Review Hyperbilirubinemia

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Hyperbilirubinemia

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Total Questions : 4

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Question 1:

A nurse is caring for a newborn with hyperbilirubinemia who is receiving phototherapy.

Which of the following actions should the nurse take?

A. Apply lotion to the newborn’s skin before phototherapy. B. Remove the newborn from phototherapy every 4 hours. C. Cover the newborn’s eyes with a mask during phototherapy. D. Place the newborn on a radiant warmer during phototherapy.

Answer and Explanation

Choice A:

Because applying lotion to the newborn’s skin before phototherapy can interfere with the light penetration and reduce the effectiveness of the treatment.

Choice B:

Because removing the newborn from phototherapy every 4 hours can interrupt the continuous exposure to the light and delay the reduction of bilirubin levels.

Choice C:

This is because phototherapy exposes the newborn to a special blue-to-green light that lowers the serum bilirubin level by transforming it into water-soluble isomers that can be eliminated without liver conjugation. However, this light can also damage the newborn’s eyes and cause retinal injury or blindness, so it is important to protect them with a mask.

Choice D:

Placing the newborn on a radiant warmer during phototherapy can increase the risk of dehydration, hyperthermia, and skin burns. The newborn should be monitored for temperature and fluid balance during phototherapy and kept in a crib or bassinet with a blanket.

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Question 2:

A nurse is assessing a newborn for signs of jaundice.

Which of the following methods should the nurse use to detect jaundice in the newborn?

A. Palpate the newborn’s abdomen for hepatomegaly. B. Measure the newborn’s serum bilirubin level. C. Blanch the newborn’s skin with digital pressure. D. Observe the newborn’s urine and stool color.

Answer and Explanation

Choice A:

Palpating the newborn’s abdomen for hepatomegaly is not a reliable way to detect jaundice. Hepatomegaly is an enlargement of the liver that may indicate liver disease, but it is not specific to jaundice.

Choice B:

Measuring the newborn’s serum bilirubin level is not a method to detect jaundice, but rather to confirm and quantify it. Serum bilirubin level is the amount of bilirubin in the blood, which is responsible for the yellow color of jaundice. A blood test is required to measure this level.

Choice C:

This method allows the nurse to detect jaundice by observing the color of the skin after applying and releasing pressure. This is a simple and noninvasive way to check for jaundice in a newborn.

Choice D:

Observing the newborn’s urine and stool color is not a reliable way to detect jaundice. The color of urine and stool may vary depending on the hydration status, feeding type and other factors of the newborn. Moreover, urine and stool color may not change until the bilirubin level is very high.

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Question 3:

A nurse is teaching a parent about how to prevent physiologic jaundice in a breastfed newborn.

Which of the following instructions should the nurse include?

A. Supplement breastfeeding with glucose water. B. Expose the newborn to natural sunlight for short periods. C. Feed the newborn on demand to promote bilirubin excretion. D. All of the above.

Answer and Explanation

Choice A:

Supplementing breastfeeding with glucose water can reduce the amount of breast milk intake and increase the risk of jaundice.

Choice B:

Exposing the newborn to natural sunlight for short periods has not been proven to be effective in preventing or treating jaundice.

Choice C:

Breastfeeding frequently can help the newborn pass more stools, which contain bilirubin, and reduce the risk of jaundice.

Choice D:

It includes choices A and B, which are incorrect.

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Question 4:

A nurse is reviewing the laboratory results of a newborn who has pathologic jaundice due to blood incompatibility.

Which of the following findings should the nurse expect?

A. Elevated direct bilirubin level. B. Decreased hematocrit level. C. Positive direct Coombs test. D. All of the above.

Answer and Explanation

Choice A:

It only explains one aspect of pathologic jaundice, but not the other two.

Choice B:

It only explains one aspect of pathologic jaundice, but not the other two.

Choice C:

It only explains one aspect of pathologic jaundice, but not the other two.

Choice D:

Elevated direct bilirubin level: Pathologic jaundice is caused by an excessive breakdown of red blood cells due to blood incompatibility or liver disease. This leads to an increased production of bilirubin, which is a yellow pigment that results from the breakdown of heme. Bilirubin can be either unconjugated (indirect) or conjugated (direct), depending on whether it is bound to a protein called albumin or not. Unconjugated bilirubin is not water-soluble and cannot be excreted in urine or bile. It needs to be converted to conjugated bilirubin by the liver, which is water-soluble and can be eliminated from the body. However, if the liver is damaged or overwhelmed by the amount of bilirubin, some of the conjugated bilirubin can leak back into the bloodstream and cause an elevated direct bilirubin level. • Decreased hematocrit level: Hematocrit is the percentage of red blood cells in the blood. When red blood cells are destroyed due to blood incompatibility or liver disease, the hematocrit level decreases. This can lead to anemia, which is a condition where the blood does not carry enough oxygen to the tissues. Positive direct Coombs test: A Coombs test is a blood test that detects antibodies that bind to red blood cells and cause them to clump together and be destroyed. A direct Coombs test checks for antibodies that are attached to the red blood cells of the newborn. A positive direct Coombs test indicates that there is an immune reaction between the mother’s and the baby’s blood types, which can cause hemolysis (destruction of red blood cells) and jaundice.

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Hyperbilirubinemia

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