5.1 - Jaundice Flashcards
1
Q
EXAM
Four processes occur in the metabolism of bilirubin
A
- Production
- Transport
- Conjugation
- Excretion
2
Q
EXAM
Bilirubin Metabolism
A
- fetal red blood cells to make way of the neonate RBC
- Bilirubin detaches from the RBC (haem)
- Attaches to Albumin
- Process through them liver and eliminated by the way of faeces
- Bilirubin requires glucose and 02 to make it water soluble bilirubin
- Bilirubin detaches from the redblood cells
- attaches to albumin to arrive at the liver
- within the liver the bilirubin requires glucose & 02
- excreted in the urine (urobilirgan) & faeces (Stercobilinogen)
3
Q
EXAM
Bilirubin Production
A
- ageing red blood cells
- Red cells are distroyed
- the haem is conververted into unconjugated bilirubin
*
4
Q
EXAM
Management of Jaudice in the neonatal
A
- Conservative
- regular bilirubin levels
- vital signs assessment
- observation of feeding patters
- phototherapy
- Extreme situations
- Exchange transfusion
5
Q
EXAM
Hyperbilirubineania
A
- ^ Production
- Decrease clearance
- ^enterohepatic circulation
- Yellow discolouration of the skin, sclera and mucous membranes due to the disposition of bilirubun
- 60% of newborns
- 80% premature infnacts
- Risk factors
- severe jaundice occurring within the first 24 hours & blood group incompatiblity
- Late onset after 2 weeks
6
Q
EXAM
Discuss the care and management of the infant with jaundice including midwifery responsibilities in care for the neonate reviving Phototherapy
A
- Temperture control
- Eye shields/patches
- Observation for any eye discharge
- skin assessment
- skin dryness
- PAC
- rashes
- Hydration status & feeding behaviours
- responsiveness to activity
- ongiong SBR to monitor levels
- nesting & comfort
7
Q
EXAM
Risk Factors for hyper bilirubinaemia
A
Maternal
- GDM
- Incompatibly blood
- maternal sepsis
- Congenital condition
- G6PD hereditary spherocytosis
- breast milk jaundice
Infant
- delayed cord clamping
- DAT
- Trauma
- preterm
- incompatibly blood
- immaturity
- poor Feeding
- FGR
- sepsis
- TTT -to twin to twin
- Cold stress
- delayed passage of meconium
- biliary atresia
8
Q
EXAM
Neonatal differences reason for jaundice
Physiologic jaundice
A
- ^HGB release
- ^RBC turnover
- HCT 50-60%
- 2-3x more bilirubin
- decrease bilirubin clearance
- immature enzyme (1% activity)
- ^Enterohepatic circulation
9
Q
EXAM
Jaundice Pathological
A
- J - Jaundice within the first 24 hours
- A - a sibling who required phototherapy in the neonatal period
- U - unrecognised haemolysis
- N - non-optimal sucking/feeding
- D - g6pd deficiency (rare)
- I - infection
- C - cephalohematoma or bruising
- E - ethnicity - Asia heritage
10
Q
An increased destruction of red blood cell is called
A
*
11
Q
Unconjagted bilirubin in the blood is bound to
A
- serum albumin
- transported to the liver
- Not water soluble
- unconjugated bilirubin is fat soluble
*
12
Q
Factors that decrease the albumin binding ability
A
- Infection
- Acidosis
- Prematiurty
- Hypoclycaemia
13
Q
Conjucated bilirubin when combined with glucose
A
- becomes water soluble
- excreted by the kidneys
- entered into the bile
- and out through the small intestine
- bacteria in the small intestines enable the bilirubin to reduce to “Stercobilinogen”
- note: Uncongjucation bilirubin absorbs into the bowl and entering the liver metabolism: enterohepatic circulation
14
Q
Phototherapy
A
- common therapy for the treatment of jaundice
- converts bilirubin to photochemical products that become water soluble
- then can be extrected by urine & bile without the need for conjucation
15
Q
Ongoing high bilirubin levles can cause
A
- Increasing jaundice
- Kernicterus
- when bilirubin deposits cause potential damage to areas of the brain
- Poor hyudration status
- adds to increasing bilirubin levels
*
- adds to increasing bilirubin levels
