Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Submitted to:
Ms. Mildred Limuaco, RN, MAN
Clinical Instructor
Submitted by:
GROUP II
Members:
Bernardino, Michelle S.
Ching, Judith U.
Ingalla, Charmaine S.
Matienzo, Evangeline N.
Sotomayor, Karen B.
October 2010
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TABLE OF CONTENTS
I. Introduction ------------------------------------------------------------------------------------2
A. Objectives -------------------------------------------------------------------------------3
B. Background of the Study ------------------------------------------------------------4
C. Rationale for Choosing the Case -------------------------------------------------4
D. Significance of the Study ------------------------------------------------------------5
E. Scope and Limitations ---------------------------------------------------------------5
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I. Introduction
HYPERBILIRUBINEMIA
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 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.
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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
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B. BACK GROUND OF THE STUDY
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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
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
Source of Information
Primary Source : Mother
Chief Complaint: “Tatlong araw nang madilaw ang anak ko” as verbalized by the
mother
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B. PHYSICAL ASSESSMENT
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- equal in size
Ears - auricles are smooth and symmetrical
- pinna recoils after it is folded
- 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
Nose - 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
Mouth - 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
Neck moving was not noted
- free from lumps and no tenderness
- no masses and tenderness upon palpation
Thorax - no adventitious breath sounds upon auscultation on
both left and right lung fields
- negative retractions
- round in shape, no lumps, no masses
Breast - areola dark brown in color
- nipples round, equal in size
- same color of the body
Abdomen - globular, soft without distention
- bowel sounds in all quadrant
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- skin pinch goes back quickly
- good range of motion was noted
Upper extremities - no lesions, no presence of abnormalities, no
tenderness
- can flex and extend arms without difficulty
- skin uniform in color
- good range of motion was noted
Lower extremities - no lesions, no presence of abnormalities, no
tenderness
- can flex and extend legs without difficulty
- no discharges
Genitalia - no bleeding
- With slightly normal genitalia (labia majora almost
covers the clitoris)
- With genital shield
Elimination - With patent anus
C. SYSTEM AFFECTED
Digestive System
Hematologic System
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Bilirubin Test
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Neonatal 25.5 mg/dl 1.0-10.5 Increased Increase
Bilirubin mg/dl destruction of
RBC resulting
in increase
unconjugated
and conjugated
bilirubin
Unconjugated 24 mg/dl 0.6-10.5 Increased An abnormal
bilirubin mg/dl accumulation of
bilirubin in the
blood caused
by the poor
function of the
liver
Conjugated 1.50 mg/dl 0-0.6 mg/dl Increased Increase
bilirubin destruction of
RBC resulting
in increase
unconjugated
and conjugated
bilirubin
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BLOOD RESULT NORMAL INTERPRETATION SIGNIFICANCE
COMPONENTS VALUE
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/ L Increase Increase WBC
Cells (WBC) signifies
infection in the
body.
Hematocrit 33% 42-59% Decrease Decrease
hematocrit
indicates that
the mass of
RBC is
decrease
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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.
• Blood reservoir
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• Excretion of adrenal cortex hormone
Spleen
• Sequesters the old, worn-out RBCs thereby removing them from the circulation
Gall Bladder
Function:
• Stores and concentrates the (greenish liquid composed of watr, cholesterol, bile
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
Pancreas
• The pancreas is an elongated, tapered organ located across the back of the
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B. PATHOPHYSIOLOGY
Predisposing Factors:
• 3 days old
• Female16
• Preterm borderline neonate
Will go to the bone marrow
for new RBC productionIron Hemoglobin will splitGlobins
HemeBiliverdin into
Breakdown into amino acids
RBC lifespan of 120 days
Unconjugated to convert
HYPERBILIRUBINEMIA
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Objective Analysis Planning Intervention Rationale Evaluation
- skin appearing Risk for Injury After series of Remove clothing and Aids in diagnosing Goal met.
light yellow related to nursing exposed to underlying cause in After series of
- sclera abnormal blood interventions the phototherapy. connection with the nursing
appearing light profile as bilirubin level will appearance of intervention the
yellow evidenced by be decreased jaundice bilirubin level was
- weak looking increase decreased to 0.20
- afebrile bilirubin level of Covered eyes and To prevent eyes from mg/dl.
- with thin and 1.59mg/dl. genitalia direct exposure to
dry skin light and prevent
- hypoactive sterility of the baby
- under intensive
and Repositioned the baby To prevent burns
phototherapy every 2 hours.
-with eye and
genital shield Kept warm and dry. To prevent further
-with IVF reg. @ complications.
14 gtts/min.
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Monitored input and To prevent
output; IVF regulated dehydration and
at 14 uggts/ min. replace fluid and
electrolyte lost
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Objective Analysis Planning Intervention Rationale Evaluation
- skin appearing Risk for skin After 8 hours of Maintained and To protect retina from Goal met.
light yellow breakdown nursing monitored baby’s eye damage due to high After 8 hours of
- sclera related to interventions, the patches while under intensity of light nursing
appearing light prolonged use patient’s risk of phototherapy interventions, the
yellow of phototherapy. skin breakdown patient was free
- afebrile will be avoided. Removed baby under To provide visual from skin
- with thin and phototherapy and stimulation and breakdown.
dry skin removed eye patches facilitates attachment
-with during feeding behaviors
desquamation of
the skin Inspected eyes every To reduce
- under intensive after phototherapy for complications and
and single conjunctivitis, drainage monitor the
phototherapy and corneal abrasions effectiveness of the
due to irritation from management
eye patches
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Objective Analysis Planning Intervention Rationale Evaluation
- with slightly Risk for fluid After series of Monitored input and To prevent Goal met.
yellowish skin imbalance nursing output; IVF regulated dehydration and After series of
color and sclera related to interventions, the at 14 uggts/ min. replace fluid and nursing
- fairly active prolonged risk for fluid electrolyte lost interventions, the
- with good exposure to imbalance will be risk for fluid
sucking reflex phototherapy as prevented Vital signs taken and To obtain the baseline imbalance is
- with slight evidenced by recorded data prevented as
depressed dry skin evidenced by good
fontanel Bedside care done To promote comfort skin turgor
- afebrile including stretching of and good hygiene
- negative (-) linens and organizing
adventitious bedsides
breath sounds
upon Instructed Strict To prevent aspiration
auscultation on Aspiration Precaution pneumonia
both bilateral (SAP)
lung fields
Kept back dry To prevent further
complications
Needs attended
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B. DRUG STUDY
Generic Name: 150mg IV Antibiotic Bactericidal Treatment of Contraindicated Lethargy, Check IV site
AMPICILLIN every 12 Penicillin action against infections with allergies to Seizures, carefully for
(6-6) sensitive caused by penicillins, Anemia, signs of
Brand Name: organisms; susceptible cephalosphorins, Thrombocyto thrombosis
Novo-Ampicillin inhibits strains of or other allergens penia,
Principen synthesis of shigella, Leukopenia, Inform the
bacterial cell Escherichia Neutropenia, guardian of the
wall, causing coli, gram- Prolonged patient that this
cell death positive bleeding drug is given to
organisms time, treat infection
(penicillin G- diarrhea
sensitive Follow the 10
staphylococci, Rights of the
streptococcus) medications and
administration
Advise the
guardian to
report signs of
hypersensitivity
such as redness
and rashes
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Drug Name Dosage Classification Mechanism Indication Contraindication Adverse Nursing
of Action Effects Responsibilities
Generic Name: 150mg IV Antibiotic Bactericidal: Septicemia Contraindicated Diarrhea, bone Reconstitution of
CEFOTAXIME every 12 Cephalosporin Inhibits caused by with allergy to marrow drug varies by
(12-12) (3rd synthesis of E.coli, cephalosporins or depression – size of package;
Brand Name: generation) bacterial cell Klebsiella penicillins decreased see
Claforan wall, causing species, S. WBC, manufacturer’s
cell death marcescens decreased directions for
platelets, details
decreased
hematocrit, 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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Drug Name Dosage Classification Mechanism Indication Contraindication Adverse Nursing
of Action Effects Responsibilities
Generic 30mg IV Aminoglycoside Bactericidal: Short-term With allergy to Fever, Monitor duration of
Name: once a Inhibits protein treatment of any seizures, treatment; usually 7-10
AMIKACIN day synthesis in serious aminoglycosides diarrhea, days. Prolonged
rash, treatment leads to
(OD) susceptible infections
Brand Name: urticaria increased risk of toxicity
strains of gram- caused by
Amikin negative susceptible Monitor intake and
bacteria, and strains of output and daily weight
the functional Pseudomonas to assess hydration
integrity of species, E.coli, status and renal function
bacterial cell Klebsiella,
membrane Enterobacter, Inform the guardian of
appears to be and Serratia the patient that this drug
disrupted, species is given to treat infection
causing cell
Follow the 10 Rights of
death
the medications and
administration
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Drug Name Dosage Classification Mechanism of Action Indication Contraindication Adverse Nursing
Effects Responsibilities
Generic Name: 9mg IV Antiepileptic General CNS Sedative, With Bradycardia, Administer IV
PHENOBARBITAL every Barbiturate depressant; Emergency hypersensitivity constipation, doses slowly
12 (12- Hypnotic barbiturates inhibit control of to barbiturates, diarrhea,
Brand Name: 12) Sedative impulse conduction acute severe rashes, Monitor injection
Luminal Sodium in the ascending seizures respiratory urticaria, sites carefully for
PMS- RAS, depress the distress respiratory irritation and
Phenobarbital cerebral cortex, depression, extravasation
alter cerebellar broncho-
function, depress spasm Monitor pulse and
motor output, and respiration
can produce carefully during IV
excitation, sedation, administration
hypnosis; at
subhypnotic doses, Follow the 10
has anti-seizure Rights of the
activity, making it medications and
suitable for long- administration
term use as an
antiepileptic
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C.COURSE IN THE WARD
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:
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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 pray for the baby’s fast recovery and gave words of
encouragement
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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 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 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
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
don’t forget to put cover over the baby’s eyes
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• 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
• 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, 2 nd
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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