Omphalitis Nursing Care Plan

Omphalitis is a bacterial infection of the umbilical cord stump and surrounding tissues in a neonate.
It carries a high risk of rapid progression to systemic sepsis or necrotizing fasciitis because the patent umbilical vessels provide direct access to the infant’s bloodstream.
Common Pathogens: Staphylococcus aureus, Streptococcus species, and Escherichia coli.

Non-sterile delivery or improper umbilical cord care.
Premature rupture of membranes (PROM) or prolonged labor.
Low birth weight and prematurity.
Placement of umbilical catheters.
Underlying immunologic defects, specifically Leukocyte Adhesion Deficiency (LAD).

Localized Signs: Periumbilical erythema (redness), edema, induration, and localized warmth.
Exudate: Purulent, malodorous (foul-smelling) discharge or persistent fluid oozing from the stump.
Systemic Signs (Sepsis Alert): Fever (or hypothermia), lethargy, poor feeding, irritability, tachycardia, and tachypnea.
Complication Signs: Fluctuance (indicating an abscess), bleeding, or bluish discoloration.

Risk for Infection (Systemic Sepsis) related to pathogen entry through the compromised umbilical stump.
Impaired Skin Integrity related to inflammation, edema, and purulent exudate at the cord site.
Ineffective Thermoregulation related to the systemic inflammatory response.
Deficient Knowledge (parents) regarding proper umbilical cord care and infection prevention.

Infection Control: Maintain strict hand hygiene and utilize an Aseptic Non-Touch Technique (ANTT) during all cord assessments and dressing changes.
Cultures: Obtain a swab of the purulent discharge for culture and sensitivity testing before initiating antibiotic therapy.
Pharmacology: Administer prescribed broad-spectrum intravenous (IV) antibiotics promptly, as omphalitis routinely requires hospitalization for IV therapy.
Cord Care: Clean the stump according to facility protocol, ensuring it remains clean, completely dry, and exposed to air to inhibit bacterial growth.
Diaper Positioning: Fold the top of the infant’s diaper down below the level of the umbilicus to prevent contamination from urine and feces.
Monitoring: Assess vital signs continuously, paying strict attention to temperature fluctuations and signs of respiratory distress that indicate systemic involvement.
Nutrition: Encourage continued breastfeeding to provide essential maternal antibodies and maintain infant hydration.

Instruct parents to avoid applying unprescribed topical agents, tight binders, or bandages over the umbilical stump.
Teach the exact signs of infection spread, including expanding redness, increased foul discharge, or a fever over 100.4°F (38°C).
Emphasize the importance of completing the full course of antibiotics and attending all follow-up appointments.