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MAY CASE STUDY - TOPIC: Fibreoptic phototherapy for neonatal jaundice.













Baby Faith is 18-hour old newborn born by spontaneous vaginal delivery to a 23-year-old gravida 2, para 1, blood type O-negative mother.


Uncomplicated pregnancy. Rupture of membranes 7 hours prior to delivery with clear fluid. APGARs 7 and 9. 


Mom states that breastfeeding-  is a struggle; baby has a poor latch and is easily frustrated. Mom has sore nipples.


General - Slightly lethargic, crying with exam, flexed posture, visible jaundice


Vital signs - T 37.3C/ 99.1F, HR 144, RR 48


HEENT - Fontanelle slightly depressed, eyes and ears normal set/shape, sclera yellow, palate intact, tongue with Epstein pearls, dry mucous membranes


Cardo/Respiratory - No murmur, pulses +2 bilaterally, breath sound clear


Gastrointestinal/Genitourinary - Soft, non-distended, liver palpable, umbilical stump intact/clamped; passed 1 meconium stool, voided 1 time since birth.


The client is most likely experiencing:

  • Breastfeeding jaundice

  • Pathological jaundice

  • Physiological jaundice


Due to:

  • Poor breastmilk intake

  • Hemolysis

  • Impaired excretion

  • Infection


Select the nursing action(s) from each of the categories the nurse should anticipate including in the plan of care. Each category may have one or more nursing action(s).


Therapy - Phototherapy

  • Apply Eye shield

  • Monitor temperature hourly

  • Start/Practice? Kangaroo care

  • Monitor phototherapy light level

You can vote for more than one answer.



Therapy - Nursing

  • Contact Lactation consultant

  • Encourage breast feeding every hour

  • Supplement feedings with infant formula

  • Weigh diapers

You can vote for more than one answer.



What is the most serious complication of neonatal jaundice?

  • A - Anemia

  • B - Kernicterus

  • C - Infection

You can vote for more than one answer.


311 views7 comments

7 Comments


Guest
Jun 04

The first step in managing the neonate would have been to check

Total bilirubin levels

Direct coobs test

Hematocrit

Hemoglobin

The results from the above would determine the course of management in regards to phototherapy, exchange transfusion and intravenous immunoglobulin  

Action with its rationale

Eye shield Phototherapy lights can cause retinal damage,

Monitor temperature hourly hyperthermia, and bronzed baby syndrome.

The nurse must plan interventions to decrease the risk of these adverse effects of therapy.

Weigh diapers to monitor hydration status Dehydration is potential complication of phototherapy. Phototherapy increases insensible water losses.

Lactation consultant*- A lactation consultant can help the breastfeeding parent maximize the efficiency of the time breastfeeding. Although this neonate is struggling to breastfeed,

supplementing feedings with formula are…

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Guest
May 29

Baby is dehydrated, ivf admistration is necessary

Baby's blood group should be checked to rule out ABO incompatibility

The cause of jaundice is most likely due to ABO incompatibility or Pathological because the jaundice occurred at 18 hour of life

Serum bilirubin should be monitored closely


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Guest
May 29

We have to know the blood group of the baby and the baby need to receive iV fluids because the baby is dehydrated.

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Baby is clearly dehydrated

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Blood group of the father is also essential for adequate nursing care.

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