Hyperbilirubinemia Flashcards
unconjugated bilirubin
-fat soluble
-formed during breakdown of hemoglobin
-toxic to body/tissues
-cross the blood brain barrier
conjugated bilirubin
-water soluble
-non-toxic
-converted from unconjugated bilirubin in liver or by phototherapy
physiologic jaundice
-appears after 24 hours
-peaks within 3-5 DOL
-preterm infant
-linked to delay meconium passing, ineffective chest feeding, and or inadequate feeding
ANTICIPATED
pathologic jaundice
-appears within 24 hours of life
-jaundice persists after 14 DOL
-stool clay/white colored; urine staining clothes yellow
EMERGENT
early-onset chest feeding physiologic jaundice
-associated with ineffective chest-feeding practices b/c of relative caloric deprivation in the 1st few days of life
-may have mild dehydration
-recommend frequent chest feeding
severe complication of pathologic jaundice
-kernicterus or bilirubin encephalopathy
risk factors for hyperbilirubinemia
-inherited disorder (RBC, trisomy 21)
-during labor (delayed cord clamping, hypoxemia, rest. distress)
-acidosis
-macrosomic IDM
-delayed meconium passing
-male
nursing management
-early detection, family education, f/u parent/newborn
-document timing of jaundice to determine physiologic vs. pathologic
-physiologic - feeding issue
-pathologic - identify & treat cause
-1st line treatment - phototherapy
signs/symptoms of jaundice
-yellowing of skin/eyes
-problems with chest feeding
-decrease in # of diapers
-stool white/clay
phototherapy guidelines
-encourage parents to interact with infant
-support chest feeding
-check for dehydration (I/O)
-eye care/protection
-check temp every 3-4 hours
-daily weight
-keep as naked as possible
clinical manifestations of kernicterus
-movement disorder (hypotonia/spasticity)
-auditory dysfunction (deafness)
-oculomotor impairment
-dental enamel hypoplasia of deciduous teeth
