Vicente Sotto Memorial Medical Center B.

Rodriguez Street, Cebu City

Nursing Service Division Training Office

A CASE REPORT ON

Submitted by: Nina Fe R. Nunez Sharmaine Keith Daitol Jillyn Loquero Rosemarie Tan NICU June 1- August 31, 2012

TABLE OF CONTENTS

I. ACKNOWLEDGEMENT- ------------------------------------------------------------2

II. Introduction- ----------------------------------------------------------------------3 A. Objectives --------------------------------------------------------------------------------4 B. Background of the Study --------------------------------------------------------------5 C. Rationale for Choosing the Case -----------------------------------------------------5 D. Significance of the Study --------------------------------------------------------------6 E. Scope and Limitations ------------------------------------------------------------------6 III. Clinical Study ------------------------------------------------------------------7 A. Demographic Data ----------------------------------------------------------------------7 B. Physical Assessment --------------------------------------------------------------------8 C. System Affected ------------------------------------------------------------------------10 D. Laboratory and Diagnostic Exam ----------------------------------------------------11 IV. Clinical Discussion ---------------------------------------------------------------14 A. Anatomy and Physiology --------------------------------------------------------------14 B. Pathophysiology ------------------------------------------------------------------------17 C. Nursing Care Plan ----------------------------------------------------------------------18 D. Drug Study ------------------------------------------------------------------------------22 E. Course in the Ward --------------------------------------------------------------------26 F. Discharge Plan --------------------------------------------------------------------------26 G. Evaluation --------------------------------------------------------------------------------28 H. Summary ---------------------------------------------------------------------------------28 I. Recommendation -----------------------------------------------------------------------28 J. Bibliography -----------------------------------------------------------------------------29

ACKNOWLEDGEMENT We would greatly like to acknowledge and extend our words of gratitude to the following people in helping us envision and thoroughly accomplish this said proposal/project: To Mrs. Araceli Navarro, our Nurse Area Supervisor, for the support and inspiring us not to give up in lifes struggles. For giving out warm ideas and extending her appreciation and her motherly love to us. To Mrs. Rebecca Ruedas, our Senior Nurse, for showing positive support in the whole 3 month journey in the delivery room, that even the littlest and slightest ideas that we imagined were appreciated. For making our duty days fun and want to learn for more. To our colleagues and Staff Nurses, for their guidance in our everyday duty. For the help, support and inspiration. They serves as our role model in our everyday struggle. To our Midwives, whom we treated our second mothers, for strengthening our confidence and inspiring us to do our best may it be inside or outside of duty. To the PEDIA Residents who have been our allies and giving out their ideas and knowledge about how to deliver the baby safely and how to care for mothers well. Also, for giving out their suggestions and concerns of what the delivery room needs which we think would be a long-term benefit to the area. To our Instructional Workers (I.Ws.) for being there for us when we need them and giving us the memorable laughs and the spirit of camaraderie and team building. To Dr. Christopher G. Samson , our Public Health Adviser, for being our guide, for patiently answering our questions -- repeated or not, complicated or not. We greatly appreciate your kindness and compassion to bring and heighten our knowledge about health in general and what the hospital needs. To the Department of Health, for giving us avenues for the improvement of hospital facilities and services for the benefit of the clientele it caters. To our Patients who have made us stronger and more skilful to do our jobs well, not to settle for less and to the smiles they brought that made our hearts melt and say wow, Im very proud to be a nurse. To VSMMC and all its personnel , for the fun-filled experience, for giving us so much knowledge and sharpening our skills to become a world class nurses.

And to our Lord Almighty, for unconditionally bestowing us with good blessings and graces, small or big, everything He gives is always for the good of us. Without Him, it would all be nothing. Our group has been very optimistic and excited to present this proposal; that this proposal will not just be a history that will be forgotten, but if taken into action and becomes a reality, will become a big benefit and great help to this institution our dear VSMMC.

I. Introduction
HYPERBILIRUBINEMIA Neonatal Hyperbilirubinemia or Neonatal Jaundice in newborn is one of the most common problems encountered in term newborns. Although up to 60 percent of the term newborns have clinical jaundice in the first week of life. Hyperbilirubinemia is a condition in which there is too much bilirubin in blood. When red blood cells breakdown, a substance called bilirubin is formed. Babies are not easily able to get rid of the bilirubin and it can build up in the blood and other tissues and fluids of the babys body. This is called Hyperbilirubinemia. Because of bilirubin has a pigment or coloring, it causes a yellowing of the babys skin and tissues. This is called jaundice. Depending on the cause of the hyperbilirubinemia, jaundice may appear at birth or at any time afterward. General signs and symptoms are yellow eyes, skin, tiredness, fatigue, light colored stools, and dark urine. During the pregnancy, the placenta excretes bilirubin. When the baby is born, the liver of the baby must take over this function. There are several causes of hyperbilirubinemia and jaundice, including (1) Physiologic Jaundice this is normal response to the babys limited ability to excrete bilirubin in the first days of life. The manifestation of jaundice is after 24 hours (2) Pathologic Jaundice this may be related to inadequate liver function due to infection or other factors. The manifestation of jaundice is within 24 hours (3) Breast milk Jaundice about 2% of the breastfed babies develop jaundice after the first week. Some develop breast milk jaundice in the first week due to low calorie intake or dehydration and (4) Jaundice from hemolysis jaundice may occur with the breakdown of RBCs due to hemolytic disease of the newborn (RH disease), having too many RBCs or bleeding.

Hyperbilirubinemia affects 60% of full-term infants and 80% of preterm infants in the first 3 days after birth. In the present study of the Department of Health (DOH), 3, 278 male newborns were screened for hyperbilirubinemia. Results show that of 3, 278, 186 screened to have a positive result. Of the 186, 65 boys had a confirmatory testing, 45 were confirmed to have hyperbilirubinemia and 20 had normal results. In the Philippines, there is a prevalence rate of 4.5% to 25.7%. This study reveals an incidence of 3.9% among male Filipinos.

A. OBJECTIVES General Objective: This case study aims to present to the readers the nature of

Hyperbilirubinemia, the origin and the effects it does on the neonate body. It also encompasses the proper approach in a patient with this kind of disease. This study aims to broaden the knowledge of the readers about this condition. Specific Objectives:

To improve knowledge on:

The fundamental information about Hyperbilirubinemia including its risk factors, etiology, signs and symptoms, and treatment

The pathophysiology of the disease

To enhance skills on:

The appropriate approach to a newborn patient undergoing systemic changes and adaptation Formulating nursing care plans and independent nursing interventions to care for fully dependent patient Different types of medical treatment necessary for hyperbilirubinemia

To modify attitude on:

Caring a newborn patient with hyperbilirubinemia Confidence in managing patients with this kind of condition

Our sense of unselfish love and empathy rendering nursing care to our patient so that we may be able to serve future clients with higher level of holistic understanding, as well as individualized care.

B. BACK GROUND OF THE STUDY Baby Boy V is Full term infant from Medellin, Cebu, born of a 39 years old G4P4 delivered via CS by her mother last Aug. 08, 2012. The newborn has been admitted at Neonatal Intensive Care Unit (NICU) because of jaundice. The patient has been diagnosed with Hyperbilirubinemia. He has undergone intensive phototherapy treatment at his first day in NICU. When we handled him, the newborn was already well and in good condition. We decided to present this case in our eagerness to learn and explore new knowledge and information about this type of newborn condition. Our group wants to formulate a correlation among the conditions that manifests in baby boy V. We believe that this can be of great help in performing appropriate nursing interventions to the patient. Our group also wants to focus on hyperbilirubinemia, which is common among newborns. It is a significant topic for the mothers especially for those who are pregnant. It is of great advantage that they have knowledge about this condition.

C. RATIONALE FOR CHOOSING THE CASE

This case has been chosen by the group under the following reasons:

To better understand Hyperbilirubinemia, its nature and appropriate nursing interventions that may contribute to patients recovery To benefit the student nurses in enhancing their skills in giving care for patient diagnosed with Hyperbilirubinemia To defy our capabilities in presenting such challenging case To challenge our skills in connecting relevant details of the disease for actual patient care

D. SIGNIFICANCE OF THE STUDY This study is done for the benefits of the following:

To the patient this study hopes to be most beneficial to the patient as the core purpose of this, is to aid in prompt and successful client recovery To the students this study presents various observations upon handling the client and sustaining for her recovery. We hope to be of help to our fellow students by sharing first hand experiences about the condition

E. SCOPE AND LIMITATION This study covers and focuses on the following:

A brief discussion of the disease and its causes, manifestations, and proper treatment A pathophysiology presented via schematic diagram format of Hyperbilirubinemia A drug study of medications prescribed to patient Nursing Care Plans which would present nursing analysis, diagnosis, plan, and appropriate interventions that would aid in patients recovery.

Discharge plan which presents follow-up care and treatment after confinement.

II. Clinical Study

DEMOGRAPHIC DATA Patient Name Age Sex Birth Date Address : : : : : Baby Boy V. Newborn Male August 08, 2012 Medellin, Cebu August 10, 2012 10:30am HYPERBILIRUBINEMIA

Date of Admission : Time of Admission : Admitting Diagnosis: Source of Information

Primary Source

Mother Patients records/ chart

Secondary Source :

Chief Complaint:

duha na ka adlaw ngyellow akong anak as verbalized by the mother

History of Present Illness According to patients mother, when Baby Boy V was born, she noticed that her babys skin became yellowish in color for 2 days. The Pediatric Resident on Duty (PROD) seen and examined him and the physician ordered and requested CBC and B1, B2. The patient then admitted to NICU on Aug. 10, 2012, friday at exactly 10:30am, afterwards, the PROD requested for Bilirubin Test and to have an intensive (continuous) phototherapy.

B. PHYSICAL ASSESSMENT slightly yellowish skin color and sclera with dry skin with desquamation of the skin with covers on eyes and genitals with good sucking reflex afebrile with negative (-) adventitious breath sounds upon auscultation on both bilateral lung fields Head fairly active with good sleeping habit normocephalic symmetrical in shape no masses, no lesions Non bulging and non depressed anterior and posterior fontanels Hair Eyelids Sclera Iris No signs of caput succedaneum and cephalhematoma evenly distributed over the scalp with black, straight and thick hair lids close symmetrically with eyeshield no edema, and no discharges slightly yellowish symmetrical in size round and black Symmetrical in size round and dark brown in color PERRLA (Pupils Equally Round And React To Light and Accommodation) equal in size auricles are smooth and symmetrical pinna recoils after it is folded the external nose is symmetrical and straight

General Appearance -

Pupils

Ears

Nose -

color is the same with the entire face lesions and tenderness were both absent nasal mucosa was pinkish both left and right nares were patent nasal septum is intact and in midline without deviations cilia present in internal nares absence of nasal discharge no signs of nasal flaring pinkish and moistened dry oral mucous membrane frenulum intact at midline tongue was located at the midline, pink in color, slightly dry and furry with whitish coating tongue moves freely uvula is in midline neck movement was coordinated and difficulty in moving was not noted free from lumps and no tenderness no masses and tenderness upon palpation no adventitious breath sounds upon auscultation on both left and right lung fields negative retractions round in shape, no lumps, no masses areola dark brown in color nipples round, equal in size same color of the body globular, soft without distention bowel sounds in all quadrant skin pinch goes back quickly good range of motion was noted no lesions, no presence of abnormalities, no tenderness can flex and extend arms without difficulty

Mouth -

Neck Thorax -

Breast Abdomen -

Upper extremities

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Lower extremities

skin uniform in color good range of motion was noted no lesions, no presence of abnormalities, no tenderness can flex and extend legs without difficulty no discharges no bleeding With slightly normal genitalia (labia majora almost covers the clitoris) With genital shield With patent anus Are present such as moro, babinski, rooting, and plantar grasp reflex sucking,

Genitalia

Elimination Reflexes

C. SYSTEM AFFECTED Digestive System Hematologic System

D. LABORATORY AND DIAGNOSTIC EXAM Bilirubin Test September 19, 2010

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TEST Neonatal Bilirubin

RESULT 20.5 mg/dl

NORMAL VALUE 1.0-10.5 mg/dl

INTERPRETATION Increased

SIGNIFICANCE Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin An abnormal accumulation of bilirubin in the blood caused by the poor function of the liver Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin

Unconjugated bilirubin

18.56 mg/dl

0.6-10.5 mg/dl

Increased

Conjugated bilirubin

1.59 mg/dl

0-0.6 mg/dl

Increased

September 20, 2010 TEST Neonatal Bilirubin RESULT 25.5 mg/dl NORMAL VALUE 1.0-10.5 mg/dl INTERPRETATION Increased SIGNIFICANCE Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin An abnormal accumulation of bilirubin in the blood caused by the poor function of the liver Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin

Unconjugated bilirubin

24 mg/dl

0.6-10.5 mg/dl

Increased

Conjugated bilirubin

1.50 mg/dl

0-0.6 mg/dl

Increased

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September 23, 2010 TEST Neonatal Bilirubin RESULT 11.10 mg/dl NORMAL VALUE 1.0-10.5 mg/dl INTERPRETATION Increased SIGNIFICANCE Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin An abnormal accumulation of bilirubin in the blood caused by the poor function of the liver

Unconjugated bilirubin

10.9 mg/dl

0.6-10.5 mg/dl

Increased

Conjugated bilirubin

0.20 mg/dl

0-0.6 mg/dl Complete Blood Count

Normal

September 19, 2010 BLOOD COMPONENTS Hemoglobin RESULT 11.0 g/dl NORMAL VALUE 13-19g/dl INTERPRETATION Decrease SIGNIFICANCE Decrease hemoglobin will result to decrease of oxygen supply to the body due to bilirubin in the bloodstream that is trying to get out Increase WBC signifies infection in the body. Decrease hematocrit indicates that the mass of RBC is decrease

White Blood Cells (WBC) Hematocrit

17.9 33%

4.5-10.5 x 10 9/ L 42-59%

Increase Decrease

III. CLINICAL DISCUSSION

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A. ANATOMY AND PHYSIOLOGY

Liver

The liver is the largest glandular organ in the body; its office is to secrete bile. It is oblong and oval in shape, and occupies the position on the right side, under the lower ribs.

Metabolism of carbohydrates, protein and fats Production of bile salts Detoxification of endogenous and exogenous substances Blood reservoir

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Excretion of adrenal cortex hormone Storage of vitamins such as Vitamin A and D

Spleen

Act as reservoir of red blood cells Sequesters the old, worn-out RBCs thereby removing them from the circulation

Gall Bladder

A pear shaped organ located on the liver that stores bile.

Function:

Stores and concentrates the (greenish liquid composed of watr, cholesterol, bile salts, electrolyte and phospholipids) produce by the liver

Important in fat emulsification and intestinal absorption of fatty acids, cholesterol and other lipids

Cystic Duct

Short duct that joins the gall bladder to the common bile duct. Bile can flow in both directions between the gallbladder and the common hepatic duct and the (common) bile duct.

Pancreas

The pancreas is an elongated, tapered organ located across the back of the abdomen, behind the stomach.

Norman Anatomy of Bilirubin Production and Elimination

15 Will go to the bone marrow for That bacteria with convert conjugated The excrete enzyme will convert The Reduct to the feces with some liver will Transport into bilirubin liver and new RBC production IronRBC will contentitfragile release it unconjugated to phagocytizedfat bilirubin conjugated of urobilinogen Macrophages willtoin splitor prone Cellular becomewillurineintobilirubin Hemoglobinunconjugated) Breakdown into amino acids HemeBiliverdin albumin (indirect, will be Globins the help of

RBC lifespan of 120 days

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B. PATHOPHYSIOLOGY Predisposing Factors: 3 days old Female Preterm borderline neonate RBC lifespan of 120 days RBC will become fragile Cellular content will be release Macrophages will phagocytized it

Hemoglobin will split into Heme Iron Will go to the bone marrow for new RBC production Biliverdin Globins Breakdown into amino acids

Reduct into bilirubin (indirect, unconjugated) fat soluble Transport to the liver with the help of albumin Absence of glucuronyl transferase produced by liver Unconjugated to convert Increase unconjugated bilirubin

To the blood stream

Yellow discoloration of sclera, skin, conjunctiva

HYPERBILIRUBINEMIA 17

Objective - skin appearing light yellow - sclera appearing light yellow - weak looking - afebrile - with thin and dry skin - hypoactive - under intensive and phototherapy -with eye and genital shield -with IVF reg. @ 14 gtts/min.

Analysis Risk for Injury related to abnormal blood profile as evidenced by increase bilirubin level of 1.59mg/dl.

Planning After series of nursing interventions the bilirubin level will be decreased

Intervention Remove clothing and exposed to phototherapy.

Rationale Aids in diagnosing underlying cause in connection with the appearance of jaundice To prevent eyes from direct exposure to light and prevent sterility of the baby To prevent burns

Evaluation Goal met. After series of nursing intervention the bilirubin level was decreased to 0.20 mg/dl.

Covered eyes and genitalia

Repositioned the baby every 2 hours. Kept warm and dry. To prevent further complications. To obtain the baseline data To prevent aspiration pneumonia and to prevent colic.

Vital signs taken and recorded every 1 hour. Instructed on Strict Aspiration Precaution (SAP) and advised the mother to burp the baby every after feeding

Monitored input and output; IVF regulated at 14 uggts/ min.

To prevent dehydration and replace fluid and electrolyte lost

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Provided quiet and warm environment

To promote comfort and prevent irritability

To promote sense of Instructed the mother to warmth, security and use stimulation technique attachment such as touching. Health teachings given to the mother such as personal hygiene, importance of breastfeeding, and newborn screening To detect early the possible diseases of the patient

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DAY 1:

August 10, 2012

Objective - skin appearing light yellow - sclera appearing light yellow - afebrile - with thin and dry skin -with desquamation of the skin - under intensive and single phototherapy

Analysis Risk for skin breakdown related to prolonged use of phototherapy.

Planning After 8 hours of nursing interventions, the patients risk of skin breakdown will be avoided.

Intervention Maintained and monitored babys eye patches while under phototherapy Removed baby under phototherapy and removed eye patches during feeding Inspected eyes every after phototherapy for conjunctivitis, drainage and corneal abrasions due to irritation from eye patches Provided minimal coverage of the body except for genitals

Rationale To protect retina from damage due to high intensity of light To provide visual stimulation and facilitates attachment behaviors To reduce complications and monitor the effectiveness of the management To provide maximal exposure and shielded the sensitive parts such as the eyes and genitals To promote equal distribution of phototherapy exposure

Evaluation Goal met. After 8 hours of nursing interventions, the patient was free from skin breakdown.

Repositioned the baby every 2 hours

DAY 2:

August 11, 2012

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Objective - with slightly yellowish skin color and sclera - fairly active - with good sucking reflex - with slight depressed fontanel - afebrile - negative (-) adventitious breath sounds upon auscultation on both bilateral lung fields

Analysis Risk for fluid imbalance related to prolonged exposure to phototherapy as evidenced by dry skin

Planning After series of nursing interventions, the risk for fluid imbalance will be prevented

Intervention Monitored input and output; IVF regulated at 14 uggts/ min. Vital signs taken and recorded Bedside care done including stretching of linens and organizing bedsides Instructed Strict Aspiration Precaution (SAP) Kept back dry Health teachings given to the mother such as the importance of breastfeeding, hand washing, and proper hygiene Needs attended

Rationale To prevent dehydration and replace fluid and electrolyte lost To obtain the baseline data To promote comfort and good hygiene

Evaluation Goal met. After series of nursing interventions, the risk for fluid imbalance is prevented as evidenced by good skin turgor

To prevent aspiration pneumonia To prevent further complications To promote healthy lifestyle

DAY 3:

August 12, 2012

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B. DRUG STUDY
Drug Name Generic Name: AMPICILLIN Brand Name: Novo-Ampicillin Principen Dosage 150mg IV every 12 (6-6) Classification Antibiotic Penicillin Mechanism of Action Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death Indication Treatment of infections caused by susceptible strains of shigella, Escherichia coli, gram-positive organisms (penicillin Gsensitive staphylococci, streptococcus) Contraindication Contraindicated with allergies to penicillins, cephalosphorins, or other allergens Adverse Effects Lethargy, Seizures, Anemia, Thrombocytop enia, Leukopenia, Neutropenia, Prolonged bleeding time, diarrhea Nursing Responsibilities Check IV site carefully for signs of thrombosis Inform the guardian of the patient that this drug is given to treat infection Follow the 10 Rights of the medications and administration Advise the guardian to report signs of hypersensitivity such as redness and rashes

Drug Name

Dosage

Classification

Mechanism of Action

Indication

Contraindication

Adverse Effects

Nursing Responsibilities

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Generic Name: CEFOTAXIME Brand Name: Claforan

150mg IV every 12 (12-12)

Antibiotic Bactericidal: Cephalosporin Inhibits (3rd generation) synthesis of bacterial cell wall, causing cell death

Septicemia caused by E.coli, Klebsiella species, S. marcescens

Contraindicated with allergy to cephalosporins or penicillins

Diarrhea, bone marrow depression decreased WBC, decreased platelets, decreased hematocrit,

Reconstitution of drug varies by size of package; see manufacturers directions for details Inform the guardian of the patient that this drug is given to treat infection Follow the 10 Rights of the medications and administration Advise the guardian to report signs of hypersensitivity such as redness and rashes

Drug Name

Dosage

Classification

Mechanism

Indication

Contraindication

Adverse

Nursing Responsibilities

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of Action Generic Name: AMIKACIN Brand Name: Amikin 30mg IV Aminoglycoside once a day (OD) Bactericidal: Inhibits protein synthesis in susceptible strains of gram-negative bacteria, and the functional integrity of bacterial cell membrane appears to be disrupted, causing cell death Short-term treatment of serious infections caused by susceptible strains of Pseudomonas species, E.coli, Klebsiella, Enterobacter, and Serratia species

Effects With allergy to any Fever, aminoglycosides seizures, diarrhea, rash, urticaria Monitor duration of treatment; usually 7-10 days. Prolonged treatment leads to increased risk of toxicity Monitor intake and output and daily weight to assess hydration status and renal function Inform the guardian of the patient that this drug is given to treat infection Follow the 10 Rights of the medications and administration Advise the guardian to report signs of hypersensitivity such as redness and rashes Assess patient for sign of super infection (fever, upper respiratory infection)

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Drug Name Generic Name: PHENOBARBITAL Brand Name: Luminal Sodium PMS-Phenobarbital

Dosage

Classification

Mechanism of Action General CNS depressant; barbiturates inhibit impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, depress motor output, and can produce excitation, sedation, hypnosis; at subhypnotic doses, has anti-seizure activity, making it suitable for long-term use as an antiepileptic

Indication Sedative, Emergency control of acute seizures

Contraindication With hypersensitivity to barbiturates, severe respiratory distress

Adverse Effects Bradycardia, constipation, diarrhea, rashes, urticaria, respiratory depression, broncho-spasm

Nursing Responsibilities Administer IV doses slowly Monitor injection sites carefully for irritation and extravasation Monitor pulse and respiration carefully during IV administration Follow the 10 Rights of the medications and administration

9mg IV Antiepileptic every 12 Barbiturate (12-12) Hypnotic Sedative

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C.COURSE IN THE WARD Date August 14, 2010 Time 10:00PM Vital Sign T 36.3 oC P 130 bpm R 38 cpm T 36.5 oC P 131 bpm R 42 cpm T 36.8 oC P 134 bpm R 39 cpm Observation - with slightly yellowish skin color and sclera - With good skin turgor with good sucking Afebrile reflex - with negative (-) adventitious breath sounds upon auscultation on both bilateral lung fields - fairly active - with good sleeping habit

2:00AM

6:00AM

DISCHARGE PLAN Medication:

Instructed the mother to give Nutrilin 0.3 ml drops once a day (OD) for optimum recovery and good health

Environment:

Encouraged the mother to keep an environment clean and conducive to health for the rapid recovery of infant and to avoid infection and keep environment quiet to make the patient comfortable

Treatment: Emphasized to the mother the importance of regular follow-up check-ups and as instructed by physician

Advised the mother to seek medical advice if any strange arises

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Encouraged the mother to let the baby be monitored by the health care provider until complete recovery is met

Health Teachings: Advised the mother to exposed the patient to sunlight around 6:00am 8:00am Emphasized to the mother the importance of proper hand washing and proper hygiene Emphasized the need for compliance and cooperation of the mother in helping treat the infant Emphasized that the baby is on trust vs. mistrust stage: the needs must be met for a healthy emotional development Out Patient:

Reminded the mother that even though the patient feels better, it is important to have the doctor monitor her progress. The patient is scheduled on October 4, 2010 at 8:00am in Out-Patient Department in Laguna Provincial Hospital (LPH) to evaluate the recovery of the infant

Diet:

Encouraged the mother for breastfeeding to help the baby gain resistance and protection from diseases in the future

Emphasized to the mother to breast fed the baby up to two years. An increase in feeding will help a faster gain in weight of the baby

Spirituality: Encouraged the mother to continue to seek Gods guidance and to continue to have a positive outlook in life Emphasized the importance of prayers in healing Encouraged the mother to pray for the babys fast recovery and gave words of encouragement

EVALUATION Though the group found the chosen case on its wellness stage or with may go home order, it was still given us the opportunity to know the disease specifically the Hyperbilirubinemia or Neonatal Jaundice for better understanding and appropriate nursing care

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to be done for any newborn acquired this kind of disease. There were several factors how this disease can be acquired and each of us was challenged to search the causes and details why many newborns suffered from this health problem. The nursing intervention we had during the shift were closed monitoring on babys vital signs, kept baby under phototherapy, kept baby comfortable, assured baby that she was well fed and provided health teachings to the parent. The goal of the group has been met as evidenced by parent showed knowledge and understanding about the health condition of their child and improved parenting manner. There were no significant circumstances arise during our shift.

SUMMARY

Hyperbilirubinemia is a condition in which there is too much bilirubin in blood. When red blood cells breakdown, a substance called bilirubin is formed. Patient was a baby Girl HB a premature borderline infant from Lumban, Laguna, born of a 37 years old G4P4 delivered via NSD by her mother last September 16, 2010 at home. The newborn has been admitted at Pediatric Intensive Care Unit (PICU) last September 19, 2010 at 10:30am because of jaundice. The patient has been diagnosed with Hyperbilirubinemia. She has undergone intensive phototherapy; medications were Ampicillin, Amikacin, Cefotaxime and Phenobarbital.

Patient was discharged on September 27, 2010 at 8:00 AM.

RECOMMENDATION The group recommends to the parent the following care:

Expose their child under sunlight ideally between 6:00-7:00 in the morning and dont forget to put cover over the babys eyes Provide baby quality breast feeding every 2-3 hours or as frequent as needed for this promotes improved wellness condition and effective bonding technique between mother and child.

Go to the nearest health center for babys immunization Keep baby clean and dry

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Give home meds as prescribed. Seek immediate doctors advice if there is any significant changes observe on the child or return child for follow up check-up.

BIBLIOGRAPHY

Fundamentals of Maternal and Child Nursing, London, Ladewig, Ball and Bindler, 2nd ed., Vol. 1, pp. 835 844 Nursing Drug Guide, Lippincotts, 2009, pp. 126, 101, 246, 948 http://www.merck.com/mmpe/lexicomp/bisacodyl.html

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