Question

Jaundice Case study

Situation: Anders is a 2 day/40 week infant. WT 7lb 11 oz HT 22 inches

     Admitted for treatment of hyperbilirubinemia (jaundice).  

Background: He lives with his parents and older brother who is 3 years old. MOB reports that the sibling was also treated for jaundice as an infant. MOB is breastfeeding exclusively with reports of the infant being difficult to wake for feeds. He is feeding about every 4 hours for 15 minutes.  

Labs from ED:

Serum Bilirubin level: 14 mg/dl

Coomb’s- negative

CBC-Hg 213, Ptl 176, WBC 9.8- no left shift

Assessment:

Infant is visibly jaundiced at torso and head. Responsive to touch but sleepy. Reflexes WNL Anterior fontanel is soft and flat. Milia visible on face. Skin is warm and dry.

HR 148, no murmur

RR 50, CTA bilaterally

Temp 36.8

BP on admit 76/54, Capillary refill less than 3 sec

BT are +

Admit Orders:

Diet BF ALD

Strict I & O

VS per routine

Phototherapy- double- blanket and lights

Redraw bilirubin level in 12 hours

1. Do you have any additional HX questions you would like to ask the family?

2. What are your initial nursing priorities?

3. What other healthcare team member may you need to consult with?

4. What interventions do you anticipate regarding initiation and monitoring of phototherapy?

5. What concerns do you anticipate needing to address for the family?

Answer 1

Q1.

Answer. The additional history that can be asked from the family members are regarding the Rh incompatibity in previous delivery of baby, blood group of the mother, breastfeeding the baby properly or not because lack of breastfeeding may leads to jaundice, any liver disease in the family member, whether the baby born as premature or not because premature also can develop jaundice.

Q2.

Answer. The nursing diagnosis are

1. Fluid volume deficit related to lack of feeding and prolong expose to phototherapy as evidence by dry skin.

2. Altered thermo regulation related to effect of phototherapy as evidenced by increase body temperature.

3. Parental knowledge deficient related to lack of information regarding the treatment of the baby and its prognosis.

4. Parental anxiety related to separation of the infant

Q3.

Answer. The health care team member that neat to consult include neonatologist and the heptologist doctors to treat the patient properly and understand aamy damage in liver.

Q4.

Answer.

- Before initiation of the phototherapy make sure that there is no electrical circuit in the phototherapy machine

- check the working condition of the phototherapy.

- Make sure that the patient undress and cover the genital area and the eyes during the phototherapy.

- strictly monitor the intake and output of the patient

- check the stool color

- breastfeeding should be done 2nd hourly to prevent from dehydration.

Q6.

Answer. For the family members, educate regarding the condition of the baby and its treament, prognosis. Provide psychological support to them.