Question

A 31-year-old woman has not received any prenatal care. She is single, is unemployed of low socioeconomic status, and has a seventh grade education. At 40 weeks’ gestation, the client gives birth to a 5 pound, 2 oz female neonate, her second child. After birth, the nurse notes that the neonate is very jaundiced, has an enlarged, edematous abdomen, and is having difficulty breathing.

a. Discuss why the nurse would immediately bring the neonate to the neonatal intensive care unit.

b. A student nurse who is assigned to the client and her neonate states, “If she only had cared for herself and the baby while she was pregnant.” What elements of health promotion strategies for the client’s situation would the nurse include in her explanation to the student?

Answer 1

In this case, the symptoms of newborn such as jaundice, edematous abdomen, breathless suggestive of hemolytic disease of the newborn, is an emergency, life threatening condition needs immediate attention and care.

• Hemolytic disease of newborn is a commonest cause of hyperbilirubinemia in the newborn.
• it occurs due to blood group incompatibility between the mother and foetus
• The common incompatibilities are Rh and ABO.
• normal fetal and maternal blood vessels do not communicate with each other but in some cases,during labour, there is a feto maternal bleeding, when fetal blood crosses the placenta into maternal circulation that produces antibodies against fetal RBC s. These antibodies are IgG type and cross the plants in the barrier to produce haemolysis of fetal RBC s. In subsequent pregnancy. Depending upon the extent of isoimmunization, the neonates may develop severe anaemia and jaundice.

Rh-i compatibility

Aarakshi Aarakshan isoimmunization is also known as erythroblastosis fetalis, a major cause of severe hyperbilirubinemia. It occurs Rh negative mother who is carrying Rh positive foetus.the antigen of fatal RBC may invoke antibody response in the maternal immunologic system.enough antibodies may not present during first pregnancy what is a subsequent pregnancy with positive foetus result in the increase antibody response.

The clinical manifestations of Rh hemolytic disease of newborn vary from stillborn baby with hydrops fetalis, icterus gravis neonatorum for congenital hemolytic anaemia

in severe cases baby born with severe anaemia grows hepatosplenomegaly and generalized anarsarca. Jaundice may appear as earliest 30 minutes after birth or usually within 24 hours of age.neonate also may have birth asphyxia hypothermia hypoglycemia acidosis and coagulopathy.

Health promotion strategies during pregnancy

• imran Himachal article and instrumental investigations that should be performed in the antenatal and perinatal period. The immune prophylaxis to prevent hemolytic disease of the foetus and newborn are
• a b o blood group and RH factor must be determined in all pregnant women preferably within the first trimester of pregnancy test must be performed using validated methods.
• all pregnant RH negative women should be given appropriate it certificate stating there are HD group and indication for IP with anti-d immunoglobulin.
• at the same time typing woman's blood group in first trimester , search for irregular antibodies to blood cells must be carried out in the plasma serum of pregnant women using indirect antiglobulin test with validated method capable of picking up the all clinicaly significant antibodies.
• HD negative women who undergo antenatal prophylaxis at 28 weeks of gestation.