Question

The nurse is assigned to care for an infant with physiologic jaundice. Which action by the nurse would facilitate elimination of the bilirubin? A. Increasing the infant's fluid intake B. Maintaining the infant's body temperature at \(98.6^{\circ} \mathrm{F}\) C. Minimizing tactile stimulation D. Decreasing caloric intake

Short answer

Answer: A. Increasing the infant's fluid intake.

Step-by-step solution

Understanding physiologic jaundice and bilirubin elimination

Physiologic jaundice is a common, temporary, and harmless condition that affects newborns, usually within the first week of life. It occurs due to an elevation in serum bilirubin, which causes a yellowing of the skin. Bilirubin is a waste product that results from the breakdown of red blood cells. It is eliminated from the body through the liver, which conjugates bilirubin into a water-soluble form that can then be excreted via urine and feces.

Analyze each option

A. Increasing the infant's fluid intake: Increased fluid intake can help facilitate the elimination of waste products, including bilirubin, by promoting urine production. This option seems like a plausible choice. B. Maintaining the infant's body temperature at \(98.6^{\circ} \mathrm{F}\): Although maintaining a stable body temperature is essential for overall infant health, it is not directly related to the elimination of bilirubin. This option is unlikely. C. Minimizing tactile stimulation: Minimizing tactile stimulation prevents distress and conserves energy for the infant, but it doesn't directly aid in the elimination of bilirubin. Unlikely to be the correct option. D. Decreasing caloric intake: Adequate caloric intake is essential for the infant's growth and development. Decreasing caloric intake would not help with bilirubin elimination and could be harmful to the infant. This option is not correct.

Choose the correct answer

Based on the analysis of each option, the choice that would best facilitate the elimination of bilirubin in an infant with physiologic jaundice is: A. Increasing the infant's fluid intake.

Key concepts

Bilirubin Elimination

Understanding the process of bilirubin elimination in newborns is crucial, especially when managing the common condition of physiologic jaundice. Bilirubin is a yellowish substance produced during the normal breakdown of red blood cells. Newborns have a high turn-over of red blood cells, leading to increased bilirubin production. Since the liver of a newborn is still maturing, it may not be efficient enough to process all the bilirubin, resulting in a buildup that causes the skin and whites of the eyes to appear yellow.

To facilitate bilirubin elimination, promoting liver function and enhancing the excretion process is vital. This can be done through increasing the infant's fluid intake, as fluids help to dilute bilirubin in the bloodstream and encourage its passage through the liver and eventual excretion in urine and feces. In addition to hydration, other treatments like phototherapy utilize light to convert bilirubin into a form that can be eliminated more easily. Careful monitoring of bilirubin levels is necessary to ensure they decrease to normal ranges in a safe and timely manner.

Newborn Care

Proper newborn care is essential to mitigate and manage various conditions, including physiological jaundice. Maintaining the appropriate environment for a newborn is a multipronged approach that encompasses various aspects like temperature regulation. Infants are sensitive to temperature changes and can lose body heat quickly; thus, keeping the infant at a neutral thermal environment, typically around 98.6°F, is important for thermoregulation and overall well-being but does not directly impact bilirubin levels.

Newborn care also involves ensuring sufficient nutrition. Calories are necessary for growth, development, and the energy required for the breakdown and elimination of bilirubin. Fluids are part of nutritional care but from a perspective of supporting bilirubin elimination, increasing fluid intake specifically aids in getting rid of excess bilirubin. Therefore, while routine care plays a foundational role, special attention to fluid levels is particularly pertinent when addressing increased bilirubin.

Nursing Interventions

Effective nursing interventions are imperative to address and prevent complications arising from conditions such as physiological jaundice. First and foremost, monitoring the infant's bilirubin levels through regular testing ensures timely treatment interventions. In the context of facilitating bilirubin elimination, nurses play a vital role in increasing hydration levels and possibly implementing phototherapy, if prescribed by a physician.

In addition to these measures, nursing interventions include educating parents about the importance of proper feeding practices and the need to observe any changes in their infant's color or behavior that may indicate increasing jaundice. Moreover, it is necessary to create a calm environment by minimizing tactile stimulation; yet, this action does not have a direct impact on bilirubin elimination. Hence, the strategic focus should be on increasing fluid intake to improve the infant's condition efficiently and safely.