Phototherapy: consists of the application of fluorescent light to the infant's exposed skin.Light promotes bilirubin excretion by alters the structure of bilirubin to a soluble form for easier excretion. The infant's skin must be fully exposed to an adequate amount of the light source. Best results occur within the first 24-48 hours of treatment.
Prognosis: severe brain damage (bilirubin encephalopathy)
Assessment: Observing the infant's skin color from head to toe and sclerae and mucus membranes in natural daylight Blood samples are also taken for the measurement of bilirubin in the laboratory. while blood is drawn, phototherapy lights are turned off. Family history. Type of delivery Method of feeding.
Nursing diagnoses: Body temperature, risk for imbalanced related to use of phototherapy. Fluid volume, risk for deficient related to phototherapy. Family processes, interrupted, related to situational crisis, prolonged hospitalization of infant, or rehospitalization for therapy injury, risk for, related for phototherapy.
Planning: the goals: Infant will receive appropriate therapy I needed to reduce serum bilirubin levels. Infant will experience no complications from therapy. Family will receive emotional support. Family will be prepared for home phototherapy (if prescribed).
Implementation: NCP of the Newborn chapter 8. and NCP of the high-risk newbornp:277. Nursing care for infant under Phototherapy: Repositioned frequently to expose all body surface areas to the light. Frequent serum bilirubin levels every 4-12 hours are necessary. The infant's eyes are shielded by an opaque mask The infant's eyelids are closed before the mask is applied. On each nursing shift the eyes are checked Eye shield are removed during feeding. Temperature is closely monitored
Nursing consideration 1. 2. 3. 4. 5. 6.
Accurate charting is important nursing responsibility and includes: Times that phototherapy is started and stopped. Proper shielding of the eyes. Type of fluorescent lamp. Number of lamps. Distance between surface of lamps and infant (should be no less than 18 inches. Use of phototherapy in combination with an incubator or open bassinet. Occurrence of side effects .as: loose, greenish stools, transient skin rashes, hyperthermia, increase metabolic rate, dehydration, electrolyte disturbances as hypocalcemia Oily lubricant or lotions are not used on the skin in order to prevent increased heat Additional fluid volume needed.