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:
I. Define the following terms:
1. Apnea - breathing stops for a short period of time, usually while sleeping
2. Respiratory Distress Syndrome - a potentially fatal lung injury that allows fluid to leak
into the lungs. Breathing becomes difficult, and oxygen is unable to enter the
body.
3. Sudden Infant Death Syndrome - _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 his or her lungs shortly after birth
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 fetal condition characterized by abnormal fluid accumulation

in two or more fetal compartments, including ascites, pleural effusion,
pericardial effusion, and skin edema.
7. Kernicterus - a type of brain damage caused by high bilirubin levels in a baby's blood. It
has the potential to cause athetoid cerebral palsy and hearing loss.
Kernicterus can also cause vision and tooth problems, as well as intellectual
disabilities.
8. Physiologic Jaundice - caused by a combination of increased bilirubin production as a

result of erythrocyte destruction, decreased excretory capacity as a result of
low ligandin levels in hepatocytes, and low activity of the bilirubin-conjugating
enzyme uridine diphosphoglucuronyltransferase (UDPGT).
1
9. Pathologic Jaundice - the most severe form of jaundice. It happens within 24 hours of
birth and is distinguished by a rapid rise in a baby's bilirubin level. Blood
incompatibility or liver disease are the most likely causes. Immediate medical
attention is required, and blood transfusions may be required.
10. Conventional Phototherapy - _Nonlightemitting diode (LED) units such as special blue
fluorescent tubes, compact fluorescent tubes, and halogen spotlights are
included.
11. Fiberoptic Phototherapy - _ a new type of phototherapy in which light is applied directly
to the infant's skin via optical fibers, allowing the infants to nurse fully clothed
and close 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.
Questions:
1. What are the most common causes of pathologic hyperbilirubinemia in neonates?
Prematurity, fetal-maternal blood group incompatibility, and a previously affected sibling are all
common risk factors for hyperbilirubinemia. Serum bilirubin elevation may be exacerbated by
cephalohematomas, bruising, and trauma from instrumented delivery. Delayed meconium passage
2
raises the risk as well. Infants with risk factors should be closely monitored during their first few weeks
of life.
2. What are the 2 most common types of neonatal hyperbilirubinemia?

Breastfed newborns may develop one of two types of jaundice. Both types are usually innocuous.
Breastfed babies develop jaundice during their first week of life.
 Physiological jaundice – most common type of newborn hyperbilirubinemia and has no

serious consequences.
 Pathological jaundice – defined as bilirubin levels that deviate from the normal range and
necessitate intervention.
2. In Jayden’s case, you suspect that the type of hyperbilirubinemia is?

 Pathologic Hyperbilirubinemia
3. What are the possible laboratory/diagnostic tests to be done to Jayden?

Bilirubin levels, both direct and indirect. A blood test can determine whether the bilirubin is
bound with other substances by the liver and excreted directly (direct) or is circulating in the
blood circulation (indirect) (indirect)
4. What are the common treatment/management plans for Jayden?

 Initiation of early feeding
 Home Phototherapy
 Transcutaneous Bilirubinometer
 Phototherapy
 Exchange transfusion
 Exchange Transfusion
5. 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.
6. How does phototherapy work to Jayden’s jaundice?

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 hour
per dL (342 mol per L) in infants older than 72 hour
3
per dL (342 mol per L) in infants older than 72 hours.
It lowers the amount of bilirubin released by destroyed red blood cells or performs an exchange
transfusion to remove hemolyzed red blood cells and replace them with healthy blood cells.
7. Supply the rationale to the following considerations during Jayden’s conventional phototherapy:
a. eyes should be covered – continuous phototherapy exposure to bright lights may be harmful
to a newborn's retina.
b. monitor body temperature – to keep him or her from overheating in front of the bright lights.
c. assess skin turgor and monitor intake and output – to ensure that dehydration does not
occur as a result of the warm environment
d. continue breastfeeding – to maintain their relationship with their mother
e. should be undressed – they are naked except for a diaper so that he can be exposed to the
lights as much as possible.
f. should wear diaper – to protect the ovaries or testes, the infant is undressed except for a
diaper, and as much skin surface as possible is exposed to the light.

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SCHOOL OF HEALTH AND ALLIED HEALTH SCIENCES

SELF-DIRECTED LEARNING (NUR 146 - CLINICAL AREA)

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,

6. Hydrops Fetalis - is a serious fetal condition characterized by abnormal fluid accumulation

8. Physiologic Jaundice - caused by a combination of increased bilirubin production as a

II. Case Study

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

 Physiological jaundice – most common type of newborn hyperbilirubinemia and has no

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

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

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

5. What level of bilirubin requires phototherapy?

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

d. continue breastfeeding – to maintain their relationship with their mother

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