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Exam 3 NUR113
Jaundice
| Question | Answer |
|---|---|
| What causes jaundice? | Increased serum unconjugated bilirubin (By product of RBC breakdown) |
| True or false: Unconjugated bilirubin can be excreted | False; it cannot which leads to toxic blood levels |
| True or false: After birth it is normal for bilirubin to rise some after birth. | True; d/t newborn body adapting to extrauterine life and liver beginning to function |
| How is bilirubin conjugated and excreted? | Unconjugated bili binds to albumin -> liver to bind to proteins -> intestines bacteria transforms to excretable forms (Urine and stool) |
| What enzyme naturally occurring in the body can de-conjugate bilirubin? Where does it live? | beta-D-glucuronidase (enzyme in gut); re-enters blood after breakdown |
| How can a nurse prevent hyperbilirubinemia? | >Monitor stool-inadequate stooling can cause bilirubin to become unconjugated >Maintain temp-keep above 97.8, cold stress=acidosis=decreases albumin >Early breastfeeding-colostrum has laxative effect; inadequate hydration/nutrition=incr. bilirubin |
| What lab tests are done to test bilirubin levels? | -Indirect serum bili, Direct serum bili = Total serum bilirubin -Transcutaneous bilirubin meter - not as accurate as blood test but less traumatic -calculated using special math and the website |
| What is Pathological Jaundice? | Jaundice that appears in the first 24hrs of life; there is an underlying reason for the jaundice |
| What are possible causes of pathological jaundice? | -Maternal ABO type (O) -Maternal RH factors (-) -Gestational age (35-36wks) -Asphyxia (suffocation) / hypoxia -Lower APGAR scores |
| What is given to mothers with Rh - blood to prevent complications? | Rhogam |
| What is physiological jaundice? | Jaundice that appears around day 2-3 of life that results from the normal biological processes |
| Why does physiological jaundice occur? | >Immature liver and GI tract >Use of forceps or vacuum (trauma breaks RBCs) >Delayed cord clamping/increased blood volume (too many RBCs = more bilirubin) >Inadequate intake or excretion |
| What is breastfeeding jaundice? | Occurs in first days of life and peaks around day 3, resolves as intake increases |
| What causes breastfeeding jaundice? | Inadequate intake |
| What can be done to prevent breastfeeding jaundice? | >Q2-3hr feedings or on demand >avoid supplementing with formula (this decreases mom milk supply) >lactation consultant |
| When is it okay to supplement with formula for an infant who has breastfeeding jaundice? | When the infant is dehydrated |
| What is Breast Milk jaundice? | Levels rise after the 1st week of life |
| What causes breast milk jaundice? | an excess of fatty enzymes that binds with albumin (decreases available albumin that can bind with bilirubin = hyperbilirubinemia) |
| What is the treatment for breast milk jaundice? | stop breast feeding for a few days supplement with formula and IV fluids try breastfeeding again |
| What treatment options are available for hyperbilirubinemia? | >Hydration >Promoting elimination >Phototherapy |
| What interventions should be performed for an infant receiving phototherapy? | Feed before and q2-3h, check light lvl w. photometer, Position light 18in above infant, Cover eyes, Monitor body temp, No oil/lotion on skin, Obtain bili levels as ordered, Monitor urine/stool output close, Expose skin as possible, Reposition q2h & assess |
| What treatment is available for severe hyperbilirubinemia? | >Exchange transfusion - removes bili and gives albumin (like dialysis) >Intravenous Immunoglobulin (IVIG)-With ABO incompatibility can reduce duration of phototherapy and need for exchange transfusion; Has a lots of risks, only used when necessary |
| What is bilirubin encephalopathy (Kernicterus)? | When bilirubin crosses the blood brain barrier and causes irreversible brain damage |
| What conditions accelerate encephalopathy? | Hypoxia Hypothermia Hypoglycemia Metabolic Acidosis |
| What are the s/s of bilirubin encephalopathy? | Lethargy, hypotonic, poor feeding, decreased activity, high-pitched cry, temperature instability |
| What does unconjugated bilirubin bind to? | albumin |
| albumin carries unconjugated bilirubin where? | the liver to be transferred to hepatocytes |
| What happens to conjugated bilirubin? | sent to intestines bacteria transforms into excretable forms (urine and stool) |
| If baby is not having good stool output what might that mean? | bad bacteria is sending the bilrubin back in the bloodstream |
| How does cold effect albumin? | acidosis which decreases the availability of albumin |
| How does breastfeeding help with hyperbilirubinemia? | laxative effect encourages good bacteria in the intestines provides protien for conjugation process |
| What can effect the accuracy of the transcutaneous bilirubin test? | skin tone temperature can change the reading |
| What is the total serum bilirubin and interventions based on? | based on the amount of hours old the baby is |
| When obtaining serum bilirubin levels how long prior should infant be removed from light? | usually around 30 minutes |
| How often do we take temperature of baby under phototherapy? | q 2 hours |
| What bilirubin level is considered severe? | over 20 |
Created by:
failingstudent88
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