Surgical Nursing Series Home Page Surgical Nursing Series

[Abstract]

Objective: To explore the nursing experience of blue light treatment of neonatal jaundice, improve the quality of nursing and improve the relationship between nurses and patients. Methods According to the characteristics of neonates and their families.

Analysis: Illumination therapy and intensive nursing were adopted to make the children recover soon. Results All the 86 cases were cured, and no nucleus jaundice occurred.

Conclusion: Careful nursing and close observation in the course of neonatal jaundice under blue light can effectively improve the cure rate of neonatal jaundice and promote the early recovery of the patients.

[Key words] Blue light therapy; Neonatal jaundice; Nursing

Neonatal jaundice, also known as neonatal jaundice hemoglobinemia, is one of the common symptoms of neonates. It is due to the high level of serum bilirubin (mostly unconjugated bilirubin) which causes yellow staining of skin, sclera and mucosa. Normally, it occurs 2-3 days after birth and subsides in about 2 weeks. Serum bilirubin concentration is 85-103b-moUL. The neonates are generally in good condition. They are physiological jaundice and need no special treatment. Special treatment, if jaundice occurs within 24 hours, or jaundice subsides delayed or recurs, serum bilirubin concentration exceeds 205-mol/L, mostly pathological jaundice, which needs timely treatment. It is generally considered that serum bilirubin > 307.8-342} xmol/L can be called "critical concentration". Those who exceed the critical concentration are prone to nucleus jaundice, thus causing irreversible damage to the central nervous system and leaving sequelae? At present, the clinical use of blue light irradiation combined with drug treatment, the effect is satisfactory. The nursing experience of 86 cases of neonatal jaundice treated by blue light from November 2009 to November 2010 in our department is reported as follows:

1 Clinical data

1.1 General data: 86 neonates were hospitalized in pediatrics department of our hospital with body mass of 2000-3750g, 8 within 24 hours of age, 25 within 2-7 days, 23 within 8-14 days, 20 within 15-28 days, 10 within 29-40 days, 46 males and 40 females.

1.2 Indications of blue light therapy: jaundice appeared too early (within 24 hours after birth), jaundice was too severe (serum bilirubin > 205.2-mol/L, premature infants > 256.5/xmol/L), jaundice subsided delayed (lasting more than 2 weeks, premature infants exceeded 3-4 weeks), jaundice recurred or aggravated (daily increase > 85.5l-mol/L).

1.3 Principle of Blu-ray Therapy]: Blu-ray can oxidize blood into water-soluble bilirubin after irradiation without bilirubin. It can expel bilirubin from biliary sweat and urine quickly, so as to reduce the concentration of bilirubin in blood. The curative effect is definite, the method is simple, the treatment is safe and the side effects are few.

1.4 Blu-ray treatment equipment: all neonatal jaundice treatment boxes produced by Ningbo Davidian Medical Devices Co., Ltd.

1.5 Preparations before Blu-ray treatment:

1.5.1 Parents'preparation: Because children are treated with blue light, parents will inevitably have a lot of concerns about the impact of light radiation on children, worry about children's cold, treatment effect and sequelae. Therefore, it is necessary to patiently and meticulously introduce the harmfulness and treatment purpose of neonatal hyperbilirubinemia to parents of children, explain the principle and safety of blue light therapy, so as to relieve the concerns of family members of children and enable them to receive blue light treatment as soon as possible.

1.5.2 Preparation of phototherapy box: Clean the phototherapy box, pay special attention to cleaning the dust of lamp tube and reflector board, so as not to affect the light penetration force, turn on the power supply, check whether the line and lamp tube are all bright, and replace them in time if not bright. The phototherapy box should be preheated so that the temperature of the box rises to the moderate temperature of the child, and the relative humidity is 55%-65%, before the child can be put in.

1.5.3 Preparations for children: Before entering the blue light box, they should clean their skin. No powder or oil should be applied on their skin to prevent light from irradiating the skin. The nails of children should be cut short so as not to cut the skin. Infusion children should use elastic mesh bandage to restrain their hands slightly in order to prevent them from grabbing scalp vein needles, wearing neonatal phototherapy eye shield on both eyes, avoiding light damage to the retina and taking off their clothes. Pants, whole body bare, perineum wrapped in diapers, baby diapers around the black shade cloth to cover the scrotum, into the preheated light therapy box, record the start of irradiation time.

Nursing Care of 1.6 Blu-ray Therapy

1.6.1 closely observed the changes of the disease: during the phototherapy, we should observe the mental reaction and vital signs of the children closely, pay attention to the location, degree and change of jaundice, monitor the changes of serum bilirubin, so as to judge the curative effect; observe the color and character of the stool and urine, if there is slight diarrhea, it is dark green and thin, with many bubbles and deep yellow urine, which belongs to the normal reaction, and can disappear with the improvement of the illness. Check the skin for redness, dryness, rash, apnea, irritability, lethargy, fever, abdominal distension, vomiting, convulsions, etc. Attention to sucking ability, cry changes. If there is any abnormality, contact the doctor in time and deal with it in time.

1.6.2 Close monitoring of body temperature and box temperature: Blue light will naturally produce heat during phototherapy, which will increase the temperature in the box, while the development of neonatal body temperature regulation center is immature and easy to rise with the increase of ambient temperature. Therefore, the body temperature should be measured every hour during phototherapy. According to the temperature of the thermostat, keep the temperature between 36 and 37 degrees. If the temperature of the patient exceeds 37.5cc, the door of the thermostat can be opened properly. If the temperature exceeds 38.5 degrees, phototherapy should be suspended until the temperature drops to normal before continuing irradiation.

1.6.3 Guarantee adequate water and nutrition supply to prevent dehydration: Because children in phototherapy are prone to crying, sweating, and non-dominant loss of water increases by about 40% L3J, therefore, in the course of phototherapy, intravenous infusion according to doctor's advice, feeding on demand, two feeding questions can be added boiled water, it should be noted that each feeding should not be too full, the speed should not be too fast, after feeding should be right side.