Nursing Care Plan
Neonatal hyperbilirubinemia or Neonatal jaundice or Neonatal icterus is a yellowing of the skin and other tissues of a newborn infant. In newborns, jaundice is detected by blanching the skin with digital pressure so that it reveals underlying skin and subcutaneous tissue. Jaundiced newborns have an apparent icteric sclera, and yellowing of the face, extending down onto the chest. In neonates the dermal icterus is first noted in the face and as the bilirubin level rises proceeds caudal to the trunk and then to the extremities.
Jaundice is the most common condition that requires medical attention in newborns. In most infants, unconjugated hyperbilirubinemia reflects a normal transitional phenomenon. However, in some infants, serum bilirubin levels may excessively rise, which can be cause for concern because unconjugated bilirubin is neurotoxic and can cause death in newborns and lifelong neurologic sequelae in infants who survive (kernicterus).
1. History of the parents:
The imbalance of maternal and child blood type as Rh, ABO, polycythemia, infection, hematoma, gastrointestinal obstruction and breast milk.
2. Physical Examination:
Yellow, pallor convulsions, lethargy, hypotonic, shrill cry, weak reflexes feeding, irritability.
3. Psychosocial Assessment:
The impact of child illness on relationships with parents, whether the parents feel guilty, problems Bonding, separation from children.
4. Family knowledge include:
The cause of the disease and treatment, further treatment, whether the family knew others who had the same level of education, the ability to learn hyperbilirubinemia (Cindy Smith Greenberg. 1988)
Nursing Diagnosis Intervetions - Neonatal Hyperbilirubinemia
1. Fluid Volume Deficit related to inadequate fluid intake, photo-therapy, and diarrhea.
Goal: Body fluids of neonates adequate
Record the amount and quality of feces, skin turgor monitor, monitor intake output, give water between nursing or giving a bottle.
2. Hyperthermia related to the effects of phototherapy
Goal: The stability of a baby's body temperature can be maintained.
Give a neutral ambient temperature, keep the temperature between 35.5 ° - 37 ° C, check vital signs every 2 hours.
3. Impaired skin integrity related to hyperbilirubinemia and diarrhea
Goal: baby skin integrity can be maintained.
Assess skin color every 8 hours, monitor direct and indirect bilirubin, change position every 2 hours, massage areas that stand out, keep skin clean and moisture.
4. Impaired Parenting related to separation
Goal: Parents and infants showed behavior "Attachment", parents can express a lack of understanding of the Bounding.
Take the baby to the mother for feeding, close eyes open at the breast, for social stimulation with mothers, encourage parents to talk to their children, involve parents in treatment whenever possible, encourage the parents to express their feelings.
5. Anxiety related to therapy given to infants.
Goal: Parents know about care, it can identify the symptoms to pass the health care team.
Assess the client's knowledge of the family, give health education the cause of yellow, the process of therapy and treatment. Give health education on how to care of the baby.
6. Risk for injury related to transfusion rate
Goal: exchange transfusion can be performed without complications.
Note the umbilical condition, if the umbilical vein is used; wet umbilical with NaCl for 30 minutes before taking action, fasting neonates 4 hours before the procedure, keep the baby's body temperature, record the mother's blood type and Rh and blood to be transfused blood is fresh; monitor signs vital signs, during and after the transfusion; prepare suction when required; observe for fluid and electrolyte disturbances; apnoe, bradycardia, seizures; monitor laboratory according to the program.
Planing Discharge Application.
Growth and development and the changing needs of infants with hiperbilirubin (such as stimulation, exercise, and social contact) are always the responsibility of the parents to comply with the rules and the description given during hospitalization and follow-up care at home.
Factors that should be delivered so that the mother can perform the best action in the treatment of infants with hyperbilirubinemia (Warley & Wong, 1994):
Encourage the mother revealed / reported when babies have disorders of consciousness such as seizures, anxiety, apathy, appetite decreased breastfeeding.
Encourage her to use a pump milk for a few days to maintain smooth milk.
Provide an explanation of the photo-therapy procedure, a replacement for the lower levels of bilirubin baby.
Advised the mother to consider stopping breastfeeding in preventing an increase in bilirubin.
Teach about skin care.
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