Neonatal Themoregaulation

In my current placement I am working alongside a team of Transitional care nurses. Transitional care is support given to mothers as primary care provider for their babies. It requires extra care for pre-term and sick babies with neonatal problems. The transitional care is based on a postnatal ward rather that a neonatal unit like SCUBU. This service allows a smooth passage to be discharge home from the neonatal unit for sick or pre-term babies.

On Thursday 23th March, I was allocated a baby who was under the Transitional care team because of jaundice. Jaundice refers to the yellowish coloration on the skin and Sclera (white part of the eyes). This is a medical condition in new-borns that require urgent medical treatment.

My role as a student nurse, who’s patients has jaundice was to ensure all vital signs were within normal parameter. For example; Heart Rate should be between 120-160 beats per minute. In some cases it can vary between 110-120. Respiratory rate should be between 40-60 breaths per-minute. And temperature should be between 36.5-37.5 degrees. These vital signs are to be done every 4 hours. Before I entered the bay my patient was in, I put my Personal Protective Equipment’s on. This requires Gloves, Apron and Face mask. I introduce myself to my patient and explain to the patient’s guardian what i will be doing and ask for consent. While checking my patient’s vital signs, I was also doing my A-E assessment. This assessment involves checking Airway, Breathing, Circulation, Disability and Exposure. During this assessment everything was within normal parameter, however I did notice baby was yellowish in colour. I told my patient’s Mother and also my Practice supervisor my findings. I also document my findings onto the trust patients record (Cerner).

My Supervisor, performed a Transcutaneous Bilirubinometer as I was not as confident to perform the check. The Transcutaneous Bilirubinometer also known as TCB is used to measure the bilirubin levels. The TCB is pressed on the baby’s chest 3 times. On the third press some numbers will appear on the meter indicating the estimate level of bilirubin. Once my supervisor performed the TCB on the patient, it was then plotted on a graph. The Treatment Threshold Graph measures the threshold of the bilirubin level according to the baby’s gestation (in whole weeks) for example infant born at 35+2 would use a 35 week graph and day 0 is the day of birth. Also if the numbers are above the line depending on gestation or above 250mml, the baby will automatically receive a blood test.

When looking at the graph, my patient’s bilirubin level was a few boxes above the treatment line. Myself and my supervisor informed the doctor. Th doctor advised us to do a SBR test to get an accurate level of the bilirubin. An SBR also known as serum bilirubin level. This is a blood test to measure the level of bilirubin in the baby’s blood.

This was then explain to my patient’s parents. I asked for consent before my supervisor did the SBR. Once the blood was collected, it was sent to the laboratory.

Within the hour the blood results came back. The results was plotted on to the graph. The levels showed that the baby needed phototherapy treatment. Phototherapy is a treatment that involves light-sensitive medicine and a light source to destroy abnormal cells.

myself and my supervisor went to the patient’s parents to explain the blood test result, the treatment which would be give to baby and ask for consent. Once this was all done I got the items needed for the phototherapy. This involves therapy light, bili-blank and heated mattress. I stripped baby down leaving the nappy on and put an eye mask on the baby. I also created a nest around the baby so that the baby can be comfortable and settled. I set the heated mattress to 38 degrees, so baby can stay warm.

I also reassured the parents and told them to call me or my supervisor for any support they may need. The parents were really grateful.