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case presentation

group 1 presentation "erythroblastosis fetalis"
by

Ovhie Almenanza

on 10 September 2012

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Transcript of case presentation

Erythroblastosis Fetalis INTRODUCTION Erythroblastosis Fetalis

Erythroblastosis Fetalis, also known as Hemolytic Disease of the Newborn (HDN), is a blood disorder in a fetus or newborn infant that can develop when a mother and her unborn baby have different blood types. HDN is classified as both congenital and hereditary. The most common form of HDN is ABO incompatibility, which is usually not very severe, with the least common form being Rh incompatibility, which can almost always be prevented. Rh incompatibility only occurs if a mother is Rh-negative and her baby is Rh-positive.
Significant problems with ABO incompatibility occur mostly with babies whose mothers have O blood type and where the baby is either A & B blood type. Premature babies are much more likely to experience sever problems from ABO incompatibility, while healthy full term babies are generally only mildly affected. Unlike hemolytic disease that can result in subsequent babies when a mother has a negative blood group, ABO incompatibility can occur in first born babies and does not become more severe in further pregnancies. CAUSES •Type B
(BB or BO molecules) •Type AB
•Type O Type A
(AA or AO molecules) A, B, and O are the three major blood types. The types are based on small substances (molecules) on the surface of the blood cells. In people who have different blood types, these molecules act as immune system triggers (antigens).
Each person has a combination of two of these surface molecules. Type O lacks any molecule. The different blood types are: Back pain Fever Blood in
urine •Feeling of
"impending doom" SYMPTOMS Yellow skin (jaundice) PATIENT’S PROFILE NAME: S.D.F
AGE: 28y/o
ADDRESS: Blk. 10, AlcarazBayananMuntinlupa City.
GENDER: Female
RELIGION: Catholic
STATUS: Single
AOG: 38wks
LMP: November 13, 2011
EDC: August 12, 2012
DATE OF ADMISSION: August 12, 2012
CHIEF COMPLAINT: labor pain T3 P0 A0 L3 NAME: B.F.
ADDRESS: Blk.10, AlcarazBayananMuntinlupa City
BIRTHDATE: August 12, 2012
AGE: 2day old
GENDER: Boy
RELIGION: Catholic BABY MOTHER PHYSICAL EXAMINATION ANATOMY & PHYSIOLOGY The Circulatory System

The circulatory system consisting of the heart, arteries, capillaries, and veins, is the pumping mechanism that transports blood throughout the body.In the heart, the left ventricle contracts, pushing red blood cells into the aorta, the body’s largest artery.From here, blood moves through a series of increasingly smaller arteries, until it reaches a capillary, the junction between arteries and veins.Here oxygen molecules detach from the red blood cells and slip across the capillary wall into body tissue.Now de-oxygenated, blood begins its return to the heart. It passes through increasingly larger veins to eventually reach the right atrium. It enters the right ventricle, which pumps it through the pulmonary arteries into the lungs, to pick up more oxygen. Oxygenated blood reenters the left atrium, moves into the left ventricle, and the blood’s journey begins again. The components of blood and their importance

Blood is a specialized fluid in your body that has four main components, each with a different function: Plasma, red blood cells, white blood cells, and platelets. NURSING MANAGEMENT Initiation of Early Feeding

- Bilirubin is removed from the body by being incorporated into feces. Therefore, the sooner bowel eliminations begin, the sooner bilirubin removal begins.
- Early feeding (either breast milk or formula), therefore, stimulates bowel peristalsis and accomplishes this. Phototherapy

-In phototherapy, an infant is continuously exposed to specialized light such as quarts halogen, cool white daylight or special blue fluorescent light. The lights are placed 12-30 inches above the newborn’s bassinet or incubator.
-Eye dressing or cotton balls can be firmly secured in placed by an infant mask.
-Check the dressings frequently to be certain they have not slipped or are causing corneal irritation.
-Assess skin turgor and intake and output to ensure that dehydration is not occurring.
-Monitor axillary temperature to prevent an infant from overheating under the bright lights.
-Monitor fluid intake and output (note signs of dehydration – reduced urine output, depressed fontanels, dry or warm skin with poor turgor, and sunken eyes.
-Assist with preparation and administration of exchange transfusion if needed.
Therapeutic Management
 Initiation of Early Feeding

Bilirubin is removed from the body by being incorporated into feces. Therefore, the sooner bowel eliminations begin, the sooner bilirubin removal begins. Early feeding (either breast milk or formula), therefore, stimulates bowel peristalsis and accomplishes this.  Phototherapy

– an infants liver’s processes little bilirubin in utero because the mother’s circulation does this for an infant. With birth, exposure to light apparently triggers the liver to assume this function. Additional light supplied by phototherapy appears to speed the conversion potential of the liver. In phototherapy, an infant is continuously exposed to specialized light such as quartz halogen. cool white daylight or special blue fluorescent light. The lights are placed 12-30 inches above the newborns bassinet or incubator. Specialized fiberotic light system incorporated into a fiberotic blanket also have been developed and are ideal for home care.
- Continues exposure to bright lights this way maybe harmful to the newborn’s retina, so the infant’s eye must always be covered while under bilirubin lights.
- Eye dressings or cotton balls can be firmly secured in placed by an infant mask.
- Check the dressings frequently to be certain they have not slipped or are causing corneal irritation. A constant concern is that suffocation from eye patches could occur.
- The stools of an infant under bilirubin lights are often bright green because of the excessive bilirubin that is excreted as the result of the therapy.
- Urine maybe dark -colored from urobilinogen formation.
- Asses skin turgor and intake and output to ensure that dehydration is not occurring .
- Monitor axillary temperature to prevent an infant from over heating under the bright lights.
- An infants receiving phototherapy should be removed from under the lights for feeding so that he or she continues to have interaction with the mother . remove the eye patches while the infant is with the mother to give an infant a period of visual stimulation.
- Explain to the parents the rationale of phototherapy. Exchange Transfusion

-before the procedure, the baby’s stomach is aspirated to minimized the risk of aspiration from the manipulation involved. The umbilical vein is catheterized as the sight for transfusion. The procedure involves alternatively withdrawing small amounts of blood (2 to 10 ml)of the infant’s blood and then replacing it with equal amount of donor blood.
-The blood is exchanged slowly to prevent alternating hypovolemia and hypervolemia. This can make an exchange transfusion a lengthy procedure of 1 to 3 hours. Automatic pumps are healthful to perform the exhausting repeated ritual. At the end of the procedure, using the last specimen of blood withdrawn, hematocrit, bilirubin, electrolytes,(specially calcium) glucose determination and blood culture are taken. Exchanged transfusion may need to be repeated because additional unconjugated bilirubin from tissue moves into the circulation after the initial exchange. During the Transfusion, carefully monitor the newborn’s heart rate, respirations and blood pressure. (because blood stored for transfusion contains Acid-Citrate-Dextrose (ACD), added to blood as an anticoagulant, which can lower blood calcium level and acidosis, calcium gluconate is given through the exchange catheter after each 100 ml of blood. If citrate-phosphate-dextrose was used as preservative hyperglycemia may occur during the transfusion from the dextrose in the preservative. This is followed by over production of insulin and hypoglycemia.
After the Transfusion, closely observe the infant for:
•Umbilical vessel bleeding
•Redness or inflammation of the cord suggests infection
•Report any changes in vital signs.
•Take and record a blood glucose determination at 1 hour after the procedure.
•Monitor bilirubin levels for 2 or 3 days after the transfusion to ensure the level of bilirubin is not rising again and that no further transfusion is necessary.
•Erythropoietin maybe administered to increase new blood cell growth and prevent extended anemia LABORATORY/ DIAGNOSTICS Laboratory Results

Blood type are done before a person gets a blood transfusion and to check a pregnant woman blood type. Human blood type by certain makers (called antigens) on the surface of red blood cells. Blood type may also be done to sec if two people are likely to be blood relatives. Name of patient B.F. Sex Age Date requested Male 2 day old ... small PATHOPHYSIOLOGY NURSING
CARE PLAN Nursing diagnosis: knowledge deficit related to lack of information of Jaundice

Medical Diagnosis: ABO INCOMPATIBILITY Patient name: Baby boy B.F
Age: 3 days old
Diagnosis: ABO Incompatibility Nursing diagnosis: Knowledge deficit related to lack of information of Phototherapy for infant

Medical Diagnosis: ABO INCOMPATIBILITY Short term goal: Within 8 hours of my shift the family or mother of the infant will gain knowledge about Phototherapy

Long term goal: After 8 hours of my shift the mother can now understand what is Phototherapy for she will now have enough knowledge regarding Phototherapy Nursing diagnosis: Impaired skin integrity related to yellowish discoloration of the skin secondary to hepatic jaundice

Medical Diagnosis: ABO INCOMPATIBILITY Short term goal: Within 8 hours of my shift baby will decrease breaks in for skin integrity

Long term goal: After 8 hours of my shift potential for skin integrity and discomfort was avoided Nursing diagnosis: Ineffective coping related to deficit in coping and ability behavior of the clients mother to address the problem secondary to the condition of her new born

Medical Diagnosis: ABO INCOMPATIBILITY
Short term goal: within 8 hours of my shift the mother will be able to cope up with the current situation of her new born

Long term goal: after 8 hours of my shift the mother was able to cope up with the current situation of her new born DRUG STUDY Risk Factors:
• Rh incompatibility
• ABO incompatibility Rh (-) woman
prepregnancy Pregnancy with
Rh(+) fetus Placental
Separation Maternal sensitization
to Rh(+) blood Maternal development
of anti-Rh(+) antibodies Next pregnancy
with Rh(+) fetus Maternal anti-Rh(+) antibodies
introduced into fetal circulation Attatchment of anti-Rh(+) antibody
to fetal Rh(+) red blood cells (RBCs) Fetus inherits blood group antigens (ABO antigens) Fetal blood gets into
mother’s circulation Mother makes antibodies;
blood group antigens Mother makes antibodies;
blood group antigens Antibodies cross placenta;
attack fetus RBCs Hemolysis of
Fetal RBC Hyperbilirubinemia Erythroblast Jaundice Enlarged liver/Spleen
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