Physiological Jaundice

Subject: Midwifery III (Theory)

Overview

Physiological jaundice is caused by immature bilirubin metabolism and transport in newborns, as well as an increased bilirubin load from pronounced hemolysis of red blood cells.Icterus of body parts, baby may be irritable, baby may not suck well, and baby may be inactive are all signs and symptoms of physiological jaundice.Nursing management of physiological jaundice includes encouraging pregnant women to seek early antenatal care to determine blood group and Rh factor, identifying infants at risk for hyperbilirubinemia and kernicterus, assisting in medical therapies and phototherapy, exchange transfusion, phototherapy, and providing emotional support to parents.Refer infants with jaundice and rising bilirubin levels to a physician within the first 24 hours.

Physiological Jaundice

Physiological jaundice is caused by immature bilirubin metabolism and transport in newborns, as well as an increased bilirubin load caused by hemolysis of red blood cells.

Sign and symptoms

  • body part icterus
  • The infant may be irritable.
  • Baby may not be able to suck well and may be inactive.

Nursing Management

Prevent Blood Incompatibility

  • Encourage pregnant women to seek early antenatal care to determine blood group and Rh type. Carefully monitor all Rh-negative women with an Rh-positive fetus for rising bilirubin levels

Identify Infants at Risk for Hyperbilirubinaemia and Kernicterus

  • Examine the color of amniotic fluid at the time of membrane rupture.
  • Look for signs of jaundice, anemia, and irritability in the central nervous system.
  • Refer infants with jaundice and rising bilirubin levels within the first 24 hours to a physician.
  • Be aware of conditions that increase the risk of kernicterus at low bilirubin levels (acidosis, hypoxia, and hypothermia).

Assist in Medical Therapies and Phototherapy

  • Shield an infant's eyes; ensure that the lids are closed before applying the shield, and check each eye for drainage or irrigation.
  • Place the infant under a light, but cover the testes.
  • Every two hours, position should be changed.
  • Keep an eye on your body temperature.
  • Ensure that a protective glass shield separates the infant from lights.

Exchange Transfusion

  • Before the procedure, give the infant nothing by mouth.
  • Check donor blood with a physician to ensure it is of the correct blood group and Rh type.
  • Assist the physician during the procedure and maintain asepsis.
  • Keep accurate records of the amount of blood infused and withdrawn. Monitor vital signs, especially after a calcium gluconate infusion.
  • Maintain the infant's body temperature at its optimal level throughout the procedure.
  • Look for signs of an exchange transfusion reaction.
  • Apply a barrier cream to the catchment area.
  • Examine the umbilical site for signs of bleeding or infection.

Observe for Complications

  • Keep an eye out for signs of central nervous system complications such as depression or absent reflexes, hypotonia, and poor shucking.

Observation for Phototherapy

  • Look for hypothermia, dehydration, loose stools, and bronze.
  • Provide emotional support to parents who are incompatible.
  • Parents should be informed about therapies.
  • Assist parents with various procedures.
  • Allow parents to express their feelings about the cause of blood incompatibility.
  • Plan for a follow-up, especially if bilirubin levels in a full-term neonate approached 20mg/100ml.
  • Encourage parents to report their child's parental history during subsequent infant assessments, especially if the child is being seen by unfamiliar health personnel.
  • Plan for early developmental and hearing evaluations. Check blood for anemia and the need for supplemental iron during the first two months.
Things to remember
  • Physiological jaundice is caused by immature bilirubin metabolism and transport in newborns, as well as an increased bilirubin load from hemolysis of red blood cells.
  • Icterus of body parts, baby may be irritable, baby may not suck well, and baby may be inactive are signs and symptoms of physiological jaundice.
  • Encourage a pregnant woman to seek early antenatal care to determine blood group and Rh factor, identify infants at risk for hyperbilirubinaemia and kernicterus, assist in medical therapies and phototherapy, exchange transfusion, phototherapy, and provide emotional support to parents.
  • Refer infants with jaundice and rising bilirubin levels to a doctor within the first 24 hours.
Questions and Answers

A newborn's immature bilirubin metabolism and transport, along with an elevated bilirubin load from prominent red blood cell hemolysis, result in physiological jaundice.

  • Prevent Blood Incompatibility
    • A pregnant woman should be encouraged to get an early antenatal checkup to determine her blood type and Rh factor.
    • Establish Rh type and blood group.
    • Watch out for rising bilirubin levels in all Rh-negative women who may be carrying an Rh-positive fetus.
  • Determine Infants Who are at Kernicterus and yperbilirubinemia risk
    • When the membranes are rupturing, look at the color of the amniotic fluid.
    • Check for signs of anemia, irritation of the central nervous system, and jaundice.
    • Send a baby to the doctor if there are jaundice symptoms and rising bilirubin levels during the first 24 hours.
    • Acidosis, hypoxia, and hypothermia are conditions to be cautious of as they raise the risk of kernicterus at lower bilirubin levels.
  • Assist in Medical Therapies and Phototherapy
    • Protect the eyes of young children by making sure the lids are shut before applying the shield and by checking each eye for discharge or irrigation.
    • Place baby in light, but shield testicles.
    • 2 hourly position changes.
    • Observe your body's temperature.
    • Make sure that a protective glass shield keeps baby flashlights apart.
  • Exchange Transfusion
    • Give the baby nothing to eat or drink before the surgery.
    • With a doctor, confirm the correct blood type and Rh genotype of the donor.
    • Assist the doctor during the procedure and maintain asepsis.
    • Keep thorough records of the blood that has been drawn and injected.
    • After receiving a calcium gluconate infusion, in particular, watch your vital signs.
    • During the process, keep the infant's body temperature at its ideal level.
    • Keep an eye out for any exchange transfusion response symptoms.
    • Dress the catchment area in a sterile dressing.
    • Check for bleeding or infection at the umbilical site.
  • Observe for Complications
    • Keep an eye out for symptoms of complications with the central nervous system, such as depression or absent reflexes, hypotonia, or poor shucking.
  • Observation for Phototherapy
    • Keep an eye out for hypothermia, dehydration symptoms, loose stools, and bronze.
    • Give the parent emotional support.
    • Incompatibility of the blood.
  • To Parents
    • Describe the therapies.
    • During several processes, reassure the parents.
    • Give parents the opportunity to express their feelings about the factors causing blood incompatibility.
  • Make plans for follow-up, especially if a full-term newborn's bilirubin levels approached 20 mg/100 ml..
    • Encourage parents to share their family history during subsequent infant evaluations, especially if the child is examined by a new member of the medical staff.
    • Prepare for a hearing and early developmental testing.
    • In the first two months, check blood for signs of anemia and whether you need to take additional iron.

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