Hyperbilirubinemia Care Plan : Assessment, Nursing Diagnosis and Interventions (NIC NOC)
Hyperbilirubinemia is a clinical condition characterized by elevated levels of bilirubin in the blood. This condition is commonly observed in newborns, especially within the first week of life. When bilirubin levels exceed normal thresholds, the skin and sclera may appear yellowish, a condition known as jaundice. While mild hyperbilirubinemia is common and usually resolves naturally, severe untreated cases can lead to neurological complications such as Kernicterus, which may cause long-term cognitive and motor impairments.
A clear and structured care plan is essential for nurses to assess, diagnose, and manage hyperbilirubinemia effectively. This article provides a complete Hyperbilirubinemia Nursing Care Plan including Assessment, Nursing Diagnosis, Nursing Interventions (NIC), Nursing Outcomes (NOC), along with supportive references.
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Understanding Hyperbilirubinemia
Bilirubin is a yellow pigment produced from the breakdown of red blood cells. The liver plays an essential role in converting bilirubin into a form that can be excreted. Newborns often have immature liver function, leading to increased bilirubin levels.
Causes of Hyperbilirubinemia
- Physiological jaundice (immature liver)
- Breastfeeding or breast milk jaundice
- Hemolytic disease (such as ABO or Rh incompatibility)
- Prematurity
- Genetic disorders (e.g., G6PD deficiency)
Common Clinical Manifestations
- Yellow discoloration of skin and sclera
- Lethargy
- Poor feeding
- High-pitched crying
- Hypotonia or hypertonia
Nursing Assessment for Hyperbilirubinemia
The initial nursing assessment should include both subjective and objective data collection:
Subjective Data
- Mother reports baby appears “yellowish”
- History of inadequate breastfeeding or poor latch
- Maternal or family history of blood disorders
- History of bruising during birth
Objective Data
- Yellowing of skin (face, chest, abdomen, limbs) and sclera
- Serum bilirubin level above normal range
- Positive Coombs test (if hemolytic disease suspected)
- Vital signs monitoring (watch for fever, respiratory changes)
- Weight loss >10% from birth weight
Possible Nursing Diagnosis
- Risk for Injury (Kernicterus) related to elevated serum bilirubin levels.
- Ineffective Breastfeeding related to poor latch or insufficient milk intake.
- Imbalanced Nutrition: Less than Body Requirements related to feeding difficulties.
- Family Knowledge Deficit related to lack of understanding about jaundice management.
Nursing Outcomes (NOC)
| NOC Outcome | Indicators |
|---|---|
| Neonatal Jaundice Severity | Reduction in bilirubin level, improved skin tone, improved feeding |
| Nutritional Status: Infant | Stable weight gain, effective breastfeeding |
| Parent Knowledge: Infant Care | Parents demonstrate understanding of jaundice and treatment |
Nursing Interventions (NIC) and Rationales
1. Phototherapy Administration (NIC)
- Prepare and initiate phototherapy as prescribed.
- Ensure infant’s eyes are protected during phototherapy.
- Monitor skin integrity and hydration status.
- Reassess bilirubin levels as scheduled.
Rationale: Phototherapy converts bilirubin into a form that can be excreted without liver conjugation.
2. Promote Effective Feeding (NIC)
- Encourage breastfeeding 8–12 times per day.
- Assist with latch and positioning.
- Monitor wet and dirty diaper output.
Rationale: Increased feeding promotes bilirubin elimination via stool.
3. Parent Education (NIC)
- Explain causes and normal progression of newborn jaundice.
- Teach signs of worsening jaundice (poor feeding, drowsiness).
- Encourage follow-up serum bilirubin testing.
Rationale: Informed parents are better able to participate in early detection and timely treatment.
4. Risk Reduction for Kernicterus (NIC)
- Monitor neurological status: reflexes, tone, alertness.
- Report rapidly increasing bilirubin levels to physician.
- Prepare for exchange transfusion if ordered.
Rationale: Early recognition prevents irreversible brain damage.
Example Nursing Care Plan (Summary Table)
| Nursing Diagnosis | NOC Goals | NIC Interventions |
|---|---|---|
| Risk for Injury related to high bilirubin level | Infant bilirubin remains within safe range | Phototherapy, Bilirubin Monitoring, Neurologic Assessment |
| Ineffective Breastfeeding | Infant shows adequate latch and weight gain | Feeding Support, Lactation Counseling |
| Knowledge Deficit (Parents) | Parents understand jaundice care instructions | Health Education, Discharge Teaching |
Conclusion
Hyperbilirubinemia is a common condition in neonates, but with proper assessment and timely nursing interventions, complications can be prevented. Nurses play a critical role in monitoring bilirubin levels, supporting feeding, educating parents, and implementing phototherapy when needed. A structured care plan ensures effective treatment and promotes safe infant recovery.
References
- American Academy of Pediatrics (AAP). Management of Hyperbilirubinemia in the Newborn Infant. Pediatrics.
- Maisels MJ, Bhutani VK. Neonatal Jaundice and Kernicterus. New England Journal of Medicine.
- Merenstein & Gardner. Handbook of Neonatal Intensive Care.