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NURS 4500: Final Material > Class 10: Jaundice > Flashcards

Class 10: Jaundice Flashcards

1
Q

jaundice is the clinical manifestation of…

A
  • elevated serum unconjugated bilirubin lvls
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2
Q

jaundice is the clinical manifestation of…

A
  • elevated serum unconjugated bilirubin lvls = hyperbilirubinemia
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3
Q

how is jaundice seen as?

A
  • yellow coloring in the sclera, skin, and mucosal membranes
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4
Q

jaundice is characterized as..

A
  • physiologic vs pathologic
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5
Q

__% of full term newborns and __% of preterm newborns experience physiological jaundice

A
  • 60% of full term newborns
  • 80% of preterm
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6
Q

what is the best method to prevent jaundice

A
  • early & freq breastfeeding
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7
Q

what also helps clear bilirubin

A
  • freq passage of stools
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8
Q

what are risks for jaundice in the NB (13)

A
  • prematurity (35-38 weeks)
  • exclusive breast feeding that is not well-established breastfeeding (less milk = less stool) & excessive weight loss
  • sibling who had neonatal jaundice
  • visible bruising
  • cephalohematoma
  • DAT+ or other hemolytic disease (G6PD)
  • ethnic background (East Asian)
  • asphyxia
  • acidosis (pH <7)
  • albumin <30 g/L
  • sepsis
  • temp instability
  • lethargy/poor feeding
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9
Q

what are signs of asphyxia in the NB that contributes to the risk of jaundice (2)

A
  • APGAR 0-3 beyond 5 min
  • cord pH <7
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10
Q

what impact can hyperbilirubinemia have on the neuro system>

A

neurotoxicity:
- acute bilirubin encephalopathy
- chronic bilirubin encephalopathy (Kernicterus)

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11
Q

what are signs of acute encephalopathy (2)

A
  • poor sucking
  • poor muscle tone
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12
Q

what occurs w chronic encephalopathy

A
  • irreversible brain damage
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13
Q

what is pathologic jaundice

A
  • jaundice that presents in the first 24 hrs after birth is always considered abnormal (pathologic) and needs to be investigated
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14
Q

what total serum bilirubin (TSB) indicated pathologic jaundice (2)

A
  • if TSB increases more than 100 mcmol/L in 24 hrs
  • if TSB >256 mcmol/L at any time (any age of infant)
  • high lvl for gestational age/weight
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15
Q

what else indicates pathologic jaundice

A
  • if caused by pathological condition (ex. HDN)
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16
Q

if jaundice is present in first 24 hrs after birth, what is it typically due to?

A
  • hemolytic disease of the newborn (HDN)
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17
Q

what therapy can be used to treat pathologic jaundice (2)

A
  • phototherapy
  • if severe, exchange transfusion
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18
Q

describe treatment for physiologic jaundice

A
  • treatment not required if serum bilirubin not overly high & not rising rapidly
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19
Q

what is considered physiologic jaundice

A
  • jaundice that occurs after that 1st 24 hrs and usually within the 1st week
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20
Q

what are 2 types of jaundice related to breastfeeding

A
  • breastfeeding-associated jaundice = “early”
  • breastmilk jaundice = “late”
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21
Q

when does breastfeeding-associated jaundice occur?

A
  • usually occurs during days 2-5
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22
Q

breastfeeding-associated jaundice is mainly related to? (2)

A
  • insufficient feeding
  • insufficient stooling
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23
Q

how can we correct breastfeeding-associated jaundice r/t insufficient feeding & stooling (3)

A
  • increase feed freq
  • assess for position, latch, engorgement
  • may require BF support +/- supplemental feeding device while continuing BF
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24
Q

when does breast milk jaundice usually occur?

A
  • between days 5-10
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25
Q

with breast milk jaundice, infants are usually…

A
  • feeding well
  • gaining weight
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26
Q

breast milk jaundice is uncommon to be…

A
  • uncommon to be pathological
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27
Q

breast milk jaundice is thought to occur due to

A
  • a compound in the breastmilk that competitively inhibits glucuronyl transferase
28
Q

if at any time the serum bilirubin falls in higher than acceptable range with jaundice r/t breastfeeding, they may require?? (2)

A
  • phototherapy
  • alone w measures to ensure adequate feeding and stooling
29
Q

if the infant looks jaundiced at ______ days/weeks, the parents should follow up & have serum bilirubin measured

A
  • at 2-3 weeks
30
Q

define: hemolytic disease of the newborn (HDN)

A
  • an abnormally rapid rate of RBC destruction
31
Q

HDN usually occurs due.. (2), which is more common? which has less severe effects?

A
  • Rh isoimmunization
  • ABO incompatibility –> more common, and less severe effects
32
Q

why has Rh isoimmunization become reduced?

A
  • reduced due to prenatal screening and prophylactic admin of WinRho
33
Q

what is isoimmunization

A
  • occurs with Rh- mom and Rh+ fetus
  • mom can develop antibodies against the fetal RBCs, which attac and cause lysis of the fetal RBCs –> usually in subsequent pregnancy
34
Q

describe ABO incompatability in NB

A
  • when mother has blood type “O” and baby has “A”, “B”, or “AB”
  • no prior exposure to fetal blood required to develop
  • all individuals naturally have antibodies against other blood types (except those w AB)
35
Q

what other conditions can also cause HDN? (5)

A
  • G6PD
  • hereditary spherocytosis
  • galactosemia
  • Crigler-najjar disease
  • hypothyroidism
36
Q

what occurs with HDN

A
  • something causes lysis of fetal RBCs = overproduction of bilirubin that newborn cannot efficiently excrete = jaundice
37
Q

when does HDN usually occur

A
  • early in the first 24-48 hrs
38
Q

HDN with more significant lvls of bilirubin require treatment w? (2)

A
  • phototherapy
  • and/or exchange transfusion
39
Q

if Rh isoimmunization is determined during pregnancy (maternal antibody screen is positive) what treatment options can be offered? (2)

A
  • IVIG
  • intrauterine transfusion
40
Q

describe use of IVIG as treatment for isoimmunization (2)

A
  • may be given to mother (decreases severity of HDN)
  • may be given to neonate to block maternal antibody effect of attacking newborn RBCs, decreasing hemolysis, and jaundice
41
Q

describe intrauterine transfusion (IUT)

A
  • infusion of donor blood into the umbilical vein of the fetus
42
Q

what is used w intrauterine transfusion to determine the degree of fetal anemia & need for IUT

A
  • serial US measuring the peak systolic velocity of the fetal middle cerebral artery
43
Q

severe forms of HDN are referred to as…

A
  • erythroblastosis fetalis
44
Q

what is the nurse’s role in assessing for jaundice (9)

A
  • visually assess for jaundice during every interaction
  • universal screening for jaundice
  • assess infant weight, feeding, stools, urine output
  • provide support & education for breastfeeding, consider referral for lactation consult
  • provide community resources
  • advise mother when to be concerned about jaundice, where to seek help
  • encourage to keep breastfeeding
  • support & encourage continued feeding even when phototherpy required
  • facilitate skin to skin & bonding
45
Q

who is included in universal screening for jaundice

A

screen all NB of any gestation age who, have not received phototherapy or an exchange transfusion, for the development of hyperbilirubinemia using the TcB monitor

46
Q

what is a TcB monitor

A
  • handheld transcutaneous bilirubin monitor that provides an estimate of circulating bilirubin
47
Q

when is universal screening for jaundice completed?

A
  • initially between 24-30 hrs and every am thereafter until discharged from hospital
48
Q

describe universal screening for jaundice in NB admitted to a neonatal intensive care unit

A
  • continue for the first 7 days unless otherwise ordered by infant’s prescribing practitioner
49
Q

what is the primary site for TcB reading?

A
  • infant’s forehead
50
Q

when shouldn’t the infant forehead by used as primary site for TcB

A
  • if extensively bruised or discolored
51
Q

what is the 2ndary site for TcB monitoring

A
  • sternum
52
Q

when is the sternum used for TcB monitoring (2)

A
  • if cannot use forehead
  • or infant has been discharged and exposed to ambient sunlight
53
Q

what is the measurement range for TcB

A
  • measurement range is 0-340 umol/L
54
Q

what does a reading of “ _ _ _” on the TcB monitor indciate?

A

> 340

55
Q

what is total serum bilirubin (TSB)

A
  • blood sample sent to lab to determine serum bilirubin
56
Q

if clinically you suspect high lvl than TcB reading, what should you do?

A
  • advocate for TSB lvl (handheld model isn’t always reliable)
57
Q

what should be done if the baby appears jaundiced <24 hrs of age (4)

A
  • screen using TcB
  • plot TcB on nomogram
  • notify infant’s care provider of result
  • obtain order for TSB and DAT
58
Q

what does a nomogram show?

A
  • graph where plot bilirubin lvl in terms of age (hr)
  • shows 4 different zones: high, high intermediate, low intermediate, low zone
59
Q

what zone do we want the infants in on a nomogram?

A
  • low zone
60
Q

what assessments cause concern for jaundice? (5)

A
  • infant weight loss >7%
  • decreased mill intake (decreased freq & length of feeds)
  • decrease in stools
  • decrease in urine output
  • check bilirubin lvls
61
Q

what stool output causes causes concern for jaundice

A

<3 stools/day by day 4

62
Q

what urine output causes concern for jaundice

A

<4-6 voids/day by day 4

63
Q

what is recommended during phototherapy for jaundice (2)

A
  • professional breastfeeding support
  • exclusive breastfeeding support
64
Q

what is the nurses role during phototherapy (7)

A
  • expose as much skin as possible –> aim for 80% exposed to light
  • cover infant’s eyes and genitals
  • no creams on skin, except diaper area prn
  • documentation & graph
  • assist BF at least 8x/day or formula feeding
  • monitor urine & stools, and amt of feeding
  • once initiated, continuous until TSB decreasing, the only interrupt for brief time
65
Q

describe assessment of temp, RR, and HR in well infants during phototherapy

A
  • temp q2h
  • q4h RR and HR
66
Q

phototherapy may use.. (3)

A
  • fibreoptic blanket
  • overhead light
  • or both

NURS 4500: Final Material (16 decks)

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