Nursing Consideration of Child with Jaundice

The following measures are to taken for Nursing Consideration of Child with Jaundice:

1. The color of the sclera and skin, particularly the palms, soles, and mucous membrane, should be observed at regular intervals under natural light.
2. Early referral and reorganization of kinds of jaundice are required.
3. Give your child supportive care in the following ways:
   • Breastfeeding from the start
   • The ideal thermal environment
   • Umbilical cord dressing bathed in sterile saline for potential exchange transfusion
   • Maintain a tight intake/output chart.
   • Correction of fluid volume
   • Assist with medical therapies such as sample collecting and distribution.
4. Maintain a precise record of vital signs.
5. Emotional assistance; parents want frequent reassurance and a thorough explanation of their infant's situation at their level of understanding.
6. Avoid blood incompatibility by doing the following:
   • Encourage pregnant women to obtain antenatal care as early as possible.
   • Determine the blood type
   • RhoGAM should be given to Rh-negative women during labor or abortion.
7. Identify infants who are at high risk of hyperbilirubinemia and kernicterus by doing the following:
   • Examine the color of the amniotic fluid at the time of membrane rupture and delivery.
   • Early discovery and referral to a doctor
   • Early identification of risk circumstances (acidosis, hypoxia, and hypothermia) reduces kernicterus risk.
8. Taking care of an infant who is undergoing phototherapy
   • Parents should be informed about the procedure.
   • Warm the space and make sure the temperature beneath the light is between 28 and 30 degrees Celsius.
   • Place the infant 45 cm away from the machine to ensure adequate irradiance. Replace bulbs every 2000 hours of usage, and do frequent checks on the spectrum of irradiance provided by various phototherapy equipment.
   • Provide eye protection; ensure that the lids are closed before applying the shield, and monitor the eye for discharge, discomfort, and pressure. Starting with the inner canthus of the eye and going outward in a single, smooth stroke, gently wipe the infant's eye with sterile cotton or soft gauze saturated with sterile water or saline. Each eye should be cleaned with a different cleaning pad.
   •  
   • Baby's position should be changed on a regular basis ( every three hours)
   • Vital signs should be checked every four hours.
   • Assess skin exposure and care: the trunk, the infant's greatest surface area, should be positioned in the middle of the light, where irradiance is maximum, and changed position as needed. When the serum bilirubin level approaches a high level, remove the diapers for extensive phototherapy.
   • Examine and fine-tune thermoregulation devices
   • Promoting skin integrity and elimination
   • Maintain hydration in the following ways:
     1. Examine for early indications of dehydration.
     2. Make certain that the infant is nourished.
     3. Encourage the woman to breastfeed at least three times each day. If the infant is getting intravenous fluid or expressed breastmilk, increase the volume of fluid by 10% of total daily volume every day for the duration of phototherapy.
     4. Keep the intake output chart.
   • Increasing parent-infant interaction: Unless the jaundice is severe, phototherapy can be safely interrupted at the feeding times, allowing parental visits and encouraging skin-to-skin contact.
   • Monitoring bilirubin levels: The greatest dramatic drop in bilirubin levels happens within the first 4-6 hours of starting phototherapy, thus check bilirubin levels on a regular basis.
   • Proper documentation of the duration and kind of therapy
9. Care for a newborn who is receiving an exchange transfusion:
   • Before the procedure, give the child nothing by mouth ( usually for 3-4 hours)
   • Prior to transfusion, examine donor blood.
   • Assist the doctor during the process.
   • Maintain an appropriate body temperature during the process.
   • Keep an eye out for indicators of exchange transfusion reactions.
   • Maintain resuscitation equipment at the bedside ( baby size)
   • Check for bleeding after applying a sterile bandage to the catheter site1.
   • Continue to keep proper records ( amount of blood infused and withdrawn)
   • Look for indicators of central nervous system depression such lethargy, hypotonia, poor sucking, convulsions, and a high-pitched scream.
   • Keep an eye out for hypothermia, dehydration, diarrhea, and bronze-baby syndrome.
   • Keep an eye out for cord bleeding and infections.
10. Follow-up care and visits: frequent examination of baby's condition, nursing, monitoring for symptoms of anemia, and providing ferrous sulphate supplementation at 2-3 month age for 2 months.
11. Parents instructing their children on a condition, treatment, home care, dietary care, symptoms of severity, infections, and so forth.

REFERENCE

Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/007309.htm
Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/001559.htm
HealthLine. 2005. 2017 http://www.healthline.com/health/newborn-jaundice
Medscape. 1994. 2017 http://emedicine.medscape.com/article/178757-overview
KidsHealth. 1995. 2017
http://www.aboutkidshealth.ca/En/HealthAZ/ConditionsandDiseases/Symptoms/Pages/Jaundice-in-newborns.aspx
Mayo Clinic. 1998. 03 April 2014 http://www.mayoclinic.org/diseases-conditions/infant-jaundice/basics/definition/con-20019637
MedicineNet. 1996. 2017 http://www.medicinenet.com/jaundice_in_adults/article.htm
Web MD. 2005. 2017 http://www.webmd.com/parenting/baby/tc/jaundice-in-newborns-hyperbilirubinemia-topic-overview#1
NHS Choice. http://www.nhs.uk/Conditions/Jaundice-newborn/Pages/Treatment.aspx