Atención de enfermería en caso probable de tetano neonatal

Abstract

Neonatal tetanus is a deadly disease caused by a Gram-positive bacterium Clostridium Tetani, which is introduced into the body by the umbilical cord, by not applying a asepsis and antisepsis technique in both the cut and the manipulation during The birth. Already admitted in the organism continues to the bloodstream and the central nervous system causing a hyperactivity of the motor neurons. International data mention that before immunizations neonatal tetanus was more frequent, according to estimates the World Health Organization in the year 2015 provoked the death of approximately 34.000 newborns however these data reflected a Significant decrease of 96% compared to the year 1988 that claimed the life of 787.000 newborns in their first 28 days of life. In the case of study is a female newborn of 4 days of birth; It is brought by mother to the obstetrical Hospital Ángela Loayza of Ollague to the area of emergency by presenting thermal increase of 37.5 ℃, more rejection to the suction, makes a food type vomit, Bradypnea, apneas of 5 to 10 seconds; Mother relates that at 2 days of life, family of newborn with the purpose of removing the clamp, it performs manipulation of the umbilical cord with sharp object (knife), then proceeds to burn umbilical cord with direct fire (candle) for two occasions. He enters the neonatology service presenting Icterus skin, prolonged capillary filling, respiratory distress 32-36 per minute, generalized muscular stiffness, bradypnea and trismus. It has continuous apneas, so we proceed to tracheal intubation remaining in mechanical ventilation SIMV mode. By clinical picture and by Mother's history with 5 prenatal controls and not remember vaccines, it is treated as suspected/confirmatory neonatal tetanus. So it starts with treatment with penicillin G sodium and metronidazole. Later, neonatal tetanus is ruled out and clinical Sepsis is diagnosed. The objective of this study is to analyse the probable case of neonatal tetanus in a term newborn; To develop a nursing care plan using Marjory Gordon's theory as a reference. The method used is qualitative, because it focuses on the collection of information and description of the clinical characteristics of the study population. The information was obtained through a bibliographical search in scientific articles, in manuals, guides of clinical practice and by the systematic review of the unique clinical history of the patient attended at the obstetric Hospital Ángela Loayza de Ollague. It was obtained as a result that the diagnosis of neonatal tetanus was ruled out because of the lack of evidence and the diagnosis of clinical sepsis was confirmed because the blood cultures performed were negative. It is concluded that it is essential to make an adequate assessment of the patient and to apply the differential diagnosis, in this way to determine a disease through the exclusion of other possible causes that have a clinical picture similar to the one that the patient presents. Marjory Gordon's theory allowed us to identify the altered patterns in the newborn in a systematized way. The nursing care process is essential in the professional practice of nursing, to carry out the interventions because it is oriented in the resolution of problems of the patient.