Hyperbilirubinemia is a condition that occurs from having too much bilirubin in the blood. Bilirubin is formed when red blood cells are broken down into protein and heme fragments. Heme is composed of unconjugated bilirubin, which binds with albumin and is transported to the liver where it combines with glucuronide to form conjugated bilirubin. Typically, the conjugated bilirubin would be excreted in the urine or feces once it is metabolized as urobilinogen. If the body is unable to rid itself of the bilirubin, it causes a yellowing of the skin, eyes, and other tissues which is known as jaundice.
In infants, there are multiple causes of hyperbilirubinemia. Physiologic jaundice is a term used to describe the first few days of life when the
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infant has a poor ability to excrete the bilirubin. The liver is not mature enough yet to metabolize bilirubin and as a result, it is not uncommon to see a degree of jaundice in newborns. According to the CDC, approximately 60% of full-term infants develop jaundice within the first few days of life. Another cause of jaundice can result from breast feeding because there is believed to be a substance in some women’s milk supply that decreases the infant liver’s ability to metabolize bilirubin. Inadequate breastfeeding can also cause jaundice if the infant becomes dehydrated and unable to produce sufficient feces or urine. Other causes of jaundice can be Rh or ABO incompatibilities, biliary obstruction, genetic predisposition, or an intrauterine infection. Hyperbilirubinemia is fairly common. About 50% of term and 80% of preterm babies develop jaundice and it is typically resolved by the second week of life. The common lower levels of increased bilirubin are not usually concerning until they reach 15 mg/dL or more and normal lab values range from 0.03 – 1.0 mg/dL (Woodgate & Jardine, 2011). Risk factors for developing hyperbilirubinemia include birth trauma, infections, infrequent feedings, polycythemia, prematurity, genetic predisposition, hypothyroidism, and breastfeeding. Jaundice is more coming in males and more common in blacks than whites. The risk of developing hyperbilirubinemia is increased as gestational age is decreased. Other complications that can occur are kernicterus (a type of brain disorder), cerebral palsy, epilepsy, and mental impairment ("Hyperbilirubinemia (neonatal)," 2016). The main treatment for hyperbilirubinemia is phototherapy and in most cases, will prevent more invasive treatments like exchange blood transfusions.
The light source from phototherapy works by transforming bilirubin into water-soluble particles that can be eliminated in the urine ("Fundamentals of Phototherapy," 2007). If a neonate has risk factors such as gestational age under 38 weeks, previous jaundiced sibling, mother exclusively breastfeeding, or visible jaundice in the first 24 hours of life, further workup will be completed ("Hyperbilirubinemia (neonatal)," 2016). The effectiveness of phototherapy depends on the intensity of the light source used, time under the light, and the surface area of the neonate’s body exposed. Phototherapy is typically administered constantly, except for feedings and specific medical care or lab draws. Common policies for phototherapy include placing the infant in a radiant warmer set to a specific temperature, protective eye shields, measurement and documentation for changes in lights, and turning off the light prior to bilirubin lab draws. Duties as a nurse should include verifying provider’s orders, education on phototherapy to the family, light checks, labs, and patient temperature (American Academy of Pediatrics, 2012). Most hospitals have clinical pathways and guidelines that aid in timely interventions and prevention of further complications from hyperbilirubinemia. Some hospitals may have nurse-initiated neonatal jaundice management
protocols that have been shown to reduce time in retrieving blood test, reduced phototherapy time, reduced length of stay, and improved nurse documentation (Long et al., 2017). Considering the high percentage of babies that develop jaundice, it is imperative that nurses be aware of the risk factors, interventions, and complications of hyperbilirubinemia. Early detection and initiation of phototherapy can lead to less invasive measures to correct bilirubin levels and lessen hospital stays.
This allows the nurse to assess the patient’s pain and suffering related to the treatment plan in place (Settle, 2014). The ability to communicate well is essential for ethical decision making in the NICU (Monterosso et al., 2005). Nurses play a big role in supporting the parents while their child is in the NICU. Showing compassion and demonstrating caring actions when caring for the patient makes it more likely that the parents will trust the nurse and the information the nurse gives them regarding their child’s condition. This trust is important as it helps the parents feel confident in the decisions they are making about their child’s care. When the parents of an ill child in the NICU have decided to terminate treatment palliative care by the nurse and other healthcare providers comes into play. Palliative care is keeping the child comfortable by treating the symptoms and being there for the parents and child physically, emotionally, and spiritually (Eden & Callister, 2010). The patient and family should be placed in a private room that is dimly lit and has minimal noise. There should be enough room to accommodate other family members as well. All unnecessary medical equipment such as ventilators and monitors should be removed from the patient. IV access should remain in place to give adequate medication for pain. Supplemental
A patient should remain on bed rest and receive well balanced nutrition. Patients should be restricted from school and or work until fever is reduced and jaundice diminishes. If the patient is vomiting and or has diarrhea, they can be treated with antiemetic medications. Also, adequate water intake is necessary.
According to Indira & Jyotsna (2015), “hypoglycemia is one of the most common metabolic problems seen in the newborn nursery.” Early newborn hypoglycemia and prolonged hypoglycemia can lead to mental retardation and brain damage (Indira& Jyotsna, 2015). A newborn is deemed hypoglycemia if their
Since neonatal nursing is my special interest and field, I chose to write about the health care options which are available to parents having children in different hospitals throughout the world. With the state of the art technological advances in the neonatal units, there are so many options available for the care of newborn babies. I reviewed the neonatal units in Australia, Saudi Arabia, New York, Tokyo, Ireland, and California, and I have learned what It takes to run a neonatal intensive care unit all around the world.
In summary, the paper focused on caring for an infant with bronchiolitis. The student nurse has realised that it is important to gather information from the parents because they know their baby best. Nursing interventions should encourage family members to participate as well as they are the one who care about their child most. Special attention need to pay for children who attend day-care facility and follow up care is necessary.
New technologies are being developed every day. The latest advance in fetal monitoring is the fetal oxygen monitor: “A device that directly measures fetal oxygen saturation during labor and delivery is now available and has the potential to reduce the number of Cesarean sections performed for non-reassuring heart rates.” (Mechcatie) The article by Mechcatie describes the monitor extremely well: “The device’s sensor, located at the end of a flexible tube, is made of pliable plastic and is inserted through the cervical os until it lies along the fetal cheek, where the pressure of the uterine wall keeps it in place during labor. The sensor shines light into the fetal skin and computes the oxygen saturation by measuring the color of the reflected light coming through the blood cells.”
As a NICU RN I will work as a team member with other nurse practitioners and physicians. My main goal is to ensure that a newborn's critical care treatment is secure. These are very delicate infants some of which are barely clinging to life in which their chances of survival rates are as low as zero at less than twenty two weeks gestation and upwards of seventy seven percent in the twenty sixth week. As a NICU RN I will also perform life-sustaining care. These duties can include administering medications, monitoring vital signs, changing diapers, and providing vital nutrients to newborns. Due to the fact most premature and sick newborns lungs are not fully developed, I will have to ensure that infants are breathing and maturing properly. Neonatal nursing being a subspecialty I will work with upper-level nurses and physicians and assist in treatment plans and examinations. I will keep, maintain and update records of the patient's care. In addition to medical care, NICU RNs communicate with and educate parents on day-to-day operations as well as home-care procedures. In this field I could work with a variety of problems ranging from prematurity, birth defects, infection, cardiac malformation, and surgical problems. During each shift I could work with 1 to 4 babies presenting varying needs and challenges. I can expect to make a significant difference in the lives of the infants and their
Each year there are over five hundred thousand babies that are born premature. Neonatology is the pediatric subspecialty trained specifically to handle these complex and high-risk situations that newborn babies face. Neonatologists dedicate their practice to babies born in hospitals, but not yet released, or to those transferred into Neonatal Intensive Care Units, also known as NICUs. Over the past one hundred years, the rate of survival for premature babies has increased from five percent to ninety-five percent. Neonatology is a very risky, but important job that is critical to the well-being of newborn babies.
Bilirubin absorbs light most strongly in the blue region of the spectrum (425–475 nm). The absorption of light by dermal and subcutaneous bilirubin induces various photochemical reactions, and the toxic, native, unconjugated bilirubin is converted to less toxic, water-soluble photoisomers, which are excreted in the bile and urine without requiring conjugation. Light can penetrate the skin and adjacent vascular beds (Jori et al., 1990; Rosenfeld et al., 1986) to a depth of 2 mm from the skin surface (Whitington et al., 1992; Kleigeman et al., 1996). The fact that premature babies have thin skin, as do neonatal rats, may lead to an increased effect of phototherapy on testes of newborn rats which are located within the abdomen during the first 3 weeks of life. Since the gonads of the newborn are immature and may be sensitive to light, gonads may be damaged due to
Albinism is a very serious disease that could end up in death. Albinism is a recessive inherited defect in melanin, which is metabolism in which pigment is absent from skin, hair, and eyes. Albinism in hair, skin, and eyes is called oculocutaneous albinism. Humans that have oculocotaneous albinism are not able to produce melanin. These people have white, yellow, or yellow brown hair, very light ( usually blue ) eyes, and very pale skin. Their eyes may appear pink because they have very little pigment.
Hemoglobin is the protein in red blood cells that carries oxygen to the body. This diseases causes anemia, which can lead to the destruction of red blood cells. Possible symptoms include fussiness, paleness, frequent infections, poor appetite, failure to grow well and jaundice or enlarged organs. The treatment depends on the type and severity of this disease. Treatment options include: bone marrow transplants, blood transfusions, medications and supplements and possible surgery to remove the spleen and/or gallbladder (Thalassemia, healthline,
Today I was fortunate enough to go to the NICU. As soon as I got there, I had to scrub in for three minutes. After I finished, the nurse that I was assigned to gave me a tour and allowed me to see most of the infants in the NICU. I even got the chance to see a baby with jaundice that was under a light. The infants that my nurse was assigned to were premature. Although they were twins, one was bigger than the other and improving quicker. I learned that there was a possibly that he could go home earlier. After conversing with the nurse for a few minutes, we went to warm up the babies bottles. I learned that before you give any fluids or medicines to a baby, you must get another nurse to double check that you are giving the right stuff to the
1. The neonatal intensive care unit clinical setting provided a calm and cooperative environment to ensure for the well-being and stability of the high acuity patients. The waiting area for the patient’s family was private with moderate lighting. The lighting throughout the unit varied depending on the stability and comfort of the neonate. Noises in the NICU were relatively low and the smells provided a clean fragrance. The temperature throughout the facility was comfortably warm and radiant warmers were provided to accustom to each patient’s thermoregulatory needs. Personal items for each patient were stored within their specific area and privacy was achieved using curtains. Artwork throughout the facility was pleasant and compliments the
Hyperinsulinemia develops due to an increased tissue demand. As tissue response to insulin is decreased, the beta cells in the pancreas must produce more. Over time the pancreas must produce more and more until the beta cells cannot keep up with tissue demand. Beta cell dysfunction develops and leads to type 2 diabetes. This dysfunction can be due to a relative decrease in mass of beta cells (beta cell death), abnormal secretion in insulin by beta cells, or a combination of the two. Because beta cells are especially sensitive to elevated glucose levels and free fatty acids, beta cells will undergo programmed cell death when confronted with these conditions. Other conditions associated with obesity also contribute to apoptosis of beta cells;
When babies are delivered in the hospital, there is a usual sequence of events that happen to ensure a safe and successful delivery. The mother goes into labor, healthcare professionals prepare themselves and the mother to deliver the baby and finally after minutes or hours of coaching and appropriate exercises the baby is born and introduced to their new environment. Before the parents can have any contact with the newborn, nurses will characteristically whisk the baby away to check for presence of important reflexes, abnormalities, and wipe away the birth materials such as vernix. After completion of these required tasks, the baby is then presented to the parents wrapped up like a shiny, new gift on Christmas day. Sometimes the baby and