Component Task: Management of a Neonate Undergoing Phototherapy

This is a non-invasive procedure carried out by the Paediatric nurse for the neonate who shows signs of jaundice. It involves the use of blue florescent light/lamp on a neonate exposed skin for the treatment of hyperbilirubinaemia.

Aims

·         Decrease serum bilirubin levels

·         Prevent the neurotoxic effects of high serum unconjugated bilirubin(Kernicterus)

·         Shorten hospital stay

·         Prevent dehydration

Types

·         Conventional phototherapy

·         Fibre-optic phototherapy

Requirements

·         Phototherapy fluorescent light

·         Fire fly

·         Eye shield

·         Incubator

·         Treasure cot

·         A pair of scissors

·         Diaper

·         Glucometer with strip

·         Thermometer

·         Pulse oximeter

·         Cannula

·         Sterile swabs

·         Adhesive tape

·         IV fluids

·         Drip stand with infusion pump

Steps

1.        Establish rapport (Refer to steps)

2.      Explain procedure to the caregiver/family (Refer to steps)

3.      Obtain informed consent

4.      Ensure ambient room temperature is between 25-28℃

5.      Perform five moments of hand hygiene

6.      Perform baseline vital signs (temperature, pulse, respiration, SPO2 and RBS)

7.       Remove all clothes of baby except diaper

8.      Cover the eye with opaque shield/patches

9.      Place baby under light in a cot or incubator

10.    Position baby at a distance of 30-45cm from light source

11.      Ensure eye shield does not slip or too tight the eyelids well before applying shied

12.    Close the eyelids well before applying shied

13.    Monitor temperature every 2-4 hours

14.    Support and encourage mother to breastfeed neonate to feed 8-12 times daily

15.    Nurse baby in supine or prone position with maximum skin exposure to light

16.    Change position frequently to prevent break in skin

17.    Monitor for signs of dehydration

18.    Perform I. V. cannulation for IV fluids administration if necessary

19.    Monitor fluid intake and output

20.  Obtain baby’s weight daily

21.    Observe passage of stools for colour and frequency

22.  Change nappies when soiled

23.  Encourage care giver to be involved in the care of the neonate

24.  Express appreciation to care giver for her support

25.  Clean incubator daily and thoroughly twice a week

26.  Dispose off, decontaminate and clean used items

27.  Documents procedures manually and electronically