A Study To Assess The Effectiveness Of Informative Booklet On Knowledge Regarding Care Of Newborn During Phototherapy Among Nursing Students At Selected Institution Of Hosangabad (M.P.)

Abstract

Introduction Phototherapy is one of the key procedures in the neonatal care setting. Most infants with physiologic jaundice do not have elevated bilirubin levels that require treatment. Phototherapy is an effective treatment to lower serum bilirubin levels in severe jaundice. Jaundice is an accumulation of bilirubin in the blood that is formed by the breakdown of red blood cells, naturally removed by the liver, and excreted in feces and urine. rises. Physiologic jaundice in newborns usually appears after 30 hours. Serum bilirubin peaks (up to 12 mg/dl) are reached on day 4 or 5, and jaundice resolves by days 7-14. Resolution within 14 days to 1 month (Wong's, 2006) Jaundice appears on the first day of life and is common in newborns, accounting for approximately 50-75% of this period, and all infants have higher plasma bilirubin than normal adults. It appears 72 to 96 hours after birth and usually disappears 1 to 2 weeks after birth. In term newborns, bilirubin levels rise for a few days, then reach high levels and then decline by the end of the first week of life. Premature babies may take more time to resolve as their normal elimination mechanisms mature (Paruldutta, 2009). Hyperbilirubinemia refers to high serum bilirubin levels and treatment is based on elevated bilirubin levels. Phototherapy is the most common treatment for neonatal jaundice. Neonatal hyperbilirubinemia is a common problem in neonates with clinical manifestations of jaundice. Hyperbilirubinemia occurs in approximately 25-50% of newborns and in a higher proportion of preterm infants. Approximately 3% of babies born in Indian hospitals show significant jaundice levels above 15 mg/dL (Meharban Singh, 2009). Since the early 1970s, phototherapy has been used primarily to treat jaundice. Phototherapy is a non-invasive way to lower bilirubin levels by exposing your baby's skin to blue or cool white light. Light converts bilirubin into non-toxic, water-soluble compounds that are excreted in urine and feces. In addition to diapers, babies should be undressed to protect their gonads. To prevent colds, it is necessary to use external means of maintaining body temperature (Guptesuraj). Obtain vital signs at least every 4 hours to monitor the baby's temperature. The eyes are covered to prevent damage to the retina. Place the baby under the phototherapy lamp at a distance of 45 cm from her and reposition the baby every 2 hours or after each feeding to maximize exposure. Phototherapy was discontinued and bilirubin returned to safe levels as planned. During phototherapy, neonates should be cared for appropriately to improve efficacy and minimize complications such as green stools, rashes, and electrolyte disturbances (Marilyn J. Huckleberry, 2005).). It has become the most widely used tool for the treatment of unconjugated pathological hyperbilirubinemia. Bilirubin exhibits maximum light absorption between 420 and 490 nanometers. Under light sources in this range, it is oxidized to biliverdin and excreted in bile or, to a lesser extent, urine. Phototherapy techniques are now generally considered superior to white light, but plain sunlight is also useful. Fluorescent tubes are very attractive as efficient sources of blue light. These tubes can be attached to reflectors inside the frame. The infant was placed 18 inches below her in the light. An exposure time of 24-48 hours is sufficient to reduce serum bilirubin levels to safe limits. Serum bilirubin assessment was performed every 12 hours. Phototherapy discontinuation was indicated if results were less than 11 gm/dl from two consecutive doses 24 hours apart (Wong's, 2006) Phototherapy is a simple, effective, inexpensive and acceptable method for lowering bilirubin in newborns. During phototherapy, bilirubin molecules in peripheral tissues are activated to biliverdin by absorbing photons. Accurate charting is another important nursing responsibility it includes times that phototherapy is started and stopped, proper shielding of the eyes, types of fluorescent lamps number of lamps , distance between surface of lamps and infant , use of phototherapy in combination with incubator or open bassinet , photometer measurement of light intensity, occurrence of side effects. (Paruldutta, 2009). Neonatal hyperbilirubinemia is the most common cause for hospital re admission in the first weeks of life. Bilirubin induced complication can be prevented by instituting a neonatal jaundice protocol to identify infants at risk for significant hyperbilirubinemia, by ensuring adequate parental education and preparedness, and by implementing a good neonatal tracking system for follow-up care. Hyperbirubinemia is easily treated with phototherapy, which can be administered at home in selected infants (SurajGupte, 2009). Nurses play a important role in caring the newborn during phototherapy. Nurses are the ones with the newborn for 24 hours in NICU. So, I felt that, there is need to provide knowledge regarding care of newborn during phototherapy among future nurses and decided to administer structured teaching programme on care of newborn during phototherapy (Wong's, 2006).