Nursing diagnosis for baby with jaundice?

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    Besides risk for injury r/t burns secondary to phototherapy, can you think of any other diagnosis for a baby with hyperbilirubinemia?

    Thanks!
    Megan
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    Hmmm.... higher priority would be the possible devastating effects of too high serum bilirubin on brain cells (kernicterus) or dehydration from the phototherapy lamps (dehydration is always very dangerous with the very young and the very old)...
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    Poor feeding is another one. Often babies who are well below the kernicterus levels, but are jaundiced become lethargic and need help eating (IV fluids which also help with dehydration and sometimes tube feeding as well).
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    Risk for injury from breaking down products of red blood cells in greater numbers than normal and functional immaturatity of the liver.

    Interrupted family process related to infant with potentially adverse physiologic response.

    I'm a dork, I looked it up in my text. (That's good for a new grad right?, if you don't know, LOOK IT UP!) These were the two my peds book listed. All kinds of goals, interventions, and rationales for appropriate phototherapy.
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    Thanks so much! These are great! My book only has one diagnosis so these are a big help!

    Megan
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    Potential for dehydration r/t photo therapy lights.
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    Risk for altered body temperature (hypothermia): This diagnosis would apply if the baby was underphototherpy lights, but not under a heat source. Also, be aware the phototherpay lights provide light only, not heat so the baby would be at risk for burn injury. There is risk for retinal damage however if the eyes are not covered.

    Sensory/Perceptual Alteration (Visual and Tactile) R/T phototherpy, as evidenced by neonate under phototherapy lights, with eyes covered, and limited physical contact (only removed and held for feedings).

    Risk for Injury (neurological), related to elevated serum bilirubin levels, and physiological stressors associated with phototherapy (decreased oral intake, increased fluid loss, risk for hypothermia, risk for hypoglycemia, etc. all of which further increase serum bilirubin levels)
  11. 0
    Quote from megamoo1979
    Besides risk for injury r/t burns secondary to phototherapy, can you think of any other diagnosis for a baby with hyperbilirubinemia?

    Thanks!
    Megan
    Risk for disproportionate Growth: infant r/t disinterest in feeding because of jaundice-related lethargy.
  12. 0
    [QUOTE=Leda] Also, be aware the phototherpay lights provide light only, not heat so the baby would be at risk for burn injury.


    Really? See, my book really only discusses one nsg diagnosis for hyperbilirubinemia. It talks about preventing elevation of the baby's temp from exposure to the heat of the bili lights, and positioning the bili lights appropriately to prevent overheating or burning of the skin. Hmm.

    Megan
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    In my experience (30+), there is a danger from the bililights, specifically the danger of injury from breakage of the lights. This is why the light bank must be covered with a sheild. In addition the light bank must be at the proper distance from the infant, to have maximum effectivenes, and yes prevent burn injury if the lights were extremeley close to their skin. So, your text is correct in that regard. However, when the lights are properly positioned and are the correct distance from the neonate, the greater danger is hyothermia/heat loss because the child is exposed to the environment. Other than eye and perhaps genital covering they are unclother. Therefore they can lose heat to the environment rapidly, unless they are under a heat source.

    More often than not the neonate will be place in/under an additional heat source because the lights in and of themselves do not provide adequate heat. It is critical to avoid hypothermia, because this would lead to hypoglycemia and acidosis, which would in turn cause the bilirubin levels to raise even higher. I hope this clarifies things.


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