hyperbilirubinemia
DESCRIPTION
case study about hyperbilirubinemiaTRANSCRIPT
STI College of Nursing
Sta. Cruz, Laguna
Submitted to:
Ms. Mildred Limuaco, RN, MANClinical Instructor
Submitted by:GROUP II
Members:
Bernardino, Michelle S.
Bernas, Nikki Lou P.
Ching, Judith U.
De Ramos, Robert Immanuel
Ingalla, Charmaine S.
Matienzo, Evangeline N.
Monteseña, Roselle Ann N.
Sotomayor, Karen B.
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October 2010
TABLE OF CONTENTS
I. Introduction ------------------------------------------------------------------------------------2A. Objectives -------------------------------------------------------------------------------3
B. Background of the Study ------------------------------------------------------------4
C. Rationale for Choosing the Case -------------------------------------------------4
D. Significance of the Study ------------------------------------------------------------5
E. Scope and Limitations ---------------------------------------------------------------5
II. Clinical Study ------------------------------------------------------------------------------------6A. Demographic Data ----------------------------------------------------------------------6
B. Physical Assessment -------------------------------------------------------------------7
C. System Affected --------------------------------------------------------------------------9
D. Laboratory and Diagnostic Exam ---------------------------------------------------10
III. Clinical Discussion ----------------------------------------------------------------------------13A. Anatomy and Physiology -------------------------------------------------------------13
B. Pathophysiology ------------------------------------------------------------------------16
C. Nursing Care Plan ----------------------------------------------------------------------17
D. Drug Study -------------------------------------------------------------------------------21
E. Course in the Ward --------------------------------------------------------------------25
F. Discharge Plan --------------------------------------------------------------------------25
G. Evaluation --------------------------------------------------------------------------------27
H. Summary ----------------------------------------------------------------------------------
27
I. Recommendation -----------------------------------------------------------------------27
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J. Bibliography ------------------------------------------------------------------------------28
I. Introduction
HYPERBILIRUBINEMIA
Neonatal Hyperbilirubinemia or Neonatal Jaundice in newborn is one of the most
common problems encountered in term newborns. Although up to 60 percent of the
term newborns have clinical jaundice in the first week of life. Hyperbilirubinemia is a
condition in which there is too much bilirubin in blood. When red blood cells breakdown,
a substance called bilirubin is formed. Babies are not easily able to get rid of the
bilirubin and it can build up in the blood and other tissues and fluids of the baby’s body.
This is called Hyperbilirubinemia. Because of bilirubin has a pigment or coloring, it
causes a yellowing of the baby’s skin and tissues. This is called jaundice. Depending on
the cause of the hyperbilirubinemia, jaundice may appear at birth or at any time
afterward. General signs and symptoms are yellow eyes, skin, tiredness, fatigue, light
colored stools, and dark urine.
During the pregnancy, the placenta excretes bilirubin. When the baby is born, the
liver of the baby must take over this function. There are several causes of
hyperbilirubinemia and jaundice, including (1) Physiologic Jaundice – this is normal
response to the baby’s limited ability to excrete bilirubin in the first days of life. The
manifestation of jaundice is after 24 hours (2) Pathologic Jaundice – this may be related
to inadequate liver function due to infection or other factors. The manifestation of
jaundice is within 24 hours (3) Breast milk Jaundice – about 2% of the breastfed babies
develop jaundice after the first week. Some develop breast milk jaundice in the first
week due to low calorie intake or dehydration and (4) Jaundice from hemolysis –
jaundice may occur with the breakdown of RBC’s due to hemolytic disease of the
newborn (RH disease), having too many RBC’s or bleeding.
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Hyperbilirubinemia affects 60% of full-term infants and 80% of preterm infants in
the first 3 days after birth. In the present study of the Department of Health (DOH),
3, 278 male newborns were screened for hyperbilirubinemia. Results show that of
3, 278, 186 screened to have a positive result. Of the 186, 65 boys had a confirmatory
testing, 45 were confirmed to have hyperbilirubinemia and 20 had normal results. In the
Philippines, there is a prevalence rate of 4.5% to 25.7%. This study reveals an
incidence of 3.9% among male Filipinos.
A. OBJECTIVES
General Objective: This case study aims to present to the readers the nature of
Hyperbilirubinemia, the origin and the effects it does on the neonate body. It also
encompasses the proper approach in a patient with this kind of disease. This study
aims to broaden the knowledge of the readers about this condition.
Specific Objectives:To improve knowledge on:
The fundamental information about Hyperbilirubinemia including its risk
factors, etiology, signs and symptoms, and treatment
The pathophysiology of the disease
To enhance skills on:
The appropriate approach to a newborn patient undergoing systemic changes
and adaptation
Formulating nursing care plans and independent nursing interventions to care
for fully dependent patient
Different types of medical treatment necessary for hyperbilirubinemia
To modify attitude on:
Caring a newborn patient with hyperbilirubinemia
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Confidence in managing patients with this kind of condition
Our sense of unselfish love and empathy rendering nursing care to our
patient so that we may be able to serve future clients with higher level of
holistic understanding, as well as individualized care.
B. BACK GROUND OF THE STUDY
Baby Girl HB is a premature borderline infant from Lumban, Laguna, born of a 37
years old G4P4 delivered via NSD by her mother last September 16, 2010 at home.
The newborn has been admitted at Pediatric Intensive Care Unit (PICU) last
September 19, 2010 at 10:30am because of jaundice. The patient has been
diagnosed with Hyperbilirubinemia. She has undergone intensive phototherapy
treatment at her first day in PICU. When we handled her, the newborn was already
well and in good condition and she was about to go home or for MGH.
We decided to present this case in our eagerness to learn and explore
new knowledge and information about this type of newborn condition. Our group
wants to formulate a correlation among the conditions that manifests in baby girl HB.
We believe that this can be of great help in performing appropriate nursing
interventions to the patient. Our group also wants to focus on hyperbilirubinemia,
which is common among newborns. It is a significant topic for the mothers especially
for those who are pregnant. It is of great advantage that they have knowledge about
this condition.
C. RATIONALE FOR CHOOSING THE CASEThis case has been chosen by the group under the following reasons:
To better understand Hyperbilirubinemia, its nature and appropriate nursing
interventions that may contribute to patient’s recovery
To benefit the student nurses in enhancing their skills in giving care for patient
diagnosed with Hyperbilirubinemia
To defy our capabilities in presenting such challenging case
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To challenge our skills in connecting relevant details of the disease for actual
patient care
D. SIGNIFICANCE OF THE STUDYThis study is done for the benefits of the following:
To the patient – this study hopes to be most beneficial to the patient as the core
purpose of this, is to aid in prompt and successful client recovery
To the students – this study presents various observations upon handling the
client and sustaining for her recovery. We hope to be of help to our fellow
students by sharing first hand experiences about the condition
E. SCOPE AND LIMITATIONThis study covers and focuses on the following:
A brief discussion of the disease and its causes, manifestations, and proper
treatment
A pathophysiology presented via schematic diagram format of Hyperbilirubinemia
A drug study of medications prescribed to patient
Nursing Care Plans which would present nursing analysis, diagnosis, plan, and
appropriate interventions that would aid in patients recovery.
Discharge plan which presents follow-up care and treatment after confinement.
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II. Clinical Study
DEMOGRAPHIC DATA
Patient Name : Baby Girl HB
Age : 3 days old
Sex : Female
Birth Date : September 16, 2010
Address : Lumban, Laguna
Date of Admission : September 19, 2010
Time of Admission: 10:30am
Admitting Diagnosis: HYPERBILIRUBINEMIA
Source of InformationPrimary Source : Mother
Secondary Source : Patient’s records/ chart
Chief Complaint: “Tatlong araw nang madilaw ang anak ko” as verbalized by the
mother
History of Present Illness According to patient’s mother, when Baby Girl HB was born, she noticed that her
baby’s skin became yellowish in color for 3 days. The Pediatric Resident on Duty
(PROD) seen and examined her and the physician ordered and requested CBC and
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B1, B2. The patient then admitted to PICU on September 19, 2010, Sunday at
exactly 10:30am, afterwards, the PROD requested for Bilirubin Test and to have an
intensive (continuous) phototherapy.
B. PHYSICAL ASSESSMENT
General Appearance
- slightly yellowish skin color and sclera
- with dry skin
- with desquamation of the skin
- with covers on eyes and genitals
- with good sucking reflex
- afebrile
- with negative (-) adventitious breath sounds upon
auscultation on both bilateral lung fields
- fairly active
- with good sleeping habit
Head
- normocephalic
- symmetrical in shape
- no masses, no lesions
- Non bulging and non depressed anterior and
posterior fontanels
- No signs of caput succedaneum and
cephalhematoma
Hair - evenly distributed over the scalp
- with black, straight and thick hair
Eyelids - lids close symmetrically
- with eyeshield
- no edema, and no discharges
Sclera - slightly yellowish
Iris - symmetrical in size
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- round and black
Pupils- Symmetrical in size
- round and dark brown in color
- PERRLA (Pupils Equally Round And React To
Light and Accommodation)
Ears- equal in size
- auricles are smooth and symmetrical
- pinna recoils after it is folded
Nose
- the external nose is symmetrical and straight
- color is the same with the entire face
- lesions and tenderness were both absent
- nasal mucosa was pinkish
- both left and right nares were patent
- nasal septum is intact and in midline without
deviations
- cilia present in internal nares
- absence of nasal discharge
- no signs of nasal flaring
Mouth
- pinkish and moistened
- dry oral mucous membrane
- frenulum intact at midline
- tongue was located at the midline, pink in color,
slightly dry and furry with whitish coating
- tongue moves freely
- uvula is in midline
Neck- neck movement was coordinated and difficulty in
moving was not noted
- free from lumps and no tenderness
Thorax- no masses and tenderness upon palpation
- no adventitious breath sounds upon auscultation on
both left and right lung fields
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- negative retractions
Breast- round in shape, no lumps, no masses
- areola dark brown in color
- nipples round, equal in size
Abdomen- same color of the body
- globular, soft without distention
- bowel sounds in all quadrant
- skin pinch goes back quickly
Upper extremities- good range of motion was noted
- no lesions, no presence of abnormalities, no
tenderness
- can flex and extend arms without difficulty
Lower extremities
- skin uniform in color
- good range of motion was noted
- no lesions, no presence of abnormalities, no
tenderness
- can flex and extend legs without difficulty
Genitalia
- no discharges
- no bleeding
- With slightly normal genitalia (labia majora
almost covers the clitoris)
- With genital shield
Elimination - With patent anus
Reflexes - Are present such as moro, babinski, rooting,
sucking, and plantar grasp reflex
C. SYSTEM AFFECTED
Digestive System Hematologic System
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D. LABORATORY AND DIAGNOSTIC EXAM
Bilirubin Test
September 19, 2010
TEST RESULT NORMAL VALUE
INTERPRETATION SIGNIFICANCE
Neonatal Bilirubin
20.5 mg/dl 1.0-10.5 mg/dl
Increased Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin
Unconjugated bilirubin
18.56 mg/dl 0.6-10.5 mg/dl
Increased An abnormal accumulation of bilirubin in the blood caused by the poor function of the liver
Conjugated bilirubin
1.59 mg/dl 0-0.6 mg/dl Increased Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin
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September 20, 2010
TEST RESULT NORMAL VALUE
INTERPRETATION SIGNIFICANCE
Neonatal Bilirubin
25.5 mg/dl 1.0-10.5 mg/dl
Increased Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin
Unconjugated bilirubin
24 mg/dl 0.6-10.5 mg/dl
Increased An abnormal accumulation of bilirubin in the blood caused by the poor function of the liver
Conjugated bilirubin
1.50 mg/dl 0-0.6 mg/dl Increased Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin
September 23, 2010
TEST RESULT NORMAL VALUE
INTERPRETATION SIGNIFICANCE
Neonatal Bilirubin
11.10 mg/dl 1.0-10.5 mg/dl
Increased Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin
Unconjugated bilirubin
10.9 mg/dl 0.6-10.5 mg/dl
Increased An abnormal accumulation of
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bilirubin in the blood caused by the poor function of the liver
Conjugated bilirubin
0.20 mg/dl 0-0.6 mg/dl Normal
Complete Blood Count
September 19, 2010
BLOOD COMPONENTS
RESULT NORMAL VALUE
INTERPRETATION SIGNIFICANCE
Hemoglobin 11.0 g/dl 13-19g/dl Decrease Decrease hemoglobin will result to decrease of oxygen supply to the body due to bilirubin in the bloodstream that is trying to get out
White Blood Cells (WBC)
17.9 4.5-10.5 x 10 9/ L Increase Increase WBC signifies infection in the body.
Hematocrit 33% 42-59% Decrease Decrease hematocrit indicates that the mass of RBC is decrease
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III. CLINICAL DISCUSSION
A. ANATOMY AND PHYSIOLOGY
Liver
The liver is the largest glandular organ in the body; its office is to secrete bile. It
is oblong and oval in shape, and occupies the position on the right side, under
the lower ribs.
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Metabolism of carbohydrates, protein and fats
Production of bile salts
Detoxification of endogenous and exogenous substances
Blood reservoir
Excretion of adrenal cortex hormone
Storage of vitamins such as Vitamin A and D
Spleen
Act as reservoir of red blood cells
Sequesters the old, worn-out RBCs thereby removing them from the circulation
Gall Bladder
A pear shaped organ located on the liver that stores bile.
Function:
Stores and concentrates the (greenish liquid composed of watr, cholesterol, bile
salts, electrolyte and phospholipids) produce by the liver
Important in fat emulsification and intestinal absorption of fatty acids, cholesterol
and other lipids
Cystic Duct
Short duct that joins the gall bladder to the common bile duct.
Bile can flow in both directions between the gallbladder and the common hepatic
duct and the (common) bile duct.
Pancreas
The pancreas is an elongated, tapered organ located across the back of the
abdomen, behind the stomach.
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Norman Anatomy of Bilirubin Production and Elimination
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RBC lifespan of 120 days
RBC will become fragile or prone
Cellular content will be release
Macrophages will phagocytized it
Hemoglobin will split into
Heme Globins
Iron Biliverdin Breakdown into amino acids
Will go to the bone marrow for new RBC production
Reduct into bilirubin (indirect, unconjugated) fat
Transport to the liver with the help of albumin
The liver enzyme will convert unconjugated to conjugated bilirubin
The bacteria will convert conjugated bilirubin to urobilinogen
That excrete with the feces and some of it in urine
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B. PATHOPHYSIOLOGY
RBC lifespan of 120 days
RBC will become fragile
Cellular content will be release
Macrophages will phagocytized it
Hemoglobin will split into
Heme Globins
Iron Biliverdin Breakdown into amino acids
Will go to the bone marrow for new RBC production
Reduct into bilirubin (indirect, unconjugated) fat soluble
Transport to the liver with the help of albumin
Unconjugated to convert
Increase unconjugated bilirubin
To the blood stream
Yellow discoloration of sclera, skin, conjunctivaHYPERBILIRUBINEMIA
Predisposing Factors: 3 days old Female Preterm borderline neonate
Absence of glucuronyl transferase produced by liver
Objective Analysis Planning Intervention Rationale Evaluation
- skin appearing light yellow - sclera appearing light yellow- weak looking- afebrile- with thin and dry skin- hypoactive - under intensive and phototherapy-with eye and genital shield-with IVF reg. @ 14 gtts/min.
Risk for Injury related to abnormal blood profile as evidenced by increase bilirubin level of 1.59mg/dl.
After series of nursing interventions the bilirubin level will be decreased
Remove clothing and exposed to phototherapy.
Covered eyes and genitalia
Repositioned the baby every 2 hours.
Kept warm and dry.
Vital signs taken and recorded every 1 hour.
Instructed on Strict Aspiration Precaution (SAP) and advised the mother to burp the baby every after feeding
Aids in diagnosing underlying cause in connection with the appearance of jaundice
To prevent eyes from direct exposure to light and prevent sterility of the baby
To prevent burns
To prevent further complications.
To obtain the baseline data
To prevent aspiration pneumonia and to prevent colic.
Goal met.After series of nursing intervention the bilirubin level was decreased to 0.20 mg/dl.
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Monitored input and output; IVF regulated at 14 uggts/ min.
Provided quiet and warm environment
Instructed the mother to use stimulation technique such as touching.
Health teachings given to the mother such as personal hygiene, importance of breastfeeding, and newborn screening
To prevent dehydration and replace fluid and electrolyte lost
To promote comfort and prevent irritability
To promote sense of warmth, security and attachment
To detect early the possible diseases of the patient
DAY 1: 19 September 2010
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Objective Analysis Planning Intervention Rationale Evaluation
- skin appearing light yellow - sclera appearing light yellow- afebrile- with thin and dry skin-with desquamation of the skin- under intensive and single phototherapy
Risk for skin breakdown related to prolonged use of phototherapy.
After 8 hours of nursing interventions, the patient’s risk of skin breakdown will be avoided.
Maintained and monitored baby’s eye patches while under phototherapy
Removed baby under phototherapy and removed eye patches during feeding
Inspected eyes every after phototherapy for conjunctivitis, drainage and corneal abrasions due to irritation from eye patches
Provided minimal coverage of the body except for genitals
Repositioned the baby every 2 hours
To protect retina from damage due to high intensity of light
To provide visual stimulation and facilitates attachment behaviors
To reduce complications and monitor the effectiveness of the management
To provide maximal exposure and shielded the sensitive parts such as the eyes and genitals
To promote equal distribution of phototherapy exposure
Goal met.After 8 hours of nursing interventions, the patient was free from skin breakdown.
DAY 2: 20 SEPTEMBER 2010
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Objective Analysis Planning Intervention Rationale Evaluation
- with slightly yellowish skin color and sclera- fairly active- with good sucking reflex- with slight depressed fontanel- afebrile- negative (-) adventitious breath sounds upon auscultation on both bilateral lung fields
Risk for fluid imbalance related to prolonged exposure to phototherapy as evidenced by dry skin
After series of nursing interventions, the risk for fluid imbalance will be prevented
Monitored input and output; IVF regulated at 14 uggts/ min.
Vital signs taken and recorded
Bedside care done including stretching of linens and organizing bedsides
Instructed Strict Aspiration Precaution (SAP)
Kept back dry
Health teachings given to the mother such as the importance of breastfeeding, hand washing, and proper hygiene
Needs attended
To prevent dehydration and replace fluid and electrolyte lost
To obtain the baseline data
To promote comfort and good hygiene
To prevent aspiration pneumonia
To prevent further complications
To promote healthy lifestyle
Goal met. After series of nursing interventions, the risk for fluid imbalance is prevented as evidenced by good skin turgor
DAY 3: 26 SEPTEMBER 2010
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B. DRUG STUDY
Drug Name Dosage Classification Mechanism of Action
Indication Contraindication Adverse Effects
Nursing Responsibilities
Generic Name:AMPICILLIN
Brand Name:Novo-AmpicillinPrincipen
150mg IV every 12 (6-6)
AntibioticPenicillin
Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death
Treatment of infections caused by susceptible strains of shigella, Escherichia coli, gram-positive organisms (penicillin G-sensitive staphylococci, streptococcus)
Contraindicated with allergies to penicillins, cephalosphorins, or other allergens
Lethargy,Seizures,Anemia,Thrombocytopenia,Leukopenia,Neutropenia,Prolonged bleeding time, diarrhea
Check IV site carefully for signs of thrombosis
Inform the guardian of the patient that this drug is given to treat infection
Follow the 10 Rights of the medications and administration
Advise the guardian to report signs of hypersensitivity such as redness and rashes
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Drug Name Dosage Classification Mechanism of Action
Indication Contraindication Adverse Effects
Nursing Responsibilities
Generic Name:CEFOTAXIME
Brand Name:Claforan
150mg IV every 12 (12-12)
AntibioticCephalosporin (3rd generation)
Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death
Septicemia caused by E.coli, Klebsiella species, S. marcescens
Contraindicated with allergy to cephalosporins or penicillins
Diarrhea, bone marrow depression – decreased WBC, decreased platelets, decreased hematocrit,
Reconstitution of drug varies by size of package; see manufacturer’s directions for details
Inform the guardian of the patient that this drug is given to treat infection
Follow the 10 Rights of the medications and administration
Advise the guardian to report signs of hypersensitivity such as redness and rashes
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Drug Name Dosage Classification Mechanism of Action
Indication Contraindication Adverse Effects
Nursing Responsibilities
Generic Name:AMIKACIN
Brand Name:Amikin
30mg IV once a day (OD)
Aminoglycoside Bactericidal: Inhibits protein synthesis in susceptible strains of gram-negative bacteria, and the functional integrity of bacterial cell membrane appears to be disrupted, causing cell death
Short-term treatment of serious infections caused by susceptible strains of Pseudomonas species, E.coli, Klebsiella, Enterobacter, and Serratia species
With allergy to any aminoglycosides
Fever, seizures, diarrhea, rash, urticaria
Monitor duration of treatment; usually 7-10 days. Prolonged treatment leads to increased risk of toxicity
Monitor intake and output and daily weight to assess hydration status and renal function
Inform the guardian of the patient that this drug is given to treat infection
Follow the 10 Rights of the medications and administration
Advise the guardian to report signs of hypersensitivity such as redness and rashes
Assess patient for sign of super infection (fever, upper respiratory infection)
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Drug Name Dosage Classification Mechanism of Action Indication Contraindication Adverse Effects
Nursing Responsibilities
Generic Name:PHENOBARBITAL
Brand Name:Luminal SodiumPMS-Phenobarbital
9mg IV every 12 (12-12)
AntiepilepticBarbiturateHypnoticSedative
General CNS depressant; barbiturates inhibit impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, depress motor output, and can produce excitation, sedation, hypnosis; at subhypnotic doses, has anti-seizure activity, making it suitable for long-term use as an antiepileptic
Sedative,Emergency control of acute seizures
With hypersensitivity to barbiturates, severe respiratory distress
Bradycardia, constipation, diarrhea, rashes, urticaria, respiratory depression, broncho-spasm
Administer IV doses slowly
Monitor injection sites carefully for irritation and extravasation
Monitor pulse and respiration carefully during IV administration
Follow the 10 Rights of the medications and administration
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C.COURSE IN THE WARD
Date Time Vital Sign Observation
September 26, 2010 10:00PM
2:00AM
6:00AM
T – 36.3 oCP – 130 bpmR – 38 cpm
T – 36.5 oCP – 131 bpmR – 42 cpm
T – 36.8 oCP – 134 bpmR – 39 cpm
- with slightly yellowish
skin color and sclera
- With good skin turgor
- with good sucking
reflex
- Afebrile
- with negative (-)
adventitious breath
sounds upon
auscultation on both
bilateral lung fields
- fairly active
- with good sleeping
habit
DISCHARGE PLANMedication:
Instructed the mother to give Nutrilin 0.3 ml drops once a day (OD) for optimum
recovery and good health
Environment:
Encouraged the mother to keep an environment clean and conducive to health
for the rapid recovery of infant and to avoid infection and keep environment quiet
to make the patient comfortable
Treatment:
Emphasized to the mother the importance of regular follow-up check-ups and as
instructed by physician
Advised the mother to seek medical advice if any strange arises
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Encouraged the mother to let the baby be monitored by the health care provider
until complete recovery is met
Health Teachings:
Advised the mother to exposed the patient to sunlight around 6:00am – 8:00am
Emphasized to the mother the importance of proper hand washing and proper
hygiene
Emphasized the need for compliance and cooperation of the mother in helping
treat the infant
Emphasized that the baby is on trust vs. mistrust stage: the needs must be met
for a healthy emotional development
Out Patient:
Reminded the mother that even though the patient feels better, it is important to
have the doctor monitor her progress. The patient is scheduled on October 4,
2010 at 8:00am in Out-Patient Department in Laguna Provincial Hospital (LPH)
to evaluate the recovery of the infant
Diet:
Encouraged the mother for breastfeeding to help the baby gain resistance and
protection from diseases in the future
Emphasized to the mother to breast fed the baby up to two years. An increase in
feeding will help a faster gain in weight of the baby
Spirituality:
Encouraged the mother to continue to seek God’s guidance and to continue to
have a positive outlook in life
Emphasized the importance of prayers in healing
Encouraged the mother to pray for the baby’s fast recovery and gave words of
encouragement
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EVALUATION
Though the group found the chosen case on its wellness stage or with may go
home order, it was still given us the opportunity to know the disease specifically the
Hyperbilirubinemia or Neonatal Jaundice for better understanding and appropriate
nursing care to be done for any newborn acquired this kind of disease. There were
several factors how this disease can be acquired and each of us was challenged to
search the causes and details why many newborns suffered from this health problem.
The nursing intervention we had during the shift were closed monitoring on
baby’s vital signs, kept baby under phototherapy, kept baby comfortable, assured baby
that she was well fed and provided health teachings to the parent. The goal of the group
has been met as evidenced by parent showed knowledge and understanding about the
health condition of their child and improved parenting manner. There were no significant
circumstances arise during our shift.
SUMMARY
Hyperbilirubinemia is a condition in which there is too much bilirubin in blood.
When red blood cells breakdown, a substance called bilirubin is formed.
Patient was a baby Girl “HB” a premature borderline infant from Lumban,
Laguna, born of a 37 years old G4P4 delivered via NSD by her mother last
September 16, 2010 at home. The newborn has been admitted at Pediatric
Intensive Care Unit (PICU) last September 19, 2010 at 10:30am because of
jaundice. The patient has been diagnosed with Hyperbilirubinemia. She has
undergone intensive phototherapy; medications were Ampicillin, Amikacin,
Cefotaxime and Phenobarbital.
Patient was discharged on September 27, 2010 at 8:00 AM.
RECOMMENDATIONThe group recommends to the parent the following care:
Expose their child under sunlight ideally between 6:00-7:00 in the morning and
don’t forget to put cover over the baby’s eyes
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Provide baby quality breast feeding every 2-3 hours or as frequent as needed for
this promotes improved wellness condition and effective bonding technique
between mother and child.
Go to the nearest health center for baby’s immunization
Keep baby clean and dry
Give home meds as prescribed. Seek immediate doctor’s advice if there is any
significant changes observe on the child or return child for follow up check-up.
BIBLIOGRAPHY
Fundamentals of Maternal and Child Nursing, London, Ladewig, Ball and Bindler, 2nd
ed., Vol. 1, pp. 835 – 844
Nursing Drug Guide, Lippincott’s, 2009, pp. 126, 101, 246, 948
http://www.merck.com/mmpe/lexicomp/bisacodyl.html
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