Photo therapy:
It is non invasive, inexpensive procedure and
easy method of degradation of unconjugated bilirubin by photo-oxidation.
MECHANISM OF ACTION:
Geometric photoisomerization:The
light waves convert the toxic bilirubin into water soluble non- toxic
(lumirubin) form which is easily excreted from the blood in the bile, stool and
urine by the process of photoisomerization . It enhances hepatic excretion of
unconjugated bilirubin to the intestinal lumen.
Oxidation mechanism resulting in
colorless buproducts and excreted by liver and kidney without need for
conjugation. This is the least important mechanism.
Converting bilirubin to lumirubin
through structural isomerization. Which can be excreted into the bile without
the need for further hepatic conjugation.
INDICATION OF
PHOTOTHERAPY:
Infants weighing 1500g is at
level of 5 to 8 mg/dl.
For those weighing
1500 to 1999g level\s of 8to 12mg/dl
For those weighing 2000 to
2499g, level of 11 to 14 mg/dl.
Prophylactic treatment of low
birth weight baby, bruised babiesand preterm babies.
TECHNIQUES OF PHOTOTHERAPY:
1. Blue light is more effective
for phototherapy. It interferes with observation of skin color of the baby.
2. White day light lamps are
also effective. A combination of white and blue lamps are prefered.
3. The wave length of the light
should have in the range of 420 to 600 nm for maximum absorbtion of skin color
of the baby.
4. A baby care unit with to 8 light source or tube lights can be used
which should be covered with plastic sheet or flexi glass. Light source is
flexed over crib or incubator or it can be portable type.
5. A naked infant is lying on a
fiberoptic blanket under the light source at a distance of about 45cm from the
skin of the baby.
6. It can be reduced to 15 to
20cm for intensive phototherapy.
7. Best result occur with in
the firt 24 to 48 hours of treatment.
TYPES OF PHOTOTHERAPY:
1. Single side phototherapy
2. Double side phototherapy
Depending upon the severity of
the condition type of phototherapy will be selected.
AN ALTERNATIVE TO TRAITIONAL PHOTOTHERAPY:
Bililight is the fiberoptic
blanket or panal. Which consist of light generating illuminator, a bundle of
plastic fibers affixed to a panel that distributes the energy and a soft,
disposable, light permeable cover to protect the infant. The blanket delivers
therapeutic light consistently and continuously to the infant and achieve
photoisomerization as conventionally phototherapy. The fiberoptic blanket is
especially suited for home phototherapy.
WHEN TO DISCONTINUE THE PTHOTOTHERAPY:
When
serum bilirubin level are less than 10mg/dl for two times.
Intensive
phototherapy usually reduce 1 to 2 mg/dl of serum bilirubin within 4 to 6 hours
of exposure.
NURSING CARE:
NURSING
ACTION
|
RATIONALE
|
1.
Assess the need For phototherapy. Check level of bilirubin and skin color
2.
Get consent from the parents
Feed
the baby before placing on the phototherapy
3.
Check vitals and weight of the baby
4.
Cover the eye of the baby
5.
Cover the genetalia with diaper
6.
Position the child every 2 hours or after each feed.
7.
Temperature should be recorded every 2 hourly
8.
More frequent breast feeding should be encouraged
9.
Extra fluids should be administered through IV infusion or NG tube feeding.
10.
Baby weight should be recoded once in a day.
11.
Switch off the light every 2 hours
12.
Constant supervision should be made for urine, stool, skin changes (cyanosis,
pallor, and jaundice) and behavioral changes.
13.
Serum bilirubin level to be estimated
every 12 hours.
14.
Maintain records of frequency, length, duration of phototherapy and intake
out put chart.
|
To
know the indication for phototherapy
For
legal safeguard
To
prevent hypoglycemia and
to
know whether ptototherapy is inducing
hypothermia or any other condition.and to determine dehydration.
To
prevent retinal damage.
To
prevent gonadal damage.
For
maximum exposure to light.
To
determine hypothermia or hyperthermia.
To
prevent dehydration
To
prevent dehydration
To
calculate requirement of IV fluids and caloric.
To
prevent hyperthermia.
To
note for improvement or compication
To
terminate the phototherapy.
To
make evaluation
|
COMPLICATION OF PHOTOTHERAPY:
I.Short term complication:
Dehydration
Hypothermia
Hyperthermia
Loose
stool or green stool
Bronze
baby syndrome
Electric
shock
Skin
rash.
Hypocalcemia
II. Long term complication:
Disturbances
of endocrine
Sexual
maturation
Retinal
damage
Skin
cancer
BIBLIOGRAPHY:
Datta Parul (2007) “Pediatric
Nursing” J.B. medical publication, new
Delhi , Pp-100
Ghai .O.P (2004) “Essential
Pediatrics”, 6th edition, CSB publishers and distributors, Pp-
172-173
Wong’s( 2005) , “ Essentials of
Pediatric Nursing” 7th edition, Elsevier publication, New Delhi, Pp-
264 to 267.
Nicely Described the Points for Photherapy Units
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