Hyperbilirubinemia
SKINNY Reasoning
Sarah Daniels, newborn infant
Primary Concept
Elimination
Interrelated Concepts (In order of emphasis)
Clinical Judgment
Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23%
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights
reserved.
, SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
Sarah Daniels was born six hours ago by vaginal delivery after 22 hours of labor at 36 weeks gestation because of
premature rupture of membranes. She weighed 9 lbs 0 ounces. (4090 g). Her Apgar was 8 at one minute and 9 at 5
minutes. Her newborn assessment revealed a cephalohematoma on the right-posterior aspect of her head. All other
assessment data is within normal limits. Sarah has breastfed once since birth for seven minutes. She is noted to be sleepy
when at the breast and not an aggressive feeder, consistent with her gestational age. She has voided once since birth, but
has not yet stooled.
Sarah’s mom Morgan was a diet-controlled gestational diabetic. Morgan’s prenatal labs are as follows: Blood type is
O +, GBS is negative, Hepatitis B is negative. Her prenatal course was unremarkable other than the premature rupture of
membranes.
Sarah’s blood type is A+. Blood sugars were obtained per protocol starting at two hours after birth and have been
consistently > 50 mg/dL. Her hematocrit was tested per protocol of a baby of a diabetic mother born before 37 weeks and
was 48% four hours after birth. Twelve hours after birth, her transcutaneous bilirubin level is 6.1 mg/dL.
Personal/Social History:
Morgan Daniels is a 22-year-old single mom who attends a local community college. The father of the baby is not
involved. Morgan lives with her parents, who are supportive and available.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
premature
chephlohematoma
premature babies risk the chance of having
A+ blood type, premature liver, the lab values may indicate signs
mother o+ Billiruben
6.1 of liver issues and the low Hct may indicate sign of
Hct 48 (low) insufficient RBC, the mother has gestational
breast fed for 7 mins
9.0 pounds diabetes causing the high birth weight
RELEVANT Data from Social History: Clinical Significance:
mother is student, age of this mother is a first time mother at a young age,
mother, support system from absence of father can cause additional stress as well
mothers parents, father not as school, has a good support system through
involved mothers parents
Patient Care Begins:
Current VS: NIPS Pain Assessment:
T: 98.3 F/36.8 C (axillary) Facial Expression: Relaxed
P: 138 (regular) Cry: No cry
R: 54 (regular) Breathing Pattern: Relaxed
Legs: Relaxed
State of Arousal: Sleeping
NIPS Score: 0
Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights
reserved.
SKINNY Reasoning
Sarah Daniels, newborn infant
Primary Concept
Elimination
Interrelated Concepts (In order of emphasis)
Clinical Judgment
Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23%
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights
reserved.
, SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
Sarah Daniels was born six hours ago by vaginal delivery after 22 hours of labor at 36 weeks gestation because of
premature rupture of membranes. She weighed 9 lbs 0 ounces. (4090 g). Her Apgar was 8 at one minute and 9 at 5
minutes. Her newborn assessment revealed a cephalohematoma on the right-posterior aspect of her head. All other
assessment data is within normal limits. Sarah has breastfed once since birth for seven minutes. She is noted to be sleepy
when at the breast and not an aggressive feeder, consistent with her gestational age. She has voided once since birth, but
has not yet stooled.
Sarah’s mom Morgan was a diet-controlled gestational diabetic. Morgan’s prenatal labs are as follows: Blood type is
O +, GBS is negative, Hepatitis B is negative. Her prenatal course was unremarkable other than the premature rupture of
membranes.
Sarah’s blood type is A+. Blood sugars were obtained per protocol starting at two hours after birth and have been
consistently > 50 mg/dL. Her hematocrit was tested per protocol of a baby of a diabetic mother born before 37 weeks and
was 48% four hours after birth. Twelve hours after birth, her transcutaneous bilirubin level is 6.1 mg/dL.
Personal/Social History:
Morgan Daniels is a 22-year-old single mom who attends a local community college. The father of the baby is not
involved. Morgan lives with her parents, who are supportive and available.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
premature
chephlohematoma
premature babies risk the chance of having
A+ blood type, premature liver, the lab values may indicate signs
mother o+ Billiruben
6.1 of liver issues and the low Hct may indicate sign of
Hct 48 (low) insufficient RBC, the mother has gestational
breast fed for 7 mins
9.0 pounds diabetes causing the high birth weight
RELEVANT Data from Social History: Clinical Significance:
mother is student, age of this mother is a first time mother at a young age,
mother, support system from absence of father can cause additional stress as well
mothers parents, father not as school, has a good support system through
involved mothers parents
Patient Care Begins:
Current VS: NIPS Pain Assessment:
T: 98.3 F/36.8 C (axillary) Facial Expression: Relaxed
P: 138 (regular) Cry: No cry
R: 54 (regular) Breathing Pattern: Relaxed
Legs: Relaxed
State of Arousal: Sleeping
NIPS Score: 0
Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights
reserved.
