[law3576]

I am doing my OB rotation now. I had a newborn with a bilirubin of 10 and also a small scalp laceration due to birth. I need help coming up with nanda's for the bilirubin and maybe an idea for the scalp laceration.

For the scalp I can do risk for infection r/t laceration and also impaired skin intergrity. I have no idea what to do about the bilirubin levels.
Thanks for any ideas.

[Jolie]

Elevated bilirubin is a safety issue, as it places baby at risk for neurological injury.

If the elevated bili is due to ABO or Rh incompatibility, there is a risk for anemia and decreased tissue perfusion due to destruction of excessive numbers of RBCs.

Elevated bili can also lead to interrupted breast feeding if mom and baby are separated by hospitalization, or by a physician order to with-hold breast milk.

I think you're on the right track with the scalp laceration. Pain may be an apropriate nursing diagnosis also.

[GingerSue]

checking the maternal-newborn textbook:
in the section about hyperbilirubinemia - neurotoxicity is possible because unconjugated bilirubin has a high affinity for extravascular tissue, including subcutaneous fatty tissue and the tissues of the brain. Bilirubin not bound to albumin is free to cross the blood-brain barrier, damage cells of the CNS, and producekernitcterus or bilirubin encephalopathy.
Neurologic signs may include lethargy, diminished reflexes, hypotonia, or seizures.

Will this newborn require phototherapy, or exchange transfusion to reduce serum bilirubin levels?

Nursing diagnoses that may apply to a newborn with jaundice include:
Sensory/Perceptual Alterations related to neurologic damage secondary to kernicterus
Risk for Injury related to use of phototherapy

[Daytonite]

What are the symptoms of the elevated bilirubin levels? That is how you determine the nursing problem. The skin is discolored and the baby is place under bili-light. So, the problem is one of potential injury to the skin. Therefore, your NANDA, as you call it, actually your patient's problem is Risk for Injury (side effects of the phototherapy) R/T therapeutic intervention. The reason I put "side effects of phototherapy" in parentheses is because when you write the nursing interventions and goals/outcomes for this nursing diagnosis, you will focus on monitoring for and preventing those side effects. I do not mean for you to include those words in your actual nursing diagnostic statement. However, when you write any "Risk for" nursing diagnosis, it must have a specific target risk. In this case, the specific target risk would be the side effects of the phototherapy. The actual nursing diagnosis you would use is: Risk for Injury R/T therapeutic intervention.

[law3576]

Thank you so much for these responses. I am usually very good with my careplans but for some reason I was stumped. Now it makes sense and I understand it alot better than what I did before.