jaundice - case study

Following your breastfeeding assessment, how should you instruct the mothers of Baby Fulton and Baby Yang?

"Awaken your baby every 2 to 3 hours to breastfeed for the next few days." "Record the time and color of all your baby's wet and dirty diapers for the next few days."

You update the pediatrician and Baby Johnson's parents regarding his status. The parents are happy to hear that the serum bilirubin level has decreased and ask when phototherapy can stop. What is the most appropriate nursing response?

"Your baby appears to be tolerating and responding well to the phototherapy. We will check your baby's bilirubin level again in 12 hours. I expect that your pediatrician will reevaluate after those lab results are reported."

Baby Johnson fusses when you patch his eyes and turn on the phototherapy lights. His mother becomes tearful, and his father asks if there is anything that he can do to help. Which response would provide appropriate emotional support?

-"I will monitor your baby closely. I will remove the eye patches when you feed him every 2 hours, so you can look into his eyes while you hold and cuddle him." -"You can talk or sing softly to your baby while he is under the lights. He will recognize your voices."

Baby Johnson's parents wish for him to continue rooming in during the phototherapy if possible. You recognize that as first-time young parents, Baby Johnson's mother and father may be intimidated by the phototherapy equipment. To let them know what to expect during the phototherapy, what information do you share with them?

-"The time required for phototherapy varies for each baby. We will take periodic blood samples to see if the phototherapy is working to decrease your baby's bilirubin level." -"I will assist you to change your baby's diaper as soon as it becomes wet or soiled, and we will change his position every 2 hours to prevent damage to his skin." -"I will check on your baby at least hourly. I will assess your baby at least every 2 hours when I assist you to interrupt the phototherapy for feeding and cuddling. Please call me anytime if you have concerns or need help."

Which priority goals do you set for Baby Johnson when you initiate phototherapy?

-Baby Johnson will maintain adequate hydration throughout phototherapy, as evidenced by maintaining 90% or more of birth weight and soaking two or more diapers with yellow to light amber urine in the next 24 hours. -Baby Johnson will demonstrate improved excretion of bilirubin throughout phototherapy, as evidenced by a TSB of 9 mg/dL or less after 4 hours of phototherapy. -Baby Johnson will demonstrate effective thermoregulation throughout phototherapy as evidenced by an axillary temperature of 97.8° to 99°F.

Which nursing interventions will provide effective psychosocial support for Baby Johnson's parents?

-Encourage them to invite close family members and friends to visit as desired. -Ask them if they have named their baby, and if so, if it is okay for you to call their baby by his first name. -Offer to call their clergyperson or a hospital chaplain to visit if desired.

Baby Johnson's father expresses concern about the possibility of long-term neurologic problems and asks you what will happen if the phototherapy does not work. You respond that if the bilirubin level continues to rise despite phototherapy, treatment options may include the administration of:

-Intravenous immunoglobulin (IVIG). -Exchange transfusions.

You assess Baby Johnson every 2 hours. Which findings indicate improvement related to hyperbilirubinemia 4 hours after the initiation of phototherapy?

-Passage of two large meconium stools -TSB 9 mg/dL

The most important assessment for you to make at this time for Baby Fulton and for Baby Yang is:

A breastfeeding assessment.

Why did you think it was important to check the results of the indirect Coombs test?

A positive indirect Coombs test result could indicate possible pathologic jaundice related to a different type of antigen such as Kell.

You receive change-of-shift report on three newborns: Baby Johnson, Baby Fulton, and Baby Yang. The RN from the previous shift reports that all three exhibited jaundice for the first time in the past 2 hours. He requested additional lab tests per standing orders, and those labs are pending. Based on the reports, which newborn is at the highest risk for pathologic hyperbilirubinemia and should be assessed first?

Baby Johnson

You review the shift report, the health records, and the lab results for Baby Fulton and Baby Yang. Based on the available data, you determine that they are most likely exhibiting signs of which conditions?

Breastfeeding jaundice Physiologic jaundice

You inform Baby Johnson's mother that you will perform which priority nursing interventions to promote her baby's fluid and electrolyte status during the phototherapy?

Count, weigh, and record all wet and soiled diapers. Ensure that Baby Johnson ingests formula every 2 to 3 hours.

You review the records of Baby Fulton and Baby Yang and determine that you need more information to assess their current risk related to hyperbilirubinemia. The most important additional data that you need at this time is:

Current newborns weight

Why is the current weight of the two newborns important to your assessment of neonatal jaundice?

Current weight reflects whether or not the newborn is adequately hydrated.

As you prepare to initiate phototherapy according to the pediatrician's orders, which nursing interventions should you perform?

Encourage Baby Johnson's mother to feed him prior to starting phototherapy. Assess Baby Johnson's vital signs.

Which factors led you to determine that Baby Johnson is at the highest risk?

Jaundice and TcB level of 7 mg/dL at 12 hr of life

Which factors led you to determine that Baby Fulton is at highest risk?

Jaundice and TcB of 10 mg/dL at 36 hr of life following a vacuum-assisted delivery XX Feeding type and pattern

Recognizing that Baby Johnson is exhibiting signs of pathological jaundice, you review his record again. Which factors contribute to his risk for hyperbilirubinemia?

Maternal ABO type Gestational age

You review Baby Johnson's labs when they become available and notify the pediatrician. The pediatrician writes an order to initiate phototherapy. You explain to Baby Johnson's parents that the phototherapy will address which priority nursing diagnosis?

Neurologic Injury: Risk for, related to TSB of 10 mg/dL at 12 hr of age

Why is the blood type of the two newborns important to your assessment of neonatal jaundice?

The newborn blood type could indicate the possibility of pathologic jaundice related to Rh incompatibility for Baby Fulton and Baby Yang. The newborn blood type could indicate the possibility of pathologic jaundice related to ABO incompatibility for Baby Fulton and Baby Yang.