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STI College of Nursing

Sta. Cruz, Laguna

Submitted to:
Ms. Mildred Limuaco, RN, MAN
Clinical Instructor

Submitted by:
GROUP II
Members:

Bernardino, Michelle S.

Bernas, Nikki Lou P.

Ching, Judith U.

De Ramos, Robert Immanuel

Ingalla, Charmaine S.

Matienzo, Evangeline N.

Monteseña, Roselle Ann N.

Sotomayor, Karen B.

October 2010

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TABLE OF CONTENTS

I. Introduction ------------------------------------------------------------------------------------2
A. Objectives -------------------------------------------------------------------------------3
B. Background of the Study ------------------------------------------------------------4
C. Rationale for Choosing the Case -------------------------------------------------4
D. Significance of the Study ------------------------------------------------------------5
E. Scope and Limitations ---------------------------------------------------------------5

II. Clinical Study ------------------------------------------------------------------------------------6


A. Demographic Data ----------------------------------------------------------------------6
B. Physical Assessment -------------------------------------------------------------------7
C. System Affected --------------------------------------------------------------------------9
D. Laboratory and Diagnostic Exam ---------------------------------------------------10

III. Clinical Discussion ----------------------------------------------------------------------------13


A. Anatomy and Physiology -------------------------------------------------------------13
B. Pathophysiology ------------------------------------------------------------------------16
C. Nursing Care Plan ----------------------------------------------------------------------17
D. Drug Study -------------------------------------------------------------------------------21
E. Course in the Ward --------------------------------------------------------------------25
F. Discharge Plan --------------------------------------------------------------------------25
G. Evaluation --------------------------------------------------------------------------------27
H. Summary ----------------------------------------------------------------------------------27
I. Recommendation -----------------------------------------------------------------------27
J. Bibliography ------------------------------------------------------------------------------28

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I. Introduction

HYPERBILIRUBINEMIA

Neonatal Hyperbilirubinemia or Neonatal Jaundice in newborn is one of the most


common problems encountered in term newborns. Although up to 60 percent of the term
newborns have clinical jaundice in the first week of life. Hyperbilirubinemia is a condition
in which there is too much bilirubin in blood. When red blood cells breakdown, a
substance called bilirubin is formed. Babies are not easily able to get rid of the bilirubin
and it can build up in the blood and other tissues and fluids of the baby’s body. This is
called Hyperbilirubinemia. Because of bilirubin has a pigment or coloring, it causes a
yellowing of the baby’s skin and tissues. This is called jaundice. Depending on the cause
of the hyperbilirubinemia, jaundice may appear at birth or at any time afterward. General
signs and symptoms are yellow eyes, skin, tiredness, fatigue, light colored stools, and
dark urine.

During the pregnancy, the placenta excretes bilirubin. When the baby is born, the
liver of the baby must take over this function. There are several causes of
hyperbilirubinemia and jaundice, including (1) Physiologic Jaundice – this is normal
response to the baby’s limited ability to excrete bilirubin in the first days of life. The
manifestation of jaundice is after 24 hours (2) Pathologic Jaundice – this may be related
to inadequate liver function due to infection or other factors. The manifestation of
jaundice is within 24 hours (3) Breast milk Jaundice – about 2% of the breastfed babies
develop jaundice after the first week. Some develop breast milk jaundice in the first
week due to low calorie intake or dehydration and (4) Jaundice from hemolysis –
jaundice may occur with the breakdown of RBC’s due to hemolytic disease of the
newborn (RH disease), having too many RBC’s or bleeding.

Hyperbilirubinemia affects 60% of full-term infants and 80% of preterm infants in


the first 3 days after birth. In the present study of the Department of Health (DOH),
3, 278 male newborns were screened for hyperbilirubinemia. Results show that of

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3, 278, 186 screened to have a positive result. Of the 186, 65 boys had a confirmatory
testing, 45 were confirmed to have hyperbilirubinemia and 20 had normal results. In the
Philippines, there is a prevalence rate of 4.5% to 25.7%. This study reveals an
incidence of 3.9% among male Filipinos.

A. OBJECTIVES

General Objective: This case study aims to present to the readers the nature of
Hyperbilirubinemia, the origin and the effects it does on the neonate body. It also
encompasses the proper approach in a patient with this kind of disease. This study
aims to broaden the knowledge of the readers about this condition.

Specific Objectives:
To improve knowledge on:
• The fundamental information about Hyperbilirubinemia including its risk
factors, etiology, signs and symptoms, and treatment
• The pathophysiology of the disease

To enhance skills on:


• The appropriate approach to a newborn patient undergoing systemic changes
and adaptation
• Formulating nursing care plans and independent nursing interventions to care
for fully dependent patient
• Different types of medical treatment necessary for hyperbilirubinemia

To modify attitude on:


• Caring a newborn patient with hyperbilirubinemia
• Confidence in managing patients with this kind of condition
• Our sense of unselfish love and empathy rendering nursing care to our patient
so that we may be able to serve future clients with higher level of holistic
understanding, as well as individualized care.

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B. BACK GROUND OF THE STUDY

Baby Girl HB is a premature borderline infant from Lumban, Laguna, born of a 37


years old G4P4 delivered via NSD by her mother last September 16, 2010 at home.
The newborn has been admitted at Pediatric Intensive Care Unit (PICU) last
September 19, 2010 at 10:30am because of jaundice. The patient has been
diagnosed with Hyperbilirubinemia. She has undergone intensive phototherapy
treatment at her first day in PICU. When we handled her, the newborn was already
well and in good condition and she was about to go home or for MGH.
We decided to present this case in our eagerness to learn and explore new
knowledge and information about this type of newborn condition. Our group wants to
formulate a correlation among the conditions that manifests in baby girl HB. We
believe that this can be of great help in performing appropriate nursing interventions
to the patient. Our group also wants to focus on hyperbilirubinemia, which is common
among newborns. It is a significant topic for the mothers especially for those who are
pregnant. It is of great advantage that they have knowledge about this condition.

C. RATIONALE FOR CHOOSING THE CASE


This case has been chosen by the group under the following reasons:
• To better understand Hyperbilirubinemia, its nature and appropriate nursing
interventions that may contribute to patient’s recovery
• To benefit the student nurses in enhancing their skills in giving care for patient
diagnosed with Hyperbilirubinemia
• To defy our capabilities in presenting such challenging case
• To challenge our skills in connecting relevant details of the disease for actual
patient care

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D. SIGNIFICANCE OF THE STUDY
This study is done for the benefits of the following:
• To the patient – this study hopes to be most beneficial to the patient as the core
purpose of this, is to aid in prompt and successful client recovery
• To the students – this study presents various observations upon handling the
client and sustaining for her recovery. We hope to be of help to our fellow
students by sharing first hand experiences about the condition

E. SCOPE AND LIMITATION


This study covers and focuses on the following:
 A brief discussion of the disease and its causes, manifestations, and proper
treatment

 A pathophysiology presented via schematic diagram format of Hyperbilirubinemia

 A drug study of medications prescribed to patient

 Nursing Care Plans which would present nursing analysis, diagnosis, plan, and
appropriate interventions that would aid in patients recovery.

 Discharge plan which presents follow-up care and treatment after confinement.

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II. Clinical Study

DEMOGRAPHIC DATA

Patient Name : Baby Girl HB


Age : 3 days old
Sex : Female
Birth Date : September 16, 2010
Address : Lumban, Laguna
Date of Admission : September 19, 2010
Time of Admission: 10:30am
Admitting Diagnosis: HYPERBILIRUBINEMIA

Source of Information
Primary Source : Mother

Secondary Source : Patient’s records/ chart

Chief Complaint: “Tatlong araw nang madilaw ang anak ko” as verbalized by the
mother

History of Present Illness


According to patient’s mother, when Baby Girl HB was born, she noticed that her
baby’s skin became yellowish in color for 3 days. The Pediatric Resident on Duty
(PROD) seen and examined her and the physician ordered and requested CBC and
B1, B2. The patient then admitted to PICU on September 19, 2010, Sunday at
exactly 10:30am, afterwards, the PROD requested for Bilirubin Test and to have an
intensive (continuous) phototherapy.

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B. PHYSICAL ASSESSMENT

- slightly yellowish skin color and sclera


- with dry skin
- with desquamation of the skin
- with covers on eyes and genitals
General Appearance - with good sucking reflex
- afebrile
- with negative (-) adventitious breath sounds upon
auscultation on both bilateral lung fields
- fairly active
- with good sleeping habit
- normocephalic
- symmetrical in shape
- no masses, no lesions
Head - Non bulging and non depressed anterior and
posterior fontanels
- No signs of caput succedaneum and
cephalhematoma
Hair - evenly distributed over the scalp
- with black, straight and thick hair
Eyelids - lids close symmetrically
- with eyeshield
- no edema, and no discharges
Sclera - slightly yellowish
Iris - symmetrical in size
- round and black
- Symmetrical in size
Pupils - round and dark brown in color
- PERRLA (Pupils Equally Round And React To
Light and Accommodation)

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- equal in size
Ears - auricles are smooth and symmetrical
- pinna recoils after it is folded
- the external nose is symmetrical and straight
- color is the same with the entire face
- lesions and tenderness were both absent
- nasal mucosa was pinkish
Nose - both left and right nares were patent
- nasal septum is intact and in midline without
deviations
- cilia present in internal nares
- absence of nasal discharge
- no signs of nasal flaring
- pinkish and moistened
- dry oral mucous membrane
- frenulum intact at midline
Mouth - tongue was located at the midline, pink in color,
slightly dry and furry with whitish coating
- tongue moves freely
- uvula is in midline
- neck movement was coordinated and difficulty in
Neck moving was not noted
- free from lumps and no tenderness
- no masses and tenderness upon palpation
Thorax - no adventitious breath sounds upon auscultation on
both left and right lung fields
- negative retractions
- round in shape, no lumps, no masses
Breast - areola dark brown in color
- nipples round, equal in size
- same color of the body
Abdomen - globular, soft without distention
- bowel sounds in all quadrant

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- skin pinch goes back quickly
- good range of motion was noted
Upper extremities - no lesions, no presence of abnormalities, no
tenderness
- can flex and extend arms without difficulty
- skin uniform in color
- good range of motion was noted
Lower extremities - no lesions, no presence of abnormalities, no
tenderness
- can flex and extend legs without difficulty
- no discharges
Genitalia - no bleeding
- With slightly normal genitalia (labia majora almost
covers the clitoris)
- With genital shield
Elimination - With patent anus

Reflexes - Are present such as moro, babinski, rooting,


sucking, and plantar grasp reflex

C. SYSTEM AFFECTED

 Digestive System

 Hematologic System

D. LABORATORY AND DIAGNOSTIC EXAM

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Bilirubin Test

September 19, 2010

TEST RESULT NORMAL INTERPRETATION SIGNIFICANCE


VALUE
Neonatal 20.5 mg/dl 1.0-10.5 Increased Increase
Bilirubin mg/dl destruction of
RBC resulting
in increase
unconjugated
and conjugated
bilirubin
Unconjugated 18.56 mg/dl 0.6-10.5 Increased An abnormal
bilirubin mg/dl accumulation of
bilirubin in the
blood caused
by the poor
function of the
liver
Conjugated 1.59 mg/dl 0-0.6 mg/dl Increased Increase
bilirubin destruction of
RBC resulting
in increase
unconjugated
and conjugated
bilirubin

September 20, 2010

TEST RESULT NORMAL INTERPRETATION SIGNIFICANCE


VALUE

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Neonatal 25.5 mg/dl 1.0-10.5 Increased Increase
Bilirubin mg/dl destruction of
RBC resulting
in increase
unconjugated
and conjugated
bilirubin
Unconjugated 24 mg/dl 0.6-10.5 Increased An abnormal
bilirubin mg/dl accumulation of
bilirubin in the
blood caused
by the poor
function of the
liver
Conjugated 1.50 mg/dl 0-0.6 mg/dl Increased Increase
bilirubin destruction of
RBC resulting
in increase
unconjugated
and conjugated
bilirubin

September 23, 2010

TEST RESULT NORMAL INTERPRETATION SIGNIFICANCE


VALUE
Neonatal 11.10 mg/dl 1.0-10.5 Increased Increase
Bilirubin mg/dl destruction of
RBC resulting
in increase
unconjugated
and conjugated
bilirubin
Unconjugated 10.9 mg/dl 0.6-10.5 Increased An abnormal
bilirubin mg/dl accumulation of
bilirubin in the
blood caused
by the poor
function of the
liver
Conjugated 0.20 mg/dl 0-0.6 mg/dl Normal
bilirubin

Complete Blood Count

September 19, 2010

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BLOOD RESULT NORMAL INTERPRETATION SIGNIFICANCE
COMPONENTS VALUE
Hemoglobin 11.0 g/dl 13-19g/dl Decrease Decrease
hemoglobin will
result to
decrease of
oxygen supply
to the body due
to bilirubin in the
bloodstream
that is trying to
get out
White Blood 17.9 4.5-10.5 x 10 9/ L Increase Increase WBC
Cells (WBC) signifies
infection in the
body.
Hematocrit 33% 42-59% Decrease Decrease
hematocrit
indicates that
the mass of
RBC is
decrease

III. CLINICAL DISCUSSION

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A. ANATOMY AND PHYSIOLOGY

Liver

• The liver is the largest glandular organ in the body; its office is to secrete bile. It is

oblong and oval in shape, and occupies the position on the right side, under the

lower ribs.

• Metabolism of carbohydrates, protein and fats

• Production of bile salts

• Detoxification of endogenous and exogenous substances

• Blood reservoir

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• Excretion of adrenal cortex hormone

• Storage of vitamins such as Vitamin A and D

Spleen

• Act as reservoir of red blood cells

• Sequesters the old, worn-out RBCs thereby removing them from the circulation

Gall Bladder

• A pear shaped organ located on the liver that stores bile.

Function:

• Stores and concentrates the (greenish liquid composed of watr, cholesterol, bile

salts, electrolyte and phospholipids) produce by the liver

• Important in fat emulsification and intestinal absorption of fatty acids, cholesterol

and other lipids

Cystic Duct

• Short duct that joins the gall bladder to the common bile duct.

• Bile can flow in both directions between the gallbladder and the common hepatic

duct and the (common) bile duct.

Pancreas

• The pancreas is an elongated, tapered organ located across the back of the

abdomen, behind the stomach.

Norman Anatomy of Bilirubin Production and Elimination

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Will go to the bone marrow That


TheThe
bacteria
excrete
liver with
Reduct
Transportenzyme
will
into
to convert
thebilirubin
will
feces
liverconjugated
convert
and some
with
for new RBC productionIronRBC
unconjugated
bilirubin
Macrophages
Cellular
Hemoglobin
will
Heme ofto
content
become it
will
(indirect,
the toconjugated
Biliverdin
willin
ofurobilinogen
will urine
fragile
phagocytized
split
be release
unconjugated)
help orintobilirubin
Globins
albumin prone
Breakdown
it
fat into amino acids
RBC lifespan of 120 days

B. PATHOPHYSIOLOGY

Predisposing Factors:
• 3 days old
• Female16
• Preterm borderline neonate
Will go to the bone marrow
for new RBC productionIron Hemoglobin will splitGlobins
HemeBiliverdin into
Breakdown into amino acids
RBC lifespan of 120 days

RBC will become fragile

Cellular content will be release

Macrophages will phagocytized it

Reduct into bilirubin (indirect, unconjugated) fat soluble

Transport to the liver with the help of albumin

Absence of glucuronyl transferase produced by liver

Unconjugated to convert

Increase unconjugated bilirubin

To the blood stream

Yellow discoloration of sclera, skin,


conjunctiva

HYPERBILIRUBINEMIA
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Objective Analysis Planning Intervention Rationale Evaluation

- skin appearing Risk for Injury After series of Remove clothing and Aids in diagnosing Goal met.
light yellow related to nursing exposed to underlying cause in After series of
- sclera abnormal blood interventions the phototherapy. connection with the nursing
appearing light profile as bilirubin level will appearance of intervention the
yellow evidenced by be decreased jaundice bilirubin level was
- weak looking increase decreased to 0.20
- afebrile bilirubin level of Covered eyes and To prevent eyes from mg/dl.
- with thin and 1.59mg/dl. genitalia direct exposure to
dry skin light and prevent
- hypoactive sterility of the baby
- under intensive
and Repositioned the baby To prevent burns
phototherapy every 2 hours.
-with eye and
genital shield Kept warm and dry. To prevent further
-with IVF reg. @ complications.
14 gtts/min.

Vital signs taken and To obtain the baseline


recorded every 1 hour. data

Instructed on Strict To prevent aspiration


Aspiration Precaution pneumonia and to
(SAP) and advised the prevent colic.
mother to burp the
baby every after
feeding

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Monitored input and To prevent
output; IVF regulated dehydration and
at 14 uggts/ min. replace fluid and
electrolyte lost

Provided quiet and To promote comfort


warm environment and prevent irritability

Instructed the mother To promote sense of


to use stimulation warmth, security and
technique such as attachment
touching.

Health teachings given To detect early the


to the mother such as possible diseases of
personal hygiene, the patient
importance of
breastfeeding, and
newborn screening

DAY 1: 19 September 2010

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Objective Analysis Planning Intervention Rationale Evaluation

- skin appearing Risk for skin After 8 hours of Maintained and To protect retina from Goal met.
light yellow breakdown nursing monitored baby’s eye damage due to high After 8 hours of
- sclera related to interventions, the patches while under intensity of light nursing
appearing light prolonged use patient’s risk of phototherapy interventions, the
yellow of phototherapy. skin breakdown patient was free
- afebrile will be avoided. Removed baby under To provide visual from skin
- with thin and phototherapy and stimulation and breakdown.
dry skin removed eye patches facilitates attachment
-with during feeding behaviors
desquamation of
the skin Inspected eyes every To reduce
- under intensive after phototherapy for complications and
and single conjunctivitis, drainage monitor the
phototherapy and corneal abrasions effectiveness of the
due to irritation from management
eye patches

Provided minimal To provide maximal


coverage of the body exposure and
except for genitals shielded the sensitive
parts such as the
eyes and genitals

Repositioned the baby To promote equal


every 2 hours distribution of
phototherapy
exposure

DAY 2: 20 SEPTEMBER 2010

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Objective Analysis Planning Intervention Rationale Evaluation

- with slightly Risk for fluid After series of Monitored input and To prevent Goal met.
yellowish skin imbalance nursing output; IVF regulated dehydration and After series of
color and sclera related to interventions, the at 14 uggts/ min. replace fluid and nursing
- fairly active prolonged risk for fluid electrolyte lost interventions, the
- with good exposure to imbalance will be risk for fluid
sucking reflex phototherapy as prevented Vital signs taken and To obtain the baseline imbalance is
- with slight evidenced by recorded data prevented as
depressed dry skin evidenced by good
fontanel Bedside care done To promote comfort skin turgor
- afebrile including stretching of and good hygiene
- negative (-) linens and organizing
adventitious bedsides
breath sounds
upon Instructed Strict To prevent aspiration
auscultation on Aspiration Precaution pneumonia
both bilateral (SAP)
lung fields
Kept back dry To prevent further
complications

Health teachings given To promote healthy


to the mother such as lifestyle
the importance of
breastfeeding, hand
washing, and proper
hygiene

Needs attended

DAY 3: 26 SEPTEMBER 2010

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B. DRUG STUDY

Drug Name Dosage Classification Mechanism of Indication Contraindication Adverse Nursing


Action Effects Responsibilities

Generic Name: 150mg IV Antibiotic Bactericidal Treatment of Contraindicated Lethargy, Check IV site
AMPICILLIN every 12 Penicillin action against infections with allergies to Seizures, carefully for
(6-6) sensitive caused by penicillins, Anemia, signs of
Brand Name: organisms; susceptible cephalosphorins, Thrombocyto thrombosis
Novo-Ampicillin inhibits strains of or other allergens penia,
Principen synthesis of shigella, Leukopenia, Inform the
bacterial cell Escherichia Neutropenia, guardian of the
wall, causing coli, gram- Prolonged patient that this
cell death positive bleeding drug is given to
organisms time, treat infection
(penicillin G- diarrhea
sensitive Follow the 10
staphylococci, Rights of the
streptococcus) medications and
administration

Advise the
guardian to
report signs of
hypersensitivity
such as redness
and rashes

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Drug Name Dosage Classification Mechanism Indication Contraindication Adverse Nursing
of Action Effects Responsibilities

Generic Name: 150mg IV Antibiotic Bactericidal: Septicemia Contraindicated Diarrhea, bone Reconstitution of
CEFOTAXIME every 12 Cephalosporin Inhibits caused by with allergy to marrow drug varies by
(12-12) (3rd synthesis of E.coli, cephalosporins or depression – size of package;
Brand Name: generation) bacterial cell Klebsiella penicillins decreased see
Claforan wall, causing species, S. WBC, manufacturer’s
cell death marcescens decreased directions for
platelets, details
decreased
hematocrit, Inform the
guardian of the
patient that this
drug is given to
treat infection

Follow the 10
Rights of the
medications and
administration

Advise the
guardian to
report signs of
hypersensitivity
such as redness
and rashes

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Drug Name Dosage Classification Mechanism Indication Contraindication Adverse Nursing
of Action Effects Responsibilities

Generic 30mg IV Aminoglycoside Bactericidal: Short-term With allergy to Fever, Monitor duration of
Name: once a Inhibits protein treatment of any seizures, treatment; usually 7-10
AMIKACIN day synthesis in serious aminoglycosides diarrhea, days. Prolonged
rash, treatment leads to
(OD) susceptible infections
Brand Name: urticaria increased risk of toxicity
strains of gram- caused by
Amikin negative susceptible Monitor intake and
bacteria, and strains of output and daily weight
the functional Pseudomonas to assess hydration
integrity of species, E.coli, status and renal function
bacterial cell Klebsiella,
membrane Enterobacter, Inform the guardian of
appears to be and Serratia the patient that this drug
disrupted, species is given to treat infection
causing cell
Follow the 10 Rights of
death
the medications and
administration

Advise the guardian to


report signs of
hypersensitivity such as
redness and rashes

Assess patient for sign


of super infection (fever,
upper respiratory
infection)

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Drug Name Dosage Classification Mechanism of Action Indication Contraindication Adverse Nursing
Effects Responsibilities

Generic Name: 9mg IV Antiepileptic General CNS Sedative, With Bradycardia, Administer IV
PHENOBARBITAL every Barbiturate depressant; Emergency hypersensitivity constipation, doses slowly
12 (12- Hypnotic barbiturates inhibit control of to barbiturates, diarrhea,
Brand Name: 12) Sedative impulse conduction acute severe rashes, Monitor injection
Luminal Sodium in the ascending seizures respiratory urticaria, sites carefully for
PMS- RAS, depress the distress respiratory irritation and
Phenobarbital cerebral cortex, depression, extravasation
alter cerebellar broncho-
function, depress spasm Monitor pulse and
motor output, and respiration
can produce carefully during IV
excitation, sedation, administration
hypnosis; at
subhypnotic doses, Follow the 10
has anti-seizure Rights of the
activity, making it medications and
suitable for long- administration
term use as an
antiepileptic

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C.COURSE IN THE WARD

Date Time Vital Sign Observation

September 26, 2010 10:00PM T – 36.3 oC


- with slightly yellowish
P – 130 bpm
R – 38 cpm skin color and sclera
- With good skin turgor
2:00AM T – 36.5 oC
P – 131 bpm - with good sucking
R – 42 cpm
reflex
6:00AM T – 36.8 oC - Afebrile
P – 134 bpm
- with negative (-)
R – 39 cpm
adventitious breath
sounds upon
auscultation on both
bilateral lung fields
- fairly active
- with good sleeping
habit

DISCHARGE PLAN
Medication:

 Instructed the mother to give Nutrilin 0.3 ml drops once a day (OD) for optimum
recovery and good health
Environment:

 Encouraged the mother to keep an environment clean and conducive to health for
the rapid recovery of infant and to avoid infection and keep environment quiet to
make the patient comfortable
Treatment:

 Emphasized to the mother the importance of regular follow-up check-ups and as


instructed by physician

 Advised the mother to seek medical advice if any strange arises

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 Encouraged the mother to let the baby be monitored by the health care provider
until complete recovery is met
Health Teachings:

 Advised the mother to exposed the patient to sunlight around 6:00am – 8:00am

 Emphasized to the mother the importance of proper hand washing and proper
hygiene

 Emphasized the need for compliance and cooperation of the mother in helping
treat the infant

 Emphasized that the baby is on trust vs. mistrust stage: the needs must be met
for a healthy emotional development
Out Patient:

 Reminded the mother that even though the patient feels better, it is important to
have the doctor monitor her progress. The patient is scheduled on October 4,
2010 at 8:00am in Out-Patient Department in Laguna Provincial Hospital (LPH) to
evaluate the recovery of the infant
Diet:

 Encouraged the mother for breastfeeding to help the baby gain resistance and
protection from diseases in the future

 Emphasized to the mother to breast fed the baby up to two years. An increase in
feeding will help a faster gain in weight of the baby
Spirituality:

 Encouraged the mother to continue to seek God’s guidance and to continue to


have a positive outlook in life

 Emphasized the importance of prayers in healing

 Encouraged the mother to pray for the baby’s fast recovery and gave words of
encouragement

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EVALUATION
Though the group found the chosen case on its wellness stage or with may go
home order, it was still given us the opportunity to know the disease specifically the
Hyperbilirubinemia or Neonatal Jaundice for better understanding and appropriate
nursing care to be done for any newborn acquired this kind of disease. There were
several factors how this disease can be acquired and each of us was challenged to
search the causes and details why many newborns suffered from this health problem.
The nursing intervention we had during the shift were closed monitoring on baby’s
vital signs, kept baby under phototherapy, kept baby comfortable, assured baby that she
was well fed and provided health teachings to the parent. The goal of the group has
been met as evidenced by parent showed knowledge and understanding about the
health condition of their child and improved parenting manner. There were no significant
circumstances arise during our shift.

SUMMARY

• Hyperbilirubinemia is a condition in which there is too much bilirubin in blood.


When red blood cells breakdown, a substance called bilirubin is formed.
• Patient was a baby Girl “HB” a premature borderline infant from Lumban, Laguna,
born of a 37 years old G4P4 delivered via NSD by her mother last September 16,
2010 at home. The newborn has been admitted at Pediatric Intensive Care Unit
(PICU) last September 19, 2010 at 10:30am because of jaundice. The patient has
been diagnosed with Hyperbilirubinemia. She has undergone intensive
phototherapy; medications were Ampicillin, Amikacin, Cefotaxime and
Phenobarbital.
• Patient was discharged on September 27, 2010 at 8:00 AM.

RECOMMENDATION
The group recommends to the parent the following care:
• Expose their child under sunlight ideally between 6:00-7:00 in the morning and
don’t forget to put cover over the baby’s eyes
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• Provide baby quality breast feeding every 2-3 hours or as frequent as needed for
this promotes improved wellness condition and effective bonding technique
between mother and child.
• Go to the nearest health center for baby’s immunization
• Keep baby clean and dry
• Give home meds as prescribed. Seek immediate doctor’s advice if there is any
significant changes observe on the child or return child for follow up check-up.

BIBLIOGRAPHY

Fundamentals of Maternal and Child Nursing, London, Ladewig, Ball and Bindler, 2 nd
ed., Vol. 1, pp. 835 – 844

Nursing Drug Guide, Lippincott’s, 2009, pp. 126, 101, 246, 948

http://www.merck.com/mmpe/lexicomp/bisacodyl.html

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