nursing diagnoses!

[MIA-RN1]

Hi all. At work we write PAR notes (Problem, assessment, response)

Anyway, the P is a nursing diagnosis, or should be. I am having a terrible time finding a nursing diagnosis for jaundice. Specifically, asymptomatic jaundice of the newborn. Some people write risk for impaired skin integrity, which I know is wrong. Others just write hyperbilirubinemia or just plain jaundice (what I've done til now) But I want to get it right. Help! If the bilimeter is high, and I do a blood draw for bili, would it be okay to write risk for jaundice r/t increased bilirubin as evidenced by facial yellowing? I can't believe this wasn't covered in school. I've been thru all my notes and simply can't find the right diagnosis. At work we don't use the 'r/t' part anyway, but I want to get them right. Thanks!

[mitchsmom]

Have you tried searching this one? It seems like a student asked this same question on the site before (I'm pretty sure- but I don't know which forum).

My dx book (Nursing Dx Handbook: A Guide to Planning Care - Ackley and Ladwig) lists:

Disturbed thought process r/t toxic blood metabolites

Impaired comfort: pruritis r/t toxic metabolites excreted in the skin

Risk for impaired skin integrity r/t pruritis, itching

also Readiness for enhanced knowledge

you could also use nutrition ones, especially if breastfeeding has been interrupted.

[MIA-RN1, RN]

ok, i understand your dilemma here. a nursing diagnosis represents a problem or potential problem that the patient is having or might have. so, with an elevated bilirubin or the appearance of jaundice, what is going on in your mind? what is the concern for the baby? that is where you look to formulate a nursing diagnosis. i think that where you need to start is to do a little investigation of the medical diagnosis and pathophysiology of jaundice in newborns. with that in mind, i found a ce article for physicians on emedicine about it. http://www.emedicine.com/ped/topic1061.htm i did read through it and it is rather involved. but, i can see why there is concern for this. there seem to be a number of serious pre-existing conditions that could be the potential reasons and worst case scenarios for which jaundice is one of the first indications. now, most of the time things don't turn into those worst case scenarios, but in the interest of good standards of care, that is really what the physicians are wanting to monitor for because the worst case scenarios have a really bad outcome for the babies. the symptoms of those diseases, then, need to be monitored for. that monitoring would be nursing interventions. your nursing diagnosis, then, would be a "risk for" problem(s) caused by some of these diseases whose appearance or nonappearance of symptoms you are going to be addressing in your charting when the first evidence of jaundice is noted. does that make a lot more sense to you?

yes it does and that is a great article~ jaundice can be so hard to explain to parents and it was hard for me to learn about in school, combined with all the rh stuff and coombs testing etc.

i think that risk for injury r/t (facial, nipple line, umbilical etc) jaundice secondary to increased bilirubin levels. would be the best bet, since jaundice in and of itself wouldn't really be a medical dx, don't you think? i mean, its a description, not a medical diagnosis. i think lol.

thank you so much for your help.

[MIA-RN1, RN]

Have you tried searching this one? It seems like a student asked this same question on the site before (I'm pretty sure- but I don't know which forum).

My dx book (Nursing Dx Handbook: A Guide to Planning Care - Ackley and Ladwig) lists:

Disturbed thought process r/t toxic blood metabolites

Impaired comfort: pruritis r/t toxic metabolites excreted in the skin

Risk for impaired skin integrity r/t pruritis, itching

also Readiness for enhanced knowledge

you could also use nutrition ones, especially if breastfeeding has been interrupted.

yep I have the ackly book too but those dx's seemed more related to jaundice secondary to hepatits, cirrhosis, and liver disease. The babies I see aren't bothered at all by their jaundice. I agree that the readiness for enhanced knowledge will work for the mom's record tho, to document teaching.