School of Health and Allied Health Sciences Nursing Department Self-Directed Learning (Nur 146 - Clinical Area)

SCHOOL OF HEALTH AND ALLIED HEALTH SCIENCES
Nursing Department
SELF-DIRECTED LEARNING (NUR 146 - CLINICAL AREA)
Name: Cumayas, Divine Grace N. Group: _____ Date: 03/19/2021
I. Define the following terms:
1. Apnea - is the cessation of breathing. During apnea, there is no movement of the

muscles of inhalation, and the volume of the lungs initially remains unchanged.
2. Respiratory Distress Syndrome - is a lung disease that affects newborns and prevents
normal breathing.
3. Sudden Infant Death Syndrome - is the unexplained death, usually during sleep, of a
seemingly healthy baby less than a year old.
4. Meconium Aspiration Syndrome - occurs when a newborn breathes a mixture of

meconium and amniotic fluid into the lungs around the time of delivery.
5. Hyperbilirubinemia - is a condition in which there is a build up of bilirubin in the blood,

causing yellow discoloration of the eyes and skin, called jaundice.
6. Hydrops Fetalis - is a serious condition. It occurs when abnormal amounts of fluid build
up in two or more body areas of a fetus or newborn. It is a symptom of underlying
problems.
7. Kernicterus - is a type of brain damage that can result from high levels of bilirubin in a
baby's blood.
8. Physiologic Jaundice - A newborn's immature liver often can't remove bilirubin quickly
enough, causing an excess of bilirubin. Jaundice due to these normal newborn conditions is
called physiologic jaundice, and it typically appears on the second or third day of life.
9. Pathologic Jaundice - Jaundice is considered pathologic if it presents within the first 24

hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 mol per
1
L) per day or is higher than 17 mg per dL (290 mol per L), or an infant has signs and
symptoms suggestive of serious illness.
10. Conventional Phototherapy - units provide light in the 425-475 nm wavelength band
corresponding to the peak absorption of light by bilirubin and the usual light intensity is6-12
pwatt/cm2 per nm.
11. Fiberoptic Phototherapy - is a new type of phototherapy in which the light is applied
directly to the skin of the infant via optical fibres, enabling the infants to be nursed fully
clothed near to their parents.
II. Case Study
You receive a call indicating a jaundiced baby boy and they would like you to
have a look at.
You meet with the parents to review the history. You learn that mom is a
33yo, G2T1A0L1 healthy woman. She was HepB/HIV negative and rubella immune.
Her blood group is O positive. There were no significant infections during the
pregnancy. She received regular pre-natal care at the maternity center.
Family has a 10-yr-old boy who did not have trouble with jaundice as an
infant. There is no known history of liver disease or inborn errors of metabolism.
Mom was booked for C-section for transverse lie but went into spontaneous
labor at 37 weeks’ gestation. Baby was noted to be vertex at that point. The labor
was augmented with oxytocin and baby Jayden delivered vaginally. There were no
HR decelerations or maternal temperature noted. Membranes ruptured
spontaneously 2 hours prior to delivery. Baby was vigorous with Apgars 9 (1) and 9
(5). Birth weight was 3306 g, length 49 cm and head circumference 35 cm. Baby
was placed skin-to-skin immediately after delivery and initiated breast feeding.
Jayden was in breast feeding in the hospital and was discharged home at 36
hours of age. Bilirubin at discharge was in high and follow up check was arranged.
At home, breast feeding is continued frequently. He is now 59 hours old and is
having 3 stools and 4-5 wet diapers per day.
Jayden's sclera and skin appear jaundiced. He has moist membranes,
normotensive fontanelle and normal skin turgour. No signs of infection and with no
underlying disorders. He awakens for examination and appears alert with normal
tone. There is no hepatosplenomegaly. Phototherapy is advised to Jayden.
2
Questions:
1. What are the most common causes of pathologic hyperbilirubinemia in
neonates?
Causes of increased bilirubin production in pathologic jaundice are

immune-mediated hemolysis such as ABO and Rhesus incompatibility, non-
immune mediated causes such as cephalhematoma, red blood cell membrane
defects like hereditary spherocytosis and elliptocytosis, enzyme defects like
glucose-6-phosphate dehydrogenase (G6PD) deficiency and pyruvate kinase.
2. What are the 2 most common types of neonatal hyperbilirubinemia?
Pathologic and Physiologic Jaundice. Pathologic jaundice is the most

serious type of jaundice. It occurs within 24 hours after birth, and is
characterized by a rapid rise in a baby’s bilirubin level. The most likely cause
is blood incompatibility or liver disease. Physiologic jaundice usually appears
at day 2-5 and lasts about 10–12 days. The best treatment for physiologic
jaundice is frequent and effective breastfeeding—at least 8-12 or more times
in each 24-hour period.
3. In Jayden’s case, you suspect that the type of hyperbilirubinemia is?
The type of hyperbilirubinemia Jayden has physiologic jaundice since

Jayden’s skin and sclera of the eyes appear noticeably yellow.
4. What are the possible laboratory/diagnostic tests to be done to Jayden?
 direct and indirect bilirubin levels: these reflect whether the bilirubin is
bound with other substances by the liver so that it can be excreted
(direct), or is circulating in the blood circulation (indirect)
 red blood cell counts
 blood type and testing for Rh incompatibility (Coomb’s test)
5. What are the common treatment/management plans for Jayden?
3
The common treatment/management plans for Jayden includes
phototherapy, fiberoptic blanket, exchange transfusion, and ceasing
breastfeeding for one or two days.
6. What level of bilirubin requires phototherapy?
Phototherapy should be instituted when the total serum bilirubin level is at or

above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL
(308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in
infants older than 72 hours.
7. How does phototherapy work to Jayden’s jaundice?
An infant’s liver processes little bilirubin in utero because the mother’s

circulation does this for an infant. With birth, exposure to light apparently triggers
the liver to assume this function. Additional light supplied by phototherapy appears
to speed the conversion potential of the liver.
8. Supply the rationale to the following considerations during Jayden’s

conventional phototherapy:
a. eyes should be covered – Prolonged exposure to blue light can cause

retinal damage.
b. monitor body temperature – Checking the body temperature every 3 to 4

hours. Remove the baby from the phototherapy unit and wrap them in a swaddle.
Increase the temperature of the room. Recheck the baby’s temperature in 15
minutes.
c. assess skin turgor and monitor intake and output – To aid the parents to
recognize signs and symptoms of increasing bilirubin levels.
d. continue breastfeeding – It is important to breastfeed because hydration

also keeps the levels of bilirubin low.
e. should be undressed – The baby should be undressed so that the light

waves are easily absorbed in the baby’s skin and blood. This can change bilirubin
into products, which can pass through their system.
4
f. should wear diaper – The baby must wear a diaper while receiving
phototherapy. Phototherapy may cause loose, watery stools, as the bilirubin leaves
the body. As the bilirubin levels decrease, the baby may get a pain-less, bluish-red
skin rash (bilirash). It will go away after the therapy is complete.

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SCHOOL OF HEALTH AND ALLIED HEALTH SCIENCES

SELF-DIRECTED LEARNING (NUR 146 - CLINICAL AREA)

Name: Cumayas, Divine Grace N. Group: _____ Date: 03/19/2021

I. Define the following terms:

1. Apnea - is the cessation of breathing. During apnea, there is no movement of the

4. Meconium Aspiration Syndrome - occurs when a newborn breathes a mixture of

5. Hyperbilirubinemia - is a condition in which there is a build up of bilirubin in the blood,

9. Pathologic Jaundice - Jaundice is considered pathologic if it presents within the first 24

II. Case Study

Causes of increased bilirubin production in pathologic jaundice are

2. What are the 2 most common types of neonatal hyperbilirubinemia?

Pathologic and Physiologic Jaundice. Pathologic jaundice is the most

3. In Jayden’s case, you suspect that the type of hyperbilirubinemia is?

The type of hyperbilirubinemia Jayden has physiologic jaundice since

4. What are the possible laboratory/diagnostic tests to be done to Jayden?

5. What are the common treatment/management plans for Jayden?

6. What level of bilirubin requires phototherapy?

Phototherapy should be instituted when the total serum bilirubin level is at or

7. How does phototherapy work to Jayden’s jaundice?

An infant’s liver processes little bilirubin in utero because the mother’s

8. Supply the rationale to the following considerations during Jayden’s

a. eyes should be covered – Prolonged exposure to blue light can cause

b. monitor body temperature – Checking the body temperature every 3 to 4

d. continue breastfeeding – It is important to breastfeed because hydration

e. should be undressed – The baby should be undressed so that the light

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