Check the physician's
formation by B lymphocytes, order.
Mupicin
and may inhibit recruitment
Therapeutic Class:
of leukocytes into sites of
Antibacterials CONTRAINDICATION: Tx:
inflammation and graft
Pharmacologic Class: ● Contraindicated in ● Prepare the medication as
rejection
Antibiotics patients hypersensitive ordered.

Dosage: apply on the to the drug or its EDx:

umbilical area twice a day components ● Educate significant others

in 7 days. ● Use cautiously in about the adverse effects
patients with burns or of medication.
Route:
large open wounds
Topical
and in those with
During:
impaired renal function
Dx:
because serious renal
● Assess and note the
toxicity may occur.
infected area.
Tx:
● Administer medication
using proper aseptic
techniques
EDx:
● For Unconscious or Infant
patients, inform their
significant others about the

19
 importance of drugs and
their effect on the
patient-affected area.

After:
Dx:
● Monitor the healing of the
affected area.
Tx:
● Ensure safety by raising the
side rail.
EDx:
● Document the medication
administration correctly
and accordingly.

Generic: Inhibits RNA-dependent INDICATION: SKIN: dryness, irritation, BEFORE:

Erythromycin Eye Ointment protein synthesis by binding To prevent Ophthalmia peeling, and sensitivity Dx:
Brand: to bacteria 50s ribosomal Neonatorum reactions. ● Observe 12 rights of
subunits. OTHER: hypersensitivity administration.
Erygel
CONTRAINDICATION: reactions. Tx:
Therapeutic Class:
Antibiotics ● Contraindicated in ● Prepare drugs properly and

Pharmacologic Class: patients hypersensitive administer them through

to drugs. the Ophthalmic route.
Macrolides

20
Dosage: ● Safety and EDx:
Apply a ribbon of ointment effectiveness of topical ● For Unconscious or Infant
about 1 cm long in the lower drugs in children patients, inform the
conjunctival sac of each haven’t been significant others about the
eye. established. importance of drugs and
Route: and their effect on the

Ophthalmic patient's affected area.

DURING:
Dx:
● Assess the infected area.
Tx:
● Cleanse the infected area
with a cotton pad soaked
with normal saline solution
as needed.
● Apply a thin ribbon of
Ointment about 1 cm from
the inner canthus to the
outer canthus.
EDx:
● Instruct significant others to
verbalize feelings and
concerns.

AFTER:
Dx:

21
 ● Note for any adverse
effects observed.
Tx:
● Provide comfort and safety.
EDx:
● Store ophthalmic drugs at
room temperature in tightly
closed, light-resistant
containers.
● Topical drugs may be
flammable; keep away
from heat and flame.
● Document the medication
administration correctly
and accordingly.

B. IV Fluids
Name Classification Component/s Use & Effects Nursing Responsibilities
Generic: Hypertonic Each 100ml contains 5g of Maintenance of fluids and BEFORE:
D5IMB every 8 hours Intravenous solution. Dextrose Monohydrate, 189 electrolytes, especially for patients Dx:
mg of Sodium Acetate who need calories and hydration.
Brand: ● Monitor for fluid imbalances
Anhydrous, 141 mg of
D5IMB ● Check for allergies
Potassium Chloride, 21.4mg
Therapeutic Class: ● Assess vital signs
of Sodium Phosphate
For maintenance of Monobasic, 30.5mg of
fluid and electrolytes Tx:
Magnesium Chloride
● Compute for how many mL/hr

22
Pharmacologic Hexahydrate, 15mg of EDx:
Class: Monopotassium ● Ensure that IV was properly fixed
Phosphate, and 20mg

Dosage: (approx. 1.1mmol/L) of

DURING:
Sodium Metabisulfite.
150 mL every 8 hours Dx:
Route: ● IV dressing changes are done as
IV necessary based on assessment. Do not
reinforce wet or soiled tapes, instead,
change them and ensure that the tape
and IV board are clean.
Tx:
● Should not be given to newborn babies
whose body weight is low; or patients
who have damaged blood vessels,
weakened kidneys, and heart problems.
● Regulate drops per minute
EDx:
● Educate the significant other about the
purpose of the IVF administration or
replacement and its purpose.

AFTER:
Dx:
● Monitor for effectiveness as exhibited by
a decrease in symptoms
● Monitor for side effects
23
 ● Monitor for correct drops per minute

Tx:
● Observe IV dressing to ensure that it is
clean and intact
EDx:
● Palpate and inspect site for puffiness,
redness, blanching, skin temperature
(very warm or very cool), wetness.
● In very low birth weight infants, excessive
or rapid administration of dextrose
injection may result in increased serum
osmolality and possible intracerebral
hemorrhage

Generic: Carbohydrate, Treatment of hypoglycaemia. BEFORE:

Each mL of fluid contains 0.5
hypertonic solution
D5050 g dextrose, hydrous which Dx:
Brand: delivers 3.4 kcal/gram. The ● Monitor Blood glucose level as ordered
D5050 solution has an osmolarity of ● Check doctor’s order

Therapeutic Class: 2.53 mOsmol/mL (calc.), a ● Assess history of Allergies

pH of 4.2 (3.2 to 6.5) and ● Assess Vital Signs
Emergency care to
may contain sodium
treat hypoglycemia
hydroxide and/or
Pharmacologic Tx:
hydrochloric acid for pH
Class: ● Prepare D5050
adjustment.

Dosage: EDx:

24
10 mL every 8 hours ● Inform the significant other the purpose
Route: of administering the medication and the

IV importance of intact IVF

DURING:
Dx:
● IV dressing changes are done as
necessary based on assessment. Do not
reinforce wet or soiled tapes, instead,
change them and ensure that the tape
and IV board are clean.
Tx:
● Perform aseptic technique
● Secure patient by raising said railings
● Regulate drops per minute

EDx:
● Educate the significant other about the
purpose of the IVF administration or
replacement and its purpose.

AFTER:
Dx:
● Monitor blood glucose level to evaluate
effectiveness of the drug

25
 ● Monitor Vital Signs

Tx:
● Keep newborn in a comfortable and
safe position
● Ensure intact and patency of the IV
Dressing
● Evaluate for any adverse effects such as
hyperglycemia

EDx:
● Encourage the significant other for any
health concerns and feelings.
● Inform significant other to report any
adverse effects
● Provide significant other about drug
effects and warning signs to report to
enhance patient knowledge and to
promote compliance.

26
XV. Nursing Care Plans

A. Prioritization of Problems

a.1. List of Problems

1. Elevated body temperature related to Neonatal sepsis.
2. Ineffective Breastfeeding related to poor sucking reflex.
3. Imbalanced Nutrition: less than body requirements related to Insufficient Nutrient
Intake.
4. Hyperbilirubinemia related to the inability to excrete excess bilirubin.
5. Impaired skin integrity related to Jaundice as evidenced by yellowing of the skin
from the face to the lower extremity.

a.2. Basis for Prioritization

NURSING DIAGNOSES JUSTIFICATION

One reason why elevated body temperature is

present is due to an infection that could be from a
disease. This is prioritized as first among all since
1. Elevated body
disease is on the physiological needs on Maslow’s
temperature related to
hierarchy of needs. Maintaining the temperature of
Neonatal sepsis.
the patient is essential so that the body can
function properly. Since there is a presence of
infection, the patient's temperature reached 38°C
which is an indication of hyperthermia .

Ineffective breastfeeding was caused by the poor

sucking reflex of the neonate due to the infection
present in her body. This is prioritized as second
2. Ineffective Breastfeeding
among all since in Maslow’s hierarchy of needs,
related to poor sucking
food/nutrition is essential to the body. Ineffective
reflex
breastfeeding of the neonate will lead to possible
deprivation of essential nutrients that the neonate’s
body needs for her immune system.

Imbalanced Nutrition is the result of ineffective

3. Imbalanced Nutrition: less breastfeeding. This is prioritized as third on
than body requirements justification since this also falls under food/nutrition
related to Insufficient but as a result of ineffective breastfeeding.
Nutrient Intake Inadequate intake of breastfeed leads to poor
weight gain and weakened immune system. With
poor nutrition, the patient's immune system does not
function properly which contributes also to infection.

27
 Hyperbilirubinemia is a condition where the body is
exposed to high levels of bilirubin resulting in
yellowish change in skin color. This condition was
placed fourth in the prioritization in Maslow's
hierarchy of needs. Additionally, in terms of the
patient’s case, skin-related conditions are medical
problems that will be resolved through long-term
4. Hyperbilirubinemia
treatment and will not be too detrimental to the
related to Inability to
patient compared to the first three conditions. In this
excrete excess bilirubin
condition, the healthcare provider’s focus is to lower
the level of bilirubin in the patient’s body and to
encourage and instruct the mother about proper
breastfeeding the patient since lethargy and poor
feeding are the common signs and symptoms of
hyperbilirubinemia.

Impaired skin integrity is the result of

hyperbilirubinemia or jaundice itself. This is placed as
the last priority since resolving jaundice takes time
5. Impaired skin integrity and continuous treatment such as phototherapy.
related to Jaundice The same goes for hyperbilirubinemia, impaired skin
integrity signs and symptoms are not that
detrimental to the patient since her jaundice is
diminishing already.

28
 B. Nursing Care Plans

NCP 1: Elevated Body Temperature

Explanation of the
Assessment Objective Nursing Intervention Rationale Evaluation
Problem

OBJECTIVE: Neonatal sepsis is the STO: Dx: STO:

● T: 38 °C result of an overreaction After 1 - 2 hours of nursing ● Assessed underlying ● To obtain comparative (GOAL MET)
● Warm to by the body to an interventions condition/disease that baseline data and to After 1-2 hours of
touch infection. Fever and a) The mother will be might be a contributing assess the contributing nursing interventions
● Flushed skin inflammation are able to verbalize factor. factors that cause fever. a) The mother will
common symptoms in a and show be able to
newborn with sepsis understanding ● Monitored temperature ● To immediately detect verbalize and
NURSING DIAGNOSIS: caused by infection. regarding the regularly every 2 hrs. subtle higher temperatures show
Elevated Body Following the infection, underlying cause understanding
Temperature related the patient's body of elevated body Tx: regarding the
to Neonatal Sepsis. temperature rises as a temperature. ● Promoted surface ● To lower body underlying
result of the infection. b) The patient’s cooling by means of a temperature cause of
The patient gets a fever temperature will tepid sponge bath. hyperthermia.
because the body is decrease from b) The patient’s
trying to kill the virus or 38°C to the ● Administered medication ● To help in lowering the temperature
bacteria that caused normal range of as ordered. temperature decreased from
the infection. Most of 36.5 - 37.5 °C 38 °C to 37.4 °C.
those bacteria and Edx:
viruses do well when the LTO: ● Instructed significant ● Fever may be treated at LTO:
body is at the normal After 8 hours of nursing other inappropriate care home to relieve discomfort (GOAL MET)
temperature. interventions the patient measures for the infant. and lethargy associated After 8 hours of nursing
will maintain a core with fever interventions the
temperature within the ● Encouraged mother to patient was able to
normal range of 36.5 - breastfeed baby as ● To prevent dehydration. maintain a core
37.5 °C. much as possible. temperature of 36.7 °C.

29
NCP 2: Ineffective Breastfeeding
Explanation of the
Assessment Objective Nursing Intervention Rationale Evaluation
Problem

OBJECTIVE: Ineffective breastfeeding STO: Dx: STO:

● Poor sucking is defined as a process of After 1-2 hours of nursing ● Assessed for sucking ● To assess for strong, (GOAL MET)
reflex nursing a baby through interventions: patterns. rhythmic sucking and After hours of nursing
● Body weight breastfeeding that does swallowing or if there are interventions:
of 2.3 kg not meet the nutritional a.) The mother will be any difficulties and
● Less than 10 needs of the baby able to verbalize ineffective sucking a.)The mother
diapers adequately. The and show patterns. verbalized and
consumed per patient’s ineffective understanding showed
day breastfeeding is due to regarding the ● Assessed for skin turgor. ● To assess hydration status. understanding
her poor sucking reflex factors that regarding the
due to muscle weakness caused the Tx: factors that
NURSING DIAGNOSIS: as a result of the ineffective ● Monitored for pre and ● To help determine if there caused the
Ineffective presence of infection breastfeeding post-feeding weight. is an adequate amount of ineffective
breastfeeding from her neonatal sepsis. and its possible breastmilk received. breastfeeding
related to poor effects on the ● Monitored diaper output. ● To ensure that there is a and its possible
sucking reflex infant if not sufficient number of wet effects on the
addressed. diapers and bowel infant if not
b.)The mother will movements which addressed.
demonstrate an indicate an adequate b.)The mother
understanding of nutrition intake. demonstrate
breastfeeding an
techniques and ● Assisted the mother in ● To facilitate successful understanding
positioning. proper breastfeeding breastfeeding. of
LTO: positions. breastfeeding
After 1-2 days of nursing Edx: techniques
interventions: ● Encouraged the mother ● To help ensure that there is and
to offer frequent an adequate amount of positioning.
a.)The patient will breastfeeding sessions breastmilk received.

30
 demonstrate ideally for 8 - 12 times
improved sucking within a day. LTO:
reflex (GOAL MET)
● Educated and ● To ensure that there is an After days of nursing
demonstrated the effective milk transfer from interventions:
proper breastfeeding the mother.
positions to the mother. a.)The patient
● To help the mother demonstrated
● Educated mother on respond to breastfeeding improved
breastfeeding cues. cues and to promptly sucking reflex
facilitate successful
breastfeeding.

NCP 3: Imbalanced Nutrition: Less than body requirements

Explanation of the
Assessment Objective Nursing Intervention Rationale Evaluation
Problem

OBJECTIVE: An imbalance in the STO: Dx: STO:

● Body weight nutritional needs of a Following efficient nursing ● Assessed the factors of ● For further identification of (GOAL MET)
of 2.3kg person occurs when the interventions, after 1 to 2 having imbalanced causative and After 1 to 2 hours:
● height of 43 individual's metabolic hours: nutrition of the newborn contributing points ● The mother
cm and nutritional demands ● The mother will regarding lack of nutrients verbalized
● poor sucking are not sufficiently verbalize and intake. understanding
reflex supplied. With the understanding of of causative
● poor skin patient having poor causative factors factors when
turgor (2-3 sucking reflex, she when known and ● Determined client’s ● All factors that affect known and
seconds) cannot withstand long necessary ability to suck and ingestion and digestion of necessary
● Low blood feeds and tires easily. As interventions. swallow nutrients interventions.
sugar a result, the newborn ● Assessed the weight of ● Provides baseline data
Diagnostic could not get the LTO: the client
Result: appropriate nutrition After 1-2 days of nursing

31
 CBG-68 mg/dl intake. interventions, the client Tx: LTO:
should be able to: ● Demonstrated proper ● To promote successful (GOAL NOT MET)
NURSING DIAGNOSIS: ● Demonstrate attachment of the breastfeeding of the After 1-2 days of
Imbalanced Nutrition: progressive weight newborn to the mother’s mother to her newborn nursing interventions,
less than body gain to normal breasts for the client was not able
requirements related range of 2.5-4.5 kg. breastfeeding. to:
to insufficient nutrient ● Weighed the patient ● To monitor effectiveness of ● gain the
intake . and documented results the intervention plan desirable
● Regulated IV fluids of ● To increase sugar levels normal weight,
D50/50 and D5IMB and maintain fluid and the patient still
accordingly. electrolytes. weighs 2.3 kg.
Edx:
● Encouraged mother to ● Breast milk is the best source
continue breastfeeding of nutrition to offer to the
exclusively up to six newborn babies which is
months. important to meet all the
nutritional needs of human
babies for the first six months
of life.
● To motivate the mother to
● Informed mother about
keep on providing
breastfeeding’s benefits
adequate breastfeeding
for her newborn infant.
and to also give the mother
the information about the
importance of
breastfeeding.

32
NCP 4: Hyperbilirubinemia
Explanation of the
Assessment Objective Nursing Intervention Rationale Evaluation
Problem

SUBJECTIVE: Neonatal STO: Dx: STO:

“Naninilaw ngay hyperbilirubinemia is the Within 1 - 2 hours of ● Assessed skin, noting skin ● To detect evidence of (GOAL MET)
yung balat nya”, as accumulation of nursing interventions: color clinical jaundice and rising Within hours of nursing
verbalized by the unconjugated bilirubin in a) the mother will be bilirubin level intervention:
mother. the circulation (less than able to verbalize a) The mother
● Monitored vital signs
15 mL/dL) that occurs understanding of ● To evaluate transitional verbalized
OBJECTIVE: after 24 hours of life. The the cause, every 4 hours. events and ensure infants understanding
● Skin appears patient’s diagnostic treatment, and are making an effective of the cause,
yellowish from result for bilirubin is 22.37 possible outcomes transition without treatment, and
face to lower mL/dL, due to this, the of cardiorespiratory, possible
extremity. patient’s skin appears to hyperbilirubinemia. metabolic, outcomes of
● Yellowish have a yellowish color thermoregulatory, or other hyperbilirubine
discoloration from her face to her LTO: physiologic problems mia
Tx:
of the lower extremities. After 1 - 2 days of nursing
conjunctiva intervention: ● Phototherapy treatment ● To allow the utilization of LTO:
● Diagnostic a) The patient will is done twice a day for ultimate pathways or (GOAL PARTIALLY MET)
result: show resolution of an hour. bilirubin excretion After 1 -2 days of
➢ bilirubin jaundice as nursing intervention:
● Kept the eyes and
22.37 evidenced by ● To protect them from a) The patient
mg/dL improvement of genitals covered direct exposure to showed
skin color. high-intensity light resolution of
NURSING DIAGNOSIS: jaundice as
Hyperbilirubinemia ● Developed a systematic ● To prevent overexposure evidenced by
related to inability to schedule of turning the and prevent the improvement of
excrete excess development of skin color from
infant
bilirubin complications. yellowing from
the face to the
lower extremity

33
 Edx: to mild
● Instructed parents about ● To promote physical care yellowing of the
newborn care, including of the newborn and body.
jaundice appearance, decrease parents' anxiety
significance, and related to home care.
feeding methods.
● Encouraged the mother ● Heat exposure may lead
to continue to dehydration.
breastfeeding.

NCP 5: Impaired Skin Integrity

Explanation of the
Assessment Objective Nursing Intervention Rationale Evaluation
Problem

OBJECTIVE: Impaired skin integrity is STO: Dx: STO:

● Yellowish skin defined as the altered Following efficient nursing ● Monitored vital signs and ● To identify and create a (GOAL MET)
epidermis and/or dermis. interventions after 1 to 2 recorded baseline for the overall After 1 to 2 hours:
● Altered skin
This is altered due to hours: well-being of the patient ● The mother
turgor for 2 to varying causes such as ● The mother will ● Assessed the infant’s skin ● To determine whether the verbalized
3 seconds poor nutrition, certain verbalize characteristics and underlying condition is understanding
underlying health understanding of condition, noting skin improving or deteriorating of the causes
NURSING DIAGNOSIS: problems, surgical
the causes and color and skin turgor and possible
procedures, or immobility.
Impaired skin integrity possible effects of ● Assessed the mother’s ● To ascertain the mother's effects of
The patient’s impaired skin
related to Jaundice impaired skin knowledge about capacity to lessen the risks impaired skin
integrity is due to her
as evidenced by integrity. newborn skin health of compromised skin integrity.
underlying health
● The mother will integrity in infants and to ● The mother
yellowing of the skin condition — Jaundice,
which resulted in a
demonstrate assist in choosing the most demonstrated
from the face to the interventions that suitable mode of interventions
yellowish appearance
lower extremity promote newborn instruction. that promote
from her face to the lower

34
extremity and an altered skin health. Tx: newborn skin
skin turgor for 3 to 4 ● Assisted in the ● To help break down health.
seconds. Jaundice was LTO: phototherapy treatment bilirubin and reduce its
observed and noted due After 1 to 2 days of level in the blood LTO:
to a high amount of nursing interventions, the ● Provided guidance and ● To optimize feeding
(GOAL MET)
produced bilirubin client should be able to: support to breastfeeding practices that can help After 1 to 2 days, the
confirmed through a ● Show with bilirubin elimination
client was able to:
diagnostic result, and was
improvement in and improve the nutrition ● Show
accumulated in the tissue.
the resolution of of the infant improvement in
yellowish ● Regulated IV therapy as ● To increase fluid in the the resolution of
appearance prescribed body that will help in the yellowish
● Have intact and improvement of skin turgor appearance
adequate skin ● Have an intact
turgor Edx: and adequate
● Educated the parent ● To provide understanding skin turgor
regarding care for an and knowledge to the
infant with impaired skin significant other
integrity
● Instructed the ● To help in the
mother/significant other improvement of skin
to follow the schedule of characteristics and
phototherapy treatment condition such as the skin
and to educate them color and skin turgor.
with newborn skin health
● Instructed the ● To help in the nurse’s
mother/significant other assessment and to know
to report any untoward what interventions should
incidents, complications, be considered and done
and difficulties.

35
C. Discharged Plan
Health Teaching
1. Encourage continuous breastfeeding for at least
6 months.

2. Educate the importance of adequate

Diet/Nutrition breastfeeding and its purpose.

3. Inform and educate parents that after 6 months,

give complementary foods such as pureed fruits
or finely mashed vegetables.

1. Advise the mother to promote the newborn’s rest

as much as necessary.

2. Advise Parents to monitor and change diapers as

soon as the baby defecates and urinates.
Activity
3. Encourage the mother to practice basking the
infant with sunlight in the morning preferably from
6 to 7 A.M., exposing the infant for at least 10 to
15 minutes.

1. Advise the mother to follow any drug medication

Medication
as prescribed by the doctor, as needed.

1. Advise parents to maintain the cleanliness of

their house and their environment.

2. Advise parents to contact physician if infant

experiences any signs and symptoms of illness
Other 3. Advise parents to consider engaging in family
planning.

4. Inform the parents about the importance of

handwashing and proper clean food
preparation

36
XVI. Learning Insights

A. ABAD, Arianne Yules

Our two-day shift and the formulation of this case presentation made
me knowledgeable about what hyperbilirubinemia is. Honestly, the first time
we handled the patient and knew about her condition, I was really clueless
about what could be the cause of her sepsis and jaundice. However, through
the entire process of completing this study, I gained new knowledge and
understanding of things I usually see in theoretical books. Having such
knowledge made me and my groupmates more competent and, even for a
bit, more skilled in the interventions that should be done for someone who has
jaundice and is experiencing hyperbilirubinemia. This case also helped us to
be better in terms of educating and imparting understanding, not only to the
patients but to their significant others as well.

B. ABAD, Keena Rainzelle

This case study has taught me that a patient’s condition can be
affected by many factors that may not always be visible or obvious to us. Just
like the patient’s case, neonatal jaundice. The patient was born at their home
in Itogon Benguet where the mother had the delivery with the assistance of
her husband who was able to help her throughout the birthing process. The
patient was already their 9th child so you can assume that the parents are
experts with home delivery and yet there were complications with the infant
later on. Although they knew how the birthing process worked, they did not
have the proper equipment needed for a delivery. These are only some of
the factors that could have caused the patient’s jaundice. I find it interesting
to learn and investigate how a small detail could have caused the progress
of the patient’s condition now. It truly requires dedication and a thorough
assessment for an accurate diagnosis and appropriate treatment.

C. BAÑAGO, Rhea Jean

Within the 2-day shift, I have gained a lot of knowledge not only from
my Clinical Instructor but also from my group mates and especially my own
patient. Being able to carry out our tasks properly is my goal within this shift.
Using our critical thinking skills and our own knowledge and understanding is
very essential. By doing this case study, my own understanding about our
patient’s disease has increased. I also learned to understand and listen to our
patient’s feelings and concerns. It is very important to handle our patients
with accurate interventions so that they can recover quickly and effectively.

D. BANGTUAN, Neil Cyrus Gian

During my 2-day duty, I got to handle a lot of patients, some had the
same disease and some were severe. These patients taught us how to
appropriately do every nursing intervention with accuracy. I learned that

37
 providing full care is really important. We, nurses, must do our job to heart to
relieve and help our patients ease the pain they’re going through. As we
assess this patient from the time of our duty until we make this case study I
have learned how important proper intervention and good rapport could
hugely contribute to providing care to our patients. I also gave much
importance to reading because it could hugely affect our intervention
towards our patients. We must have enough knowledge with appropriate skills
to attain the best intervention for every patient we handle. I also learned how
to provide health teaching and information to caretakers or parents of my
patients so they to know what to do in case some emergency happens. I was
able to see the patient on our second day of duty and helped in the
assessment, so I learned that Neonatal Sepsis is caused by a transmission of
bacteria to the patient. In our case, bacterial transmission is caused by the
usage of unsanitized materials used in cord cutting and clamping, because
of this complications happen such as the patient being immunocompromised
and the patient having jaundice. This all happens because of the lack of
knowledge of the parents of the patient and the different services offered by
our community so as the hospital about pregnancy.

E. CAWITAN, Sarah Mae

Throughout the 2-day duty, I have realized the importance of accuracy. We
have to be accurate with all the information we can get from the patient, from
the assessment up to documentation. Manipulation should not be tolerated since
we are dealing with lives. Since we are still learning, it is desirable that we
emphasize and put the principle of accuracy into practice. Having such value
would help us become effective student nurses in providing care for our patients.

F. GALANG, Mark Glendyl

As a result of this case study, I have gained a greater understanding of the
importance of critical thinking and reasoning in the nursing profession. In the
process of our case study, I learned that critical thinking skills really come in handy
when analyzing the complex situation of our patient, interpreting the data of
diagnostic tests, and making connections between the signs, symptoms and
underlying health conditions as well as identify relevant cues, and connect the
dots to form a comprehensive understanding of our patient’s condition.

G. GALLARDO, Mayumi Elle Chloe

In the process of developing my understanding and proficiency in this case

study, I have gleaned valuable insights that emphasize the significance of
articulating a clearly defined objective, structuring the narrative in a storytellin
discernible beginning, middle, and end, meticulously identifying and
empathizing with the target audience to ensure relevance, providing
comprehensive contextual information to establish a nuanced
understanding.

H. NGALES, Senley

38
 During our duty in a pediatric ward helps me develop my deep
empathy and communication skills, which are crucial for connecting with
pediatric patients and their families. Throughout our duties in the area, it
expanded my medical knowledge and collaboration with my group and staff
nurse while witnessing the resilience of children. Despite the challenges, it
provided enriching moments and continual personal growth.

I. OCSILLOS, Edberg Jann

This case helped me acknowledge and enlightened me about the
consequences of performing the home birth or home delivery of the baby
that can or may put a newborn into complications, such as infection and
possible death due to inappropriate procedures, unsterile materials and tools,
and an unsanitized environment. With the collaboration and information that
we have gathered as a group, my groupmates and I understand the
interventions that we have provided to the patient who has this problem in
the hospital, realizing every single detail of information from our patient's
mother's interviews and the patient's diagnoses matters. But for me, though
there are many interventions that I can provide to my patient, the most
important intervention that I can provide is education. Educating the parents
inside or outside the hospital about home birth or delivery can help them
acknowledge its disadvantages and encourage the parents and families that
still perform the banned practice due to the "No home-birth policy"
implemented in the year 2008, to be more prepared and deliver their baby
into a hospital with medical workers that are professional and licensed. This
case trained us to be more knowledgeable or aware that home deliveries
were and still are being performed, and to work together as a team and as
aspiring nurses to uphold the principles of collaboration, empathy, and
responsibility.

J. ORIBELLO, Athena Jae

During our rotation, I personally learned a lot of things. There were two
things that I consider as the most important learnings. First is the importance of
being observant. I learned that being observant towards your patient will give
you an opportunity to learn in which area a patient needs the most help.
Identifying these things will also help in providing patient relief. Being
observant also can be a bridge to gaining more knowledge. The second
most important thing is knowing the external factors that contributed to the
patient’s condition. With the knowledge on these factors, we will be able to
provide health teachings they can use to modify or to decrease the risk of
exposure. As said, prevention will always be better than cure. This case
personally taught me on how to look and think outside of the box because
not all seen by the naked eye is the only reason why a patient is in the
hospital.

39
XVII. List of References
Books:

Murr, A., et.al (2013)Nurse’s Pocket Guide. (13th Edition). IGroup Press Co.,Ltd.

Williams, L., & Wilkins. (2022). Philippine Edition - Nursing 2023 Drug Handbook (43rd
Edition). Wolter Kluwer.

Online :
Wang, J., Li, P., Zhang, P., & Du, Q. (2021). Detailed nursing intervention on neonatal
septicemia can improve the clinical symptoms of children and reduce the
inflammatory reaction. American journal of translational research, 13(4),
3443–3450.

Tesini, B. L. (2023, November 12). Neonatal sepsis. MSD Manual Professional Edition.
https://www.msdmanuals.com/professional/pediatrics/infections-in-neonates/ne
onatal-sepsis

Singh, M. (2022, September 29). Neonatal sepsis. StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK531478/#:~:text=Neonatal%20sepsis%20r
efers%20to%20an,middle%20and%20lower%2Dincome%20countries

Mayo Clinic (2023). Complete blood count (CBC).

https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/pac
-20384919
Healthwise staff. (2023). Bilirubin Test.
https://www.cham.org/HealthwiseArticle.aspx?id=hw3474
MedlinePlus(2021). Electrolyte Panel. https://medlineplus.gov/lab-tests/electrolyte-panel/

Centers for Disease Control and Prevention CDC. (2023). Considerations for SARS-CoV-2
Antigen Testing for Healthcare Providers Testing Individuals in the Community.
https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guideli
nes.html

Iris Dawn Tabangcora, R. (2023, July 1). Glucose-elevating agents – Nursing

Pharmacology Study Guide. Nurseslabs.
https://nurseslabs.com/glucose-elevating-agents/

Wayne, G. (2023, October 13). Imbalanced Nutrition Nursing Care Plan and Management.
Nurseslabs. https://nurseslabs.com/imbalanced-nutrition-less-body-requirements/

40