bilirubin in newborn Flashcards
(22 cards)
why is bilirubin elevated in newborns
d/t lysis of RBCs that the body doesn’t need
how does the liver come into play with bilirubin in newborns
liver is slow to process bilirubin from unconjugated to conjugated for excretion in the urine and stool
when will infant bilirubin levels be especially high
in infant who ingested blood or has bruising or cephalohematoma d/t excessive lysing of extra RBCs
describe what kernicterus is
condition that causes brain damage
occurs when bilirubin levels >21 mg/dl
ominous sign that there may be problems within bilirubin
bilirubin level is 5-6 mg/dl in first 24 hrs
pathological bilirubin levels
unprocessed, cannot be excreted
bilirubin levels will continue to increase
indirect/unconjugated bilirubin
process bilirubin by the liver which can be excreted in the urine and stool
direct/conjugated bilirubin
what is the total bilirubin
conjugated plus unconjugated
if conjugated levels are high what will occur
total bilirubin is going to decrease rapidly as baby poops and pees
when is the direct coombs completed
on all neonates born to mothers who are Rh negative (for Rh incompatibility) and all moms who are blood type O
how is the blood drawn for direct coombs
from cord after delivery
what does a positive direct coombs mean
high probability neonate will have pathologic jaundice
what is the scale of the direct coombs results
+1 to +4
+1 = barely positive
+4 = massive hemolysis and increased bilirubin levels
how do you prevent kernicterus
renal early diagnostic blood draws ans bililigent therapy
what do bilirubin screening test identify
non invasive test
measure amount of bilirubin trapped in capillaries
identify why baby turns yellow
describe a Drager Jaundice Meter
hand held, transcutaneous bilirubin meter that provides an objective index of icterus in infants
how do you employ a drager jaundice meter
clean with swab
sternum or head
press down 3x in different places
read result
when is a total bilirubin level needed
blood test conducted of drager indicates increased bilirubin
how to read total bilirubin level result
plot level on chart to determine if elevated
want to be low risk or low intermediate zone
if high/intermediate risk on total bilirubin level…
diagnostic blood test needed
how to to a heel stick blood draw
warming device (hospital regulated) for circulation
hold walking surface with thumb
blade goes on side of foot
keep scooping blood drops into heparin vial until have enough
phototherapy nursing interventions
increase feedings
monitor for skin changes/breakdown
eyes and genitals remained covered
remain in warmer
temp, respirations, and turned every 1-4 hrs
monitor intake and output (no dehydration)
