Chapter 30: Hyperbilirubinemia

As the nurse is assessing a 2-day-old newborn, jaundice is noted on the face only. The nurse can anticipate a bilirubin level of about A. 5 mg/dL. B. 10 mg/dL. C. 15 mg/dL. D. 20 mg/dL.

A When the bilirubin level reaches 5 to 7 mg/dL, jaundice is visible in the newborn's face. It moves down the body as bilirubin levels continue to rise.

What intervention would make phototherapy most effective in reducing the indirect bilirubin in an affected newborn? A. Expose as much skin as possible. B. Increase oral intake of water between and before feedings. C. Place eye patches on the newborn. D. Wrap the infant in triple blankets to prevent cold stress.

A With bili lights, the infant wears only a diaper to ensure maximal exposure of the skin. The eyes are closed and patches placed over them to prevent injury. However, this is not what affects the bilirubin levels. The infant can be placed in an incubator or under a radiant warmer to maintain heat.

Which infant would be more likely to have Rh incompatibility? a. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor b. Infant who is Rh negative and whose mother is Rh negative c. Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor d. Infant who is Rh positive and whose mother is Rh positive

A If the mother is Rh negative and the father is Rh positive and homozygous for the Rh factor, all the children will be Rh positive. Only Rh-positive children of an Rh-negative mother are at risk for Rh incompatibility. If the mother is Rh negative and the father is Rh positive and heterozygous for the factor, there is a 50% chance that each infant born of the union will be Rh positive and a 50% chance that each will be born Rh negative.

ABO incompatibility also causes pathologic jaundice in the newborn. Mothers with what blood type have natural antibodies to types A and B blood? A. It does not matter what blood type the mother is B. Type O C. Type A D. Type B

B ABO incompatibility also causes pathologic jaundice. Mothers with type O blood have natural antibodies to types A and B blood. The antibodies cross the placenta and cause hemolysis of fetal red blood cells. However, the destruction is much less severe than with Rh incompatibility and causes milder signs.

The nurse is monitoring the feedings of the infant with hyperbilirubinemia. The purpose of ensuring that the infant receives feedings every 2 to 3 hours, whether by breast or bottle is to A. prevent hyperglycemia. B. provide fluids and protein. C. decrease gastrointestinal motility. D. prevent rapid emptying of the bilirubin from the bowel.

B Frequent feedings prevent hypoglycemia, provide protein to maintain the albumin level in the blood, and promote gastrointestinal motility and prompt removal of bilirubin in the stools.

The most common cause of pathologic hyperbilirubinemia is: a. Hepatic disease. b. Postmaturity. c. Hemolytic disorders in the newborn. d. Congenital heart defect.

C Hemolytic disorders in the newborn are the most common cause of pathologic jaundice. Hepatic damage may be a cause of pathologic hyperbilirubinemia, but it is not the most common cause. Prematurity would be a potential cause of pathologic hyperbilirubinemia in neonates, but it is not the most common cause. Congenital heart defect is not a common cause of pathologic hyperbilirubinemia in neonates.

With regard to hemolytic diseases of the newborn, nurses should be aware that: a. Rh incompatibility matters only when an Rh-negative child is born to an Rh-positive mother. b. ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia. c. Exchange transfusions frequently are required in the treatment of hemolytic disorders. d. The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth.

D An indirect Coombs' test may be performed on the mother a few times during pregnancy. Only the Rh-positive child of an Rh-negative mother is at risk. ABO incompatibility is more common than Rh incompatibility but causes less severe problems; significant anemia, for instance, is rare with ABO. Exchange transfers are needed infrequently because of the decrease in the incidence of severe hemolytic disease in newborns from Rh incompatibility.