jaundice

epiphany · Jul 28, 2008

whats the difference of pathological and physiological jaundice of neonate? the nurse responsibility or intervention?

take out your nursing book and read it.

LPN825 · Jul 28, 2008

Hello CandE25, From what I can remember from school, physiologic jaundice occurs about 48 to 72 hours after the baby is born and is considered normal, pathological jaundice occurs immediately after birth (less than 24 hours) and should be reported because this could indicate hemolytic (destruction to the red blood cells) disease. As for as interventions a heel stick blood test may be ordered to determine how much bilirubin is in the blood. If it is high then the baby undergoes phototherapy. The baby only has on a diaper and you must cover the baby's eyes with a dressing to protect the retinas from the light. Monitor the vital signs especially temperature for hypothermia or hyperthermia. The baby is feed on a 3 hour schedule to help in the excretion of the bilirubin. Don't forget that the baby needs "bonding" which can be done during feedings, vital signs, etc. I hope this helps!:)

Daytonite, BSN, RN · Jul 29, 2008

Pathologic jaundice

due to
- Rh and ABO blood incompatibilities
- infection
- hypothyroidism
- glucuronyl transferase deficiency
- polycythemia
- glucose-6-phosphate dehydrogenase deficiency
- biliary atresia
[*]predisposing factors
- prematurity
- cephalhematoma
- bruising
- hypoxia
- cold stress
- mother is diabetic
[*]symptoms
- jaundice appears in the first 24 hours of life
- total bilirubin concentration increases by more than 0.2 mg/dL/hr or 5 mg/dL/day
- direct bilirubin is greater than 1.5 to 2 mg/dL
- total bilirubin is more than 12 mg/dL in a full term baby or 10-14 mg/dL in a premie
- jaundice persists after second week of life
- complications can occur
  - encephalopathy
  - erythroblastosis fetalsis

Physiologic jaundice

due to
- hemolysis of excessive erythrocytes
- short life span of RBCs
- immaturity of the liver
- the intestines do not have the necessary flora to process bilirubin
[*]symptoms
- begin after 24 hours of life
- bilirubin levels of 5 to 6 mg/dL on 2nd to 4th day of age
- bilirubin level falls to 1 mg/dL by 10 to 14 day of age

Interventions

Assess
- the areas of the body involved
- changes in lab results and correlate them with the infant's age
- for skin breakdown from diarrhea
- for fluid loss
[*]Care
- feed milk since it stimulates stool excretion better than water
- institute phototherapy if ordered
  - prevent burning of skin
  - check level of irradiance with a light meter once a shift
  - protect eyes from retinal damage by covering them with eye patches and checking them q1h
  - remove the eye patches when the infant is out of the light
  - assess the eyes for infection when the eye patches are removed
  - only a diaper should be worn to increase maximum skin exposure to the lights
[*]Teach
- parents that adequate feedings are important to maintain and stimulate the passage of stools and to excrete bilirubin
- women who are breastfeeding should nurse at least every 2-3 hours
- parents how to check for jaundice
- use of home phototherapy if prescribed
[*]Manage
- prevent factors that increase the risk of hyperbilirubinemia
  - cold stress, hypoglycemia, inadequate intake

http://www.medscape.com/viewarticle/541770 - Jaundice in the Full-Term Newborn

I would have found this quicker if you had posted it on the Nursing Student Assistance Forum.

CandE25 · Jul 29, 2008

OK maam..thats the right thing to do,

epiphany · Jul 29, 2008

I can tell you right now that whatever explanation or intervention you do for your patients need to researched based, backed up by primary sources, and Allnurses isn't considered one.

In the nursing school, they may not ask you to cite your sources, but in real life when you treating a patient you can't do it because someone in Allnurses told you. It's irresponsible, lazy, and most importantly DANGEROUS.

I have to admit that i'm reacting to you because one of my pet peeves is people asking allnurses to do their homework for them. If you had some work on your own and needed clarity and had questions, that's a different thing. It looks like you just quoted right out of your assignment. You may not care because you are in nursing school, it's tough and merciless, but have SOME thirst of knowledge yourself because you're going to take care of human beings who are going to trust you so much they allow you to inject an unknown substance into their veins.

Think about it. Please.

Daytonite, BSN, RN · Jul 29, 2008

epiphany. . .just ask the moderators to have the post moved to the student forums if a question like this so enrages you. the students there monitor posters who continually ask for others to do their homework for them. it's easy enough to check previous posts to see what kind of threads a member has been generating and just not reply to or scold a student who seems to be asking others to do their schoolwork for them. some, it turns out, have just had poor writing skills in the way they compose their posts. sometimes you can tell from the way the question is asked that the student is from another country and that esl to them.

please tell me you didn't base your screen name on that horrible excuse of a nurse on general hospital. that character is one of the worst role models for an rn they ever planted on daytime tv with the way she yells and criticizes everyone including doctors and visitors. don't know what nursing school they imagined her from, but she would have flunked out long ago on her behavior alone.

epiphany · Jul 29, 2008

epiphany. . .just ask the moderators to have the post moved to the student forums if a question like this so enrages you. the students there monitor posters who continually ask for others to do their homework for them. it's easy enough to check previous posts to see what kind of threads a member has been generating and just not reply to or scold a student who seems to be asking others to do their schoolwork for them. some, it turns out, have just had poor writing skills in the way they compose their posts. sometimes you can tell from the way the question is asked that the student is from another country and that esl to them.
please tell me you didn't base your screen name on that horrible excuse of a nurse on general hospital. that character is one of the worst role models for an rn they ever planted on daytime tv with the way she yells and criticizes everyone including doctors and visitors. don't know what nursing school they imagined her from, but she would have flunked out long ago on her behavior alone.

um no, i've never seen general hospital. i can't decide whether you think i'm intentionally basing my personality on this character or an indirect way of attacking me, but i'll let your writing speak for itself.

the first paragraph makes sense to me. i was contacted by a moderator, and i agreed with her not to be so tough on students. there's a bit of me that thinks this is all about getting more readership on this blog, but she/he was still right about me. however, i do think that encouraging students to think for themselves and to ways to find answers to their questions is much better than feeding them because:

1. this is public forum where anyone can answer these questions. a psycho who wants to mess with student's heads would privately email the "answers" to her/him. it's not same but when a person asks for medical advise here, there's an element of danger is not totally different from asking advise on how to take care of patients.

2. teaching them how to find answers is actually the right way to prepare them. encouraging them to ask questions only if they have actually looked it up would be another.

so, your second paragraph aside, i concur with you and thank you for pointing out the nuances.

SteveNNP, MSN, NP · Jul 30, 2008

There is a lot of truth to be found in this thread.

-Speak kindly to others

-Accept the responsibility of doing your research on your own

-Ensure you have accurate and peer-reviewed sources.

Thanks to all for remaining cordial.