Nursing Care Plan Neonatal Jaundice Definition:The yellow orange tint of the neonate’s skin and mucous membranes that occurs after 24 hours of life as a result of unconjugated biliru- bin in the circulation Nursing Care Plan Neonatal Jaundice
Defining Chara Cteristics
- Neonate age 1–7 days
- Yellow orange skin
- Yellow sclerae
- Yellow mucous membranes
- Abnormal blood proﬁle (hemolysis; total serum bilirubin 2 mg/dl; total serum bilirubin in high-risk range on age in hour speciﬁcnomogram)
- Abnormal weight loss ( 7%– 8% in breast-feeding newborn)
- Feeding pattern not well established
- Infant experiences difﬁculty making transition to extrauterine life
- Stool (meconium) passage delayed
- Growth and development
- Fluid and electrolytes
Expected Outcomes The Neonate Will
- Establish effective feeding pattern (breast or bottle) that enhances stooling.
- Not experience injury as a result of increasing bilirubin levels.
- Receive bilirubin assessment and screening within the ﬁrst week of life to detect increasing levels of serum bilirubin.
- Receive appropriate therapy to enhance bilirubin excretion.
- Receive nursing assessments to determine the risk for severity of jaundice.
Suggested Noc Outcomes
Bowel Elimination; Breast-Feeding Establishment: Infant; Nutritional Status; Risk Control; Risk Detection
Interventions And Rationales
Determine: Evaluate maternal and delivery history for risk factors for neonatal jaundice (Rh, ABO, G6PD deﬁciency, direct Coombs, prolonged labor, maternal viral illness, medications) to anticipate which neonates are at higher risk for jaundice. Perform: Collect and evaluate laboratory blood specimens as ordered or per unit protocol to permit accurate and timely diagnosis and treatment of neonatal jaundice. 213 Inform: Educate parents regarding newborn care at home in relation to appearance of jaundice in association with any of the following: no stool in 48 hr, lethargy with refusal to nurse or bottle feed, less than 1 wet diaper in 12 hr, abnormal infant behavior. Parent educa- tion is crucial for the time after the neonate is discharged. Parents are the major decision makers concerning whether and when to bring the neonate back for medical and nursing assessments after being discharged from the hospital. Attend: Provide caring support to the family if a breast-fed neonate must receive supplementation. It can be upsetting and result in feel- ings of inadequacy to a breast-feeding mother for her neonate to require supplementation. Manage: Coordinate care and facilitate communication between fam- ily, nursing staff, pediatrician, and lactation specialist. A multidisci- plinary approach that includes the family enhances communication and improves outcomes.
Suggested Nic Interventions
Attachment Promotion; Bottle Feeding; Bowel Management; Breast- Feeding Assistance; Capillary Blood Sample; Discharge Planning; Infant Care; Kangaroo Care; Newborn Monitoring; Nutritional Monitoring; Risk Identiﬁcation: Childbearing Family; Surveillance; Teaching: Infant Nutrition; Vital Signs Monitoring
Bhutani, V. K., Johnson, L. H., Schwoebel, A., & Gennaro, S. (2006). A sys- tems approach for neonatal hyperbilirubinemia in term and near-term new- borns. Journal of Obstetric, Gynecologic and Neonatal Nursing, 35, 444–455.