Hyperbilirubinemia SKINNY Reasoning

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 Category/Subcategory Covered in 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%  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 A+ blood type, mother o+ Billiruben 6.1 Hct 48 (low) breast fed for 7 mins 9.0 pounds premature babies risk the chance of having premature liver, the lab values may indicate signs of liver issues and the low Hct may indicate sign of insufficient RBC, the mother has gestational diabetes causing the high birth weight RELEVANT Data from Social History: Clinical Significance: mother is student, age of mother, support system from mothers parents, father not involved this mother is a first time mother at a young age, absence of father can cause additional stress as well as school, has a good support system through 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