Client light pink in color and odorless. Since coming

Client
Background

            A.I. is a 37 year old female who delivered a baby girl on
January 16, 2018 at 12:30 p.m. at 36 weeks gestation by cesarean section. She
plans on breastfeeding the child and the mother and baby are doing well. The
patient currently has a binder and steri strips in place and is on a regular
diet.  A.I. has had a precious cesarean
section, is G2 and P2, and has a history of a breast augmentation and anxiety.
She is immune to rubella and tested negative for Group B Streptococcus and
Hepatitis B. She also has received a flu vaccine and TDAP.  The condition of the baby was normal and she
weighed 71bs 8 oz. After the delivery, the patient was placed in the
mother/baby unit and was assessed for any complications. The lochia was light
pink in color and odorless. Since coming from the delivery the patient has passed
flatus and voided, however has not been able to pass bowels. Breath sounds were
loud and clear, uterus was midline and firm, and bowel sounds were present.
There are also no signs of DVT or presence of edema. Upon inspection of the
incision, there was some redness and slight bruising. Patient did complain of
incisional pain and cramping near the lower pelvic region and tender nipples.
Current medications include Ibuprofen, 800 mg, 1 tab PO; Hydrocodone 5
mg/Acetaminophen 325 mg, 1 tab, PO; Furosemide, 20 mg, 1 tab, PO and Triple
nipple cream, 2 x day. While there was no maternal complications, the infant
did have slight yellowing of the eyes and skin after delivery.

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Learning
Needs Assessment

            After being taken
to the mother/baby unit, the nurse had found slight yellowing of the eyes and
skin in the newborn. To assess what was going on, the nurse drew blood and the
lab results came back with a 5.9 bilirubin level.  Within 36 hours after delivery another blood
sample was drawn and it came back as 5.7 bilirubin level. Within 72 hours, the
last blood sample was taken and the lab results showed a 5.2 bilirubin level.
During this whole process, the mother was constantly asking questions. She
asked why the nurse was sticking her baby, what does the high bilirubin level
mean, and how will the high levels of bilirubin affect her baby. In addition,
the mother had a furrowed brow when the nurse was trying to explain everything.
This was the first time she had experienced this because she stated that her
first child did not have to be stuck all the time as a newborn. One could tell
based on her body language and her inquisitive nature that she was a little
worried about what was going on.

Summary
of Teaching Plan

            The topic that was
discussed with the patient was jaundice and its causes, symptoms, treatment and
prevention. Based on the Maternal and Child Nursing
book, jaundice is common within 60% of newborns and it is common to find
yellowing of the skin 24 hours after birth. During the transition from
intrauterine life to extrauterine life, the neonate goes through several
physiologic adaptions in order to survive. Those physiologic adjustments
include 1) establishing and maintaining
respirations; (2) adjusting to circulatory changes; (3) regulating temperature;
(4) ingesting, retaining, and digesting nutrients; (5) eliminating waste; and
(6) regulating weight (London et al., 2014, p. 556).  Jaundice deals with the elimination process,
specifically related to the inability of the liver to excrete high amounts of
bilirubin. Bilirubin is something that is comes from the breakdown of your red
blood cells and is usually excreted through the liver. However, the liver can
only metabolize and excrete a certain amount of serum bilirubin levels. Also
there are few bilirubin binding sites due to the low levels of albumin in the
newborn (London et al., 2014, p. 565).

            Jaundice can be caused by breast
feeding or another condition. With breast feeding there are to types of
jaundice that can occur. The first type is called breastfeeding jaundice and it
occurs when the babies do not nurse well or the mother’s milk is coming out to
slow. The second type is breast milk jaundice, in which there are certain
substances in the breastmilk that prevents the breakdown of bilirubin. Other
conditions that are responsible for jaundice in sickle cell anemia, blood
mismatch between the mother and infant, bleeding underneath the scalp,
infection, higher levels of red blood cells, and lack of a certain protein (Kaneshiro,
Zieve, & Conaway, 2017).   Symptoms include yellowing of the skin and
sclera; sometimes the baby will be very sleepy and have difficulty feeding.  A patient is diagnosed by applying pressure with
a finger over a bony area for several seconds. If jaundice is present, the area
will appear yellow before the capillaries refill. In darker-skinned newborns,
the conjunctival sacs and buccal mucosa also are assessed (London et al., 2014,
p. 605). 

            There are two options for treatment
of high bilirubin levels and jaundice. A newborn with jaundice needs to have
plenty of fluids with breast milk or formula. The mother should feed the baby
at least 12 times a day to help remove the bilirubin through the bowels. Some infants
also an undergo phototherapy. According to the Maternal and Child Nursing book,
phototherapy can change the shape and structure of the bilirubin, making it easier
to be released through the body. The newborn is placed under these lights in a
warm, enclosed bed with only a diaper and a special pair of glasses to protect
the eyes. They are placed under the light every 2 to 3 hours for 10 to 12 times
a day (Pearsall & Morrow, 2016).  A
at home treatment includes a bili-blanket. It is composed of fibers that
transports light from the sun while also blocking harmful UV Rays. With this
form, the baby can remained clothed and can have a diaper. Although there are
no harmful side effects, your baby’s skin can appear bleached or reddened due
to that is the area in which the bilirubin is broken down. You would want to
teach the mother that the normal skin color will return and they can continue
breastfeeding them while undergoing this therapy (UMHS Newborn Care Committee,
2015).

            While you cannot prevent jaundice
from happening, there are certain steps that you can take to prevent the
disease from progressing. The mother should breastfeed as soon as possible,
work with a consultant to make sure that the infant is latching properly, feed
the baby frequently, and avoid taking any supplements or interrupting breast
feeding (American Pregnancy Organization, 2016). If left untreated it can be
toxic to the developing brain. Before the infant is discharged, the infant
should be assessed for the risk of developing hyperbilirubinemia. Also a follow
up assessment must be done in which the nurse measures the infant’s weight,
adequacy of intake, amount of voiding and stools, and the skin color. If the
infant is not feeding well and is lethargic, take the infant to your primary
health care provider.  (“Management
of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of
Gestation,” 2013).

Goals

            By the end of this teaching session, the parent will be able to
identify and list the signs/symptoms of severe jaundice that requires immediate
attention to the primary care provider.

            By the end of this presentation, the
mother will be able to demonstrate how to properly wrap their baby in the
bili-blanket for phototherapy.

            By the end of this presentation, the
mother will be able to state the causes, treatment, and prevention of jaundice. 

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