How Phototherapy Works

Introduction:
On 28 of February and 1 of march as a requirement in the maternal health nursing course I was
assigned in NICU unit 1 which is neonatal intensive care unit . This ward is for baby who has a
critical condition or immature baby. It is critical of three dependency witch is low dependency,
intermediate dependency and high dependency. Most case of the babies in the NICU are premature,
infections, cardiac problems and breathing problems. The place is very privacy the parents only can
stay with their baby specially the mother to take care for her baby or to feed her baby . They discharge
the baby when the condition is stable and the weight will be 1.7 kg .
phototherapy :
phototherapy refers to the use of light to convert bilirubin molecules in the body into water soluble
isomers that can be excreted by the body , Also it is the use of visible light for the treatment of
hyperbilirubinemia, or jaundice, in the newborn
HOW PHOTOTHERAPY WORKS :
Phototherapy converts bilirubin that is present in the superficial capillaries and interstitial spaces of
the skin and subcutaneous tissues to water-soluble isomers that are excretable without further
metabolism by the liver . Neonatal jaundice expert Maisels suggests that phototherapy is much like a
percutaneous drug.When phototherapy illuminates the skin, an infusion of discrete photons of energy
are absorbed by bilirubin much like a drug molecule binds to a receptor. Bilirubin molecules in
lightexposed skin undergo relatively quick photo- chemical reactions configurational ,structural
isomerization, and photooxidation to form nontoxic, excretable isomers. These bilirubin isomers have
different shapes than the native isomer, are more polar, and can be excreted from the liver into the bile
without undergoing conjugation or requiring special transport for their excretion . Urinary and
gastrointestinal elimination remain important to the process of reducing the bilirubin load.
The benefit of phototherapy: is to treat newborn jaundice .
NURSING CARE WHEN RECEIVING PHOTOTHERAPY:

Provide Eye Protection : Opaque eye shields must be used during phototherapy to protect the
infant’s eyes from retinal damage
Assess Skin Exposure : The largest surface area of the infant’s body, the trunk, should be positioned
in the center of the light, where irradiance is highest. In most cases, it is not necessary to remove
diapers or boundary materials used for postural support while providing phototherapy
Proper Positioning :Frequent turning to expose different areas of skin has not been shown to improve
the effectiveness of conventional (single) phototherapy
Hydration : Several studies have documented an increase in transepidermal water loss during
phototherapy. Excessive fluid losses via the skin are of particular concern in the smallest, most
immature infants during the first week of life so we give extra fluid as 15 ml per kg to prevent
dehydration
Monitoring Bilirubin Levels : The most significant decline in bilirubin level occurs in the first 4 to 6
hours after initiating phototherapy.
The cases :
I was observing 2 babies and helping the nurse in doing baby care.
The first baby was a baby girl, the baby was with osteogenesis imperfecta ( skeletal dysplasia ) , baby
Wight is 2.55 kg . first in morning care we change her clothes and her diapers and clean her , then we
start to feed her by bottle . also we monitoring her BP and assessing her heart rate and rhythm as a
part of nursing care , skeletal survey x-ray is done there is multible fracture . and the baby is very
crrying because the pain . and the doctor decided for her to discharge.
The second baby single live birth and he diagnosed with mild jaundiced , hypoglycemia ,baby was a
baby boy, , baby Wight is 2.3 kg . first in morning care we change his clothes and his diapers and
clean him , then we start to feed him by bottle . also we monitoring his BP and assessing his heart
rate and rhythm as a part of nursing care ,the nurse give him IV medication which is ( benzyl
penicillin ) and ( gentamycin sulphat inj ) and I helped her . and she is under phototherapy.
The nursing implementation on that is to take care of the baby during each shift and proving support
for the families as well. However the nurse take the important role in been the first care provider. And
to understand the families on how also they should take care of them self because of the anxiety they
got if they have a critical ill baby.
Reflection:
The birth of baby is not sickness but it is a natural thing in the life. There are physical and emotional
change for mother and baby. Babies who are admitted in NICU are sick and have many problems.
There many factors or reasons to admitted babies’ maternal factors: Prematurity Sepsis or infection,
Hypoglycemia, Perinatal depression and maternal chorioamnionitis. It was a wonderful experiences I
see nurse their take care of the baby, feed baby and do hand wash before do anything to prevent
infection because babies have low immunity. However I feel sad because I see babies in different
condition and parents who are sad and worried about their baby, the nurses give parents emotional
support.
References:
https://nursing.ceconnection.com/ovidfiles/00149525-201110001-00003.pdf
https://acutecaretesting.org/en/articles/glucose-and-lactate-in-neonatology-clinical-focus/
https://acutecaretesting.org/en/articles/glucose-and-lactate-in-neonatology-clinical-focus/
Sultanate of Oman
Ministry of health
Oman college of health sciences
Report for:
NICUThe Royal Hospital
Maram shinain Al-yahyaei

Group 1
BSN626

How Phototherapy Works

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How Phototherapy Works

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Introduction:

NURSING CARE WHEN RECEIVING PHOTOTHERAPY:

NICUThe Royal Hospital

Maram shinain Al-yahyaei

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