Help with a nursing diagnosis?

[2372Martin]

Hi all,

I'm in my OB clinical right now and need to write a care plan on the newborn that I assessed the other day. The baby was overall healthy but slightly jaundiced. For my diagnosis for the care plan does this make sense?

At risk for altered hepatic function r/t jaundice a.e.b yellowing skin.

I know I can do something easy like at risk for infection, etc. But I wanted to try to write one about the jaundice.

Any help would be very much appreciated!

[klone, MSN, RN]

How about something related to isolation and separation from the mother d/t needing to go under lights?

[Jolie, BSN]

Most nursing programs are weak in their teaching of normal and abnormal physiology of the newborn, so I'm going to help you out a little.

In older children and adults, elevated bilirubin levels are often an indicator of abnormal liver function. But there are many ways in which newborn physiology differs from that of older children and adults, and this is an excellent example. In a healthy, normal, term newborn, mildly elevated bilirubin levels are expected and occur because of the breakdown of excess red blood cells, which is a part of the transition from fetal to extra-uterine life. Can you explain how and why the breakdown of red blood cells would cause mild, temporary jaundice?

In addition to this normal (physiologic) jaundice, there are other factors which can cause the breakdown of too many red blood cells, causing excessive (pathologic) jaundice, along with anemia. Can you name those factors? What serious (life-threatening) condition can occur if pathologic jaundice is not effectively treated in a newborn? These might make good "Risk for" nursing diagnoses.

Look in your textbooks or on-line to find a chart which helps to determine, based upon the baby's gestational age, birthweight and day of life, whether a particular bilirubin level is a cause for concern requiring treatment, or whether the baby can be safely monitored without treatment.

How is jaundice in the newborn treated?

[lolaviex]

You can use "Neonatal jaundice" it's an actual NANDA 2012-2014 nursing diagnosis.

[nurseprnRN, BSN, RN]

You can use "Neonatal jaundice" it's an actual NANDA 2012-2014 nursing diagnosis.

Gold star, lolaviex!! :anpom:

Now, for the "related to" and "as evidenced by," let's try again.

There's no "risk of" here, the kid is already yellow. :)

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________."

"Related to" means "caused by," not something else. In your original diagnosis (which isn't a nursing diagnosis, by the way) you said that altered hepatic function was caused by jaundice, which is, of course, exactly backwards. But since you can't use "altered hepatic function" because it isn't a nursing diagnosis, we'll skip that.

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic." Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2012-2014 (current edition).

So: if you use "neonatal jaundice" as your nursing diagnosis, you discover that the support you need for that includes the following in the NANDA-I 2012-2014:

Defining characteristics (must have at least one): abnormal blood profile (a number of lab results given...look in the NANDA-I to see what they are); abnormal skin bruising; yellow mucous membranes; yellow-orange skin; yellow sclera

"As evidenced by" means "these are the defining characteristics I observed/learned about in the chart." The related factors are in the NANDA-I too.

So for your baby, you've fallen in love with the idea of neonatal jaundice. Now take the sample sentence above and tell us in plain English what your diagnosis is and why you think so.

[mssjez]

I think that there is probably more s/s you can give in your aeb section to support your dx. What else is/was evident with the neonate? Labs?