NCMA 219 RLE REVIEWER  Best results occur within the first 4

to 6 hours of phototherapy.
-----------  Designed primarily for the treatment
of moderate hyperbilirubinemia
INDICATION:
PHOTOTHERAPY  Treatment of hyperbilirubinemia
Classification of neonatal jaundice  Helps liver in processing bilirubin
 Prevent kernicterus
PHYSIOLOGIC JAUNDICE
FACTOR AFFECTING EFFICACY OF
 Appears after 24 hrs
PHOTOTHERAPY
 Maximum intensity by 4th-5th day in
term & 7th day in pre-term.  Type of light used (Blue fluorescent
 TSB levels within normal centiles light or white – 430-490NM)
for age in hours based on  Light intensity (10-12Uw/cm2)
normogram.  Surface area of skin exposed to light
 Clinically not detectable after 14  Distance of light source from the
days baby (35-50cm in conventional
 Disappears without any treatment. lights)
PATHOLOGIC JAUNDICE NURSING CARE DURING
PHOTOTHERAPY
 Appears within 24 hours of age
 Increase of bilirubin > 5mg/dl/day or  Position phototherapy units no more
at a rate of > 0.2mg/dl/hr than 30.5cm from the patient.
 Serum bilirubin > 95 percentile for NEOBLUE LED phototherapy unit
age in hours based on normogram. can be positioned as close as 15cm to
 Jaundice persisting after 14 days in patient. Refer to specific
fullterm babies. phototherapy units manufacturing
 Stool clay/white colored and urine guidelines for more details.
staining clothes yellow  Expose as much of the skin surface
 Direct bilirubin > 2mg/dl or > 20% as possible to the phototherapy light.
of TSB. To maximize skin exposure, dress
the baby I a nappy and their
PHOTOTHERAPY protective eye covers only.
 Application of a special source of  Cover the eyes with appropriate
light (irradiance) to the infant’s opaque eyes covers.
exposed skin.  Ensure eye covers are removed 4-6
 Light promotes bilirubin excretion hourly for eye care during infant
by photoisomerization (alters cares or feeding. Observe for
structure of bilirubin to a soluble discharge/infection/damage and
from called Lumirubin for easier document any changes.
excretion)
  Daily fluid requirements should be INTRO:
reviewed and individualized for
• APGAR was developed in 1952 by Dr.
gestational and postnatal age. Virginia Apgar, an Anesthesiologist at
 Maintain a strict fluid balance chart. Columbia University.
 Breast feeds may need to be limited
to 20 minutes if bilirubin level is • Through the years, APGAR, become as
useful mnemonics to describe the
high to minimize amount of time out
components of the score: appearance, pulse,
of the lights.
grimace, activity and respiration.
 Monitor vital signs and temperature
at least 4 hourly, more often if • The score is a rapid method for evaluating
needed. neonates immediately after birth and in
 Cover lipid lines with light resistant, response to resuscitation.
reflective tape to avoid peroxidation. • Apgar scoring remains the accepted
 Ensure that phototherapy unit is method of assessment and is endorsed by
turned off during collection of blood both American College of Obstetrics and
for TSB/SBR levels, as both Gynecologists and American Academy of
conjugated and unconjugated Pediatrics.
bilirubin are photo-oxidized when DEFINITION:
exposed to white or ultraviolet light.
 Observe for signs of potential side APGAR SCORE
effects. • Is a rapid method for assessing a neonate
immediately after birth in response
POTENTIAL COMPLICATIONS
to resuscitation,
 Overheating – monitor neonate’s
temperature • Is designed to assess the need for
 Water loss from increased intervention to establish breathing in 1
peripheral blood flow and diarrhea minute,
(if present)
• Is designed to assess for signs of
 Diarrhea from intestinal
hemodynamic compromise such as:
hypermotility
 Ileus (preterm infants) a. Cyanosis (bluish-purple color of the
 Rash skin),
 Retinal damage b. Hypoperfusion (which include low blood
 ‘Bronzing’ of neonates with pressure, heart failure or loss of blood
conjugated volume),

Hyperbilirubinemia c. Bradycardia (slow heart rate),

 Temporary lactose intolerance d. Hypotonia (decreased muscle tone)

e. Respiratory depression or apnea
INDICATIONS:
APGAR SCORE
  APGAR SCORING is recorded in all  Suctioning is necessary when
NEWBORN infants at 1minute patients are unable to clear secretions
immediately after birth and 5 minute from the airways by coughing or less
interval. invasive procedures.
TECHNIQUE:
• There are Five Clinical Signs of an Apgar SUCTIONING TECHNIQUES:
score.
Oropharyngeal /Nasopharyngeal - is used
• Each category is weighted evenly and when a patient is able to cough effectively
assigned a value of 0, 1, or 2, but unable to clear secretions by
expectorating.
• The components are then added together to
give a total score that is recorded at 1minute Orotracheal / Nasotracheal Suctioning - is
and 5 minutes after birth. necessary when a patient with pulmonary
secretions is unable to manage secretions by
TECHNIQUE NOTE THAT: coughing and does not have an artificial
• A score of 7 to 10 is considered reassuring airway present. The procedure is same to
A score of 4 to 6 is moderately abnormal nasopharyngeal suctioning but you advance
the catheter tip farther into the patient’s
• A score of 0 to 3 is deemed to be low in trachea.
full and late preterm infants
Tracheal Suctioning - is performed through
• At 5 minutes, when an infant has a score of an artificial airway such as an Endotracheal
less than 7, NEONATAL (ET) or tracheostomy tube.
RESUSCITATION PROGRAM Guidelines
recommend continued recording at 5- Methods of Suctioning
minute intervals up to 20 minutes. Open Suctioning - involves using a new
Resuscitation must be initiated before the 1- sterile suction catheter for each suction
minute Apgar score is assigned in critically session
unwell infants.
Closed Suctioning - involves using a
reusable sterile suction catheter that is
encased in a plastic sheath to protect it
between suction sessions.
Nursing Considerations to ensure safe,
individualized patient care during
suctioning:
• Use caution when suctioning patient with
head injury
• Assess for signs and symptoms
associated with Hypoxia
• Assess for risk factor for upper and lower
SUCTIONING airway obstruction
• In most cases, use sterile technique for
suctioning.
MOTHER INFORMATION
• When suctioning, you apply negative
pressure during withdrawal catheter, never • Mother’s name • Social Security Number
on insertion. • telephone number or contact number
• Suctioning is done no longer than 10 • Date of birth
seconds. Allow the patient to rest between
passes of the catheter.
NEWBORN SCREENING (NBS) SENDER INFORMATION

HEEL PRICK METHOD • Sender’s name

• A blood collection procedure done on • Telephone number

newborns. • Address
• It consists of making a pinprick puncture
in one heel of the newborn to collect their
blood. HEEL PRICK PROCEDURES
• This technique is used frequently as the
main way to collect blood from neonates.
Materials needed:
• Gloves • 70% Isopropyl alcohol pads
Timing of the Specimen Collection
• Dry sterile gauze pads • Sterile sticking
• After 24 hours of birth device with a point >2mm in depth (lancets)
• 48 hours to 72 hours • Newborn screening filter paper collection
form with protective envelope.
• 7 days (NICU)
Bleeding procedure:
• Collect prior to Blood transfusion
• Preferred puncture site • Warm foot of
infant if necessary
Completing the Newborn Screening Car • Disinfect site with alcohol pads and allow
INFANT INFORMATION to dry

• Baby’s name • Gestational age • Puncture skin with one continuous motion
using sterile sticking device.
• Address • Date of birth
• Date of collection • Time of collection
Collecting blood spots
• Patient/hospital ID# • Birth order
• Before collecting the blood, fold back the
• Sex • TPN protective flap to expose the filter paper
• Type of formula • Weight at collection • Lightly touch the filter paper against a
• Hospital of birth • Infant blood transfusion large drop of blood and allow enough blood
to soak through to completely fill the circle.
• If blood flow is diminished, repeat the 7. Dry specimens in a horizontal position.
bleeding procedure with sterile equipment. Hanging wet specimens will cause heavier
red cells to migrate to the end of the circle
• Once all the circles have been filled, press causing an uneven saturation.
a sterile gauze pad to the puncture site and
hold the infant’s foot above the level of the 8. Do not superimpose blood drops on top of
heart until bleeding has stopped. each other.
• Dry the blood spots on a level, non- 9. Apply blood to only one side of the filter
absorptive surface away from direct sunlight paper.
and at room temperature for at least 4 hours.
10. Collecting blood samples after feeding
• After blood spots are completely dry, promotes better blood flow.
replace the protective flap over the specimen
and place form in the protective envelope 11. Do not allow specimens to come in
(do not use plastic) and mail to Laboratory contact with water, feeding formulas,
within 24 hours. antiseptics, urine, etc.

Guidelines to prevent Errors:

1. Do not touch any part of the filter paper Blood Transfusion(BT)
circles before, during, or after collection.  Introduction of whole blood or blood
2. Collect the specimen on the proper components into venous circulation
Newborn Screening collection form  Replace blood components to restore
the blood’s ability to transport
3. Complete all the demographic data. This oxygen and carbon dioxide, clot,
information is vital for interpretation of fight infection, and keep
newborn screening results and for extracellular fluid within the
identification and location of infants for intravascular compartment.
follow-up of abnormal test results.
a. Always note any transfusion of red blood
cells. Purpose of Blood Transfusion (BT)

b. Mark TPN feeding if TPN is being

administered at time of collection.  To restore blood volume
4. Wipe away the first drop of blood to  To restore the oxygen-carrying
remove tissue fluids and alcohol. Do not capacity of the blood.
“milk” the puncture site  To administer required blood
component by the patient
5. Do not expose the specimen to heat or
humidity at any time. Do not dry on heater,
in microwave, with a hair dryer, or in the
sunlight. Do not place in plastic bags, leave
in hot mailbox area, or hot car; proteins and
enzymes will be destroyed.
6. Ensure that the specimen is properly dried
before replacing the protective flap and
before placing in the protective envelope.
  Hypomagnesemia (prophylaxis
and treatment) - Replacement
therapy in magnesium deficiency
- Used to prevent or treat magnesium
deficiency in patients receiving TPN

 Tetany, uterine (treatment) -

Indicated as a myometrial relaxant.
Can be given:
BLOOD TYPING and
CROSSMATCHING
 Intramuscularly – 1 to 5 grams (2
to 10ml of 50% solution) daily in
 BLOOD TYPING - Determines the divided doses
presence of the ABO and Rh  Intravenously – 1 to 4 grams may
antigens be given in 10% to 20% solution, but
only with great caution; the rate
should not exceed 1.5mL of 10%
 CROSSMATCHING - Identify solution or equivalent per minute
possible interactions of minor until relaxation is obtained
antigens with corresponding  Intravenous infusion - Given at 4
antibodies. grams in 250mL of 5% Dextrose
injection at a rate not exceeding 3
BLOOD PRODUCTS mL per minute
 Whole blood  Usual dose ranges from 1 to 40
 Packed red blood cells (PRBC) grams per day depending on the
client condition and age.
 Autologous red blood cells
 Fresh frozen plasma SIDE EFFECTS:
 Platelets
 Flushing
 Albumin
 Sweating
MAGNESIUM SULFATE  Sharply lowered BP
INDICATIONS:  Hypothermia
 Stupor
 Respiratory depression
 Convulsions - Immediate control of ADMINISTRATION OF MGSO4:
life-threatening convulsions in the
treatment of severe toxemias (pre-  Check RR, should be at least 12
eclampsia and eclampsia) of breaths/min
pregnancy  UO, should be at least 100 ml/hr
- Treatment of acute nephritis in  DTR should be present (Knee jerk or
children patellar reflex)
  Prepare the antidote, Calcium
Gluconate if MgSo4 toxicity
develops & notify physician at once
↓ UO, ↓ RR, ↓ DTR, ↓ LOC
 MgSo4 is given up to 24H after
delivery or from the last convulsion
 If given during postpartum, monitor
for uterine atony as it can cause
uterine relaxation.
MAGNESIUM SULFATE - Magnesium
Sulfate (MgSO4) given initially is termed as
loading dose and the succeeding doses are
termed as maintenance doses. For reference,
the following are available stock per
concentration of MgSO4: