Definition:- Jaundice as defined as yellowish discoloration of (first face), skin, mucus membrane, sclera, and nails, beds due to increase level of bilirubin in blood.
Jaundice of three types:-
1. Hemolytic/ prehepatic:- Due to excess destruction of red blood cells.
2. Hepatic jaundice:- (Liver problems) Hepatic jaundice happens when your liver tissues is scarred ( knows as cirrhosis) damage aur dysfunctional.
3. Post hepatic/ obstructive jaundice:- (Excretion problem) Post hepatic obstructive jaundice, happens when Bilirubin can’t be drained properly into the bile ducts aur digestive tract because of a blockage.
Causes of Jaundice:-
- Excessive obstruction of RBC, Malaria infection.
- Decrease albumin in body.
- Lack of UDPGT, ( Diphosphate Glucuronyl- transferase) enzyme.
- Liver disease.
- Obstruction in bile duct ( Dubin jonson syndrome).
- Rh incompatibility (most common cause).
In pediatric, jaundice is two type:-
- Physiological jaundice (after 24 hrs).
- Pathological jaundice ( within 24 hours birth).
1. Physiological jaundice (95% cases) in most common.
Causes:-
- Polycythemia in new born.
- Increase bilirubin load on hepatic cell due to increase number of RBC as polycythemia and reduce life spen of RBC in newborn.
- Jaundice appear in 30-72 hrs (after 24 hrs).
- Serum bilirubin not >12 mg/dl in (terms) >15 mg in preterm.
- Peak level at 5th day and subside in 7-10 days in terms and 15th day in preterm.
- Sole and palm not involve.
- No need of T/T subside automatically.
- Need continue breast feed and hydration therapy.
2. Pathological jaundice (seen in 5% case) caused by disease condition
Causes:- Excessive destruction of RBC due to.
Hemolytic disease of newborn:-
- Rh incompatibility (most common).
- ABO incompatibility.
- G6PD def.
- Failure to excrete the conjugate Bilirubin.
- Congenital obstruction in bile duct body.
- Appear always in 24 hours of birth.
- Total serum bilirubin ( TSB) >12 mg/dl terms. >15 mg/dl — preterm.
- Increase bilirubin >5 mg/day.
- Need treatment — phototherapy.
Assessment:-
- Elevated bilirubin level.
- Poor muscle stone.
- Poor sucking reflex.
- Lethargy.
Management:-
Phototherapy:- Treatment by exposure to baby under light.
- Blue light is most effective (420- 480 nano meter wave length) but now-a-days white light is use to detect cyanosis as early as possible.
- Use 4 blue light CFL + 2 white light CFL ( CFL compact fluorescent lamp).
- Distance between light source and baby 30-45cm.
- Light exposure time depend upon S. Bilirubin level < 10 mg/ dl.
- Photoisomerisation.
Nurses Responsibility during Phototherapy:-
- Eye (to prevent retina) and genital ( prevent sterility) should be covered, than exposed much as body area is possible.
- Change in position of body every 2 hrs to expose whole body area.
- Monitor skin temperature every 2 hrs.
- IV fluid to prevent delay duration due to light exposure.
- Whole body should exposed except eye and genitalia.
I hope that you liked this article……!!
Thanking you………!!
By GS India Nursing………..!!