Hyperbilirubinemia and Phototherapy

Question 1

• is a common finding in newborns and in most cases is relatively benign

Answer 1

HYPERBILIRUBINEMIA

Question 2

highly soluble substance, which is then excreted into the bile

Answer 2

Conjugated bilirubin

Question 3

Types of Neonatal Jaundice

Answer 3

Physiologic
Breastfeeding Associated Jaundice
Breastmilk Jaundice
Hemolytic Disease

Question 4

immature hepatic function + increased bilirubin load from RBCs

Answer 4

Physiologic Jaundice

Question 5

Physiologic Jaundice
Onset:
Peak:
Duration:

Answer 5

Onset: after 24 hours
Peak: 3rd – 4th day
Duration: declines on 5th – 7th day

Question 6

decreased milk intake related to fever

Answer 6

Breastfeeding Associated Jaundice (Early Onset)

Question 7

calories consumed by infant well established before mother’s milk is well established; enterohepatic shunting

Answer 7

Breastfeeding Associated Jaundice (Early Onset)

Question 8

Breastfeeding Associated Jaundice (Early Onset)
Onset:
Peak:
Duration:

Answer 8

Onset: 2nd – 4th day
Peak: 3rd – 5th day
Duration: Variable

Question 9

-possible factors in breastmilk that prevent bilirubin conjugation
- less frequent stooling

Answer 9

Breast Milk Jaundice

Question 10

Breast Milk Jaundice
Onset:
Peak:
Duration:

Answer 10

Onset: 4th – 8th day
Peak: 10th – 15th day
Duration: May remain jaundiced for 3-12 weeks or more

Question 11

blood antigen incompatibility causing hemolysis of large number of RBCs

Answer 11

Hemolytic Disease

Question 12

liver’s inability to conjugate and excrete bilirubin for hemolysis

Answer 12

Hemolytic Disease

Question 13

Hemolytic Disease
Onset:
Peak:
Duration:

Answer 13

Onset: During the first 24 hours
Peak: Variable
Duration: Depends on severity and treatment

Question 14

a syndrome of severe brain damage resulting rom deposition of unconjugated bilirubin in brain cells

Answer 14

Bilirubin Encephalopathy

Question 15

Primary goals in the treatment of hyperbilirubinemia are to:

Answer 15

identify infants at high risk for hyperbilirubinemia, monitor serum bilirubin levels, prevent bilirubin encephalopathy, and reverse the hemolytic process

Question 16

application of a special source of light (irradiance) to the infant’s exposed skin

Answer 16

PHOTOTHERAPY

Question 17

Grade I

Answer 17

face and neck only

Question 18

Grade II

Answer 18

chest and back

Question 19

Grade III

Answer 19

abdomen below umbilicus to knee

Question 20

Grade IV

Answer 20

arms and legs below knees

Question 21

Grade V

Answer 21

hands and feet

Question 22

is generally used for reducing dangerously high bilirubin levels that may occur with hemolytic disease

Answer 22

Exchange transfusion

Question 23

Nursing Care Management
Assessment

Answer 23

1. Observe for evidence of jaundice at regular intervals
2. Blood samples for measurement of bilirubin
3. Careful history taking

Question 24

Diagnosis

Answer 24

Risk for Neonatal Jaundice
Risk for Impaired Parent–Infant Attachment
Interrupted Breastfeeding
Risk for Deficient Fluid Volume
Risk for Impaired Skin Integrity
Interrupted Family Processes

Question 25

accurately chart the:

Answer 25

1. Time started and stopped 2. Shielding of eyes 3. Type of fluorescent lamp (by manufacturer) 4. Number of lamps 5. Distance between surface of lamp and infant (no less than 46 cm) 6. Use in combination with incubator or open bassinet 7. Photometer measurement of light intensity 8. Occurrence of side effects

Question 26

side effects of phototherapy

Answer 26

1. Loose greenish stools 2. Transient skin rashes 3. Mild hyperthermia 4. Increased metabolic rate 5. Dehydration and electrolyte imbalance 6. Priapism

Question 27

a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended

Answer 27

Priapism

Question 28

Manage the side effects of phototherapy

Answer 28

1. Temperature monitoring 2. Observe skin for signs of dehydration 3. Increase fluid volume/feedings 4. Meticulous skin care

Question 29

reaction to phototherapy

Answer 29

1. rebound effect 2. bronze baby syndrome

Question 30

After phototherapy is permanently discontinued, there is often a subsequent increase in the serum bilirubin level, often called the _____________________; this is usually transient and resolves without resuming therapy

Answer 30

rebound effect