1. The caregiver can define hyperbilirubinemia.
    1. It is the excessive accumulation of bilirubin in blood (12 mg per 100 ml or greater).
    2. Bilirubin is caused by the breakdown of hemoglobin in the destruction of red blood cells.
    3. If bilirubin is 20 or greater, it is termed kernicterus and can cause permanent brain damage (signs and symptoms of kernicterus include lethargy, feeding difficulties, irritability, and seizures).
    4. A symptom of hyperbilirubinemia is jaundice (a yellowish discoloration of the skin).
  2. The caregiver can list treatment for hyperbilirubinemia.
    1. Phototherapy (most common treatment) is used.
    2. In more severe cases, exchange transfu- sions may be used.
    3. Keep newborn hydrated with breast milk or formula.
    4. Stop breastfeeding for 1 to 2 days, and give formula, which may reduce jaundice.
  3. The caregiver can define and explain purpose of phototherapy.
    1. Infant is placed under artificial light in a protected isolette to maintain constant temperature.
    2. A fiberoptic blanket (another form of phototherapy) is placed under baby (infant may remain dressed).
    3. Lights help break down bilirubin in the skin.
    4. Infant is clothed only in a diaper.
    5. The infant’s eyes are protected from light source by eye patch or headbox.
    6. Bilirubin levels need to be taken at least daily.
  4. The caregiver can list measures to protect infant during phototherapy.
    1. Increase fluids by 20% to 25%.
    2. Turn regularly to expose all parts of body, at least every 2 hours.
    3. Make certain that eyelids are closed before applying eye shield.
    4. Check eyes for drainage or irritation frequently.
    5. Cover male genitalia to prevent damage from heat and light waves.
    6. Turn the light off, and unmask eyes at least every 3 to 4 hours (with feedings).
    7. Monitor body temperature every 2 hours.
    8. Avoid oils and lotions on the skin.
    9. Report any signs of increased lethargy, difficulty arousing infant, or changes in stools or urination.
    10. Monitor elimination, and weigh twice daily.
    11. Keep skin clean and dry.
    12. Assess for symptoms of dehydration, such as
      • Poor skin turgor
      • Sunken fontanels
      • Decreased urine output
    13. Turn off phototherapy unit before drawing blood for testing.
  5. The caregiver can list possible complica- tions of untreated hyperbilirubinemia.
    1. Dehydration
    2. Brain damage
    3. Blindness
    4. Loss of hearing

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.Maternal-neonatal nursing: Lippincott manual of nursing practice pocket guides. (2007). Philadelphia: Lippincott Williams & Wilkins.Novak, J. C., & Broom, B. L. (1999). Maternal and child health nursing. St. Louis: Mosby, Inc.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.© 2008 Jones and Bartlett Publishers, Inc.www.jbpub.com

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