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Nursing Diagnoses of Newborns with Sepsis in a Neonatal Intensive Care Unit

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Nursing Diagnoses of Newborns with Sepsis in a Neonatal Intensive Care Unit Rev. Latino-Am. Enfermagem Original Article 2014 Mar.-Apr.;22(2):255-61 DOI: 10.1590/0104-1169.3101.2410 www.eerp.usp.br/rlae Nursing diagnoses of newborns with sepsis in a Neonatal Intensive Care Unit Ana Paula de Souza Santos1 Maria de Lourdes Costa da Silva2 Nilba Lima de Souza3 Gabriela Miranda Mota4 Débora Feitosa de França5 Objectives: to elaborate the Nursing Diagnoses of newborns with sepsis in a neonatal intensive care unit and characterize the profile of the neonates and their mothers. Method: a cross- sectional and quantitative study, with a sample of 41 neonates. A physical examination and consultation of the hospital records were undertaken, using an instrument. The elaboration of the Nursing Diagnoses followed a process of diagnostic inference and was based on the North American Nursing Diagnosis Association 2012-2014. Results: the mothers were around 25 years old, had a low average number of pre-natal consultations, and various complications during the pregnancy; and the newborns were predominantly premature and with very low birth weights. Five Nursing Diagnoses predominated, and all the neonates presented Risk of Shock and Risk of fluid volume imbalance. Conclusion: the Nursing Diagnoses of the neonates with sepsis can guide the formulating of specific assistential plans. The study contributes to the generation of new knowledge and found various relationships between the Nursing Diagnoses and the variables selected in the characterization of the neonates, which deserve to be elucidated in greater detail based on further research on the issue. Descriptors: Nursing Diagnosis; Infant, Newborn; Sepsis; Neonatal Nursing. 1 RN, Specialist in Neonatal Intensive Care, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil. 2 Doctoral student, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil. Assistant Professor, Departamento de Enfermagem, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil. 3 PhD, Professor, Departamento de Enfermagem, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil. 4 RN, Specialist in Neonatal Intensive Care, Hospital da Polícia Militar Coronel Pedro Germano, Natal, RN, Brazil. 5 RN, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil. Corresponding Author: Copyright © 2014 Revista Latino-Americana de Enfermagem This is an Open Access article distributed under the terms of the Creative Ana Paula de Souza Santos Commons Attribution Non-Commercial License (CC BY-NC). Rua Dom Bosco, 758 This license lets others distribute, remix, tweak, and build upon your work Bairro: Emaús non-commercially, and although their new works must also acknowledge CEP: 59148-450, Parnamirim, RN, Brasil you and be non-commercial, they don’t have to license their derivative E-mail: [email protected] works on the same terms. 256 Rev. Latino-Am. Enfermagem 2014 Mar.-Apr.;22(2):255-61. Introduction of the research for nursing because it integrates the range of studies linked to the NDs, given that the Neonatal sepsis, or Primary Infection of the operationalization of diagnostic systems contributes to Bloodstream (BSI) is a clinical syndrome characterized the construction of accurate clinical reasoning, facilitates by a systemic inflammatory response, with or without communication between the health professionals, and evidence of a suspected or confirmed infection. It is one allows the development of the profession(10-11). of the more frequent infectious pictures in the neonatal Based on this context, the study aimed to elaborate period, and is the one which most raises morbidity and the NDs of newborns with sepsis in a NICU, according mortality(1-2). to the North American Nursing Diagnosis Association BSI can develop as early-onset, when diagnosed (NANDA-I) 2012-2014(12) and to characterize the profile in the first 48 hours of the newborn’s (NB) life and in of the mothers and the affected neonates. the presence of a perinatal risk factor for infection. In the late-onset form, the diagnosis is made after the Method first 48 hours, and the incidence is related to the care environment, notably in the Neonatal Intensive Care A cross-sectional and quantitative study was Unit (NICU)(3). undertaken in the Neonatal ICU of the Januário Cicco The Nurse with the NB with this illness is, often, Maternity School, a state center of excellence in high- the professional who observes the first signs and risk maternal-infant care. symptoms of the infection, which makes her important The inclusion criteria for the sample were: neonates for early diagnosis and intervention, by advocating in interned in the NICU with a diagnosis of sepsis during the the name of the child and ensuring timely diagnostic data collection period, May – August 2012. The NBs who complementation and empirical antibiotic therapy(4-5). met these criteria were recruited through consecutive In this aspect of the care, the Systematization of convenience, by listing consecutively all the population Nursing Care (SNC) presupposes the organization of the accessible. The exclusion criteria were: neonates with work regarding the method, personnel and instruments, congenital heart defect, and those for whom the diagnosis and makes possible the operationalization of the Nursing of the illness was ruled out. The sample calculation Process, a methodological tool made up of five inter- resulted in 41 neonates, with a confidence interval of related stages: Nursing History, Nursing Diagnosis (ND), 95% (CI 95%) and a margin of error of 5%. Planning, Implementation and Evaluation(6-7). Through For data collection, a complete physical examination the ND, the nurse uses clinical reasoning and judgment of the NB was used, in line with the recommended (2,13) and concludes the surveying of data referent to the techniques and neonatal specific characteristics , and patient’s state of health, allowing the standardization consultation of the hospital records. and individualization of the care(8). The data collected was guided by an instrument After intensive searching of the literature available, developed based on another model applied in (14) only 11 works were detected whose focus was on the neonatology and already validated in the literature . NDs in Neonatology. The Nursing studies regarding The form is composed of two main parts: the first sepsis are limited to few publications(4-5,9). Only two contains maternal characteristics (identification, socio- works address the NDs of NBs with specific illnesses, demographic data and obstetric data) and neonatal there being no studies regarding the NDs of neonates characteristics (identification, occurrences of the birth, with sepsis. birth data and anthropometric data); the second has The undertaking of the study on the above- information related to the NB’s nursing history, which mentioned issue is based on the point of view that the includes the psycho-biological needs (oxygenation, NDs consist of knowledge which is relevant for the guiding hydration, nutrition, elimination, sleep and rest, motility, of the decision-making of the nurses who care for these shelter, skin and mucous membrane integrity, physical patients. The research is also justified because it aims to integrity, thermal, neurological, hydro-electrolytic and meet the compulsoriness of SNC in line with legislation(7) immunological regulation, perception, environment) and and, thus, can contribute to the implementation of the psycho-social needs (safety, love, communication). SNC in NICU, to the improvement of the care, and Subsequently, the instrument was submitted for to the reduction of mortality from neonatal sepsis in content validation by four nurses who are specialists in the long term. Emphasis is given to the importance neonatal care, in hospital infections, and/or in nursing www.eerp.usp.br/rlae Santos APS, Silva MLC, Souza NL, Mota GM, França DF. 257 diagnoses. Their recommendations were accepted and Grande do Norte (RN) (58.5%). The majority were in reflected in the instrument’s improvement. The pre- a stable relationship (87.8%). The mean age was 24.9 test was undertaken with septic newborns from another (SD±6.7 years), while 70.7% were aged between 19 institution similar to the place of the study and did not and 35 years old. result in alterations to the form. There was a mean of 4.4 pre-natal consultations So as to characterize the mothers, the following (SD±2.3) and only 19.5% had attended more than variables were chosen: where they were from, six. The recurrent gestational complications were marital status, age, number of pre-natal consultations Urinary Tract Infection (UTI) (31.7%), Pregnancy- attended, and complications during the pregnancy. And Specific Hypertensive Disorders (PSHD) (29.2%) to characterize the neonates: place of birth, sex, type of and amniotic membrane rupture (24.4%), which birth, gestational age (GA), weight at birth, Apgar scores, had a mean equivalent to 37.4 hours ± 29 hours. need for resuscitation at birth, the next event (discharge A history of drug use was ascertained in 17.1%, from NICU, transference to another hospital, or death) namely crack cocaine. Genital infections occurred in and the types of clinical manifestations of the neonatal 12.2%, such as chorioamnionitis, candidiasis, and sepsis. These variables were defined as independent and bacterial vaginosis. Syphilis affected 14.6% of the allowed the identification of the defining characteristics, women, most of whom received no or inadequate the related factors, and the risk factors which involve treatment. the NDs elaborated, considered dependent variables. Regarding the neonatal characteristics, 95.1% The process of the elaboration of the NDs followed of the NBs were born in the locale of the study; and the stages of the process of reasoning and diagnostic there was no significant predominance in the sample inference proposed in the literature(6): analysis of the in relation to females (46.3%) or males (53.7%) and grouping of indicators; lists of suspected problems; to the type of birth, either vaginal (48.8%) or surgical discarding of similar diagnoses; choice of more specific (51.2%).
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