What nursing interventions are required during phototherapy?

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phototherapy for nursing student

1. 1. PRESENTED BY:- Dharmendra Patel 1st Year M.Sc. Nursing Nootan College Of Nusing NootaN College of NusiNg PHototHeRaPY
2. 2. • Phototherapy has been used since 1958 for the treatment of neonatal hyperbilirubinaemia. It causes unconjugated bilirubin to be mobilised from the skin by structural isomerisation to a water soluble form (lumirubin) that can be excreted in the urine. • The aim of phototherapy is to decrease the level of unconjugated bilirubin in order to prevent acute bilirubin encephalopathy, hearing loss and kernicterus. INTRODUCTIONINTRODUCTION
3. 3. • Lamps emitting light between the wavelengths of 400 - 500 nanometres (peak at 460nm) are specifically used for administering phototherapy as bilirubin absorbs this wavelength of light. The light is visible blue light and contains no ultraviolet light. CONT…CONT…
4. 4. Phototherapy (light therapy) is a way of treating jaundice. Special lights help break down the bilirubin in your baby's skin so that it can be removed from his or her body. This lowers the bilirubin level in your baby's blood. DEFINITIONDEFINITION
5. 5. • To support the care of babies with hyperbilirubinemia. • To decrease infant serum bilirubin levels. • To maintain phototherapy treatment safely and effectively. • To minimize infant-maternal separation and facilitate breastfeeding. PURPOSEPURPOSE
6. 6. 1.Micro White Halogen lights They deliver light via a quartz halogen bulb and have a tendency to become quite hot so should not be positioned closer to the infant than the manufacturers recommendations of 52cm. The lights can continue to be bright despite having low irradiance levels. LIGHTS USED IN PHOTOTHERAPYLIGHTS USED IN PHOTOTHERAPY
7. 7. 2.Fluoro- 2 Blue and 2 White Fluorescent2.Fluoro- 2 Blue and 2 White Fluorescent lightslights The fluorescent blue tubes must have the serial number F20T12/BB or TL52/20W to be special phototherapy lights. Blue light is the most effective light for reducing the bilirubin.
8. 8. 3.Ohmeda Biliblanket - Blue Halogen light3.Ohmeda Biliblanket - Blue Halogen light This uses a halogen bulb directed into a fiberoptic mat. There is a filter that removes the ultraviolet and infrared components and the eventual light is a blue-green colour. Biliblankets are not to be used on infants less than 28 weeks gestation or infants with broken or reduced skin integrity.
9. 9. 4. Medela Bilibed Blue Fluorescent light4. Medela Bilibed Blue Fluorescent light A blue fluorescent tube is fitted into a plastic crib with a stretched plastic cover over the top for the baby to lie on
10. 10. TYPES OF PHOTOTHERAPYTYPES OF PHOTOTHERAPY UNITUNIT 1. Single surface unit. 2. Double surface unit. 3. Triple surface unit.
11. 11. IndicationsIndications • Localized psoriasis - mainly on chronic plaques. • Atopic dermatitis. • Folliculitis. • Mycosis fungoides. • Palmoplantar pustulosis. • Pityriasis alba. • Leukoderma.
12. 12. • Photosensitive conditions such as lupus erythematosus and xeroderma pigmentosum. • History of cutaneous malignancies. • Patient on arsenic or ionizing radiation therapy Patient on photosensitizing drugs . ContraindicationsContraindications
13. 13. Phototherapy TechniquePhototherapy Technique Perform hand wash. Place baby naked in cradle or incubator. Fix eye shades & genital area. Keep baby at least 45 cm from lights,if using closer monitor temperature of baby. Start phototherapy. Frequent extra breast feeding every 2 hourly.
14. 14.  Turn baby after each feed.  Temperature record 2 to 4 hourly.  Weight record- daily.  Monitor urine frequency.  Monitor bilirubin level. CONT…CONT…
15. 15. Mechanism of phototherapyMechanism of phototherapy Blue-green light in the range of 460-490 nm is most effective for phototherapy. The absorption of light by the normal bilirubin (4Z,15Z-bilirubin) generates configuration isomers, structural isomers, and photooxidation products. The 2 principal photoisomers formed in humans are shown. Configurational isomerization is reversible and much faster than structural isomerization.
16. 16. Structural isomerization is slow and irreversible. Photooxidation occurs more slowly than both configurational and structural isomerization. Photooxidation products are excreted mainly in urine. CONT…CONT…
17. 17. Nursing care of phototherapyNursing care of phototherapy Skin careSkin care • Infants in isolettes who are < 1200gm are generally nursed without a nappy on an absorbent sheet protector. (In cohelp) • Infants in isolettes who are > 1200gm may be nursed with a nappy on if the bilirubin is not rising rapidly. • If intensive phototherapy is required then the nappy should be removed.
18. 18. • Keep the infant clean and dry. • Clean only with water. Do not apply oils or creams to the exposed skin. • Eucerin has been proven to be safe for use when the infant is receiving phototherapy. • Infants nursed in nappies where the buttocks are not exposed may have zinc and castor oil applied to areas of skin excoriation. CONT…CONT…
19. 19. Observations All infants in Newborn Care receiving phototherapy should have a temperature, pulse and respiration rate documented 4 hourly & prevent dehydration. If an infant requires continuous cardio- respiratory monitoring for other reasons, then, this should continue whilst under phototherapy.
20. 20. Eye care • Eye pads are required for the infants comfort if overhead white or blue fluorescent lights are used :  Size N720 (micro) if < 1500g  Size N721 (small) if 1500 - 2500g  Size N722 (large) if > 2500g • Eye pads should be removed 4 hourly and eye cares attended with normal saline. • There have never been human studies showing that retinal damage occurs from with phototherapy.
21. 21. Fluid RequirementsFluid Requirements I.I. All InfantsAll Infants Accurately document fluid intake (oral orAccurately document fluid intake (oral or intravenous) and output.intravenous) and output. Urinalysis and specific gravity should beUrinalysis and specific gravity should be checked 8 hourly.checked 8 hourly. Assess and record stoolsAssess and record stools..
22. 22. II. Term Infants Breast fed infants should continue on demand breast feeds. Bottle fed infants should be fed on demand 4-6th hourly. CONT…CONT…
23. 23. III. Preterm Infants The daily fluid rate may need to be increased by 10ml-15ml/kg/day to prevent dehydration. CONT…CONT…
24. 24. When to stop phototherapy Term babies: Day 3: Stop at the discretion of the consultant as the jaundice is likely to be pathological. Day 4: Stop phototherapy when the SBR is 280 mmol/L for term infants with physiological jaundice. Premature babies: Stop at the discretion of the consultant
25. 25. Side effects of phototherapySide effects of phototherapy Increased insensible water loss. Loose stools. Skin rash. Bronze baby syndrome. Hyperthermia . Upsets maternal baby interaction. May result in hypocalcemia.

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