Case study of neonatal jaundice

Case study of neonatal jaundice

1.  IDENTIFICATION DATA:
Name : Baby of madhusmita sahoo
Age : 03days
Sex : female
Registration No : 1405539719
Father’s Name :Ghania sahoo
Mother’s Name :Pratima sahoo
Date of birth :15/01/16
Religion :Hindu
Mother tongue :Odiya
Bed No :1o
Name of the ward : NICU
Diagnosis : Neonatal Jaundice
Date of admission :07/10/18
Date of discharge :11/10/18
 CHIEF COMPLAIN:
Chief complaioon of my client-
 Yellowish discolouration f the skin and mucus membrane
 Yellowish urination
 Yellowish discolouration of the eye
 Ineffective breastfeeding
 Excessive crying

2. HISTORY OF PRESENT ILLNESS :
 Present medical history:
 Patient was last well 1 day ago where the mother has noticed yellowish
discolouration of the whole body and sclera.
 During the first two days stools were said to be dark in colour which has
turned yellowish by the 3rd day but it was pale.
 In the evening of the 3d day after birth baby was brought to the hospital
and baby was severely jaundiced and patent admitted in NICU.
 Present surgical history:
Nothing significant
 HISTORY OF PAST ILLNESS:
 Past medical history: Nothing significant
 Past surgical history: Nothing significant
 ANTENATAL HISTORY OF MOTHER:
a) Health of mother : Good
b) Inj.TT taken : Yes
c) Complication during pregnancy : No
d) Any infection during pregnancy? :No
 NATAL HISTORY:
a) Born by :Normal Vaginal
b) Condition at birth :Normal
c) A/S at birth
d) Any problem at birth :No
 NEONATAL HISTORY:
a) Any abnormalities detected :yes
b) Did the child requires any hospitalization : yes
 POST NATAL HISTORY:
Baby cried immediately after birth. Breast feeding start after birth.
 NUTRITION HISTORY:
 Exclusive breast feeding for how long : not started
 Supplementary feeding :no
 BCG given at birth within 24 hours.
 PERSONAL HISTORY:
a) Behaviour patterns :Normal
b) Developmental history :Normal

3. BOOK PICTURE PATIENT PICTURE
PHYSICAL & BIOLOGICAL
WEIGHT:
2.5 to 3.9 kg
LENGTH:
48-53cm
HEAD CIRCUMFERENCE:
33 -37cm
VITAL SIGNS:
Pulse :85-190 beats /min
Respiration :30-60breath/min
BP :120/60mmhg
REFLEX:
 Well developed sucking, gagging,
swallowing, sneezing,
coughing,extortion reflexes.
MOTOR DEVELOPMENT:
 Climbs up one step with assistance
walks side wis and backwards
 Walk with out support
 Kneels with out support
 Able to creep upstairs
 Throws small object repeatedly &
pick the again
 Jumping attempting using both feet
 Seats self in small chair
FINE MOTOR:
 Drink alone with
glass,scribble,tower of 2 cubes
 Open box
 Pokes finger in hole
 Scribbles spontaneously
 Turn pages
 Transfer object one hand to other
 Open door by turning door knob
SENSORY DEVELOPMENT :
 Determine the distance from the crib
high chair to floor
 Normal hearing
PHYSICAL & BIOLOGICAL
WEIGHT:
3.5 kg
LENGTH:
51cm
HEAD CIRCUMFERENCE:
35cm
Vital sign:
Pulse :140beats/minute
Respiration :35breath/miute
BP :100/50mmhg
REFLEX:
 Sucking,swallowing,gagging,cou
ghing,sneezing,reflexes ar
present.
MOTOR DEVELOPMENT:
 Not started

 Not started

 Not started

 Not started

 Not started
FINE MOTOR:
 Not started

 Not started

 Not started

 Not started

SENSORRY DEVELOPMENT:
 Not started

 Not started

4.  Prefers food as like
 Respond to unpleasant order
 Develop sensation of touch & pain

LANGUAGE DEVELOPMENT:
 Speak 4-6 ward without mama,
dada
 Speak ward,name,object,and
person
 Call person with name
 Enjoy stories with picture
 Name familiar picture
 Follow command


PLAY STIMULATION :
 Parallel play
 Interest in musical toys & picture
 Watch activities of others
 Interest in dramatic play
 Creative play like use of finger
plain, crayons
 Interest in motor play like use of
large car’s,truck;s,trrain
 Intrest in creative activities like
singing simple song.


 Not started

 Not started
LANGUAGE DEVELOPMENT:
 Not started

 Not started

 Not started





PLAY STIMULATION:

 Not started

 Not started

 Not started

 Not started

 Not started





 PERSONAL HISTORY:
a) Hours of sleep :4hrs/day(day)
b) Hours of sleep :8hrs/day(night)
c) Toilet training started : No
d) Bowel trained completely :No
e) Frequency of bowel movment :once/day
f) Any history of diarrhoea :No
g) Any history of constipation :No

5. h) Bladder trained completely :No
i) Any other bladder complaint :No

 FAMILY HISTORY:

NAME AGE SEX RELATION EDUCATION OCCUPATION HEAL-
TH
Rabi
sahoo
60yrs Male Grand father PG Teacher Good
Mina
sahoo
57yrs Female Grand mother Plus 2 pass House wife Good
Kuna
sahoo
38 yrs Male Father B.tech Engeneer Good
Tiki
sahoo
35 yrs Female Sister in law B .Ed Teacher Good
Liza
sahoo
35yrs Female mother +2 pass House wife Un
healthy
Saismit
a
2 days female patient Not started Neonatal
jaundiice

6. FAMILY TREE:






6060

7. VITAL SIGN:
DT: 07/10/2018
TPR & BP NORRMAL
VALUE
PATIENT VALUE REMARKS
Temperature

98.6
0
f 98.4
0
f Hypothermia
Pulse 85-190beats/min 152brth/min


Normal
Respiration 30-60brrth/min 32breath/min Normal
Blood pressure 67-84mmhg 64/29mmhg Normal
Dt :08/10/18
TPR & BP NORRMAL
VALUE
PATIENT VALUE REMARKS
Temperature

98.6
0
f 98.4
0
f Hypothermia
Pulse 85-190beats/min 152brth/min


Normal
Respiration 30-60brrth/min 32breath/min Normal
Blood pressure 67-84mmhg 64/29mmhg Normal

8. Dt :09/10/18
TPR & BP NORRMAL
VALUE
PATIENT VALUE REMARKS
Temperature

98.6
0
f 98.9
0
f Hypethermia
Pulse 85-190beats/min 152brth/min


Normal
Respiration 30-60brrth/min 32breath/min Normal
Blood pressure 67-84mmhg 64/29mmhg Normal
Dt :10/10/18
TPR & BP NORRMAL
VALUE
PATIENT VALUE REMARKS
Temperature

98.6
0
f 98.7
0
f Hyperthermia
Pulse 85-190beats/min 152brth/min


Normal
Respiration 30-60brrth/min 32breath/min Normal
Blood pressure 67-84mmhg 64/29mmhg Normal

9. Dt :11/10/18
TPR & BP NORRMAL
VALUE
PATIENT VALUE REMARKS
Temperature

98.6
0
f 98.6
0
f Normal
Pulse 85-190beats/min 152brth/min


Normal
Respiration 30-60brrth/min 32breath/min Normal
Blood pressure 67-84mmhg 64/29mmhg Normal

10. PHYSICAL ASSESSMENT:
A. ANTHROPOMETRY MEASURRMENT:
PARAMETER NORRMAL
VALUE
PATIENT VALUE REMARRKS
Height(cm) 50CM 51CM




Baby’s biogical
growth is
Adequate
Weight (kg) 2.5-3.9 KG 2.8KG
Head circum
ference
33-35 CM 35CM
Chest
Circumference
31-33 CM 31 CM
Mid arm
circumference
11CM 11CM

 GENERAL EXAMINATION:
i. Face : tearful ,lethargy
ii. Posture : Not normal
iii. Grooming :Poor
iv. Nutrition :poorly nourished
v. Behaviour :Hypoactive
vi. General buld :Short
vii. State of awareness :Not alert
i. SKIN:
i. Complexion :yellow
ii. Colour changes :Pallor
iii. Texture :Moist
iv. Integrity of skin :yellow
v. Turgor :Abnormal
vi. Skin temperature quality :cold
vii. Seat :Normal

11. ii. ACCESSORRY STRUCTURES:
HAIR:
1. Colour :black
2. Texture :dull
3. Quality :Normal
4. Quantity :Normal
5. Elasticity : pluckable
6. Distribution :Normal
7. Hygine :Average
8. Any abnormalities :No
iii. NAILS:
1. Color : yellow
2. Texture :smooth
3. Character :short
4. Quality :pliable
5. Shape :convex
6. Hygiene :average
7. Dermatoglyphics :normal
iv. LYMPHATIC:
a) Cervical :
1. Palpable /not palpable :palpable
2. Small /enlarged :small
3. Non-tender/tender :non-tender
4. Discrete/matted :nothing is significant
b) Axillary :
1. Palpable/ not palpable :palpable
2. Small /enlarged :small
3. Non-tender/tender :non-tender
4. Discrete/matted :nothing is significant
c) Inguinal :
1. Palpable/not palpable :palpable
2. Small/enlarged :small
3. Non-tender/tender :non-tender

12. 4. Discrete/matted :nothing is significant
v. Head :
1. Shape :round
2. Symmetry :symmetrical
3. ROM :normal
4. Size
5. Fontanelle & sutures :close/full
6. Lesions :absent
7. Trauma :absent
8. Hygiene :poor
9. Infestations :no
vi. EYE’S:
Eyelid:
1. Placement :normal
2. Movement :normal
3. Colour :differently colored
4. Ptosis :no
5. Ectropion :no
6. Entropion :no
7. Setting sun sign :no
8. Puffiness :no
9. Conjuctive :yellow
Eyelashe’s:
1. Distribution :normal
2. Direction of growth :straight
3. Length :normal
Sclera:
1. Colour :yellow
2. Exopthalmous :no
3. Hyoertelorism :no
4. Eyes :normal
5. Slant of eye’s :normal
6. Squint :absent

13. Pupils :
1. Size :normal
2. Shape :round
3. Movement :symmetrical
4. Reaction to light :normal
5. Accommodation :normal
Iris :
1. Shape :round
2. Colour :black
3. Size :equal
4. Clarity :clear
5. Defects :no
Lense :
1. Opacilities :absent
Fundus :normal
vii. EAR’S:
Pinna :
1. Placement : normal
2. Alignment :symmetrical
3. Shape :normal
External canal:
1. Discharge :no
2. Wax :yes
3. Tympanic membrane :normal
viii. NOSE:
1. Nostrils :equal
2. Alanasi :flaring yes
3. Bridge of nose :normal
4. Mucosal lining :moist
5. Discharge :no
6. Septum :not deviated

14. ix. MOUTH & THRROAT:
a) Lips:
1. Colour :pallor
2. Texture :dry
3. Lesion’s :absent
4. Crack’s :absent
b) Mucous membrane :
1. Lesion’s :absent
2. Odour :present
3. Bleeding :absent
c) Gingiva :
1. Colour :pale
2. Swelling :absent
3. Bleeding :absent
d) Teeth :
1. Number :no
2. Discolouration :absent
3. Dental caries :absent
e) Tongue:
1. Freely movable :yes
2. Lesion’s :absent
3. Fissuring :present
4. Colouring :present
5. Interfere with speech :not started
f) Uvula:
1. Normal/abnormal :normal
2. Palatine tonsils normal/abnormal :normal
3. Gag reflex :absent
x. Neck:
1. Size :normal
2. Trachea :central
3. Thyroid :normal
4. Nodules :present

15. 5. Carotid arteries :equal
xi. NEURROLOGICAL /MUSCULOSKELETAL:
 Level of consciousness :lethargy
 Voice :no response
 Voice cry :weak
 Behaviour :full
 Orientation :abnormal
 Memory :present
 Communication pattern :abnormal
 Balance :abnormal
 Gait :abnormal
 Tone :flacid
 Activity :doll
 Eye;s open :spontaneous
 Motor response :just moves
 Away :no response
 Verbal response :confused
 Stimulus response :no response
 Pupils :react to slowly
xii. BACK & EXTREMITIES:
i. Back curvature
 Scoliosis : no
 Lordosis :no
 Kyphosis :no
 Spina bifida present :absent
ii. Upper extremity:
 Symmetry :present
 ROM :normal
 Digit’s : normal
 Any deformity :present
iii. Lower extremity:
 Symmetry :present

16.  ROM :normal
 Digit’s :normal
 Any deformity :absent
xiii. CARDIOVASCULAR:
 Skin color :yellow
 Pulses :normal
 Skin temperature/quality :cold
 Cool :extreme
 Cold :extreme
 Clammy : extreme
 Diaphoresis :extreme
 Dry :central
 Heart sound :s1-s2 clear
 Skin turgor :normal
 Capillary rifill :3-5 sec normal
 BP : 110/70mmhg
 Temperature :97
0
F
xiv. RESPIRATORY:
 Rate/min :32brreath/min
 Pattern :regular
 Chest expansion :symmetrical
 Retraction’s :flaring
 Cough :productive
 Sputum colour :normal
 Breath sound’s :normal
 Right lungs :clear
 Left lungs :clear
 Chest tube :present
 Other :not significant
xv. GASTROINTESTINAL:
 Abdomen :flat
 Liver :palpable

17.  Bowel sounds :absent
 Nutrition :parenteral
 Umbilicus : normal
 Gastric tube :not significant
xvi. GENITAL:
 External genitalia :normal
 Urethral meatus location :normal
Anus
 Reflexes :normal
 Corrugation :normal
 Fissure :present
 Polyp :absent
 Rectal prolapsed :absent
xvii. URINARY SYSTEM:
 Kidney :not palpable
 Bladder :not palpable
 Catheters :Foley size
 Dialysis :not started
 Other :not significant
xviii. INTEGUMENTARY SYSTEM:
 Incision site :bleeding
 Dissection :redness
 Dressing :dry
 Diaper area :rash

18. ANATOMY AND PHYSIOLOGY OF LIVER
INTERDUCTION:
 The liver is the largest of the abdominal viscera, occupying a substantial portion of
the upper abdominal cavity.
 It performs a wide range of metabolic activities necessary for homeostasis, nutrition
and immune defence.
 It is situated in the upper part of the right hypochondriac region, part of the epigastric
region and extending into the left hypochondriac region.
 Weighing between 1 and 2.3 kg.
 It’s upper and anterior surfaces are smooth and curved to fit the under surface of the
diaphragm, it’s posterior surface is irregular in outline.


ORGANS ASSOCIATED WITH THE LIVER :
Superiorly and anteriorly:diaphargm and anterior abdominal wall
Inferiorly: stomach,bile ducts,duodenum,hepatic flexure of the colon,right kidney,and
adrenal gland.
Posteriorly:oesophagus,inferior venacava,aorta,gall bladder,vertrbtal column and
diaphargm.
Laterally :lower ribs and diaphragm .

19.  The liver is enclosed in a thin inlastic capsule and incomletly covered by a layer of
peritoneum.
 Folds of peritoneum form supporting ligament’s that attach the liver to the inferior
surface of the diaphargm.
 It is held in postion partly by these ligament’s and partly by the pressure of the
organ in the abdominal cavity.
 The liver has four lobes.the two most obvious are the large right lobe and the
smaller ,wedge-shaped,left lobe .
 The other two,the caudate and quadrate lobes,are areas on the posterior surface.
The portal fissure:
 The posterior surface of liver is know as portal fissure.
 Here various structures enter and leave the gland.
 The poretal vein enters, carrying arterial blood.
 It is a branch from the coeliac artery which is a branch frm the abdominal aorta.
 Nerve fibre’s, sympathetic and parasympathetic ,enter here.
 The right and left hepatic duct’s leave carrying bile from the liver to the gall bladder.
 Lymph vessel’s leave the liver,draining lymph to abdominal and thoracic nodes.
Blood supply:
 The hepatic artery and the portal vein take blood to the liver.
 Venous return is by a variable number of hepatic veins that leave the posterior
surface and immediately enter the inferior venacava just below the diaphargm.
Structure:
 The lobes of the liver are made up of tiny functual units,called lobules,which are just
visible to the naked eye.
 Liver lobules are hexagonal in outline and are formed by cuboidal cells,the
hepatocytes arranged in pairs of columns regarding from a central vein.between two
pairs of columns cells are sinusoids (blood vessels with incomplet wall,)containing a
mixture of blood from the tiny branches of the portal vein and hepatic artery.
 This arrangment allows the arterial blood and portal venous blood (with a high
concentration of nutrients) to mix and come into close contact with the liver cells.
 Amongst the cells lining the sinusoids are hepatic macrophages (kupffer cells)
whose function is to ingest and destroy worn out blood cells and any foreign
particles present in the blood flowing through the liver.
 Blood drains from the sinusoids into central or centrilobular veins.
 These then merge with veins from other lobules,forming larger veins,untill eventually
they become hepatic veins,which leave the liver and empty into the inferior vena
cava.

20. FUNCTIONS OF THE LIVER :
The liver is one of the most vital organ of the body .it is involved im metabolism.
I. Carbohydrate metabolism:
Liver helps in maintaining the normal blood glucose level.
when glucose level in the blood is less ,then it breaks down glycogen to glucose called
as glycogenolysis and release glucose into the blood stream.
when glucose level is high ,it converts glucose to glycogen,called glycogenesis.
II. Lipid metabolism:
it converts the fat into fatty acids,so that it can be used by the body.
it is called the desaturation of fats.
III. Protein metabolism:
The liver deaminates amino acids so that they can be used for ATP production or
converted to carbohydrates or fats
.it converts the resulting toxic ammonia (NH3)into the much less toxic urea for excretion
in urine.
IV. Excreton of bilirubin :
Bilirubin ,derived from the heme of worn-out red blood cells,is absorbed by the liver
from the blood and secretion into bile.
V. Removal of drugs and hormones:
The liver can detoxifies substances such as alcohol or excrete drugs.
VI. Synthesis of bile salts:
Bile salts are used n the small intestine for the emulsification and absorption of
lipids,cholesterol,phospholipids and lipiproteins.
VII. Activation of vitamin- D:
The skin,liver and kidneys participate in activating vit-D.

21. VIII. Phagocytosis :
The kupffers cells of the liver phagocytose worn pot red and white blood cells and some
bacteria.
IX. Storage :
The livers stores vitamin A,B12,D,E and K and minerals.
The iron is released from the liver when needed elsewhere in the body.
X. Metabolism of ethanol :
This follows consumption of alcoholic drinks.
XI. Production of heat:
Liver uses the considerable energy and helps in the production of heat.
Storage of bile:
Stored substances include:
 Glycogen
 Fat-soluble vitamines:A,D,E,K
 Iron ,copper
 Some water soluble vitamines e.g.vit-B12.
Composition of bile:
Between 500 and 1000 ml of bile is secreted by the liver daily.bile consists of :
 Water
 Mineral salts
 Mucus
 Bile pigments ,mainly bilirubin
 Bile salts,cholesterol

22. DISEASE CONDITION:
DFINITION:
 Hyperbilirubinemia is a condition in which the bilirubin level in the blood is
increased. it is characterized by a yellow discolouration of the skin, mucus
membrane, sclera and various organ.
 The yellow discolouration is caused primarily by accumulation in the skin of
unconjugated bilirubin,a breakdown product of haemoglobin forming after its
release from haemolysed RBCs.
Bilirubin metabolism:
 Bilirubin s one of the breakdown products of haemoglobin.
 When RBCs are destroyed, the breakdown products are released into the
circulation, where the haemoglobin spits into heme and globins.
 The body uses the globins’ (protein)and heme is converted to conjugated
bilirubin.
 In the liver the bilirubin is conjugated with the glucuronyl Transferase.
 This conjugated bliirubin is excreted into the bile.
 In the intestine, bacterial action reduces the conjugated bilirubin into
urobllnogen and stercobilinogen.
 Normally the body is able to maintain a balance between the destruction of
RBCs and the use or excretion by the body.
 When this balance is upset,bilirrubin accumulates in thee body causing
jaundice.
TYPES OF HYPERBILIRUBINEMIA:
Physiological jaundice Pathological jaundice
 Not appear before 2
nd
or 3
rd
day in term
baby.
 In premature baby, it appears after 3
rd

or 4
th
day
 In term newborn, it disappears by thee
end of 7
th
days while in premature lasts
for 9 to 10 days.
 The total level of total serum bilirubin
never exceeds 12 mg/dl in full term
newborn and 15mg/dl in preterm
 Appears within the 1
st
day
(24hours after birth)
 Needs longer time or disappears
 Serrum bilirubin exceeds
12mg/dl.
 Serum biliirubin exceeds the
daily raise of physiological
jaundice.
 Cause kernictrerus in indirect
hyperrbilirrubinemia.

23. newborn and the direct bilirubin does
not exceed 1mg/dl of the total bilirubin.
 No kernicterus
 Requires no treatment.
 The newborn is good sucker, no
anaemia, not sick, normal stool, and
urine colour.
 Treatment is important as soon
as possible
 The newborn looks sick, poor
sucking ,pale, abnormal stool
and urine colour.
Kernicterus:
 It is also called the bilirbin encephalopathy and is caused by the deposition
of the unconjugated bilirubin in the brain.
 It results in the yellowish staining of the brain tissue and the necrosis of
neurons and occurs if the concentration of the unconjugated bilirubin
reaches toxic level.
Stages of kernicterus:
 Stage 1: poor motor reflex, poor feeding, vomiting, high-pitched cry,
decreased tone and lethargy.
 Stage 2: opisthotonus, seizurrres, fever, occulogyric crises and paralysis of
upward gaze. Many newborns die in this phase.
 Stage 3:spasticity is decreased at about one week of age (a symptomatic)
 Stage 4: progressive spasticity, deafness, and mental retardation.
Causes:
 Prematurity
 Breast milk
 Excess production of bilirubin(haemolytic disease,bruises)
 Enzyme deficiency, bile duct obstruction
 Sepsis
 Diseases like hypthyroidism,IDM
 Genetic predisposition
Pathophysiology of neonatal jaundice:
Excessive haemolysis leads to haemolytic or prehepatic jaundice

24. Damage of liver parenchyma resulting disturbances of bilirubin metabolism and
bilirubin excretion.
disturbances occur in transferring of bile pigment

conjugation into the bile capillary

Hepatocellular jaundice
Sign and symptoms:
According to book According to patient
 Yellow skin
 Yellow eyes
 Sleepiness
 Poor feeding
 Brown urine
 Fever
 High pitched cry
 vomiting
 yellow skin
 yellow sclera
 ineffective breast feeding
 yellow urine
 hypothermia
 high pitched cry

DIAGNOSTIC EVALUATION: 07/10/18(day 1 admission)
ACCORDING TO BOOK ACCORDING TO PATIENT
 FBC
 CRP
 SBR
 GP
 DCT
 BLOOD picture
 Reticulocyte count
FBC:
 Hb-12.9g/dl
 RBC -3.34 10ᶺ12/L
 HCT-37%
 WBC-14.53 10ᶺ9/L
 N-38.1%
 L-42.8%
 PLT-343 10ᶺ9/L
CRP:1.4mg/L
SBR:
 total -26.46mg/dl
 direct bil-1.21mg/dl
 indirect bil-25.25mg/dl
DCT:-Negative
Blood group-B+VE

25. Dt:08/10/18
ACCORDING TO BOOK ACCORDING TO PATIENT
 FBC
 CRP
 SBR
 GP
 DCT
 BLOOD picture
 Reticulocyte count
FBC: 6pm
 Hb-11.6g/dl
 RBC -2.99 10ᶺ12/L
 HCT-32.4%
 WBC-15.91 10ᶺ9/L
 N-41.7%
 L-39.8%
 PLT-356 10ᶺ9/L
SBR:at 5pm
 Total bil -20.06mg/dl
 direct bil-1.73mg/dl
 indirect bil-18.33mg/dl

Reticulocyte count:at 10 am-:10%
SBR:at 6pm
 Total bil -16.55mg/dl
 direct bil-1.59mg/dl
 indirect bil-14.96mg/dl

Dt:09/10/18
ACCORDING TO BOOK ACCORDING TO PATIENT
 FBC
 CRP
 SBR
 GP
 DCT
 BLOOD picture
 Reticulocyte count
 Total bilirubin at 8 am-13.1mg/dl
 Blood picture
RBC-normochromic macrocytic red
cells occational sphyrrocytes,tear
drops,contracted cells and
basophilic stipling.
 WBC-neutrrophilia.no abnormal
cells
 PLT- plentiful
Dt :10/10/18
ACCORDING TO BOOK ACCORDING TO PATIENT
 FBC
 CRP
 SBR
 GP
 DCT
 BLOOD picture
 Reticulocyte count
FBC: 7pm
 Hb-11.6g/dl
 RBC -3.1410ᶺ12/L
 HCT-33.4%
 WBC-14.4 10ᶺ9/L
 N-35%
 L-48%
 PLT-382 10ᶺ9/L
SBR:at 5pm
 Total bilirubin at 9am -
15.06mg/dl

26.  direct bil-1.73mg/dl
 indirect bil-18.33mg/dl

Reticulocyte count:at 10 am-:10%
SBR:at 6pm
 Total bil -16.55mg/dl
 direct bil-1.59mg/dl
 indirect bil-14.96mg/dl

Dt 11/10/18
ACCORDING TO BOOK ACCORDING TO PATIENT
 FBC
 CRP
 SBR
 GP
 DCT
 BLOOD picture
 Reticulocyte count

SBR:at 6pm
 Total bil -15.96mg/dl
 direct bil-1.07mg/dl
 indirect bil-14.89mg/dl


MANAGMENT:
ACCORDING TO BOOK ACCORDING TO PATIENT
 phototherapy
 exchange transfusion
 intravenous immunoglobulin
 metalloporphyrins
 breast feeding
 Phenobarbital 5mg/kg
 High dose of IV immunoglobulin
 Provid parents with information
about newborn jaundice
 Checking the baby’s nappies for
dark urine or pale chalky stool
 Assessement of jaundice must be
performed in a well-lit roo ,or
preferrbly,in day light at a window
 Triple phototherapy
 Single phtotherapy
 i.v immunoglobulin:500mg/kg
 metalloporrphyrins
 adequate breast feeding provided
 information given to parents
 assess the baby’s condition by
nuses

27. THEORY APPLICATION:
As per the condition of my patient I am using Henderson’s theory for my patient.
Virginia’s Henderson given 14 basic component ,these are
 Breath normally
 Eat and drink adequately
 Eliminate body waste
 Move and maintain desirable posture
 Sleep and rest
 Select suitable clothes –dress and undress
 Mantain body temperature within normal range by adjusting clothing and
modifying environment.
 Keep the body clean and well groomed and protect the integument.
 Avoid dangers in the environment and avoid injuries to others.
 Communicate with others in expressing emotions ,needs,fears,or
opinions.
 Worship according to one’s faith.
 Work in such a way that there is a sense of accomplishment.
 Play or participate in various form’s of recreation.
 Learn ,discover,or satisfy the curiosity that leads to normal development
and health and use available health facilities.





 yellowish skin
 yellowish eye
 Poor breast feeding
 High pitched crying
 Hypothermia
 seizure



Source of
difficulty


Patient
Jaundice

28. Nurses ability to define & identify the needs of the patient.
 Yellowish of the skin
 Poor suck
 High pitched crying
 fever
 Restlessness
 lethargy




 Assess baby’s condition
 Providing NICU for phototherapy
 Provide well lit ventilated room
 Follow doctor’s order for giving
Medications.
 Administer oxygen .
 Maintaining hydration by adminis-
tering IV fluid.
 Avoid overcrowding.
 Exchange transfusion.











Independence in satisfaction of the human beings 14 fundamental basic needs
NURSES ROLE
 Explaining about promote
& support breast feeding to
the family members
 Provide appropriate follow
-up

29.  Breath normally
 Sleep and rest
 Warming comfortable




Goal met














 Breath normally
 Sleep and rest
 Warming comfortable
clothes
 Maintaining personal
hygiene.

30. NURSING PROCES:
PROBLEM IDENTIFIED:
 Yellowish skin
 Yellowish eyes
 Poor sucking of breast feeding
 Lethargy
 Fever
 Seizure
 Restlessness
SETTING PRIORITY:
 Yellowish skin
 Yellow eyes
 Poor feeding
 Seizure
 fever
NURSING DIAGNOSIS:
 Risk for injury related to procedure of phototherapy as evidenced by skin rashes
of the baby.
 Altered family process related to maturational crisis of term infant as evidenced
by anxious of the family members.
 Impaired skin integrity related to hyperbilrubnemia.
 Deficient fluid volume related to inadequate fluid intake ,phototherapy and
diarrhoea
 Anxiety related to medical therapy given to the baby.