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NUEVA ECIJA UNIVERSITY OF SCIENCE AND

Cabanatuan City, Nueva Ecija, Philippines
TECHNOLOGY
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CASE STUDY
PEDIATRIC SEPSIS
In partial fulfillment of the requirements in Related Learning Experiences

Submitted by:
Dela Cruz, Shainna Lee R.
Esguerra, Marie Denise M.
Eugenio, Thea Irise M.
Gabaldon, Alicia Jane R.
Gose, Marianne
Guevarra, Camille M.
Guillermo, Pauline S.
Gutierrez, Denise Gabrielle C.
BSN IV-A
NUEST S.N. 2022

Naomi Eunice B. Guitap, MSN., RN., EMT-B

Clinical Instructor

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TECHNOLOGY
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COLLEGE OF NURSING

GENARAL OBJECTIVES

This study aims to provide knowledge about what Pediatric Sepsis means, to also know

the causes of it, and how it should be acquired and prevented. As a nursing student, I should be

familiarized with the signs and symptoms of the said illness, and what are the corresponding

nursing interventions for Pediatric Sepsis.

SPECIFIC OBJECTIVES

At the end of 5 weeks of online virtual exposure to the clinical area, we will be able to:

a. Define and understand Pediatric Sepsis.

b. Understand and illustrate the pathophysiology with the risks-associated with Pediatric

Sepsis.

c. Gather information about suggested medical management to resolve the problems

d. Assess the client health status to identify health need including past and present illness;

e. Formulate nursing diagnoses and prioritize the problem what we need to address first;

f. Set our objectives of care including the short and long-term care for our client;

g. Provide a quality individualized nursing intervention including the independent,

dependent, and collaborative care that the patient needs;

h. Render health education based on the holistic approach to alleviate patient's suffering.

i. Formulate the necessary discharge plans that are needed by the patient.

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TECHNOLOGY
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SIGNIFICANCE OF THE CASE

This case study will serve as a basis in rendering care for patients with Pediatric Sepsis.

This will provide knowledge to the nursing students about disease process and the treatment

regimen about the disease for them to be able to render care effectively in their future profession,

nursing.

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NUEVA ECIJA UNIVERSITY OF SCIENCE AND
Cabanatuan City, Nueva Ecija, Philippines
TECHNOLOGY
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING

CHAPTER I

INTRODUCTION

I. Introduction

Pediatric sepsis is generally considered to comprise a spectrum of disorders that result

from infection by bacteria, viruses, fungi, or parasites or the toxic products of these

microorganisms. Early recognition and intervention clearly improve outcome for infants and

children with conditions that lead to sepsis.

The spectrum of sepsis ranges from microbial invasion of the bloodstream or intoxication

with early signs of circulatory compromise—including tachycardia, tachypnea, peripheral

vasodilation, and fever (or hypothermia)—to full-blown circulatory collapse with multiple organ

dysfunction syndrome (MODS) and death.

II. Family History

According to Patient XX’s mother, she has a history of pneumonia.

II. History of Past Illness

Patient XX has 3-day history of chicken pox. The mother brought her daughter to an

after-hours clinic with an area of redness around a lesion on her daughter’s abdomen. She has

fever of 38.7 degrees Celsius. She is crying constantly. At the after-hours clinic, she is given

antibiotics and is sent home.

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IV. Admitting History

Chief Compliant of rapid breathing, high fever with a temperature of 39.4 °C, limpness,

mottled skin, oxygen saturation of 94% and capillary refill of 5 seconds.

Upon the admission, the client’s vital signs are taken as follows:

HR: 168 BPM

BP: 70/35 mmHg

RR: 44 CPM

T: 39.4˚C

V. Status of Present Illness

Patient XX, a 7-month girl was diagnosed of pediatric sepsis. The present sign and

symptoms are fever with a temperature of 39.4 °C, rapid breathing with a 44cpm, mottled skin,

ill in appearance. Her mother stated that she has difficulty to rouse.

VI. Patient’s Profile

Name: Patient XX

Age: 7-month-old

Sex: Female

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Nationality: Filipino

Religion: Roman Catholic

VII. Physical Assessment (Head-to-Toe)

The table below shows the physical assessment of the client from head to toe.

Body Parts Normal findings Actual findings Result

Skull Rounded Normocephalic NORMAL

(normocephalic); smooth
skull contour

Smooth, uniform
Absence of nodules or NORMAL
consistency; absence of
any masses.
nodules or masses

Scalp Lighter in color than the Lighter than the skin NORMAL
complexion. Can be complexion of the
moist or oily. patient.

No tenderness No lesions. No NORMAL

tenderness or masses.

Hair Hair growth is Proportionately NORMAL

proportionately distributed but there are

distributed. Smooth areas with thin and dry

texture hair.

Face Symmetric or slightly Slightly asymmetric NORMAL

asymmetric facial facial features.
features; palpebral

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fissures equal in size;

symmetric nasolabial
folds

Natural color Flushed skin ABNORMAL

Eyes The sclera is white in Sclera for jaundice ABNORMAL

color and the palpebral

conjunctiva appears pink

Ears The color is skin toned, The color is skin toned NORMAL

symmetrical, Auricle and symmetrical. No

aligned with the outer tenderness.

canthus of eye, no

tenderness, no recoils

after it is folded, mobile,

firm

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Nose and Paranasal Symmetric and straight Symmetric and straight NORMAL

Sinuses No discharge No discharge NORMAL

No tenderness, no No tenderness, no NORMAL

lesions, no masses, no lesions, no masses and
displacement of bone nose are in the midline
cartilage

Air moves freely as the Airway was patent NORMAL

client breathes through
the nares

Nasal Septum intact and Nasal Septum intact NORMAL

in midline

Mouth Uniform pink color Oral mucosa was dry ABNORMAL

Soft, moist, smooth with cracked lips
texture

Symmetry of contour NORMAL

Symmetry
No discharge NORMAL
No discharge

Neck Trachea central Central placement in NORMAL

placement in middle of middle of neck
neck; spaces are equal on
both sides.

No visible mass or
The neck is straight. No NORMAL
lumps. Symmetrical. No
visible mass or lumps.
jugular venous
Symmetrical
distension (suggestive

of cardiac congestion).

Chest Normal, chest wall Chest symmetric ABNORMAL

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TECHNOLOGY
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should be intact with no

tenderness and
masses.

Lung sounds are clear

Rhonchi sound is present ABNORMAL
to auscultate.

Abdomen Abdomen was soft with Distended and rigid with ABNORMAL

no organomegaly or mass hypoactive bowel sounds

palpated.

Extremities No presence of bone No bone fracture, NORMAL

deformities, tenderness tenderness and swelling

and swelling

Skin Color are even. Yellowish – jaundice; ABNORMAL

When skin are intact
mottled skin

Genital Area There should be no No presence of abnormal NORMAL

presence of abnormal discharge.

discharge.

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TECHNOLOGY
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CHAPTER II

DISCUSSION OF CASE

I. Definition of Case

As with adults, when babies and children develop an infection, their immune

systems fight the invading culprit, whether it’s bacteria, a virus, or a fungus. But sometimes the

immune system’s response to an infection can spin out of control, leading to a life-threatening

condition called sepsis. Sepsis occurs when the body’s response to an already-present infection gets

out of hand, leading to severe inflammation throughout the body that, in turn, can cause tissue

damage and organ failure. When organs begin to stop functioning, the body can enter a stage of

sepsis called “septic shock,” and the threat of death is imminent.

Pediatric sepsis, like sepsis in adults, is generally considered to comprise a spectrum of

disorders that result from infection by bacteria, viruses, fungi, or parasites or the toxic products of

these microorganisms. The terms bacteremia, viremia, fungemia, and parasitemia refer to

bloodstream invasions (BSIs) that may be associated with fever but have no other signs or

symptoms of circulatory compromise or end-organ malperfusion or dysfunction.

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Sepsis is a problem that presents a management challenge to those who care for infants and

children; however, early recognition and intervention clearly improves the outcome for infants and

children with infections or intoxications that lead to sepsis.

Most infants and children with sepsis require monitoring and treatment in an intensive care

setting. Initial focus should be on stabilization and correction of metabolic, circulatory, and

respiratory derangements. Appropriate antimicrobial therapy should be started as soon as possible

after evaluation occurs. Ongoing reevaluation is essential.

Critical care expertise is essential for moderate-to-severe cases. Consultation with an

infectious diseases’ specialist may be necessary. Other consultations should be obtained in

accordance with the specific clinical circumstances.

A report on sepsis by the CDC that included a retrospective review of 246 adult and 79

pediatric patients (31 infants younger than 1 year and 48 children between 1 and 17 years of age)

with severe sepsis or septic shock found that nearly 80% of patients develop infections leading to

sepsis outside a hospital. The study also found that 7 in 10 sepsis patients had seen a healthcare

provider in the month preceding sepsis admission or had chronic diseases requiring frequent

medical care.

Etiology

Myriad bacteria, viruses, fungi, and parasites can cause sepsis. Among the bacterial causes

of sepsis, the following age-related patterns are observed.

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In patients with early-onset neonatal sepsis, Streptococcus agalactiae, Escherichia coli,

Haemophilus influenzae, and Listeria monocytogenes are the most frequent organisms

encountered.

In patients with late-onset neonatal sepsis, coagulase-negative Staphylococcus,

Staphylococcus aureus, E coli, Klebsiella species, Pseudomonas aeruginosa, Enterobacter species,

Candida species, S agalactiae, Serratia species, Acinetobacter species, and various anaerobes are

some of the most commonly involved organisms.

In most infants worldwide, the most frequent causes of bacterial sepsis are H influenzae

type b (Hib), Streptococcus pneumoniae, Neisseria meningitidis, and Salmonella species. In the

United States and the developed world, E coli, S aureus, S pneumoniae, and Nmeningitidis

predominate because conjugate Hib vaccination has essentially eliminated disease caused by Hib

and conjugate pneumococcal vaccination has significantly decreased the incidence of that infection.

In regions where malaria occurs, Plasmodium falciparum is a frequent cause of SIRS in infancy.

The same pathogens that cause sepsis in infancy also cause it in childhood, although the

presence of encapsulated organisms generally becomes less frequent as a child’s immune response

to polysaccharide antigens improves with age.

Prognosis

Almost half of neonatal deaths are caused by sepsis, although advances in diagnosis and

treatment have caused this rate to decrease substantially, especially in preterm infants. Again,

mortality tends to decrease as age increases in the pediatric population.

II. Anatomy and Physiology

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Our immune system is essential for our survival. Without an immune system, our bodies

would be open to attack from bacteria, viruses, parasites, and more. It is our immune system that

keeps us healthy as we drift through a sea of pathogens. This vast network of cells and tissues is

constantly on the lookout for invaders, and once an enemy is spotted, a complex attack is

mounted.

 White blood cells

White blood cells are also called leukocytes. They circulate in the body in blood vessels

and the lymphatic vessels that parallel the veins and arteries. White blood cells are on constant

patrol and looking for pathogens. When they find a target, they begin to multiply and send

signals out to other cell types to do the same.

Our white blood cells are stored in different places in the body, which are referred to as

lymphoid organs. These include the following:

 Thymus — a gland between the lungs and just below the neck.

 Spleen — an organ that filters the blood. It sits in the upper left of the abdomen.

 Bone marrow — found in the center of the

bones, it also produces red blood cells.

 Lymph nodes —small glands positioned

throughout the body, linked by lymphatic

vessels.

There are two main types of leukocytes:

1. Phagocytes

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o These cells surround and absorb pathogens and break them down, effectively

eating them. There are several types, including:

 Neutrophils — these are the most common type of phagocyte and tend to

attack bacteria.

 Monocytes — these are the largest type and have several roles.

 Macrophages — these patrol for pathogens and also remove dead and

dying cells.

 Mast cells — they have many jobs, including helping to heal wounds and

defend against pathogens.

2. Lymphocytes

o Lymphocytes help the body to remember previous invaders and recognize them if

they come back to attack again.

o Lymphocytes begin their life in bone marrow. Some stay in the marrow and

develop into B lymphocytes (B cells), others head to the thymus and become T

lymphocytes (T cells). These two cell types have different roles:

 B lymphocytes — they produce antibodies and help alert the T

lymphocytes.

 T lymphocytes — they destroy compromised cells in the body and help

alert other leukocytes.

 Circulatory System

Combined with the cardiovascular system, the circulatory system helps to fight off

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disease, helps the body maintain a normal body

temperature, and provides the right chemical balance

to provide the body’s homeostasis, or state of balance

among all its systems.

Blood moves through the circulatory system as a

result of being pumped out by the heart. Blood

leaving the heart through the arteries is saturated with

oxygen. The arteries break down into smaller and

smaller branches to bring oxygen and other nutrients

to the cells of the body's tissues and organs. As blood moves through the capillaries, the oxygen

and other nutrients move out into the cells, and waste matter from the cells moves into the

capillaries. As the blood leaves the capillaries, it moves through the veins, which become larger

and larger to carry the blood back to the heart.

 Blood

Blood consists of:

 Red blood cells – to carry oxygen

 White blood cells – that make up part of the immune system

 Platelets – needed for clotting

 Plasma – blood cells, nutrients and wastes float in this liquid.

 Heart

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The heart pumps blood around the body. It is actually a double pump made up of

four chambers, with the flow of blood going in one direction due to the presence of the

heart valves. The contractions of the chambers make the sound of heartbeats.

 Arteries

Oxygenated blood is pumped from the heart along arteries, which are muscular.

Arteries divide like tree branches until they are slender. The largest artery is the aorta,

which connects to the heart and picks up oxygenated blood from the left ventricle. The

only artery that picks up deoxygenated blood is the pulmonary artery, which runs

between the heart and lungs.

 Veins

Veins have one-way valves instead of muscles, to stop blood from running back

the wrong way. Generally, veins carry deoxygenated blood from the body to the heart,

where it can be sent to the lungs. The exception is the network of pulmonary veins, which

take oxygenated blood from the lungs to the heart.

 Capillaries

The arteries eventually divide down into the smallest blood vessel, the capillary.

Capillaries are so small that blood cells can only move through them one at a time.

Oxygen and food nutrients pass from these capillaries to the cells. Capillaries are also

connected to veins, so wastes from the cells can be transferred to the blood.

There are three different types of circulation that occur regularly in the body:

1. Pulmonary circulation: This part of the cycle carries oxygen-depleted blood away from

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the heart, to the lungs, and back to the heart.

2. Systemic circulation: This is the part that carries oxygenated blood away from the heart

and to other parts of the body.

3. Coronary circulation: This type of circulation provides the heart with oxygenated blood

so it can function properly.

III. Pathophysiology

NON-MODIFIABLE NON-MODIFIABLE
FACTORS: FACTORS:

AGE (7months old) INFECTION (3-day hx of

chicken pox)
HOSPITAL ADMISSION

INVASION OF INFECTIVE
MICROORGANISM

INNATE IMMUNE SYSTEM ACTIVATION

INTERACTION OF PAMPS AND PRRRS

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IV. Clinical Manifestations

The diagnosis of sepsis can be particularly difficult in children, in whom specific signs of

sepsis (e.g., tachycardia, tachypnea, and fever) need special interpretation due to the variable

range of normal depending on the patient age. On top of being difficult to recognize, sepsis is a

secondary medical condition that develops after an initial infection, and its symptoms can mimic

those of the original illness. Some signs of sepsis can include the following:

 Fever above 38 ◦C or a temperature below 36 ◦C

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 Heart rate higher than 90 BPM

 Respiratory rate of higher than 20 CPM

 Mottled skin due

 Decrease in capillary refill

 Decrease in urine output

 Low Blood Pressure

V. Medical Management

Immediate empirical administration of broad-spectrum anti-microbials, aggressive fluid

resuscitation, and vasoactive or inotropic support (or both) are the mainstays of the

therapeutic management of neonatal sepsis.

 Fluid replacement therapy

- The therapy is done to correct the tissue hypoperfusion, so aggressive fluid

resuscitation must be implemented.

 Nutritional therapy

- Aggressive nutritional supplementation is critical in the management of septic shock

because malnutrition further impairs the patient’s resistance to infection.

 Administer antibiotics and vasoactive medications

- The antibiotics commonly used to treat sepsis include ampicillin, gentamicin,

cefotaxime, vancomycin, erythromycin, and piperacillin. The choice of antibiotic

agents should be based on the specific organisms associated with sepsis, the

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sensitivities of the pathogen, and the prevailing nosocomial infection trends in the

nursery. Viral infections, such as herpes and fungal infections, can masquerade as

bacterial infections.

VI. Nursing Management

The role of the nurse is to be immediately involved in the assessment of patients at risk for

developing sepsis and in their treatment. The focus of nursing management in children diagnosed

with sepsis includes:

 Monitor Vital Signs

- Frequently re-assess blood pressure, heart rate, respiratory rate, temperature, urine

output, and oxygen saturation.

 Maintenance of Oxygen Delivery

- Airway, breathing, and circulation remain the fundamental principles of resuscitation

for patients with sepsis.

 Assess and immediately secure patent airways, if necessary

 High-flow oxygen via facemask or nasal cannula should be given, even in

the absence of respiratory distress or hypoxemia.

 Access for Administration of Fluids and Antibiotics

- Rapid attainment of vascular access is of critical importance, preferably through the

placement of 2 large bore peripheral venous catheters

- Initial isotonic fluid boluses of 20 mL/kg should be administered rapidly (possibly

over 5 to 10 minutes)

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- Blood samples should be taken for hematologic parameters, electrolytes, blood

glucose, serum urea nitrogen, complete blood cell count with differential, blood

cultures, and crossmatch as well as lactate levels

- Assist in administering empiric broad-spectrum antibiotics.

 Administration of inotropes and vasopressors as clinically indicated.

- Administer vasoactive medications if a patient remains hypotensive or if lactate

remains elevated following the initial fluid challenge.

 Vasoactive medications should be titrated to a mean arterial pressure

(MAP) of > 65 mmHg.

 Norepinephrine (Levophed) is typically the first vasopressor that is

initiated. This is typically started at 2-5 mcg/min and titrated to a MAP >

65 mmHg.

 The second vasoactive medication added is typically vasopressin at 0.03

U/min. Note: this medication does NOT get titrated and can be added in

attempt to decrease the dose of norepinephrine.

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CHAPTER III

LABORATORY AND DIAGNOSTIC PROCEDURES

I. Laboratory Result

Clinical Chemistry

Examination Normal Range Result Interpretation Significance

Lactate 1.0-3.3 3.5 mmol/L High Serum lactate is perhaps

the best serum marker for
mmol/L tissue perfusion. Serum
lactate measures the

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severity of the condition

and enables monitoring of
disease progression for
sepsis.

Creatinine 0.3 to 0.7 0.5 mg/dL Normal This is performed to

measure how well the
mg/dL kidneys can filter the waste
products from blood. Low
blood creatinine levels can
mean lower muscle mass.

Total bilirubin 0.3-1.2 mg/dL 1.3 mg/dL High Elevated bilirubin may
induce inflammation and
apoptosis.
Hyperbilirubinemia, or
jaundice, is a well-known
complication of sepsis or
non-bacterial infection.

Serum glucose 80 to 200 177 mg/dL Normal Hyperglycemia is a

frequent and important
mg/dL metabolic derangement
that accompanies severe
sepsis and septic shock.
Glucose control is
important in the
management of sepsis:
Hyperglycemia is
associated with higher
mortality.

Hematology

Complete Blood Count (CBC)

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Examination Normal Range Result Interpretation Significance

Hemoglobin 11-13 g/dL 10.8 Low Several mechanisms

contribute to acute
(Hgb) reduction in hemoglobin
levels in the setting of
sepsis, including reduced
production of red blood
cells induced by the
systemic inflammatory
response, as well as
increased destruction of
red cells due to hemolysis
and bleeding.

Hematocrit 34-42% 33% Low Hematocrit measures the

percentage of your total
(Hct) blood volume that consists
of red blood cells. Anemia
is a common feature
during sepsis that occurs
due to iatrogenic blood
loss, depression of serum
iron levels and
erythropoietin production,
and a decreased lifespan of
erythrocytes.

Red Blood Cells 4.4-5.8 million 4.0 Low RBC count is a count of
the actual number of red
(R.B.C) cells/mcL blood cells in your blood
sample. Reduced red blood
cell (RBC) production may
be due to systemic
inflammatory response and
increased RBC destruction
due to hemolysis and

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TECHNOLOGY
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bleeding

White Blood 5,000-20,000 21,000 High White blood cell count is a

count of the total number
Cells (W.B.C) uL of white blood cells in
your blood sample. Sepsis
usually produces an
elevated white blood cell
count, with an increased
number of neutrophils and
an increased percentage of
immature forms called
bands

Platelet Count 150-450 uL 99 Low The platelet count is the

number of platelets in your
blood sample.
Thrombocytopenia is a
common and multifactorial
phenomenon occurring
during sepsis.

Activated 23-35 seconds 36 High The PT and the aPTT are

elevated in disseminated
partial intravascular coagulation
(DIC), fibrinogen levels
thromboplastin
are decreased, and fibrin
time (aPTT) split products are
increased.

Prothrombin 11-13.5 13.9 High

time (PT) seconds

Blood Culture and Wound Sample

Examination Result Interpretation Significance

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Blood culture Purple Gram positive Blood cultures are ordered

when the doctor suspects the
(Gram stain) patient may have a blood
infection. It’s important to
test for blood infections
because they can lead to
serious complications.

Wound culture Purple Gram-positive A Gram stain is most often

used to find out if you have
(Gram stain) a bacterial infection. If
positive, the test will show
that the infection is Gram-
positive or Gram-negative.

Patient XX's blood work up to diagnose sepsis all indicate that the patient has sepsis.

With lactate, bilirubin, white blood cell count and activated partial thromboplastin time as well

as prothrombin time being above the normal range for the patient's age indicates sepsis. The low

platelet count for the patient's age also indicates sepsis. Following the work up, the lesion from

Patient XX's abdomen was also examined and obtained a wound culture that resulted in gram-

positive bacteria present from the wound. Same goes to the patient's blood culture that indicates

there are presence of gram-positive bacteria from the blood that indicates the cause of sepsis of

the patient.

II, Diagnostic Procedures

 X-ray is a procedure that produces images of the inside of the body. X-ray beams are a

form of electromagnetic radiation that are sent to through the body and the resulting

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images are recorded either on film or by a computer. The most commonly used imaging

study in the diagnosis of sepsis is a chest x-ray. Chest x-rays can provide useful

information regarding the possibility of infections (such as pneumonia or empyema) as

well as rule out pulmonary edema. X-rays can identify infections in your lungs to identify

site of infection or the cause of sepsis if not readily found.

 Ultrasound is a technology that uses sound waves to produce real-time images on a

video monitor. Ultrasound may be particularly useful to check for infections in the

gallbladder and kidneys.

 Computerized tomography (CT) is a technology that takes X-rays from a variety of

angles and combines them to depict cross-sectional slices of your body's internal

structures. Infections in your liver, pancreas or other abdominal organs are easier to see

on CT scans.

 Magnetic resonance imaging (MRI) is a technology that uses radio waves and a strong

magnet to produce cross-sectional or 3D images of the internal structures of your body.

MRIs may be helpful in identifying soft tissue or bone infections.

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TECHNOLOGY
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CHAPTER IV
NURSING CARE PLAN
ASSESSMENT DIAGNOSIS OUTCOME PLANNING IMPLEMENTATION EVALUATION
IDENTIFICATION

Subjective: Hyperthermia Within 12 hrs. of Short-term: Independent Short-term:

related to rendering
“Nilalagnat ang anak Inflammatory appropriate After 30 minutes of 1. Assess pt.’s condition and After 30 minutes of
ko” as verbalized by Nursing Intervention monitor vital signs. (To nursing intervention
Process as nursing determine the need for
the mother. evidenced by an interventions, the the patient will the patient will
intervention and the effectiveness
increased in body client will be able maintain normal maintain normal body
Objective: of therapy.)
temperature, and to maintain normal body temperature temperature
 Increased warm skin. core temperature
body 2. Monitor vital signs. (To have a
as evidenced by baseline data.)
temperature normal vital signs Long Term: Long Term:
 Weakness
and normal After 3 days of
 Skin warm to
laboratory results. 3. Provide TSB (Helps in After 3 days of nursing
touch Nursing Intervention, lowering down the temperature.) iintervention, patient
 Tachypnea patient will maintain will maintain vital signs
 Tachycardia vital signs and normal and normal laboratory
4. Ensure that all equipment used
laboratory results. for infant is sterile, scrupulously results.
T: 39.4 C clean. Do not share equipment
with other infants. (Prevents the
HR: 168 bpm spread of pathogens to the infant
from equipment.)
RR: 44 cpm

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TECHNOLOGY
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BP: 70/35 mmHg Dependent:

O2sat: 94% 1. Administer antipyretics as

ordered. (Aids in lowering down
Capillary refill: 5 the temperature.)
secs.

CHAPTER V
DRUG STUDY

DRUG MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING

ACTION RESPONSIBILITY

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TECHNOLOGY
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Generic Third-generation Most infections Hypersensitivity to CNS: Headache and Before:

Name: cephalosporin that caused by cephalosporins or dizziness.
inhibit wall-synthesis. susceptible history of severe • Observe 12 rights of drug
Ceftriaxone
organisms such hypersensitivity to other GI: Diarrhea, nausea administration
as lower type of β-lactam and vomiting.
Brand • Test for hypersensitivity
Name: respiratory track antibiotic (e.g. SKIN: Rash and to the drug and it’s
Rocephin infections, penicillins,
flushing. components.
bacteremia and monobactams,
Drug Classification: septicemia. carbapenems). Hepatic Blood and • Obtain specimen for
or renal Lymphatic: culture and sensitivity
Antibiotic
impairment. (These Eosinophilia, test.
drugs are toxic to the leucopenia,
Dosage: kidneys and could • Prepare the drugs
thrombocytopenia.
2g q12h interfere with the accordingly.
metabolism and
Route: During:
excretion of the drugs.)
IV Pregnancy Category: B • Ensure drug is
administered as
prescribed.
After:
• Instruct client to report
adverse reactions
promptly.
• Instruct client to avoid
drinking Alcohol for 72
hours after
discontinuation of the

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TECHNOLOGY
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COLLEGE OF NURSING

drug to prevent
disulfiram-like reaction
(e.g. flushing, throbbing
headache, nausea and
vomiting)

DRUG MECHANISM OF INDICATION CONTRAINDICATIONS ADVERSE NURSING

ACTION REACTIONS RESPONSIBILITIES
Generic Decreases To treat Hypersensitivity to CNS: Euphoria, Before:
Name: inflammation inflammatory Hydrocortisone or its headache, vertigo,
mainly by conditions, components, • Observe 12 rights of drug
Hydrocortisone seizures
stabilizing adrenal systemic fungal infection administration
leukocytes insufficiency and those receiving CV: Edema, heart
Brand • Test for hypersensitivity to
lysosomal and shock. immunosuppressive failure,
Name: other corticosteroids.
membrane. doses together with live hypertension.
Hydrocort, Alphosyl,
Aquacort, Cortef, virus vaccine. • Encourage patient to take
EENT: Cataracts
Cortenema, SoluCortef drugs with food or milk to
and glaucoma

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TECHNOLOGY
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GI: Nausea and decrease GI irritation.

vomiting, GI
• Instruct client to take once-
Drug Classification: irritation.
daily dose in the morning.
Corticosteroids
GU: Menstrual
During:
irregularities
Dosage:
1-5 mg/kg/day q12h • Ensure drug is
MS: Muscle
administered as prescribed.
weakness
Route: • Instruct client not to stop
IV/IM SKIN: Acne,
delayed wound drug abruptly.
healing. After:
• Watch for any possible
adverse effects.
• Discontinue drug gradually
under the guidance of the
physician.

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TECHNOLOGY
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COLLEGE OF NURSING

CHAPTER VI

EVALUATION, FINDINGS, & RECOMMENDATIONS

I. Evaluation

With this study, the nursing students understood and improved their knowledge not only

in the disease process and clinical manifestation of Pediatric Sepsis, but also acquire knowledge

and skills for effective intervention regarding in general health, possible complications and

treatment for the patient. Through thorough research and interview, the student nurses acquire

concrete and necessary information about the Pediatric Sepsis.

II. Findings

At the end of this case study, the researchers were able to find out that the patient is

diagnosed with Pediatric Sepsis by conducting blood test, X-ray, CT scan, or Ultrasound, and

assessing the sign and symptoms of the patient. The researchers understand different medications

that can be administered to the patient according to the severity of the disease. Researchers were

able to provide medical management and nursing care for the symptoms that the patient

experienced. More than that, researchers also formulate nursing care plans based on the

diagnosis of the patient as well as drug indicated for the treatment of Pediatric Sepsis.

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TECHNOLOGY
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III. Recommendations

This case study of Pediatric Sepsis has contributed not only to the improvement of

knowledge and clinical manifestations but also on how to give necessary interventions indicated

to the patient. The recommendations are as follows:

Medication

 Ceftriaxone is administered to fight infection considering that the patient is in septic

shock and have a productive cough with green sputum. This type of medication is used to

treat susceptible organisms such as lower respiratory tract infections, bacteremia and

septicemia.

 Hydrocortisone is used in children experiencing catecholamine dependent septic shock

with suspected or proven absolute adrenal insufficiency or if the patient is unresponsive

to IV fluids and vasopressor therapy.

 A respirator for breathing may also be necessary. Surgery may be performed to remove a

source of infection, such as removing infected tissue.

Environment

 Teach the family of the client the value of maintaining a clean environment, appropriate

food handling, and sterilizing feeding bottles.

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TECHNOLOGY
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Treatment

 If sepsis is left untreated, life-threatening complications occurs. To prevent further

complications, take medications as prescribe by the doctor, conduct removal of

infected/necrotic tissue if it is the source of septic shock.

Health Teaching

 Advise the family of the patient on the advantages and disadvantages of each treatment

option.

Out Patient Department

 Emphasize the importance of keeping follow-up appointments and consult health care

professionals whenever he has a concern about the condition.

Diet

 A diet that includes foods rich in glutamine like chicken that helps the body fight

infections and helps in patient’s fast recovery.

 Food rich in Thiamine shows that during and after sepsis can play a significant role in

recovery. Having thiamine through food can increase the absorption of nutrients and

recovery. Oranges, tomatoes, and milk products are the sources of thiamine.

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TECHNOLOGY
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Spiritual

 It is very important for student nurses to know the role which religion plays in the lives of

diabetic patients and should take into account religious factors in the development of

health care programs. These may suggest the application of prayer or the use of biblical

verses and texts that may support and empower patients in making correct decisions.

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TECHNOLOGY
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COLLEGE OF NURSING

References:

Sepsis - Diagnosis and treatment - Mayo Clinic. (2021). Mayoclinic.org;

https://www.mayoclinic.org/diseases-conditions/sepsis/diagnosis-treatment/drc-20351219

‌Laboratory signs of sepsis [Infographic]. (2020). Nursingcenter.com.

https://www.nursingcenter.com/ncblog/march-2017/laboratory-signs-of-sepsis

‌Marks, L. (2015, October 23). X-ray - Procedure & Risks | Everyday Health.

EverydayHealth.com. https://www.everydayhealth.com/x-ray/guide/

‌Sepsis - Diagnosis - Investigations - Treatment - TeachMeSurgery. (2019, March 25).

TeachMeSurgery. https://teachmesurgery.com/perioperative/general-complications/sepsis/

‌What causes low oxygen extraction in sepsis/septic shock? (2020, October 7). Medscape.com.

https://www.medscape.com/answers/168402-27318/what-causes-low-oxygen-extraction-

in-sepsisseptic-shock

‌Zhai, R., Sheu, C. C., Su, L., Gong, M. N., Tejera, P., Chen, F., Wang, Z., Convery, M. P.,

Thompson, B. T., & Christiani, D. C. (2009). Serum bilirubin levels on ICU admission are

associated with ARDS development and mortality in sepsis. Thorax, 64(9), 784–790.

https://doi.org/10.1136/thx.2009.113464

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