Hyperbilirubinemia Case Presentation
Hyperbilirubinemia Case Presentation
Hyperbilirubinemia Case Presentation
CASE PRESENTATION
Personal Data
Posture Lies in a relaxed attitude, limbs more Has more subcutaneous fat tissue and rests
extended; the body size is small, and the in a more flexed attitude
head may appear somewhat larger in
proportion to the body size
Ear Ear cartilages are poorly developed, and Ear cartilages are well formed
the ear may fold easily;
Sole Appears more turgid and may have only Well and deeply creased
fine wrinkles
Female Genetalia Clitoris is prominent, and labia majora are Labia majora is fully developed, and the
poorly developed clitoris is not as prominent
Lanugo Hair is fine and leathery, and the lanugo Less lanugo
may cover the back and upper arm
Scarf Sign Elbow may easily be brought across the Elbow may be brought to the midline of
chest with little or no resistance the chest , resisting attempts to bring the
elbow past the midline
Neuromuscular Maturity
Ballard’s Assesment
Physical Maturity
-1 0 1 2 3 4 5
Skin Sticky, friable, Gelatinous, red, Smooth, pink, Superficial, Cracking, pale Parchment, deep Leathery,
transparent trancslucent visible vein peeling &/or area, rare veins cracking, no cracked,
rash, few veins vessels wrinkled
Plantar Heel to toe No crease Faint red marks Anterior Creases ant. 2/3 Creases cover
creases transverse entire sole
crease only
Breast imperceptible Barely percept. Flat areola, no Stippled areola, Raised areola, Full areola, 5-10
bud 1-2 mm bud 3-4 mm bud mm bud
Eyes/Ear Lids fuses loosely Lids open, Slightly curved Well-curved Formed and Thick cartilage,
Pinna flat, stays pinna, soft with pinna, soft but firm with instant ear stiff
folded slow recoil ready recoil recoil
Female Prominent clitoris, Prominent Prominent Majora and Majora large, Clitoris and
genitals labia flat clitoris, small clitoris, minora equally minora small minora
labia minora enlarging prominent completely
minora covered
Diagnostic test
Interpretation:
Diagnostic test
CHEST X-RAY
Result:
The lung fields are clear with normovascular patterns.
The heart is normal in size and configuration
Bony walls and thorax are unremarkable
Soft tissue densities are w/in normal
Comment: Normal Chest
Interpretation:
Diagnostic test
Hematology
Normal (female) Result
Leukocytes 4.1-10.9 6
Erythrocytes 3.8-5.5 6
Hemoglobin 12-15.2gm/dL 17.5
Hematocrit 37-46% 52
Thrombocytes 140-450 482
Lymphocytes 20-50% 52.300
Diagnostic test
Interpretation:
Diagnostic test
Interpretation:
There is an increase in Bilirubin Neonates
because of hemolysis.
Disease entity
Predisposing factors: age 18 yrs.old
Pre-term
Disease Entity
Increase sequestration of RBC containing Fetal HGB
by the spleen
heme Globin
Jaundice
Treatment and Management
NURSING
CLASSIFI- FREQUENCY, ADVERSE
DRUG INDICATION CONTRAINDICATION RESPONSIBILI-
CATION ROUTE, DOSE EFFECTS
TIES
USE CAUTIOUSLY
WITH NEONATES
AND INFANTS.
XANTHINE Before giving
I.V. 3 MG +2CC
; Relief for HYPERSENSITIVITY loading dose, make
AMINOPHYLLINE STERILE WATER;
BRONCHO bronchospasm TO XANTHINE sure patient hasn’t
OD;
DILATOR had recent
theophylinne
therapy.
Monitor VS
NAUSEA AND
XANTHINE DON’T USE
RELIEF FOR VOMITING, USE CAUTIOUSLY
, I.V. 25.7 mg/ 5 Ml 0.6 EXTENDED RELEASE
THEOPHYLLINE BRONCHO- IRRITABILITY, IN NEONANATES,
BRONCHO mL OD FORMS OF ACUTE
SPASM RESTLESNESS, MONITOR VS
DILATOR BRONCHOSPASM
FLUSHING
CLASSIFI FREQUENCY, CONTRAINDICATIO ADVERSE NURSING
DRUG INDICATION
CATION ROUTE, DOSE N EFFECTS RESPONSIBILITIES
Use cautiously in
Multi- Nutritional Nausea and
CLUSIVOL PO 0.2 mL OD Hypersensitivity, patients with
vitamins supplement, vomiting
respiratory inefficiency
Contraindication in
Nausea and
Ferrous (Ferlin For iron patients with Between meals are
Hema-tinics PO 0.5 OD Vomiting, black
Drops) deficiency hemosiderosis hemolytic preferable
stool
anemia
NURSING CARE PLAN
CUES BACKGROUND NURSING OBJECTIVES
KNOWLEDGE DIAGNOSIS
Objective: Premature babies Imbalanced After 8 hours of
>31-32 weeks AOG are babies born Nutrition due to nursing
>weak suck before the target Immaturity interventions,
> 22 cc OGT gestational age patient will be able
tolerated which is 37-38 to receive adequate
weeks. Since they nourishment to
are born maintain balance.
prematurely most
of their organs are
still developing.
They must make
the same
adjustment
towards their
undeveloped body
systems but with
functional
immaturity
proportional to the
stage of
development
reached at the time
of birth.
Nutrition is the
combination of
processes by which
the living organism
receives and
utilizes the
materials necessary
for its growth .
INTERVENTION RATIONALE
Independent:
>use orogastric feeding >patient has weak suck
>use appropriate milk formula and >to avoid feeding intolerance
amount
>assess readiness to nipple feed >to recognize the sucking ability and the
coordination of swallowing and breathing
Dependent:
>maintain parenteral fluid nutrition >gives additional nourishment and
therapy as ordered renews body fluid
>administer medications as prescribed by >food supplements are necessary to
the physician support the child’s nutrition
EVALUATION
After 8 hours of nursing interventions, patient received an adequate amount of
calories and essential nutrients.
NURSING CARE PLAN
CUES BACKGROUND NURSING OBJECTIVES
KNOWLEDGE DIAGNOSIS
Objective: Premature babies are Risk for Imbalanced After 8 hours of
>dry, flaky skin babies born before the Fluid Volume nursing
>thin, parchment- target gestational age
which is 37-38 weeks. related to interventions,
like skin Since they are born immature patient will be able
>skin turgor test prematurely most of characteristics of to exhibit adequate
(slow skin recoil) their organs are still preterm infants hydration status
developing. They must
make the same
adjustment towards
their undeveloped
body systems but with
functional immaturity
proportional to the
stage of development
reached at the time of
birth.
Requirements of
water are related to
caloric
consumption and
loss through
perspiration. The
daily consumption
of fluids by infants
ranges from 10-
15% of his body
weight. The
quantity of water
absorbed in the
bloodstream
changes
considerably in
order to maintain
homeostasis within
the intracellular
and vascular
compartments
INTERVENTION RATIONALE
Independent:
>minimize use of adhesives >to preserve skin integrity
>monitor intake and laboratory results >shows evidence IF there is dehydration
>monitor urine output, especially the >it may indicate the low body fluid levels
frequency, amount and characteristics
>apply lotion or oil over the body >prevent subsequent drying of the skin
>regulate parenteral fluids >to avoid dehydration and overhydration
>assess signs of hydration >to recognize if there is dehydration or
overhydration
Dependent:
>maintain parenteral fluid nutrition >gives additional nourishment and
therapy as ordered renews body fluid
EVALUATION
After 8 hours of nursing interventions, patient exhibited evidence of fluid balance.