jaundice bsc nursing students ppt for teaching

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1. Neonatal Jaundice

2. Neonatal Jaundice
(Hyperbilirubinemia)
Definition
Hyperbilirubinemiareferstoanexcessivelevelof
accumulatedbilirubininthebloodandischaracterizedby
jaundice,ayellowishdiscolorationoftheskin,sclerae,mucous
membranesandnails.
•Unconjugatedbilirubin= Indirect bilirubin.
•Conjugated bilirubin= Direct bilirubin.

3. NJ -3

4. Neonatal Jaundice
•Visible form of bilirubinemia
–Newborn skin >5 mg / dl
•Occurs in 50-60% of term and 80% of preterm neonates
•However, significant jaundice occurs in 6 % of term babies.
•Immature liver to conjugate bilirubin from the destroyed RBCs

5. Clinical assessment of jaundice
Area of body Bilirubin levels
mg/dl(*17=umol)
1-Face 4-8
2-Upper trunk 5-12
3-Lower trunk & thighs 8-16
4-Arms and lower legs 11-18
5-Palms & soles > 15

6. Incidence of neonatal jaundice
-Term : Occurs in 60%
-Preterm : 80% of preterm neonates Jaundice
-It is the most common condition that require medical
attention in newborns.
NJ -6

7. Physiological jaundice
CHARACTERISTICS
•Appearsafter24hoursofbirth.
•Maximumintensityby4th-5thdayinterm&7thdayinpreterm.
•Serumlevellessthan15mg/dl.
•Clinicallynotdetectableafter14days.
•Disappearswithoutanytreatment

8. Why does physiological jaundice
develop?
•Increased bilirubin load.
•Defective uptake from plasma.
•Defective conjugation.
•Decreased excretion.
•Increased entero-hepatic circulation.

9. Pathological jaundice
•Appears within 24 hours of age.
•Increase of bilirubin > 5 mg/dl/day.
•Serum bilirubin > 15 mg/dl.
•Jaundice persisting after 14 days.
•Stool clay/white colored and urine staining clothes yellow.
•Direct bilirubin > 2 mg/dl.

10. Causes of jaundice
Appearing within 24 hours of age
•Hemolytic disease of NB: Rh, ABO
•Infections: TORCH, malaria, bacterial
•G6PD deficiency.
•T–Toxoplasmosis/Toxoplasma gondii
•O–Other infections
•R–Rubella
•C–Cytomegalovirus
•H–Herpes simplex virusorneonatal herpes simplex

11. Causes of jaundice
Appearing between 24-72 hours of life
•Physiological
•Sepsis
•Polycythemia
•Intraventricular hemorrhage
•Increased entero-hepatic circulation

12. Causes of jaundice
After 72 hours of age
•Sepsis
•Cephalhaematoma
•Neonatalhepatitis
•Extra-hepaticbiliaryatresia
•Breastmilkjaundice
•Metabolicdisorders(G6PD).

13. Risk factors for jaundice
JAUNDICE
•J-jaundice within first 24 hrs of life
•A -a sibling who was jaundiced as neonate
•U -unrecognized hemolysis
•N –non-optimal sucking/nursing
•D-deficiency of G6PD
•I -infection
•C–cephalhematoma /bruising
•E -East Asian/North Indian

14. Altered physiology
RBCs destruction
Bilirubininto circulation
Combines with Albumin
Unconjugatedor
Indirect bilirubin
In the Liver converted into
Direct or conjugated water
soluble bilirubin
Enzymes of bile in
the intestine
Execrated in
stool
Or
Hydrolyzed to
unconjugated
Reabsorbed
to liver

15. Diagnostic evaluation:
•Normal values of unconjugated B. are 0.2 to 1.4
mg/dL.
•Investigate the cause of jaundice.
•Mother blood Rh.

16. TherapeuticManagement
•Purposes:reducelevelofserumbilirubinand
preventbilirubintoxicity
•Preventionofhyperbilirubinemia:earlyfeeds,
adequatehydration
•Reductionofbilirubinlevels:phototherapy,
exchangetransfusion,
•DrugsUseofPhenobarbitalpromoteliver
enzymesandproteinsynthesis.

17. Phototherapy Technique
•Perform hand wash
Place baby naked in cradle or incubator
• Fix eye shades
• Keep baby at least 45 cm from lights
• Start phototherapy•
NJ -17

18. Phototherapy Technique
Frequent extra breast feeding every 2 hourly
• Turn baby after each feed
• Temperature record 2 to 4 hourly
• Weight record-daily
• Monitor urine frequency
• Monitor bilirubin level
NJ -18

19. Babies under phototherapy
Baby under conventional
phototherapy
Baby under triple unit intense
phototherapy

20. Prognosis
•Earlyrecognitionandtreatmentof
hyperbilirubinemiapreventsseverebrain
damage.

21. Nursing considerations of Hyperbilirubinemia
•Assessment:
observing for evidence of
jaundice at regular intervals.
Jaundice is common in
the first week of life and
may be missed in dark skinned
babies
Blanching the tip
of the nose

22. Approach to jaundiced baby
•Ascertain birth weight, gestation and postnatal age
•Ask when jaundice was first noticed
•Assess clinical condition (well or ill)
•Decide whether jaundice is physiological or pathological
•Look for evidence of kernicterus* in deeply jaundiced NB
*Lethargy and poor feeding, poor or absent Moro's, or
convulsions

23. Nursing diagnosis
•Seethehighriskinfantplanofcare.Plus:
BodyTemp.,riskforimbalancedTemp.relatedto
useofphototherapy.
Fluidvolume,riskfordeficientrelatedto
phototherapy.
Interruptedfamilyprocessrelatedtosituational
crisis,rehospitalizationforthetherapy.

24. The goals of planning
•Infantwillreceiveappropriatetherapyif
neededtoreduceserumbilirubinlevels.
oInfantwillexperiencenocomplicationsfrom
therapy.
oFamilywillreceiveemotionalsupport.
oFamilywillbepreparedforhome
phototherapy(ifprescribed).

25. Nursing intervention
•Distanceoflightshouldbe45-60cm.
•Covereyes.
•Turninginfantevery2h.
•Avoidhyperthermia.Monitortempevery2-4h.
•AdequatefluidorallyorIV.
NJ -25

26. QUESTIONS?