Hyper Bilirubin Emi A

Vicente Sotto Memorial Medical CenterB. Rodriguez Street, Cebu City

Nursing Service DivisionTraining Office

A CASE REPORT

ON

Submitted by:

Nina Fe R. NunezSharmaine Keith Daitol

Jillyn LoqueroRosemarie Tan

NICU

June 1- August 31, 2012

TABLE OF CONTENTS

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

II. Introduction-----------------------------------------------------------------------3A. Objectives --------------------------------------------------------------------------------4B. Background of the Study --------------------------------------------------------------5C. Rationale for Choosing the Case -----------------------------------------------------

5D. Significance of the Study --------------------------------------------------------------6E. Scope and Limitations ------------------------------------------------------------------6

III. Clinical Study ------------------------------------------------------------------7A. Demographic Data ----------------------------------------------------------------------7B. Physical Assessment --------------------------------------------------------------------8C. System Affected ------------------------------------------------------------------------10D. Laboratory and Diagnostic Exam ----------------------------------------------------

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IV. Clinical Discussion ---------------------------------------------------------------14A. Anatomy and Physiology --------------------------------------------------------------

14B. Pathophysiology ------------------------------------------------------------------------17C. Nursing Care Plan ----------------------------------------------------------------------18D. Drug Study ------------------------------------------------------------------------------22E. Course in the Ward --------------------------------------------------------------------26F. Discharge Plan --------------------------------------------------------------------------26G. Evaluation --------------------------------------------------------------------------------28H. Summary ---------------------------------------------------------------------------------28I. Recommendation -----------------------------------------------------------------------

28J. Bibliography -----------------------------------------------------------------------------29

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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 life’s 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.

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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, I’m 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 baby’s body. This is called Hyperbilirubinemia. Because of bilirubin has a pigment or coloring, it causes a yellowing of the baby’s 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 baby’s 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

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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 RBC’s due to hemolytic disease of the newborn (RH disease), having too many RBC’s 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

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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 CASEThis 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 patient’s 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

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D. SIGNIFICANCE OF THE STUDYThis 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 LIMITATIONThis 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.

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II. Clinical Study

DEMOGRAPHIC DATA

Patient Name : Baby Boy V.Age : NewbornSex : MaleBirth Date : August 08, 2012Address : Medellin, CebuDate of Admission : August 10, 2012Time of Admission : 10:30amAdmitting Diagnosis: HYPERBILIRUBINEMIA

Source of InformationPrimary Source : Mother

Secondary Source : Patient’s records/ chart

Chief Complaint: “duha na ka adlaw ngyellow akong anak” as verbalized by the mother

History of Present Illness According to patient’s mother, when Baby Boy V was born, she noticed that

her baby’s 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.

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B. PHYSICAL ASSESSMENT

General Appearance

- 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- fairly active- with good sleeping habit

Head

- normocephalic- symmetrical in shape- no masses, no lesions- Non bulging and non depressed anterior and

posterior fontanels- No signs of caput succedaneum and

cephalhematoma Hair - evenly distributed over the scalp

- with black, straight and thick hair Eyelids - lids close symmetrically

- with eyeshield- no edema, and no discharges

Sclera - slightly yellowish Iris - symmetrical in size

- round and black- Symmetrical in size

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Pupils - round and dark brown in color- PERRLA (Pupils Equally Round And React To

Light and Accommodation)

Ears- equal in size- auricles are smooth and symmetrical- pinna recoils after it is folded

Nose

- the external nose is symmetrical and straight- 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

Mouth

- 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- neck movement was coordinated and difficulty in

moving was not noted- free from lumps and no tenderness

Thorax- no masses and tenderness upon palpation- no adventitious breath sounds upon auscultation

on both left and right lung fields - negative retractions

Breast- round in shape, no lumps, no masses- areola dark brown in color- nipples round, equal in size

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Abdomen- same color of the body- globular, soft without distention- bowel sounds in all quadrant- skin pinch goes back quickly

Upper extremities

- good range of motion was noted- no lesions, no presence of abnormalities, no

tenderness- can flex and extend arms without difficulty

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

Genitalia

- no discharges- no bleeding- With slightly normal genitalia (labia majora

almost covers the clitoris)- With genital shield

Elimination - With patent anus

Reflexes - Are present such as moro, babinski, rooting, sucking, and plantar grasp reflex

C. SYSTEM AFFECTED

Digestive System Hematologic System

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D. LABORATORY AND DIAGNOSTIC EXAM

Bilirubin Test

September 19, 2010

TEST RESULT NORMAL VALUE

INTERPRETATION

SIGNIFICANCE

Neonatal Bilirubin

20.5 mg/dl 1.0-10.5 mg/dl

Increased Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin

Unconjugated bilirubin

18.56 mg/dl 0.6-10.5 mg/dl

Increased An abnormal accumulation of bilirubin in the blood caused by the poor function of the liver

Conjugated bilirubin

1.59 mg/dl 0-0.6 mg/dl Increased Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin

September 20, 2010


INTERPRETATION

SIGNIFICANCE

Neonatal Bilirubin

25.5 mg/dl 1.0-10.5 mg/dl



24 mg/dl 0.6-10.5 mg/dl

Increased An abnormal accumulation of bilirubin in the blood

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caused by the poor function of the liver


1.50 mg/dl 0-0.6 mg/dl Increased Increase destruction of RBC resulting in increase unconjugated and conjugated bilirubin

September 23, 2010


INTERPRETATION

SIGNIFICANCE

Neonatal Bilirubin

11.10 mg/dl 1.0-10.5 mg/dl



10.9 mg/dl 0.6-10.5 mg/dl

Increased An abnormal accumulation of bilirubin in the blood caused by the poor function of the liver


0.20 mg/dl 0-0.6 mg/dl Normal

Complete Blood CountSeptember 19, 2010

BLOOD COMPONENT

S

RESULT NORMAL VALUE

INTERPRETATION SIGNIFICANCE

Hemoglobin 11.0 g/dl 13-19g/dl Decrease Decrease hemoglobin will result to decrease of oxygen supply to the body due to bilirubin in the bloodstream that is trying to get out

White Blood 17.9 4.5-10.5 x 10 9/ Increase Increase WBC

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Cells (WBC) L signifies infection in the body.

Hematocrit 33% 42-59% Decrease Decrease hematocrit indicates that the mass of RBC is decrease

III. CLINICAL DISCUSSION

A. ANATOMY AND PHYSIOLOGY

Liver

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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

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

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The pancreas is an elongated, tapered organ located across the back of the

abdomen, behind the stomach.

Norman Anatomy of Bilirubin Production and Elimination

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RBC lifespan of 120 days

RBC will become fragile or prone

Cellular content will be release

Macrophages will phagocytized it

Hemoglobin will split into

Heme Globins

Iron Biliverdin Breakdown into amino acids

Will go to the bone marrow for new RBC production

Reduct into bilirubin (indirect, unconjugated) fat

Transport to the liver with the help of albumin

The liver enzyme will convert unconjugated to conjugated bilirubin

The bacteria will convert conjugated bilirubin to urobilinogen

That excrete with the feces and some of it in urine

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B. PATHOPHYSIOLOGY

RBC lifespan of 120 days

RBC will become fragile

Cellular content will be release

Macrophages will phagocytized it

Hemoglobin will split into

Heme Globins

Iron Biliverdin Breakdown into amino acids

Will go to the bone marrow for new RBC production

Reduct into bilirubin (indirect, unconjugated) fat soluble

Transport to the liver with the help of albumin

Unconjugated to convert

Increase unconjugated bilirubin

To the blood streamYellow discoloration of sclera, skin, conjunctivaHYPERBILIRUBINEMIA

Predisposing Factors: 3 days old Female Preterm borderline neonate

Absence of glucuronyl transferase produced by liver

Objective Analysis Planning Intervention Rationale Evaluation

- 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.

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

After series of nursing interventions the bilirubin level will be decreased

Remove clothing and exposed to phototherapy.

Covered eyes and genitalia

Repositioned the baby every 2 hours.

Kept warm and dry.

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

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

To prevent further complications.

To obtain the baseline data

To prevent aspiration pneumonia and to prevent colic.

To prevent dehydration and replace fluid and

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

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at 14 uggts/ min.

Provided quiet and warm environment

Instructed the mother to use stimulation technique such as touching.

Health teachings given to the mother such as personal hygiene, importance of breastfeeding, and newborn screening

electrolyte lost

To promote comfort and prevent irritability

To promote sense of warmth, security and attachment

To detect early the possible diseases of the patient

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DAY 1: August 10, 2012


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

Risk for skin breakdown related to prolonged use of phototherapy.

After 8 hours of nursing interventions, the patient’s risk of skin breakdown will be avoided.

Maintained and monitored baby’s 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

Repositioned the baby every 2 hours

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

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

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- 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

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

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

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

To prevent dehydration and replace fluid and electrolyte lost

To obtain the baseline data

To promote comfort and good hygiene

To prevent aspiration pneumonia

To prevent further complications

To promote healthy lifestyle

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

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B. DRUG STUDY

Drug Name Dosage Classification Mechanism of Action

Indication Contraindication Adverse Effects

Nursing Responsibilities

Generic Name:AMPICILLIN

Brand Name:Novo-AmpicillinPrincipen

150mg IV every 12 (6-6)

AntibioticPenicillin

Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death

Treatment of infections caused by susceptible strains of shigella, Escherichia coli, gram-positive organisms (penicillin G-sensitive staphylococci, streptococcus)

Contraindicated with allergies to penicillins, cephalosphorins, or other allergens

Lethargy,Seizures,Anemia,Thrombocytopenia,Leukopenia,Neutropenia,Prolonged bleeding time, diarrhea

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

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Generic Name:CEFOTAXIME

Brand Name:Claforan

150mg IV every 12 (12-12)

AntibioticCephalosporin (3rd generation)

Bactericidal: Inhibits 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 manufacturer’s directions for details




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Generic Name:AMIKACIN

Brand Name:Amikin

30mg IV once a day (OD)

Aminoglycoside

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

With allergy to any aminoglycosides

Fever, 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




Assess patient for sign of super infection (fever, upper respiratory infection)

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Drug Name Dosage Classification

Mechanism of Action

Indication Contraindication

Adverse Effects


Generic Name:PHENOBARBITAL

Brand Name:Luminal SodiumPMS-Phenobarbital

9mg IV every 12 (12-12)

AntiepilepticBarbiturateHypnoticSedative

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

Sedative,Emergency control of acute seizures

With hypersensitivity to barbiturates, severe respiratory distress

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

Administer IV doses slowly

Monitor injection sites carefully for irritation and extravasation

Monitor pulse and respiration carefully during IV administration


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C.COURSE IN THE WARD

Date Time Vital Sign Observation

August 14, 2010 10:00PM

2:00AM

6:00AM

T – 36.3 oCP – 130 bpmR – 38 cpm

T – 36.5 oCP – 131 bpmR – 42 cpm

T – 36.8 oCP – 134 bpmR – 39 cpm

- with slightly yellowish skin color and sclera

- With good skin turgor- with good sucking

reflex- Afebrile- with negative (-)

adventitious breath sounds upon auscultation on both bilateral lung fields

- fairly active- with good sleeping

habit

DISCHARGE PLANMedication:

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 Encouraged the mother to let the baby be monitored by the health care

provider until complete recovery is met

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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 developmentOut 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 babySpirituality:

Encouraged the mother to continue to seek God’s 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 baby’s fast recovery and gave words

of encouragement

EVALUATIONThough 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 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

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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 baby’s 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.

RECOMMENDATIONThe group recommends to the parent the following care:

Expose their child under sunlight ideally between 6:00-7:00 in the morning and don’t forget to put cover over the baby’s 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 baby’s immunization Keep baby clean and dry

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Give home meds as prescribed. Seek immediate doctor’s 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, Lippincott’s, 2009, pp. 126, 101, 246, 948

http://www.merck.com/mmpe/lexicomp/bisacodyl.html

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http://www.merck.com/mmpe/lexicomp/bisacodyl.html

Hyper Bilirubin Emi A

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