Exam 2: Hyperbilirubinemia

Question 1

What is hyperbilirubinemia?

Answer 1

Overproduction of bilirubin or imbalance in rate of production and elimination
Build up of bilirubin (waste product from RBS’s)
Liver immature at birth
Highly anticipated condition
Total serum bilirubin (TSB) level above 5 mg/dL
Exhibited as jaundice

Question 2

What are the two types of hyperbilirubinemia?

Answer 2

Physiologic jaundice
Pathologic jaundice

Question 3

Physiologic jaundice

Answer 3

Appears after 24 hours
Primarily unconjugated bilirubin, mild unless persists to pathologic
Resolves by 1-2 weeks in term infant (Peak 3-5 days of life)
Causes:
Breast feeding mother not taking in enough protein - inadequate feeding
Delayed meconium passing
Ineffective chest feeding

Question 4

Pathologic jaundice

Answer 4

Appears within 24 hours of life
Significant rapid increase in bilirubin serum level
Both unconjugated and conjugated bilirubin
White/clay colored stool, urine staining clothes yellow
Requires immediate reporting to provider and intervention

Question 5

What will decrease likelihood of high bilirubin levels?

Answer 5

Frequent and effective chest feeding

Question 6

Nursing assessment of hyperbilirubinemia

Answer 6

Review medical history (risk factors)
Physical assessment - jaundice
Inspect for pallor, excessive bruising, dehydration
S/S Rh incompatibility, hydrop newborn, neurotoxicity

Question 7

Nursing management of hyperbilirubinemia

Answer 7

Early detection
Family education
S/S: Yellowing of skin and eyes, stool color, problems with breast feeding, decrease in number of diapers per day
Document timing of jaundice to determine physiologic vs. pathologic
Monitor bilirubin levels
Reduce bilirubin level
1st line treatment: Phototherapy
If remains elevated bilirubin-exchange transfusion

Question 8

Nursing considerations for phototherapy

Answer 8

Concerns:
Dehydration
Regulating body temperature
Monitor I&O’s
Monitor skin
Water soluble will make stool green which is normal (acidic), can cause breakdown in rectal area
Provide eyecare/protection

Question 9

Complication of hyperbilirubinemia

Answer 9

Kernicterus (Bilirubin encephalopathy)
Severe hyperbilirubinemia
At risk for bilirubin-induced neurologic dysfunction (BIND)
Permanent, irreversible brain injury

Question 10

Characteristics of chronic kernicterus

Answer 10

Movement disorder
Auditory dysfunction
Oculomotor impairment
Dental enamel hypoplasia of deciduous teeth