Hyperbilirubinemia secondary to ABO incompatibility t/c Sepsis

Presented by: GROUP AUTONOMY , Aura Regene , Hazel , Jr-rey Merry Rose , Lecel , Charmaign , Mark Jhon , Daniel , Elisa Jarha , Angela Joselle

I. INTRODUCTION
Neonatal Hyperbilirubinemia or Neonatal Jaundice is one of the most common problems encountered in term newborns. Although up to 60 percent of term newborns have clinical jaundice in the first week of life. Jaundice is considered pathologic if it presents within the first 24 hours after birth. ABO incompatibility is a reaction of the immune system that occurs if two different and not compatible blood types are mixed together. ABO incompatibility disease afflicts newborns whose mothers are blood type O , and who have a baby with type A, B, or AB.

Ordinarily, the antibodies (IgG) against the foreign blood types A and B that circulate in mother's bloodstream remain there, because they are of a type that is too large to pass easily across the placenta into the fetal circulation. Some fetal red cells always leak into mother's circulation across the placental.These fetal red cells stimulate the formation of a smaller type of anti-A or anti-B antibody which can pass into the baby's circulation and there cause the destruction of fetal red cells. The increased rate of destruction of red cells causes a subsequent increase in waste product production. This excess waste product, bilirubin, can overwhelm the normal waste elimination processes and lead to jaundice, the presence of excess bilirubin.

put the newborn at increased risk of infection.On the other hand. . sepsis in a newborn is an infection that spreads throughout the baby·s body. such as premature or prolonged rupture of the membranes or infection in the mother. Sepsis occurs in less than 1 percent of newborns (1 out of every 100). but accounts for up to 30 percent of deaths in the first few weeks of life. Complications experienced during birth. full-term newborns. Infection is 510 times more common in premature newborns and in babies weighing less than 5½ pounds than in normal-weight.

Her mother and father blood type was O while baby Girl Autonomy blood type was A. Laguna and delivered via NSD by her mother last July 30. She has undergone intermittent phototherapy at her first day in Septic Intensive Care Unit then she was under intensive phototherapy when we last handled and visited her. 2010 because of jaundice and fever. she has been diagnosed by hyperbilirubinemia secondary to ABO incompatibility tc sepsis.BACKGROUND OF THE STUDY Baby Girl Autonomy is a full term baby from Pila. 2010 at LPH and has been admitted at septic ward (PICU) last August 1. .

RATIONALE FOR CHOOSING THE CASE This case has been chosen by the group under following reasons: ‡To better understand Hyperbilirubinemia with ABO incompatibility its nature and appropriate interventions that may contribute to patient·s recovery. ‡To defy our capabilities in presenting such challenging case. ‡ Challenge our skills in connecting relevant details of the disease to actual care of client. ‡To benefit the student nurses in enhancing their skills in giving care for such patient diagnose with Hyperbilirubinemia with ABO incompatibility. ‡Be able to construct a pathophysiology. .

. we hope to be of help to our fellow students by sharing first hand experiences about the condition. Hence. is to aid in prompt and successful client recovery.SIGNIFICANCE OF THE STUDY To the patient This study hopes to be most beneficial to the patient as the core purpose of this. To the students & to the Clinical Instructor This study presents various observations and encounters upon handling the client and sustaining for her recovery.

SCOPE AND LIMITATION OF THE STUDY This study covers and focuses on the following: ‡A brief discussion of Hyperbilirubinemia with ABO incompatibility. ‡Nursing Care Plans which would present nursing analysis. its causes. ‡A drug study of medications prescribed to patient. . plan and appropriate interventions that would aid in patients recovery. ‡A pathophysiology presented via schematic diagram format of Hyperbilirubinemia with ABO incompatibility. diagnosis. ‡Discharge plan which presents follow up care and treatment after confinement. manifestations and proper treatment.

Diagnosis : Baby Girl Autonomy 2 days old Female hyperbilirubinemia secondary to ABO incompatibility tc sepsis Pila. M. Sex : d.Time of Admission h. Laguna August 1.II. e. Date of Admission g. Age : c. Bio-demographic Data a. CLINICAL SUMMARY Eclectic Model 1. Name : b. 2010 6:54pm Sheryl Fandino. Address f.D. Attending Physician : : : : .

Source of Information a. Chief Complaint: Onset of fever and jaundice 4. The Pediatric Residence on Duty seen and examined her and the physician ordered to hold MGH and requested for CBC. Baby GA started to have fever and they have noticed that her skin became yellowish in color after 24 hours. July 31. History of the Present Illness: According to her grandmother. the PROD requested for Bilirubin Test and ordered to Tepid Sponge Bath the patient as well as to have intermittent phototherapy. when they were able to go home last Saturday. The patient then transferred to PICU Septic ward on August 1. Secondary Sources: ‡ Patient·s records and chart 3. Afterwards. . Sunday at exactly 6:54 pm. after Baby Girl Autonomy was born. Primary Sources: ‡Mother ‡Grandmother ‡Nurses on Duty b.2.

c. Current Health Status: a. b. Affect and Mood She·s crying at times. Nutrition Baby Girl Autonomy is being directly breastfed with aspiration precaution by her mother. Elimination She only defecated twice since she was born. c. Rest and Sleep Baby GA sleeps most of the time. Grooming and Body Odor She has no foul odor because she usually cleaned every morning and dressed neatly by her mother. . Hygiene. 6. Manner of Dressing Baby Girl Autonomy is properly and neatly dressed by her mother. b. d. Activities of Daily Living a.5. Body Movement: Baby GA is fairly active and flexes her upper and lower extremities well.

we·ve found out that she has a history of Hepatitis B since her uncle on father·s side has the disease. 8. c. b. They believed in ´hilotsµ or ´herbulariosµ.7. Laguna. 9. c. Foreign Travel No foreign travel so far. Cultural Pattern Her family believes in ´herbolariosµ and superstitions like putting wet silk on the baby·s forehead when hiccups occur. . Spiritual a. Socio Cultural Pattern a. She·s not yet also undergone newborn screening. d. Family Health History Upon the interview. Environment They lived in a well-adjusted community along the highway in Pila. They only received enough income to meet the needs of their family in everyday living. Allergies Baby GA has no history of any allergies noted so far. Economic Pattern Baby Girl Autonomy·s father works in a vulcanizing shop while her mother is only a housewife. Religious Belief and Practice Baby GA·s family is a Roman Catholic and goes to church every Sunday. b. Immunization She only received Vitamin K and Hepa B vaccine immediately after birth and no immunization vaccines received so far. Past Biophysical Health a.

7 kg . General Appearance and behavior ‡Weak in appearance ‡With yellowish discoloration of the skin ‡Skin warm to touch b.Vital Signs Temperature = 38.Physical Assessment General Observation a.1 C CR RR = 121 bpm = 39 cpm c. Height and Weight Height (Length) = 57 cm Weight = 2.

Complete Physical Examination (Head to Foot/ Cephalo ² caudal Approach) physical assessment landscpe.docx .

Laboratory and Diagnostic Examination August 1.32 UMOL/L Normal Values 1.0-10.2Mg/dl 328 UMOL/L 0.2Mg/dl 328.6-10.5 10-180 Above normal Conjugated Bilirubin 0 0 0-0.1-180 Indication Above normal Significance Due to ABO incompatibility. increase destruction of RBC resulting in increase unconjugated bilirubin Due to ABO incompatibility. 2010 Test Neonatal Bilirubin Result 19.5 17.6 0-10 Normal . increase destruction of RBC resulting in increase unconjugated bilirubin Unconjugated bilirubin 19.

3RM 35.0pg Normal Normal Normal Normal Above normal Increase related to B12 or folic acid deficiency Increase lysis RBC.0 fl 26.0-32. sometimes immature MCHC RDW 35.2G/DL 49.0-97.6-4.0-7.0% 31.8 37.5-14. parasitic infections Lymphocytes 8.5 UL Normal Values 4.07 M/UL 17.viral.0%M 12.CBC Test WBC Result 23.0-51.0-18.0-58.20-6.8-12.0-36.4 R3 52.0% 96.8%G Normal Above normal RBC Hemoglobin Hematocrit MCU MCH 5.0%G 4. body response is to provide more RBC.1 10.5%L 0.5% Normal Above normal Platelet 307 k/ul 140-440 k/ul Normal .2%L 0.0 g/dl 11.0%M 2.7fl 33.30M/UL 12.0G/DL 37.81-24.9 k/UL Indication Above Normal Signifcance Increase related to compensatory of immune system in response to infection Increase related to the compensatory of immune system in response to infection Increase may indicate bacterial.0% 80.1-10.0-92.1 g/dl 16.0 pg Above normal MID Granulocytes 2.

Initial impression and Medical Diagnosis Hyperbilirubinemia 20 ABO incompatibility t/c sepsis .

the chart was checked to gather information about the patient and if there are new doctor·s order for the patient. wrap extremities with blanket and loose clothing and note for any shaking. the temperature was decreased to 370C. at 4am. Because of fever. Then. nursing managements were done such as: TSB.10C. At 6am. we endorsed her to the staff nurses. Temperature was taken again at 12:30 am with body temperature of 38. The heplock was inserted in her right metatarsal vein. Vital signs were taken at 10:30pm. We also reminded the patient·s mother to feed the baby with milk formula with strict aspiration precaution. Physical assessment was done to the patient. intermittent droplight.7 kg at around 2:40am. We recorded 370C for the temperature and 39cpm for respiration and lastly for the cardiac rate which results to 121bpm. . She has also undergone intermittent phototherapy. chills or profuse sweating. The cardiac rate was maintained at 121bpm and 36cpm for the respiration.Course in the Ward Day 1 August 2. We weighed the patient which results to 2. 2010 The shift started at 10pm.

We weighed again the patient but the result was still the same.Vital signs were taken at 12am that showed 37.20C for the temperature.30C. 34cpm for respiration and lastly for the cardiac rate of 111bpm.Vital signs were taken again at around 4am with the body temperature of 37.Day 2 August 3. observed her for any shaking. chills or profuse diaphoresis and inspected her oral cavity for white plaques.The heplock was inserted at her right metacarpal vein. The new order was to place the patient under intensive phototherapy and may have direct breastfeeding. 2010 The shift started at 10pm. practiced standard precaution aseptic technique. we monitored her visitors as indicated. Since she was at risk for infection. 33cpm for respiration and 116bpm for cardiac rate. the chart was checked again for any new doctor·s order. . Physical assessment was done again to the patient. At 6am. we referred her accordingly to the staff nurses.

We also repositioned the patient every 2 hours.Day 3 August 4.30C.The heplock was still inserted at her right metacarpal vein. We also assessed her for any abnormalities or progress. We weighed the patient which resulted the same. the chart was checked for progress of the condition of the patient and for new doctor·s order which indicated direct breastfeeding with aspiration precaution and continue intensive phototherapy. . We also rendered interventions such as covering her eyes with eye patches while under phototherapy lights. At 6am.Vital signs were taken at 12am.Vital signs were taken again at around 4am with the body temperature of 36. 40cpm for respiration and lastly. drainage and corneal abrasions due to irritation from eye patches. removing her from phototherapy during feeding and providng minimal coverage only in the diaper area. we refer her accordingly to the staff nurses. temperature was 370C. 35cpm for the respiration and 126bpm for cardiac rate. We inspected her eyes for conjunctivitis. cardiac rate of 121bpm. 2010 The shift started at 10 pm.

III. CLINICAL DISCUSSION OF THE DISEASE ANATOMY AND PHYSIOLOGY .

LIVER FUNCTIONS: ‡Metabolism of carbohydrates. steroid and vitamins ADEK ‡Blood reservoir ‡Excretion of adrenal cortex hormone ‡Phagocytosis by kupffer cells . protein and fats ‡Production of bile salts ‡Bilirubin metabolism ‡Detoxification of endogenous and exogenous substances eg. Ammonia.

bile salts.GALL BLADDER FUNCTIONS: ‡Stores and concentrates the (greenish liquid composed of watr. cholesterol. cholesterol and other lipids ‡Bile also acids in excretion of conjugated bilirubin (an end product of hemoglobin degradation) from the liver to prevent jaundice . electrolyte and phospholipids) produce by the liver ‡Important in fat emulsification and intestinal absorption of fatty acids.

NORMAL ANATOMY OF BILIRUBIN PRODUCTION AND ELIMINATION NORMAL ANATOMY OF BILIRUBIN PRODUCTION AND ELIMINATION.docx .

ANATOMY OF ABO BLOOD GROUPS YouTube .flv .Blood groups and Blood compatibility.

Pathophysiology PATHOPHYSIOLOGY---NEW....doc ..doc PATHOPHYSIOLOGY---NEW...

Drug Study Drug name Generic name: Amikacin sulfate Brand name: Amikin DOSAGE: 17 mg IV OD Classification Amino glycosides Mechanism of action Bactericidal: Inhibits protein synthesis in susceptible strains of gramnegative bacteria and the functional integrity of bacterial cell membrane appears to be disrupted. -Monitor intake and output and daily weight to assess hydration status and renal function. preexisting hearing loss. First dose may be given before receiving results. urticaria. -Assess patient for sign of super infection (fever.) Contraindication Contraindicated with glycosides renal or hepatic disease. pruritus and hypotension -Obtain specimen for culture and sensitivity before initiating therapy. infant botulism. Indication Neonatal sepsis when other antibodies cannot be used (often used in combination with penicillin type drug. lactation. myasthenia. Adverse effects -confusion -depression -lethargy -nysthagmus -headache -fever -tremor -muscle twitching -seizures -muscular weakness -nausea -vomiting -anorexia -diarrhea -weight loss -increased salivation Nursing Responsibilities Assess patient for allergic reaction: rash. causing cell death. upper respiratory infection.) . gravis parkinsonism.

biliary and intestinal tracts. .Drug name Generic name: Ampicillin Brand name: Principen DOSAGE: 165 mg IV every 12 hours 6/6 Classification Anti-infectives· Mechanism of action Bactericidal action against sensitive organisms. Indication Treatment of a variety of infections including those of the urinary. -Report pain/ discomfort at site unusual bleeding/ bruishing. -Assess skin for ampiciilin rash a non allergic dull red. cephalosporin· s or other allergens Adverse effects Hypersensitivi ty: rash. wheezing). First dose may be given before receiving results. stool and WBC) at the beginning and throughout the therapy. Discontinue the drug and notify the physician or other health care. and anaphylaxis. Contraindicati on Contraindicate d with allergies to penicillin·s. Nursing Responsibilities Assess for infection (Vital signs. difficulty of breathing. -Obtain a history before initiating therapy to determine previous use reaction to penicillin or cephalosporin·s. pruritus. wheezing. fever. respiratory. -Observe patient for signs and symptoms of anaphylaxia (rash. mouth sores. -Obtain specimens for culture and sensitivity before therapy. urine. inhibits synthesis of bacterial cell wall easing cell death.

impaired liver or renal function. May cause decreases serum bilirubin concentration in neonates.Drug name Generic name: Phenobarbital Brand name: Luminal sodium DOSAGE: 15 mg pptab mixed with feeding 12 hours 12/12 Classification Mechanism of action General CNS depressant. adventitious sounds and bowel sounds 5. manifest or latent porphyria. marked severe liver impairment. Antiepileptic . 4. barbiturates inhibit impulse conduction in the ascending RAS. reflexes. 3. Assess patients condition before therapy and regularly. seizure disorders. Indication Emergency control of acute seizures Contraindication Adverse effects Contraindicated with hypersensitivity to barbiturates. Monitor for possible drug adverse reaction. lactation. these after to monitor drug effectiveness 2. severe respiratory distress -Use cautiously with acute/chronic pain. Assess skin color. in patients with congenital nonhemolytic unconjugated hyperbilirubinemia and in epileptic. Monitor respiration character rate and rhythm. Hold drug if respiration < 10 / minutes or if pupil are dilated. -confusion -bradycardia -pain -tissue necrosis at injection site Nursing Responsibilities 1. depress the cerebral cortex. fever.

actually elevating temp.10C direct effect of circulating ‡Warm to endotoxin on touch. limit bed linens as indicated (3)Perform TSB. (4)Apply towel to provide cooling effect (5) Maintain bed rest. (3)May help reduce fever. alcohol may cause chills. ‡Weak & pale the hypothalamus in appearance altering temperature ‡persistent regulation as crying ‡With slightly evidenced by increase in dry lips body temp.) maximizes activity effectiveness of tissue perfusion (6) Promote surface and energy/oxygen cooling by means of conservation undressing (6)heat loss by evaporation .10C to 370C. Heat loss by conduction Evaluation After 4hrs. NURSING CARE PLAN Planning After 4hrs.Assessment Diagnosis Hyperthermia related to Objective: ‡Temp 38. the patient will maintain core temperature within normal range (370C). of blanket should be altered to maintain nearnormal body temp.. of nursing interventions. assist with care 5. Intervention (1)Monitor patient¶s temperature (2)Monitor environmental temp. avoid use of alcohol Rationale (1) to evaluate degree of hyperthermia (2) Room temp or no.of nursing interventions. alcohol is very drying to skin (4)used to reduce fever. the patient was able to maintain core temperature within normal range from 38. higher than normal range IV.

Ineffective infant feeding pattern related to limited consumption of breast milk as evidenced by the mother is unable to provide adequate breast milk to her baby continuously. NCP new (feeding pattern).doc .

Rationale (1)Protects retina from damage due to high intensity light. (6) Reposition baby every 2hours. As evidenced by infant¶s eyes are free from corneal irritation and skin breakdown. (4) Inspect eyes every after phototherapy for conjunctivitis. (5) Provides maximal exposure and shielded the sensitive parts such as the eyes and genitals. . (6) to promote equal distribution of phototherapy exposure. Intervention (1) Maintained and monitored baby¶s eye patches while under phototherapy. (2) Remove baby from under phototherapy and remove eye patches during feeding. (4) to reduce complications and monitor the effectiveness of the management Evaluation After series of nursing Interventions Neonate was free from injury. the patient¶s risk of acquiring corneal irritation/skin breakdown will be reduced. ‡Sclera appearing yellow. (5) Provide minimal coverage of the body except for genitals. drainage and corneal abrasions due to irritation from eye patches. (2) Provides visual stimulation and facilitates attachment behaviors.Assessment Objective: Diagnosis Risk for corneal irritation and ‡patient is in skin intensive breakdown photo therapy related to prolonged for 3 days used of phototherapy ‡With single photo therapy ‡Frequent removal of the eye patches ‡Skin appearing light to bright yellow. ‡With diaper on Planning after series of nursing interventions.

‡Advised SO to seek medical advice if any unusuality arises.V. . Treatment: ‡Emphasized SO the importance of regular follow-up check-ups and as instructed by physician. Environment: ‡Encouraged SO to keep environment clean to avoid infection. Health Teachings: ‡Advised SO to expose the patient to sunlight around 6:00am-8:00am. DISCHARGE PLAN Medications: ‡Encouraged SO to comply with medications to prevent further complications. ‡Emphasized to SO the importance of proper handwashing. ‡ Encouraged SO to keep environment quiet to make the patient comfortable. ‡Encouraged SO for proper hygiene of the patient.

Spirituality: ‡Encouraged SO and Family members to go to church every Sunday. EVALUATION ‡The nursing procedure was rendered to the patient accordingly. ‡Emphasized SO the importance of prayers in healing. . ‡Encouraged SO to continue to seek God·s guidance and enlightenment. skills and attitudes of providing care for the patient. ‡Encouraged SO to continue to have a positive outlook in life. Application of these procedures was done independently by the group autonomy. the knowledge.Diet: ‡Encouraged the mother for breast feeding.

flv Our case study is all about Hyperbilirubinemia with ABO incompatibility. or AB.SUMMARY YouTube . The doctor ordered complete blood count and bilirubin test.neonatal jaundice. The laboratory result confirms her diagnosis Hyperbilirubinemia because of high neonatal bilirubin and high unconjugated bilirubin. Hyperbilirubinemia also known as neonatal jaundice is a yellow discoloration of the skin of a baby due to high unconjugated bilirubin because of breakdown of RBC and immaturity of the liver. also there·s high WBC and lymphocytes in her CBC that·s why she experienced fever. . so she was admitted to septic ward (PICU). and her baby blood type was A. Our patient was also diagnosed from ABO incompatibility because her mother and father were blood type O while baby girl autonomy was blood type A. Our patient Baby Girl Autonomy was diagnosed from Hyperbilirubinemia secondary to ABO incompatibility t/c sepsis because she experienced fever and her skin became yellowish in color after 24 hours after delivery which is a physiologic sign of jaundice. B. During our duty Group Autonomy rendered quality nursing care for our patient to aid quick and successful patient recovery. while ABO incompatibility occurs when mother blood was O.

we conclude that ABO Incompatibility afflicts newborns whose mothers are blood type O can lead to destruction of RBC·s. The incresed rate of destruction of RBC·s causes a subsequent increase in bilirubin that can overwhelm the normal waste product elimination processes and lead to jaundice. still. We·ve also rendered some health teachings to her family and provided them support. she has jaundice but has normal normal vital signs.CONCLUSION Therefore. At the end of our shifts. we maintained the core temperature of our patient within normal range since she had a hyperthermia. This type of condition of our patient requires phototherapy as its treatment. we met our goals in providing her safety and comfort.We seen her at ntervals and attended her needs. As student nurses. At the last day in the ward. . practiced aseptic technique since she was at risk for infection and prtected her from any injury.

RECOMMENDATION To the students: ‡Study their lessons first before going to the area. ‡Emphasize SO for the proper hygiene of the patient. ‡Instruct SO to take regular medication of the patient prescribed by the physician. ‡Be responsible enough as a student nurse. ‡Always follow the hospital rules. ‡Encourage mother for breast feeding and instruct its importance. ‡Give quality nursing care to the patient. ‡Bring complete parafernalias. To the patient: ‡Encourage SO of the patient for regular check up. .

End of our Case Presentation Thank you« .

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