Hyperbilirubinemia

ƒ Name: Baby Girl L
ƒ Age: 27 days
ƒ Date of Birth: October 22, 2009
ƒ Address: B24 B186 Street Maricaban Pasay
City
ƒ Born, preterm, baby girl delivered to a 18 years old, G2P1
(1001) via NSD. Maturity Index is 31-32 weeks AOG, APGAR
Score 9,9, Amniotic Fluid is clear.
ƒ Day of birth, placed in incubator, monitored with pulse
oxymeter and put on NPO diet. Infused IVF with D5water at
80cc/kg/day and amino steril 6%.
ƒ 2
nd
hour of life had apnea episode.
ƒ 1
st
day of life, stable and maintained on NPO and given
antibiotic.
ƒ 2
nd
day of life, she manifested jaundice
ƒ 4
th
day of life manifested and increased in jaundice and was
placed under phototheraphy.
ƒ The mother of BGL had no history of diabetes mellitus,
hypertension and asthma in their family. A non-smoker but
considered as second hand smoker because her husband
consumes atleast 1 pack of cigarettes per day. She said that
during her early month of pregnancy (1st - 2nd month) she
used to drink alcohol but after she found out about her
pregnancy she immediately stop drinking. She had not been
exposed to any medications except for vitamins. She usually
eat foods rich in preservatives and she doesnǯt eat
vegetables. During her pregnancy she still do house hold
chores that makes her stressful but most of the time she just
takes a rest and sleep.
Anthropomentric measurement as follows:
ƒ GA: 31-32 weeks
ƒ HC: 25.5 cm
ƒ CC: 23.5 cm
ƒ AC: 21 cm
ƒ Wt: 1.18 kg
ƒ L: 34 cm
ƒ T Ȃ 37.1 C
Preterm Term
Posture Lies in a relaxed attitude, limbs more
extended; the body size is small, and the
head may appear somewhat larger in
proportion to the body size
Has more subcutaneous fat tissue and
rests in a more flexed attitude
Ear Ear cartilages are poorly developed, and
the ear may fold easily;
Ear cartilages are well formed
Sole Appears more turgid and may have only
fine wrinkles
Well and deeply creased
Female Genetalia Clitoris is prominent, and labia majora are
poorly developed
Labia majora is fully developed, and the
clitoris is not as prominent
Lanugo Hair is fine and leathery, and the lanugo
may cover the back and upper arm
Less lanugo
Scarf Sign Elbow may easily be brought across the
chest with little or no resistance
Elbow may be brought to the midline of
the chest , resisting attempts to bring the
elbow past the midline
ƒ Posture Ȃ slight or moderate flexion of the
knees
ƒ Square Window (wrist) Ȃ 90 degrees
ƒ Arm Recoil - incomplete / partial flexion
ƒ Popliteal Angle Ȃ 180 degrees
ƒ Scarf Sign Ȃ elbow between opposite anterior
axillary line and midline of the thorax
-1 0 1 2 3 4 5
Skin Sticky, friable,
transparent
Gelatinous, red,
trancslucent
Smooth, pink,
visible vein
Superficial,
peeling &/or
rash, few veins
Cracking, pale
area, rare veins
Parchment, deep
cracking, no
vessels
Leathery,
cracked,
wrinkled
Lanugo None sparse Abundant Thinning Bald areas Mostly bald
Plantar
creases
Heel to toe No crease Faint red marks Anterior
transverse
crease only
Creases ant. 2/3 Creases cover
entire sole
Breast imperceptible Barely percept. Flat areola, no
bud
Stippled areola,
1-2 mm bud
Raised areola, 3-
4 mm bud
Full areola, 5-10
mm bud
Eyes/Ear Lids fuses loosely Lids open,
Pinna flat, stays
folded
Slightly curved
pinna, soft with
slow recoil
Well-curved
pinna, soft but
ready recoil
Formed and
firm with instant
recoil
Thick cartilage,
ear stiff
Female
genitals
Prominent clitoris,
labia flat
Prominent clitoris,
small labia minora
Prominent
clitoris,
enlarging
minora
Majora and
minora equally
prominent
Majora large,
minora small
Clitoris and
minora
completely
covered
Ballard¶s Assesment
Physical Maturity
October 22, 2009
ƒ Culture and Sensitivity; Blood (Bactec)
ƒ Culture:
ƒ No growth after 5 days of incubation
Interpretation:
CHEST X-RAY
Result:
ƒ The lung fields are clear with normovascular patterns.
ƒ The heart is normal in size and configuration
ƒ Bony walls and thorax are unremarkable
ƒ Soft tissue densities are w/in normal
ƒ Comment: Normal Chest
Interpretation:
Normal (female) Result
Leukocytes 4.1-10.9 6
Erythrocytes 3.8-5.5 6
Hemoglobin 12-15.2gm/dL 17.5
Hematocrit 37-46% 52
Thrombocytes 140-450 482
Lymphocytes 20-50% 52.300
Hematology
October 25, 2009
CLINICAL CHEMISTRY
ƒ Total Bilirubin 10 mg/dl .2-13
ƒ Direct Bilirubin 2 mg/dl 0-.4
ƒ Indirect Bilirubin 8mag/dl 0-1.1
ƒ Sodium 147 mg/dl 137-145
Interpretation:
October 30, 2009
CLINICAL CHEMISTRY
ƒ Total Bilirubin Neonates 3.6 mg/dl 0-12
ƒ Direct Bilirubin 1.2 0-0.2
ƒ Indirect Bilirubin 2.4 0-1.1
ƒ Interpretation:
There is an increase in Bilirubin Neonates because
of hemolysis.
ƒ Predisposing factors: age 18 yrs.old
Precipitating factors: alcohol drinker,
second hand smoker , unhealthy diet
Contributing factors: sedentary lifestyle,
exposed to pollution, stress
ƒ Signs and symptoms: maturity index (31-32
weeks), low birth weight(1180g), small birth
length(34 cm), transparent skin, more
lanugo, wrinkled skin, less vernix caseosa,
poor sucking reflex, poikilothermia, labia
minora is more prominent than labia majora,
Pre-term
Increase sequestration of RBC containing Fetal HGB
by the spleen
Release of HGB and dissolution into heme and globin
portions
heme Globin
Converted into
unconjugated bilirubin
LIVER
HGB formation
Increased accumulation
of concentration of bile
in the blood
Be used for HGB
formation
Jaundice
conjugated bilirubin
DRUG
CLASSlFl
-CATlON
FREOUENCY,
ROUTE, DOSE
lNDlCATlON
CONTRAlNDlCATlO
N
ADVERSE
EFFECTS
NURSlNG
RESPONSlBlLl-
TlES
AMINOPHYLLINE
XANTHINE
;
BRONCHO
DILATOR
I.V. 3 MG +2CC
STERILE WATER;
OD;
Reííef for
bronchospasm
HYPERSENSITIVITY
TO XANTHINE
USE
CAUTIOUSLY
WITH
NEONATES AND
INFANTS.
Before gívíng
íoadíng dose,
make sure
patíent hasnીt
had recent
theophyíínne
therapy.
Monítor VS
THEOPHYLLINE
XANTHINE
,
BRONCHO
DILATOR
I.V. 25.7 mg/ 5 Mí
0.6 mL OD
RELIEF FOR
BRONCHO-
SPASM
DONીT USE
EXTENDED RELEASE
FORMS OF ACUTE
BRONCHOSPASM
NAUSEA AND
VOMITING,
IRRITABILITY,
RESTLESNESS,
FLUSHING
USE
CAUTIOUSLY IN
NEONANATES,
MONITOR VS
Treatment and Management
DRUG
CLASSlF
lCATlON
FREOUENCY,
ROUTE, DOSE
lNDlCATlON
CONTRAlNDlCATl
ON
ADVERSE
EFFECTS
NURSlNG
RESPONSlBlLlTl
ES
CLUSIVOL
Muítí-
vítamíns
PO 0.2 mL OD
Nutrítíonaí
suppíement,
Hypersensítívíty,
Nausea and
vomítíng
Use cautíousíy ín
patíents wíth
respíratory
íneffícíency
Ferrous (Feríín
Drops)
Hema-
tínícs
PO 0.5 OD
For íron
defícíency
Contraíndícatíon ín
patíents wíth
hemosíderosís
hemoíytíc anemía
Nausea and
Vomítíng,
bíack stooí
Between meaís
are preferabíe
CUES BACKGROUND
KNOWLEDGE
NURSING
DIAGNOSIS
OBJECTIVES
Objective:
>31-32 weeks AOG
>weak suck
> 22 cc OGT
tolerated
Premature babies
are babies born
before the target
gestational age
which is 37-38
weeks. Since they
are born
prematurely most
of their organs are
still developing.
They must make
the same
adjustment
towards their
Imbalanced
Nutrition due to
Immaturity
After 8 hours of
nursing
interventions,
patient will be able
to receive adequate
nourishment to
maintain balance.
undeveloped body
systems but with
functional
immaturity
proportional to the
stage of
development
reached at the time
of birth.
Nutrition is the
combination of
processes by which
the living organism
receives and
utilizes the
materials necessary
for its growth .
INTERVENTION RATIONALE
Independent:
>use orogastric feeding
>use appropriate milk formula and
amount
>assess readiness to nipple feed
Dependent:
>maintain parenteral fluid nutrition
therapy as ordered
>administer medications as prescribed by
the physician
>patient has weak suck
>to avoid feeding intolerance
>to recognize the sucking ability and the
coordination of swallowing and breathing
>gives additional nourishment and
renews body fluid
>food supplements are necessary to
support the childǯs nutrition
EVALUATION
After 8 hours of nursing interventions, patient received an adequate amount of
calories and essential nutrients.
CUES BACKGROUND
KNOWLEDGE
NURSING
DIAGNOSIS
OBJECTIVES
Objective:
>dry, flaky skin
>thin, parchment-
like skin
>skin turgor test
(slow skin recoil)
Premature babies are
babies born before the
target gestational age
which is 37-38 weeks.
Since they are born
prematurely most of
their organs are still
developing. They must
make the same
adjustment towards
their undeveloped
body systems but with
functional immaturity
proportional to the
stage of development
reached at the time of
birth.
Risk for Imbalanced
Fluid Volume
related to
immature
characteristics of
preterm infants
After 8 hours of
nursing
interventions,
patient will be able
to exhibit adequate
hydration status
Requirements of
water are related to
caloric
consumption and
loss through
perspiration. The
daily consumption
of fluids by infants
ranges from 10-
15% of his body
weight. The
quantity of water
absorbed in the
bloodstream
changes
considerably in
order to maintain
homeostasis within
the intracellular
and vascular
compartments
INTERVENTION RATIONALE
Independent:
>minimize use of adhesives
>monitor intake and laboratory results
>monitor urine output, especially the
frequency, amount and characteristics
>apply lotion or oil over the body
>regulate parenteral fluids
>assess signs of hydration
Dependent:
>maintain parenteral fluid nutrition
therapy as ordered
>to preserve skin integrity
>shows evidence IF there is dehydration
>it may indicate the low body fluid levels
>prevent subsequent drying of the skin
>to avoid dehydration and overhydration
>to recognize if there is dehydration or
overhydration
>gives additional nourishment and
renews body fluid
EVALUATION
After 8 hours of nursing interventions, patient exhibited evidence of fluid balance.

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