Care for the Child Under Photo Therapy

PHOTOTHERAPY

Prepared By: Dr/ lamiaa Ahmed Elsayed

Care for the infant under phototherapy

http://images.google.com.sa/imgres?imgurl=http://upload.wikimedia.org/wikipedia/commons/b/b9/Newborn_IMG_1058.JPG&imgrefurl=http://commons.wikimedia.org/wiki/File:Newborn_IMG_1058.JPG&usg=__Kwcbrrut3YL5G1runms8GcoEIG0=&h=1536&w=2048&sz=948&hl=ar&start=45&um=1&itbs=1&tbnid=gRQoBIeBjy6gvM:&tbnh=113&tbnw=150&prev=/images%3Fq%3Dnewborn%26start%3D36%26um%3D1%26hl%3Dar%26safe%3Dactive%26sa%3DN%26ndsp%3D18%26tbs%3Disch:1

Phototherapy


Out lines • Definition of Phototherapy• Causes of jaundice • History about Phototherapy.• Mechanism of Phototherapy• List the benefits of phototherapy • Factors Affecting On Efficacy of

phototherapy• Side Effects of Phototherapy.• Nursing Care for Infant Receiving

Phototherapy.


Objectives:

1. Define phototherapy2. List causes of jaundice3. Identify history of phototherapy4. List Indication of phototherapy 5. Understand the mechanism of phototherapy6. List the benefits of phototherapy7. Identify the factors affecting on efficacy of phototherapy8. Enumerate the side effects of phototherapy9. Apply the nursing care for infant’s receiving phototherapy



What is phototherapy?

• Phototherapy (light therapy) is a way of treating jaundice. Special lights help break down the bilirubin in your baby's skin so that it can be removed from his or her body. This lowers the bilirubin level in your baby's blood. Care for the infant under phototherapy

What is phototherapy?

Application of fluorescent light to the infant’s exposed skin used to breakdown the bilirubin in the skin


Indication of phototherapy

• Treatment of Hyperbilirubinemia• The phototherapy will help the liver to

process bilirubin, bringing your baby's level down to normal

• Prevent Kernicturus


http://images.google.com.sa/imgres?imgurl=http://upload.wikimedia.org/wikipedia/commons/b/b9/Newborn_IMG_1058.JPG&imgrefurl=http://commons.wikimedia.org/wiki/File:Newborn_IMG_1058.JPG&usg=__Kwcbrrut3YL5G1runms8GcoEIG0=&h=1536&w=2048&sz=948&hl=ar&start=45&um=1&itbs=1&tbnid=gRQoBIeBjy6gvM:&tbnh=113&tbnw=150&prev=/images%3Fq%3Dnewborn%26start%3D36%26um%3D1%26hl%3Dar%26safe%3Dactive%26sa%3DN%26ndsp%3D18%26tbs%3Disch:1

Causes of Jaundice

• Breast-feeding jaundice: Breast-feeding jaundice may occur when your baby does not drink enough breast milk. It occurs in 5% to 10% of newborns. The jaundice symptoms are similar to those of physiological jaundice, just more pronounced. The jaundice indicates a need for help with breast-feeding


Causes of Jaundice

• Physiological jaundiceThis is the most common cause of newborn jaundice and occurs in more than 50% of babies. Because the baby has an immature liver, bilirubin is processed slower. The jaundice first appears at 2 to 3 days of age. It usually disappears by 1 to 2 weeks of age, and the levels of bilirubin are harmless


Causes of jaundice• Breast-milk jaundice Breast-milk jaundice

occurs in 1% to 2% of breast-fed babies. It is caused by a special substance that some mothers produce in their milk. This substance causes your baby's intestine to absorb more bilirubin back into his body than normal. This type of jaundice starts at 4 to 7 days of age. It may last 3 to 10 weeks. It is not harmful.


Causes of Jaundice

• Blood group incompatibility (Rh or ABO problems If a baby and mother have different blood types, sometimes the mother produces antibodies that destroy the newborn's red blood cells. This causes a sudden buildup of bilirubin in the baby's blood. Rh problems formerly caused the most severe form of jaundice. However, they are now preventable if the mother is given an injection of Rho GAM within 72 hours after delivery. This prevents her from forming antibodies that might endanger other babies she has in the future


History of PHOTOTHERAPY


http://images.google.com.sa/imgres?imgurl=http://www.servitokss.com/wp-content/uploads/2009/07/man_question_mark.jpg&imgrefurl=http://www.servitokss.com/question-marks/&usg=__OYXhgEceQbIE0NhqDgtdAxnhbus=&h=359&w=286&sz=11&hl=ar&start=12&um=1&itbs=1&tbnid=RtcmX_DtJpu3_M:&tbnh=121&tbnw=96&prev=/images%3Fq%3Dquestion%2Bmark%26um%3D1%26hl%3Dar%26safe%3Dactive%26tbs%3Disch:1


History of PHOTOTHERAPY

• The use of phototherapy was first discovered, accidentally, at Rochford Hospital in Essex, England. The ward sister (Charge Nurse) of the premature baby unit


Mechanism of action

• Bilirubin is a naturally occurring molecule of the red blood cells. It is released into the bloodstream when the red blood cells break down. This is normal and occurs often. Our livers break down the bilirubin and it is excreted.


Mechanism of action-Continue

• Phototherapy (light treatment) is the process of using light to eliminate bilirubin in the blood. Your baby's skin and blood absorb these light waves. These light waves are absorbed by your baby's skin and blood and change bilirubin into products, which can pass through their system.


Mechanism of action-Continue

• wavelength of 420-448 nm, oxidized the bilirubin to biliverdin, a soluble product that does not contribute to kernicterus


Mechanism of action• The phototherapy will help the liver to

process bilirubin, bringing your baby's level down to normal

• The light waves convert the bilirubin to water soluble nontoxic forms which are then easily excreted. Every attempt should be made to find out the cause of jaundice.

• The advantages of phototherapy are that it is noninvasive, effective, inexpensive and easy to use.


MECHANISM OF WORKING


What are the benefits of phototherapy?

• The jaundice can be treated• preventing the need for more

invasive treatment and the serious complications, which can occur if excessive levels of bilirubin develop


Benefits of phototherapy -Continue• Phototherapy is a safe.• Effective method of treatment. • It provides the highest level of

therapeutic light available to treat your baby. This is the same form of light found in sunlight This is safer than sunlight though, because it filters out the harmful ultraviolet and infrared energy.


FACTORS AFFECTING EFFICACY OF PHOTOTHERY

• 1-TYPE OF LIGHT USED• 2-LIGHT INTENSITY• 3-SURFACE AREA OF SKIN EXPOSED TO LIGHT• 4- The distance of the light source from the

baby, the optimum distance being 35 - 50 cm in conventional lights.


Assessment should be Before Phototherapy

• GA Of the baby• Weight The baby• Postnatal Age• Types of Jaundice• the level of jaundice


http://images.google.com.sa/imgres?imgurl=http://regalmok.files.wordpress.com/2009/02/img_0791.jpg&imgrefurl=http://regalmok.wordpress.com/2009/02/19/phototherapy/&usg=__jHHS75t5WuD6Jl4iW91baowtP6g=&h=1200&w=1600&sz=741&hl=ar&start=93&um=1&itbs=1&tbnid=oha9SVa77kymqM:&tbnh=113&tbnw=150&prev=/images%3Fq%3Dphototherapy%26start%3D90%26um%3D1%26hl%3Dar%26safe%3Dactive%26sa%3DN%26ndsp%3D18%26tbs%3Disch:1

Nursing Care for Infant Receiving Phototherapy



• Baby will need to be in an incubator whilst under photo therapy to keep warm,

• The photo therapy unit will be placed over the top of the incubator occasionally more than one unit may be used. This can be switched off when your baby needs to come out to be fed


Nursing Care for Infant Receiving Phototherapy Cont’

Proper covering and shielding of gonad .Assess skin exposure .Proper position .



Assess and adjust thermoregulation device .Promoting elimination and skin integrity .Hydration.


Nursing Care for Infant Receiving Phototherapy.

-Assure effective of phototherapy-provide eye protection Eyes are covered with eye-

patches to prevent damage to the retina by the .


Nursing Care for Infant Receiving Phototherapy- continue

• Baby is placed naked 45 cm away from the tube lights in a crib or incubator.

• If using closer, monitor temperature of the baby.

• Baby is turned every two hours or after each feed.



• During phototherapy, the bilirubin level in your baby’s blood will be checked at least once every day. Phototherapy is stopped when the bilirubin level decreases.



• Temperature is monitored every two to four hours.– Weight is taken at least once a day.– More frequent breastfeeding or 10-20% extra fluid is

provided.– Urine frequency is monitored daily.

• Serum bilirubin is monitored at least every 12 hours.• Phototherapy is discontinued if two serum

bilirubin values are < 10 mg/dl.•



• Baby should spend as much time as possible under the phototherapy lights for it to be most effective, but your baby can come out for feeding or cuddles if he or she is upset.

• Baby will need to have regular (usually daily) blood tests whilst under photo therapy to assess the levels of bilirubin and ensure the phototherapy is effective.



Promoting infant parent interaction.


http://images.google.com.sa/imgres?imgurl=http://www.manorhousecentre.org.uk/assets/images/mumbaby1.jpg&imgrefurl=http://www.manorhousecentre.org.uk/courses/parent_infant.php&usg=__nelhue8nghcnaAjO0JnS5j7fFn0=&h=166&w=250&sz=9&hl=ar&start=115&um=1&itbs=1&tbnid=PdXjm4FgggPcLM:&tbnh=74&tbnw=111&prev=/images%3Fq%3Dinfant%2Bparent%2Binteraction%26start%3D108%26um%3D1%26hl%3Dar%26safe%3Dactive%26sa%3DN%26ndsp%3D18%26tbs%3Disch:1

Side effect of phototherapy

1. Bronze – baby syndrome. 2. Loss , greenish stool .3. Transient skin rashes.4. Hyperthermia .5. Increasing metabolic rate.6. Dehydration .7. Electrolyte disturbance .


• Thank You For your Attention


Documents

Care for the Child Under Photo Therapy