Overview of the Disease

Erythroblastosis Fetalis is a hemolytic disease of fetal or neonatal life due to fetal-

maternal blood group incompatibility; the fetus having a blood factor that its mother lacks,
and the mother producing antibodies against that factor. These maternal antibodies are
capable of agglutinating the RBC's of both the fetus and the father. Erythroblastosis Fetalis
includes at least three clinical types are , Hydrops fetalis, Icterus gravis of the newborn,
Hemolytic anemia of the newborn.

Etiology

It is now recognized that Erythroblastosis Fetalis is caused by incompatibility of

several other of the 9 blood grouping systems, most common of which appears to be
incompatibility in the ABO system. In fact ABO incompatibility may be a more common
cause of Erythroblastosis Fetalis than incompatibility in the Rh system, but it usually escapes
notice because it is rarely accompanied by significant anemia and extremely rarely by
hydrops fetalis.

Causes

During pregnancy, red blood cells from the unborn baby can cross into the mother’s
bloodstream through the placenta.

If the mother is Rh-negative, her immune system treats rh-positive fetal cells as if
they were a foreign substance and makes antibodies against the fetal blood cells. These anti
Rh antibodies may cross back through the placenta into the developing baby and destroy the
baby’s circulating red blood cells.

When red blood cells are broken down, they make bilirubin. This causes an infant to
become yellow (jaundiced). The level of bilirubin in the infant;s bloodstream may range
from mild to dangerously high.

Because it takes time for the mother to develop antibodies, firstborn infants are often
not affected unless the mother had past miscarriages or abortions that sensitized her immune
system. however, all children she has afterwards who are also Rh- positive may be affected.

Rh incompatibility develops only when the mother is Rh-negative and the infant is
Rh-positive.

Signs and symptoms

 Before your baby is born:

o Fast heart rate
o Enlarged organs, such as the heart, liver, or spleen
o Swelling of your baby's body
 After your baby is born:
o Pale skin caused by anemia
o Jaundice (yellowing of your baby's skin or the whites of his eyes)
 o Small red or brown spots, or purple patches on your baby's skin
o Swelling of your baby's body
o Trouble breathing

Clinical Manifestations

In the mother. There may be a history of previous erythroblastotic babies. Or we may

find evidence of anit-Rh agglutinins in the Rh negative wife of an Rh positive father.
Toxemia of pregnancy is not common in the mothers of erythroblastotic babies; when it does
occur it is usually mild, and is usually associated with fetal hydrops. Other complications are
extremely common with hydrops fetalis, and include dystocia, hydramunios and premature
labour. The large placenta may cause difficulty in the third stage.

In the fetus. Intrauterine diagnosis of fetal hydrops can be made by the X-ray
appearance of a halo around the infant's scalp, and the characteristic Budda attitude. At birth
the diagnosis of fetal hydrops is easy, but congenital syphilis and congenital abnormalities of
the heart and kidneys must be ruled out. In icterus gravis the baby is born jaundiced, and the
vernix caseosa and amniotic fluid may be stained a deep yellow. Purpura may be noted. The
liver is always palpable, and usually the spleen. In most cases of E.F. jaundice is not present
at birth, but becomes noticeable in the first day or two. In this regard it should be noted that
jaundice developing in the first 24 hours of life nearly always means E.F., irrespective of
whether the mother is Rh positive or negative. As the jaundice deepens signs of nervous
system involvement may appear, in the form of lethargy, poor feeding, and loss of the Moro
reflex. In severe cases there may be extreme hypotonia, spasms or convulsions.

Diagnosis

 Maternal blood and Rh typing and reflex antibody screening

 Serial antibody level measurements and middle cerebral artery blood flow
measurements for pregnancies considered at risk

 Cell-free fetal DNA screening

At the first prenatal visit, all women are screened for blood type, Rh type, and anti-
Rho(D) and other antibodies that are formed in response to antigens and that can cause
erythroblastosis fetalis (reflex antibody screening). If women have Rh-negative blood and
test positive for anti-Rho(D) or they test positive for another antibody that can cause
erythroblastosis fetalis, the father’s blood type and zygosity (if paternity is certain) are
determined. If he has Rh-negative blood and is negative for the antigen corresponding to
the antibody identified in the mother, no further testing is necessary. If he has Rh-positive
blood or has the antigen, maternal anti-Rh antibody titers are measured. If titers are
positive but less than a laboratory-specific critical value (usually 1:8 to 1:32), they are
measured every 2 to 4 weeks after 20 weeks. If the critical value is exceeded, fetal middle
cerebral artery (MCA) blood flow is measured at intervals of 1 to 2 weeks depending on
the initial blood flow result and patient history; the purpose is to detect high-output heart
failure, indicating high risk of anemia. Elevated blood flow for gestational age should
prompt consideration of percutaneous umbilical blood sampling and intrauterine blood
transfusion.

If paternity is reasonably certain and the father is likely to be heterozygous for

Rho(D), the fetus’s Rh type is determined. If fetal blood is Rh positive or status is
unknown and if MCA blood flow is elevated, fetal anemia is likely.

Prevention

Prevention involves giving the Rh-negative mother Rho(D) immune globulin at the

following times:
 At 28 weeks gestation

 Within 72 hours of pregnancy termination

 After any episode of vaginal bleeding

 After amniocentesis or chorionic villus sampling

Delivery should be as atraumatic as possible. Manual removal of the placenta should

be avoided because it may force fetal cells into maternal circulation.

Maternal sensitization and antibody production due to Rh incompatibility can be

prevented by giving the woman Rho(D) immune globulin. This preparation contains high
titers of anti-Rh antibodies, which neutralize Rh-positive fetal RBCs. Because fetomaternal
transfer and likelihood of sensitization is greatest at termination of pregnancy, the
preparation is given within 72 hours after termination of each pregnancy, whether by
delivery, abortion, or treatment of ectopic pregnancy. The standard dose is 300 mcg IM. A
rosette test can be used to rule out significant fetomaternal hemorrhage, and if results are
positive, a Kleihauer-Betke (acid elution) test can measure the amount of fetal blood in the
maternal circulation. If test results indicate fetomaternal hemorrhage is massive (> 30 mL
whole blood), additional injections (300 mcg for every 30 mL of fetal whole blood, up to 5
doses within 24 hours) are necessary.

If given only after delivery or termination of pregnancy, treatment is occasionally

ineffective because sensitization can occur earlier during pregnancy. Therefore, at about 28
weeks, all pregnant women with Rh-negative blood and no known prior sensitization are
given a dose of Rho(D) immune globulin. Some experts recommend a 2nd dose if delivery
has not occurred by 40 weeks. Rho(D) immune globulin should also be given after any
episode of vaginal bleeding and after amniocentesis or chorionic villus sampling.
 Anti-Rh antibodies persist for > 3 months after one dose.

Nursing Management

During Phototherapy:

1. Remove clothing to proper skin exposure

2. Turn infant frequently to expose all skin area
3. Record and report jaundice and blood levels of bilirubin
4. Record and report if any change in body temperature
5. Cover and check eyes with eye patches to prevent eye injury
a. Be sure the eyes close before applying eye patch to prevent corneal
irritation
b. Should be loose enough to avoid pressure
c. Eye patches should be changed 8 hourly and eye care given
6. Nurse should expect the infant’s stools to be green and the urine dark because of
photodegradation products.
7. Serum bilirubin and hematocrit should be monitored during therapy and for 24
hours following therapy.
8. In case of breast milk jaundice stop breast feeding temporarily.
9. Maintain feeding intervals to prevent dehydration

Treatment

 Fetal blood transfusions

 Sometimes delivery at 32 to 35 weeks

If fetal blood is Rh negative or if MCA blood flow remains normal, pregnancy can
continue to term untreated.

If fetal anemia is likely, the fetus can be given intravascular intrauterine blood
transfusions by a specialist at an institution equipped to care for high-risk pregnancies.
Transfusions occur every 1 to 2 weeks, usually until 32 to 35 weeks. During that time
period, delivery may be recommended if there is continuing evidence of severe fetal
anemia (based on MCA blood flow). The woman may continue to term delivery if there is
no evidence of severe fetal anemia based on MCA blood flow. Corticosteroids should be
given before the first transfusion if the pregnancy is > 24 weeks, possibly > 23 weeks.
Neonates with erythroblastosis are immediately evaluated by a pediatrician to determine
need for exchange transfusion.

(a) Treatment during pregnancy.

 In spite of a great deal of investigative effort there is still no agent of real value in the
prenatal treatment of E.F. Diethylenesulfonate, exchange transfusion of the mother, the use
of desentizing injections, and the use of ACTH and Cortisone have all proved to be useless.
Some studies seem to show an increased number of normal babies following the injection
into the sensitized mother of so-called Rh hapten; but the method requires further
investigation.

(b) Treatment during the delivery.

When E.F. is suspected, analgesia and general anesthesia should not be used during
delivery because intrauterine or neonatal asphyxia is pre- sent in many of the infants. Local
or saddle block anesthesia should be used.

(c) Postnatal treatment.

In the light of present knowledge, the same criteria for treatment should be applied to all
cases of E.F., whether due to Rh incompatibility, ABO incompatibility or incompatibility
among any other blood grouping system.

The present concensus of opinion holds that exchange transfusion is far superior to
simple transfusion. Not only are there more survivors among infants treated with exchange
transfusions, but the incidence of kernicterus is lower. In one series of 62 infants treated with
exchange transfusion, only 4 developed kernicterus, 3 of them being premature.

If sensitization to the Rh factor is demonstrated in a pregnant woman, Erythroblastosis

fetalis should be anticipated in the baby and complete preparation should be made for its
arrival. Advance preparation means preparation for exchange transition; nothing else can be
done before the birth of the infant. Careful inspection of all infants in the first day or two of
life will reveal certain mild cases of E.F., especially those due to ABO incompatibility. The
overall mortality in infants treated with ex- change transfusion is about 13%, as compared
with a mortality of 80 - 90% in infants treated without exchange transfusion.

Anatomy and Physiology

Blood is composed of plasma and three types of cells: red blood cells,
white blood cells, and platelets.
 Blood is a circulating tissue composed of fluid, plasma, and cells. The cellular
components of blood are erythrocytes (red blood cells, or RBCs), leukocytes (white blood
cells, or WBCs), and thrombocytes (platelets). By volume, the RBCs constitute about 45% of
whole blood, the plasma about 54.3%, and white blood cells about 0.7%. Platelets make up
less than 1%. Although it consists of cells suspended in fluid, blood is still considered a
tissue as it is technically a type of extracellular matrix.

Blood enables transport of cells and molecules between parts of the body. Oxygen,
carbon dioxide, and glucose are among the most vital molecules transported in blood. Blood
cells are essential for normal metabolic and immune system function.

Erythrocytes (RBCs)

Erythrocytes are discs measuring about seven to eight micrometers in diameter.

RBCs contain hemoglobin molecules which bind to oxygen so it can be transported to
tissues. Mature RBCs lack a nucleus and organelles and have no nuclear DNA. RBCs,
endothelial vessel cells, and other blood cells are also marked by glycoproteins that define
the different blood types. The ratio of RBCs to blood plasma is referred to as the hematocrit,
and is normally about 45%. The combined surface area of all red blood cells of the human
body would be roughly 2,000 times greater than the body’s exterior surface.

Leukocytes (WBCs)

Leukocytes are usually larger in size (10–14 micrometers in diameter) than red blood
cells. They lack hemoglobin but contain organelles, a nucleus, and nuclear DNA. WBCs are
the main functional component of the body’s immune system. They destroy and remove old
or aberrant cells and cellular debris, as well as attack infectious agents (pathogens) and
foreign substances. There are several different types of white blood cells: basophils,
eosinophils, neutrophils, monocytes, natural killer cells, B- and T-cell lymphocytes,
macrophages, and dendritic cells, all of which perform distinct functions.

Thrombocytes (Platelets)

Thrombocytes measure between one to two micrometers in diameter. These

membrane-bound cell fragments lack nuclei and are responsible for blood clotting
(coagulation). They result from fragmentation of large cells called megakaryocytes, which
are derived from stem cells in the bone marrow. Platelets are produced at a rate of 200 billion
per day, a process regulated by the hormone thrombopoietin. Platelets contain mitochondrial
DNA, but not nuclear DNA.

The sticky surface of platelets allows them to accumulate at the site of broken blood
vessels to form a clot, due in part to the release of clotting factors that occurs during
endothelial injury to blood vessels. This process is called hemostatis. Platelets secrete factors
that increase local platelet aggregation (e.g., thromboxane A), enhance vasoconstriction (e.g.,
serotonin), and promote blood coagulation (e.g., thromboplastin, fibrinogen). Platelets are
critically important for wound healing, which can only occur once the clot forms and
bleeding ceases completely.

Physical Characteristics and Volume

Blood contains plasma and blood cells, some of which have hemoglobin that makes
blood red. The average blood volume in adult is five liters.

Blood is a specialized bodily fluid in animals that delivers necessary substances, such
as nutrients and oxygen, to the cells and transports metabolic waste products away from
those same cells. Blood plays many roles in sustaining life and has physical characteristics
that distinguish it from other body tissues.

Physical Characteristics

Blood is a fluid that is technically considered a connective tissue. It is an extracellular

matrix in which blood cells are suspended in plasma. It normally has a pH of about 7.4 and is
slightly denser and more viscous than water. Blood contains red blood cells (RBCs), white
blood cells (WBCs), platelets, and other cell fragments, molecules, and debris. Albumin is
the main protein found in plasma, and it functions to regulate the colloidal osmotic pressure
of blood.

Blood appears red because of the high amount of hemoglobin, a molecule found on
RBCs. Each hemoglobin molecule has four heme groups that interact with various
molecules, which alters the exact color. In oxygenated blood found in arterial circulation,
hemoglobin-bound oxygen creates a distinctive red color.

Deoxygenated blood is a darker shade of red. It is present in veins and can be seen during
blood donation or lab tests. Carbon monoxide poisoning causes bright red blood due to
the formation of carboxyhemoglobin. In cyanide poisoning, venous blood remains
oxygenated, increasing the redness. Under normal conditions, blood can never truly be blue,
although most visible veins appear blue because only blue light can can penetrate
deeply enough to illuminate veins beneath the skin.

Blood Volume

Blood generally accounts for 8% of the human body weight. The average adult has a blood
volume of roughly five liters (1.3 gal). By volume, red blood cells constitute about 45% of
whole blood, plasma about 54.3%, and white cells about 0.7%, with platelets making up less
than 1%.

Blood volume is a regulated variable that is directly proportional to blood pressure

through the output of the heart. In order to maintain homeostasis, blood volume and blood
pressure must be high enough that blood can reach all of the body’s tissues, a process called
tissue perfusion. Most tissues can survive without perfusion for a short amount of time, but
the brain needs a continuous supply of oxygen and glucose to stay alive.

Many mechanisms exist to regulate blood volume and tissue perfusion, including
renal water excretion in the kidney, the pumping activity of the heart, and the abilities of the
arteries to constrict or dilate. When blood volume becomes too low, such as from an injury,
dehydration, or internal bleeding, the body will enter into a state of hypovolemic shock, in
which tissue perfusion decreases too much. A healthy adult can lose almost 20% of blood
volume (1 L) before the first symptom, restlessness, begins, and 40% of volume (2 L) before
hypovolemic shock sets in. Conversely, higher than normal blood volume may cause
hypertension, heart failure, and aneurysms.

Functions of Blood

The main function of blood is to supply oxygen to tissues and remove carbon
dioxide. Other functions include pH regulation and thermoregulation.

Blood performs many functions critical for sustaining metabolic physiological

processes in complex organisms. Blood is involved in everything from gas exchange to
nutrient transport to immune system and homeostatic functions.

Oxygen and Glucose Transport

Blood’s primary function is to transport molecules around the body to support critical
metabolic processes. All cells require oxygen and glucose to undergo cellular respiration.
Tissues cannot survive very long without these two molecules. Disruption of this process is
most dangerous to the brain, which can survive only about two minutes without oxygen and
glucose. These terms are used to describe oxygen or blood deficiency to tissues in the body:

 Hypoxia: a state in which the tissues do not receive adequate oxygen supply,
generally due to decreased tissue perfusion or decreased oxygen intake.
 Ischemia: a reversible condition in which a tissue does not receive adequate blood
supply, usually from an obstructed or ruptured blood vessel.
 Infarction: a usually irreversible condition in which tissues die as a result of
prolonged oxygen or blood supply.

Most tissues can survive in a hypoxic or ischemic state for a few hours before
infarction sets in. Heart infarction, which often occurs during a heart attack, will cause
infarction in other tissues as blood is no longer pumped.

In addition to oxygen and glucose, the blood transports several other important
molecules. Carbon dioxide, which travels through the blood mostly as bicarbonate, is
transported from tissues as a waste product of cellular respiration to the lungs during gas
exchange. Many hormones (chemical messengers) also travel through the blood as a form of
communication between interrelated organs, which are often involved in homeostatic
control.

Immune System Functions

White blood cells and antibodies circulate through the blood and destroy any foreign
invaders ( pathogens ) that they encounter. Inflammation occurs in blood vessels due to the
release of inflammatory mediators in the blood. This causes vasodilation and redness as other
white blood cells are drawn to the region through the bloodstream to destroy infectious
pathogens. They may also find molecular markers of pathogens called antigens and take
them to lymphatic organs to stimulate powerful adaptive immune system responses.

The blood also has the ability to undergo clotting in response to vascular injury such
as bleeding. Normally a series of clotting and anti-clotting factors are kept in balance
through the blood so that no clotting occurs, but when endothelial cells are injured, the
clotting factors are increased and cause blood to clot. Circulating platelets in the blood arrive
at the injury site and form a mesh and plug to coagulate the blood and stop the bleeding.
Wound healing can only begin after this clotting response occurs.

Homeostatic Functions

Blood is involved in maintaining homeostasis through several ways. Temperature

regulation occurs in part as a result of the dilation and constriction of vessels in the blood.
Blood pH is a regulated variable of the respiratory system, because the pH of blood is
directly proportional to the amount of carbon dioxide dissolved in blood. This makes blood
pH an indicator of respiratory homeostasis. Blood glucose levels are regulated by insulin and
glucagon secretion. Blood volume and blood pressure are directly proportional regulated
variables that are tied to the activity of the heart and the fluid retention of the kidney. If any
of these variables are too high or too low, severe problems can occur. For that reason, a
number of complex negative feedback mechanisms exist to keep all variables within
homeostatic range, despite influences from the internal and external environments.

Blood Plasma

Plasma comprises about 55% of total blood volume. It contains proteins and clotting
factors, transports nutrients, and removes waste.

About 55% of blood is blood plasma, a straw-colored liquid matrix in which blood
cells are suspended. It is an aqueous solution containing about 90% water, 8% soluble blood
plasma proteins, 1% electrolytes, and 1% elements in transit. One percent of the plasma is
salt, which helps with pH. Human blood plasma volume averages about 2.7–3.0 liters.

Molecular Contents of Plasma

Plasma contains molecules that are transported around the body. Respiratory gases, such as
oxygen and carbon dioxide, may be dissolved directly in the plasma. However, most oxygen
is hemoglobin bound, and most carbon dioxide is converted to bicarbonate ions in the
plasma. Hormones and nutrients such as glucose, amino acids and proteins, lipids and fatty
acids, and vitamins are also dissolved in the plasma. Waste products are carried through the
plasma during their removal, including urea and ammonia.

Plasma Proteins

The largest group of solutes in plasma contains three important proteins: albumins,
globulins, and clotting proteins.

Albumins

Albumins, produced in the liver, make up about two-thirds of the proteins in plasma.
Albumins maintain the osmotic balance between the blood and tissue fluids. These proteins
exert a force that pulls water towards them, which is called oncotic or osmotic
pressure. During inflammation, albumins leave the vascular endothelium and enter the
tissues, which transports water and some of the plasma into the interstitial fluid. This is the
principal cause of exudate edema, which is the swelling that indicates inflammation.

Albumins also assist in transport of different materials, such as vitamins and certain
molecules and drugs (e.g. bilirubin, fatty acids, and penicillin) due to the force exerted by
their oncotic pressure. Plasma that is pulled into the tissues by albumin-exerted oncotic
pressure becomes interstitial fluid. This gradually drains into the lymphatic system which it
turn recirculates it back into the plasma of the circulatory system.

Globulins

Globulins are a diverse group of proteins designated into three groups, gamma, alpha,
and beta, based on how far they move during electrophoresis tests. Their main function is to
transport various substances in the blood. For example, the beta globulin transferrin can
transport iron. Most gamma globulins are antibodies (immunoglobulin), which assist the
body’s immune system in defense against infections and illness. Alpha globulins are notable
for inhibiting certain proteases, while beta globulins often function as enzymes in the body.

Clotting Factors

Clotting proteins are mainly produced in the liver. Twelve proteins known as
“clotting factors” participate in the cascade clotting process during endothelial injury. One
important clotting factor is fibrinogen. Fibrinogen generates fibrin when activated by the
coagulant thrombin, which forms a mesh that clots blood with the assistance of a platelet
plug.  Normally, anticoagulants and fibrinolytics in the plasma, such as plasmin and heparin,
break up fibrin clots and inactivate thrombin. However, during endothelial injury, damaged
cells will release tissue factor, another type of clotting factor that causes a cascade of
thrombin production that will overpower the anticoagulants and cause a clotting response.
 Serum is a term used to describe plasma that has been removed of its clotting factors.
Serum still contains albumin and globulins, which are often called serum proteins as a result.

Pathology and Physiology

Fetus Rh (+) blood

 Mother Rh (-) blood

Rh antibodies form in mother’s blood within 72

hours after delivery or abortion of Rh (+)

Fetus in subsequent
pregnancy

Increase Hemolysis
of RBC

Destroy of RBC

Increase serum
Increase production of immature
bilirubin
RBS (erythroblast)

Enlarged liver and Jaundice

Unconjugated bilirubin pass to brain
spleen

Kernicterus
Erythroblastosis fetalis
ASSESSMENT NURSING PLANNING NURSING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Objective: Risk for fluid The infant Independent Goal met
Clinical volume will exhibit  Initiated early feedings and
jaundice evident deficit related no signs of offer feeding over 2-3 hours  To increase The infant exhibited
within 24 hour to dehydration, intestinal motility no signs of
of birth phototherapy clear amber  Monitored urine specific and promote the dehydration, clear
urine output gravity excretion of amber urine output
of 1-3 unconjugated of 1-3 ml/kg/hr, and
ml/kg/hr, and bilirubin through will display
will display  Administered fluid intake that the clearance of appropriate weight
appropriate is 25% above normal stools and gain.
weight gain. requirements. decrease the
potential for
 Assessed for signs of dehydration
dehydration such as poor skin  Urine specific
turgor, depressed fontanels, gravity can be
sunken eyes, decreased urine indicator of
output, weight loss and dehydration.
changes in electrolytes  Additional fluids
will help
 Monitored daily weight compensate for
the increased
 Assessed quantity and water that is lost
characteristics of the stool through the skin
and in the stools.
 Phototherapy
treatment may
cause liqiuid
stools and
increased
insensible water
 loss which
increases risk of
dehydration
 Increased fluid
excretion in the
stools and a
decrease in fluid
intake may put
the newborn at
risk for weight
loss. Daily
weights can
provide accurate
determination
fluid intake and
insensible water
loss that is caused
by phototherapy
 Loose stools
indicate fluid loss
which may lead
to volume deficit.
With an increase
in stools per day.
Dehydration is
possible.

ASSESSMENT NURSING PLANNING NURSING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Objective: Risk for After 1 hour Independent Partially met
-Invasive infection nursing  Monitored vital signs and
procedures related to interventions, assess patient’s condition  For baseline data After 1 hour nursing
(amniocentesis impaired the patient  Observed and report signs of interventions, the
or intrauterine primary will infection such as redness,  With the onset of patient partially
blood defense demonstrate warmth, discharge and infection the demonstrated
transfusion) techniques in increased body temperature immune system techniques in
-insufficient reducing risk  Stressed the importance of is activated and reducing risk of
knowledge to of having proper handwashing to SO signs of infection having infection.
avoid exposure infection. appear
to pathogen  Stricted compliance to  A first line
-inadequate hospital control, sterilization defense against
secondary and aseptic policies nosocomial
defenses infection to cross
-rupture of  Told patient/SO to comply to contamination
amniotic antibiotic therapy as  To establish
membranes prophylaxis mechanism to
 Monitored medication prevent
regimen occurrence of
infection
 To prevent the
occurrence of
infection
 To determine
effectiveness of
therapy

ASSESSMENT NURSING PLANNING NURSING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Objective: Risk for After the Independent After the nursing
-skin appearing injury related nursing  Note the infant’s age interventions, the
light to bright to interventions,  Assist phototherapy treatment  May aids in patient skin color
color prematurity the patient  Have the infant completely diagnosing become normal
-sclerae skin color undressed underlying cause
appearing will be  Keep the eyes and gonads in connection
yellow normal covered with the
-dark amber  Develop a systemic schedule appearance of
urine of turning the infant jaundice
 To allow
Collaborative utilization of
alternate
 Obtain bilirubin level as pathways for
directed bilirubin
 Administer fluids as directed excretion
 To expose the
entire skin in
phototherapy
 To protect them
from the constant
exposure to high
intensity light
 Ideally every 2
hours so that all
the surfaces are
exposed

 To have baseline
data if the
therapeutic
regimen is
 effective
 To ensure
adequate
hydration

DRUG STUDY
DRUG NAME MECHANISM INDI- CONRA- SIDE ADVERSE NURSING
OF ACTION CATION INDICATION EFFECTS EFFECTS RESPONSIBILITY
BRAND NAME: Act by Pregnancy/ Rh-positive Fever, back Injection For Im use only. Do not
Rhogam suppressing the delivery of individuals and pain, nausea site inject intravenously. In
GENERIC NAME: immune an Rh in patients with and vomiting, reaction, the case of postpartum
Rhophylac response of Rh- positive known history hypo or muscle use, the product is
DOSE: negative baby of anaphylactic hypertension pain, fever, intended for maternal
300 microgram individuals to irrespective or severe dizziness, administration. Do not
CLASSIFICATION: Rh-positive red of ABO systemic tiredness, inject the newborn infant.
Immune globulin blood cells. groups of reactions to the weakness
the mother administration and itching
and baby, of human
abortion/thr immune
eatened globulin
abortion, products
ectopic
pregnancy,
antepartum
fetal-
maternal
hemorrhag
e
 DRUG NAME MECHANISM OF INDICATION CONTRAINDICATION SIDE/ ADVERSE NURSING
ACTION EFFECTS RESPONSIBILITY
Generic name: Prevent production IM/IV: administer Contraindicated in:  Anemia  Observe patient
Rhogam of anti- Rh0 (D) to Rh0(D) negative Rh0(D) or Du positive  Intravascular for 20 minutes after
Brand name: antibodies in Rh0 patients who have patients. Patients hemoysis injection.
Rhogam (D)- negative been exposed to previously sentized to  Pain at IM site  Instruct patient
Classification: patients who were Rh0 positive blood Rh0(D) or Du.  fever to report early signs
immunizing agents exposed to Rh0 (D)- by delivering an of hypersensitivity,
positive blood. Rh0(D) positive hives, generalized
Increase platelets infant, miscarrying urticaria, tightness of
count inpatient with or aborting an chess,wheezing
ITP. Rh0(D) positive hypotension, and
fetus, having anaphylaxis.
amniocentesis or  Treatments
intra-abdominal depends on severity
trauma while of reaction.
carrying Rh0(D)
positive, following
accidental
transfusion of
Rh(D) postive
blood to an Rh0(D)
negative patients.