Nursing diagnosis – NEONATAL JAUNDICE

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

DEFINING CHARACTERISTICS

• 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-specific
nomogram)

RELATED FACTORS

• 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

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Elimination

• Growth and development

• Fluid and electrolytes

• Nutrition

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.

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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

Reference

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.

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