FIRST ASIA INSTITUTE OF TECHNOLOGY AND HUMANITIES

COLLEGE OF NURSING

OLIGOHYDRAMNIOS

PREPARED BY:
Casapao, Jennalyn D.
BSN-IV

January 25, 2017

ACKNOWLEDGEMENT

First, I would like to thank the Almighty God for giving me the strength and
resources to finish this case study. This would not be possible without His
guidance all throughout the study.
I also want to acknowledge the support and encouragement of the entire
faculty and staff of First Asia Institute of Technology and Humanities, College of
Nursing while making this study.
I also want to extend my gratitude to my clinical instructor Mrs. Maribel
Esguerra, RN, MAN, for giving me the opportunity to acquire the case in the
Station II OB ward together with the entire staff of Batangas Medical Center.
Lastly, I would like to recognize my parents and families for the financial
assistance and unending love and support.

TABLE OF CONTENTS
I

INTRODUCTION
A Description of the case---------------------------------------------------------3
B Scope and Limitation -----------------------------------------------------------7
C Background of the Study ------------------------------------------------------8
D Significance of the Study-------------------------------------------------------8
E Objectives--------------------------------------------------------------------------9

II

PRESENTATION OF THE CLIET

A Patients Profile -----------------------------------------------------------------10
B Patients History ----------------------------------------------------------------12
C Patterns of Functioning-------------------------------------------------------15
D Physical Assessment ---------------------------------------------------------20

III

CLINICAL DISCUSSION
A Anatomy and Physiology ----------------------------------------------------29
B Pathophysiology ---------------------------------------------------------------32
C Laboratory Results ------------------------------------------------------------33
D Course in the Ward -----------------------------------------------------------37
E Prioritization of the Problem-------------------------------------------------38
F Nursing Care Plan ------------------------------------------------------------39
G Drug Study ----------------------------------------------------------------------43
3

H Discharge Plan ----------------------------------------------------------------46

I

I.

Bibliography --------------------------------------------------------------------48

INTRODUCTION
A. Description of the case
Patient CAL is a gravid 1 para 1 mother delivered to a live baby girl

through cesarean section with diagnosis of oligohydramnios. Definition of

Oligohydramnios (Source?).
what are the possible risk factors for oligohydramnios? (Source)
etiology or what are the causes? (source)
Why is it indicated for oligohydramnios to be cesearan? (source)
Complications of Oligohydramnios? (Source)
Statistics
a. Hospital?
b. Local?
c. National?
d. International?
Local data
Batangas

National data
Philippines
International data
World
Morbidity/Mortality
B. Scope and Limitation
The case study was done during the clinical experience of student-nurse
at the Station II OB Ward specific to CS Ward of Batangas Medical Center on
January 23 and 24, 2017. She was given an opportunity by their clinical instructor
and hospital staff to select a case and perform thorough assessment to the
patient to gather all the needed details for the study. She interviewed the patient
and gathered additional information using the medical chart with the permission
of the staff on-duty.
This study covers and focuses on the brief discussion of the disease and
its causes, manifestations, and proper treatment; a pathophysiology presented
via schematic diagram format of oligohydramnios; a drug study of medications
prescribed to the patient; nursing care plans which would present nursing
analysis, diagnosis, plan and appropriate interventions that would aid in recovery
of the patient; and discharge plan which presents follow-up care and treatment
after confinement.
C. Background of the Study
5

The student-nurse had their clinical duty in Station II OB Ward on

January 3 to 6, January 23 to 27, February 13 to 17, February 27, 28, March 1 to
3, March 6 to 9 and March 13 from 7:00 am to 3:00 pm. On January 23, she
handled a 20 years old G1P1 post-cesarean section mother admitted at CS Ward
on January 21, 1:30 am after the operation.
The student-nurse wanted to broaden her knowledge on how to take care
of a patient having this type of case. This has been chosen to better understand
the disease, its nature and appropriate nursing interventions that may contribute
to patients recovery. This will also serve as an instrument to improve and
broaden her knowledge and skills regarding Maternal and Child Nursing. As a
fourth year student, she believes that this case is very helpful to challenge her
skills in connecting relevant details of the disease for actual patient care.
D. Significance of the Study
This study is done for the benefits of the patient this study hopes to be
most beneficial to the patient as the core purpose of this is to aid in prompt and
successful client recovery; and of the nursing students this study presents
various observations and nursing interventions upon handling the client.

E. Objectives
General Objective

This case study aims to present to the readers the nature of

oligohydramnios. It also encompasses the proper approach in a patient with this
kind of disease.
Specific Objectives
To improve knowledge on:

the fundamental information about oligohydramnios including its risk

factors, etiology, signs and symptoms, and treatment; and

the pathophysiology of the disease.

To enhance skills on:

the appropriate approach to a patient undergoing systemic changes

and adaptation;
formulating nursing care plans and independent nursing interventions

to care for fully dependent patient; and

different types of medical treatment necessary for oligohydramnios.

To modify attitude on:

II.

caring a patient post-cesarean section; and

confidence in managing patients with this kind of condition.

PRESENTATION OF THE CLIENT

A. Patients Profile

The patients profile provides demographics that may be linked to health status.
Patients Name:

CAD

Age:

20 years old

Address:

Calamba, Laguna

Date of Birth:

October 25, 1996

Place of Birth:

Calamba, Laguna

Hospital Number:

254082

Gender:

Female

Nationality:

Filipino

Religion:

Roman Catholic

Status:

Single

LMP*:

April 27

EDC*:

January 12

*LMP Last Menstrual Period

*EDC Expected Date of Confinement

Clinical Admitting Data
Date of Admission:

January 20, 2017

Time of admission:

11:49 pm

Hospital:

Batangas Medical Center

Admitting Physician:

M.M.A.T., M.D

Admitting Diagnosis:

Gravida 1 Para 0 Pregnancy Uterine 41 1/7 weeks

age of gestation Cephalic in Beginning Labor
Oligohydramnios

Post-operative Diagnosis: G1P1 (1001) Pregnancy Uterine delivered term

cephalic to a live baby girl at 1:30 pm
Procedure:

Primary Low Segment Cesarean Section

B. Patients History
The health history is usually the first step of patient assessment. It is the
collection of subjective information on the patients health status from the well or
ill patient and from other sources. The health history can provide information on a
patients health status as well as social, emotional, physical, cultural,
developmental and spiritual identities. Patient strengths and areas of need can
be identified. This information is combined with the physical assessment findings
to guide the nurse in identifying patient problems, which serve as the foundation
for the plan of care for the patient.
Source of Information
Primary Source

Secondary Source :

Mother
Patients records/ chart

Reason for Seeking Health Care and Chief Complaint

According to patients mother, when Baby RSL was born, she noticed that
her babys skin became yellowish in color.
Present Illness History
Patient RSL is a two days old baby diagnosed with hyperbilirubinemia. He
has an apgar score of 6 and after five minutes her apgar score is 8.The Pediatric
Resident on Duty (PROD) seen and examined the baby and the physician
ordered and requested CBC and bilirubin test. Afterwards, the PROD requested
for Bilirubin Test and to have an intensive (continuous) phototherapy.

10

Past-illness History
Birth History

Prenatal

Patient RSL was MSs first baby with her live-in partner. They did not plan
to have a baby at this age.When she noticed that she had delayed menstruation
and feel nausea at the morning, she took a pregnancy test. It was positive. At first
she cannot accept the fact since it is not planned. But eventually, as her partner
comforts her, she accepted her pregnancy. She did not do anything to abort the
baby. She had her first prenatal visit in their barangay health center on her third
month of pregnancy. Vital signs and urinalysis were done. There are no
abnormalities noted. She completed her tetanus toxoid vaccine.

Labor and Delivery

MSs expected date of delivery was August 28, 2016. She delivered the
baby at 7:00 pm on the same day through spontaneous vaginal delivery.

Postnatal

MS was discharged after three days of admission for observation. In

Batangas Medical Center, normal admitting days for spontaneous vaginal
delivery are three days. Breastfeeding was taught and highly encouraged.

11

Immunizations
Vitamin K

1 mL, intramuscular, vastus lateralis

Hepatitis B

0.5 mL, intramuscular, vastus lateralis

BCG

0.05 mL, intradermal, right upper deltoid

Family Health History

Patient RSL has no history of familial disease.
LFL

GFS

LML

FL

GMS

MS

RSL

Figure 1.Males are shown by squares and females by circles.

Legend:
-

Hyperbilirubinemia

12

C. Patterns of Functioning
Patterns of functioning of the mother during the pregnancy period impose
different factors concerning the condition of the newborn.
Social History

Alcohol use
She used to drink beers and hard drinks everyday especially lambanog

but after sheknew that she was pregnant she stopped drinking alcohol because
she knew that it will take risk to the baby. She started drinking alcohol since she
is in high school because of peer pressure.
Analysis: The intermittent and prolonged use of alcohol can interfere with normal
metabolism and normal body function.
Interpretation: Knowledgeable to the effects of alcohol intake in pregnancy

Tobacco use
She is a second hand smoker because her mother and father as well as

her husband are smoking.

Analysis: Second hand smoker can also a risk factor to different diseases and
can impose a great risk to the babys health.
Interpretation:Not a conducive environment for pregnant mother

13

Drug use
She never tried to use marijuana, amphetamines, uppers, downers,

cocaine, crack, heroin, inhalants or other recreational/street drugs before and

during pregnancy. She also did not take any medications except for vitamins
given in barangay health center.
Analysis: Taking medications can have detrimental effects to the health of the
baby.
Interpretation: Proper drug orientation

Hobbies and leisure activities

During her spare time, she loves to watch television and read

pocketbooks.
Analysis: Acquiring information on patients hobbies and leisure activities is
necessary because some activities can pose health risk.
Interpretation: No activities that could affect the babys condition

Religion
She is a Roman Catholic. She always goes to church every Sunday when

she is not yet pregnant but when she conceived, she used to go to church with
her husband every Friday. She believes and has faith in God.
Analysis: Religion and spirituality can be powerful forces in patients life.

14

Interpretation: Good religious habit

Socio-Cultural
During her pregnancy, she verbalized that she has harmonious

relationship with everyone she encounters.

Analysis: Socio-cultural factors have a great impact in the present condition of
the patient.
Interpretation: Good relationship pattern
Co-workers

MSs maternity
health provider

Church

RSL
MS
FL

Local political
party
Neighbors

Figure 2. This is an ecomap of the L familys relationship to its community. The

family members are shown in the center circle.

15

Health Maintenance

Sleep
Before she got pregnant, she used to always stay awake at night and

sleep at the morning however, when she got pregnant, she used to always sleep.
She goes to bed by 7 pm and wakes up by 9 am.
Analysis: Frequent urge to sleep is a normal process during pregnancy.
Interpretation: Good sleeping pattern

Nutrition
Vegetables and fruits are always served in their meal because she

requested it. She seldom eats pork and meats which are unhealthy eating habit.
Analysis: The process of eating the right kind of food is necessary in order to give
sufficient nutrients to the fetus.
Interpretation: Good eating habit

Elimination
When she was pregnant, her frequency of urination increased up to five

times a day. Normally, she used to urinate three times a day before she got
pregnant. She defecates three times a day without discomfort.
Analysis: Frequent urination is also one of the presumptive signs of pregnancy.
Interpretation: Normal pattern of elimination

16

Exercise
Walking is the patients way of exercise.

Analysis: Exercise should be done and encouraged for pregnant patient to ease
the time of labor and delivery.
Interpretation: Needs more activities and exercises for effective delivery

Hygiene
Taking a bath and brushing her teeth everyday is her form of hygiene. Her

nails are cut and have a normal capillary refill.

Analysis: Proper hygiene provides comfort and relaxation.
Interpretation: Proper hygiene

Psychological
When it comes to her senses that she is pregnant, she did not accept it

because of financial constraints but her husband helped her to accept it.
Eventually, both sides of the family accepted her pregnancy.
Analysis: She finally accepted the baby.
Interpretation: Effective coping mechanism
Sexual Activity
They had their intercourse once a week. The only family planning that they
use before is withdrawal. Now, they are planning to have another baby after three
years.
Analysis: Right interval of giving birth is necessary for the mother to recover well.

17

Interpretation: Proper sexual activity

D. Physical Assessment
Date of Assessment:

August 30, 2016

Patient RSL is a fullterm live baby boy delivered via spontaneous vaginal
delivery to a 21 year old gravida 1 para 1 (1001) with an apgar score of 6,
8. The patient has hyperbilirubinemia.
Vital Signs upon assessment:

Temperature:
Apical heart rate:
Respiratory rate:

36.3 degree Celsius

130 bpm
38 cpm

RESULT
SPECIFIC BODY
PART/CRITERION

SIGNIFICANCE

METHOD
OF

18

General Apperance

ASSESSMENT
Inspection,
The patient has slightly Yellowish skin
Palpation,

yellowish skin color

color signifies

Auscultation

and sclera. He has dry

jaundice.

skin and
desquamation of the
skin. He has covers on
eyes and genitals. He
has good sucking
reflex. He is afebrile.
He has negative (-)
adventitious breath
sounds upon
auscultation on both
bilateral lung fields. He
is fairly active and with
good sleeping habit.

METHOD
SPECIFIC BODY

RESULT

SIGNIFICANCE

OF
PART/CRITERION
Head

ASSESSMENT
Inspection,
The patients head is

Normal
19

Palpation

normocephalic,
symmetrical in shape,
no masses, no lesions,
non bulging and non
depressed anterior
and posterior
fontanels, and no
signs of caput
succedaneum and

Hair

Inspection

cephalhematoma.
He has evenly

Normal

distributed black,
straight and thick hair
Eyelids

Inspection

over the scalp.

His lids close

Eyeshield was

symmetrically. He has

used to protect

eyeshield. There is no

the childs

edema, and no

eyesfrom

discharges.

phototherapy.

METHOD
SPECIFIC BODY

RESULT

SIGNIFICANCE

OF
PART/CRITERION
Sclera

ASSESSMENT
Inspection
His sclera is slightly

Iris

Inspection

yellowish.
His iris is symmetrical

It signifies
jaundice.
Normal
20

in size. It is round and

Pupils

Inspection

black.
His pupils are

Normal

symmetrical in size. It
is round and dark
brown in color. His
pupils are equally
rounded and react to
light and
Ears

Inspection,

accommodation.
His ears are equal in

Palpation

size. Auricles are

Normal

smooth and
symmetrical. Pinna
recoils after it is folded.
METHOD
SPECIFIC BODY

RESULT

SIGNIFICANCE

OF
PART/CRITERION
Nose

ASSESSMENT
Inspection,
The external nose is
Palpation

Normal

symmetrical and
straight. Color is the
same with the entire
face. Lesions and
tenderness were both

21

absent. Nasal mucosa

was pinkish. Both left
and right nares were
patent. Nasal septum
is intact and in midline
without deviations.
Cilia are present in
internal nares. There is
no nasal discharge
and no signs of nasal
flaring.

METHOD
SPECIFIC BODY

RESULT

SIGNIFICANCE

OF
PART/CRITERION
Mouth

ASSESSMENT
Inspection
The mouth is pinkish

Normal

and moistened. The

frenulum is intact at
midline. The tongue
was located at the
midline, pink in color,
slightly dry and furry

22

with whitish coating.

The tongue moves
freely. Uvula is in
Neck

Inspection,

midline.
Neck movement was

Palpation

coordinated and

Normal

difficulty in moving was

not noted. It is free
from lumps and no
tenderness.

METHOD
SPECIFIC BODY

RESULT

SIGNIFICANCE

OF
PART/CRITERION
Thorax

ASSESSMENT
Inspection,
There is no masses
Palpation,

and tenderness upon

Auscultation

palpation, and no

Normal

adventitious breath
sounds upon
auscultation on both
left and right lung
Breast

Inspection

fields.
It is round in shape, no

Normal

23

lumps, and no
masses. Areola isdark
brown in color. Nipples
are round, and equal
Abdomen

Inspection

in size.
It has the same color

Normal

of the body. It is
globular, soft without
distention. Skin pinch
goes back quickly.
METHOD
SPECIFIC BODY

RESULT

SIGNIFICANCE

OF
PART/CRITERION
Upper extremities

ASSESSMENT
Inspection
Good range of motion

Normal

was noted. There is no

lesions, no presence
of abnormalities, and
no tenderness. It can
flex and extend arms
Lower extremities

Inspection

without difficulty.
The skin is uniform in

Normal

color. Good range of

motion was noted.
There is no lesions, no

24

presence of
abnormalities, and no
tenderness. It can flex
and extend legs
without difficulty.

METHOD
SPECIFIC BODY

RESULT

SIGNIFICANCE

OF
PART/CRITERION
Genitalia

ASSESSMENT
Inspection
There are no

Normal

discharges, and no
Elimination

Inspection

bleeding.
The patient has patent

Normal

anus.
Reflexes

Inspection

Reflexes are present

Normal

such as moro,
babinski, rooting,
sucking, and plantar
grasp reflex.

ANTHROPOMETRIC MEASUREMENT

25

DATE/TIME

WEIGHT

08/30/2016

2770

10:00 AM

grams

50 cm

III.

HEAD

CHEST

ABDOMINAL

CIRCUMFERENCE

CIRCUMFERENCE

CIRCUMFERENCE

32 cm

32 cm

31 cm

HEIGHT

Clinical Discussion
A. Anatomy and Physiology

Liver

The liver is the largest glandular organ in the body; its office is to secrete
bile. It is oblong and oval in shape, and occupies the position on the right
side, under the lower ribs.

Metabolism of carbohydrates, protein and fats

Production of bile salts
Detoxification of endogenous and exogenous substances
Blood reservoir
Excretion of adrenal cortex hormone
Storage of vitamins such as Vitamin A and D
Spleen
Act as reservoir of red blood cells

26

Sequesters the old, worn-out RBCs thereby removing them from the
circulation

Gall Bladder

A pear shaped organ located on the liver that stores bile.

Function:

Stores and concentrates the (greenish liquid composed of water,

cholesterol, bile salts, electrolyte and phospholipids) produce by the liver

Important in fat emulsification and intestinal absorption of fatty acids,
cholesterol and other lipids

Cystic Duct

Short duct that joins the gall bladder to the common bile duct.

Bile can flow in both directions between the gallbladder and the common
hepatic duct and the (common) bile duct.

Pancreas

The pancreas is an elongated, tapered organ located across the back of

the abdomen, behind the stomach.

27

Norman Anatomy of Bilirubin Production and Elimination

RBC lifespan of 120 days

RBC will become fragile or
prone to rupture
Cellular content will be
release
Macrophages will
phagocytized it
Hemoglobin will split into
Heme
Iron
Will go to the bone
marrow for new RBC
production

Biliverdin

Globins
Breakdown into amino
acids

Reduct into bilirubin

(indirect, unconjugated)
fat soluble
Transport to the liver
with the help of albumin

The liver enzyme will convert

unconjugated to conjugated
bilirubin
The bacteria will convert
conjugated bilirubin to
That excrete with the feces and
some of it in urine

28

B. PATHOPHYSIOLOGY
Predisposing Factors:

2 days old
Male

RBC lifespan of 120 days

RBC will become fragile
Cellular content will be
release
Macrophages will
phagocytized it
Hemoglobin will split into
Heme
Iron
Will go to the bone
marrow for new RBC
production

Globins

Biliverdin

Breakdown into amino

acids

Reduct into bilirubin (indirect, unconjugated) fat

soluble
Transport to the liver with the help of
albumin
Absence of glucuronyltransferase produced by
liver
Unconjugated to convert
Increase unconjugated
bilirubin to the blood stream
29
Yellow discoloration of sclera, skin, conjunctiva
HYPERBILIRUBINEMIA

Yellow discoloration of sclera and skin

C. LABORATORY RESULTS
HYPERBILIRUBINEMIA

Date performed: August 28, 2016

BILIRUBIN TEST
RESUL

NORMAL

INTER-

TEST

SIGNIFICANCE
T

VALUE

PRETATION

Neonatal

20.5

1.0-10.5

Increased

Bilirubin

mg/dl

mg/dl

Increase destruction of
RBC resulting in
increase unconjugated
and conjugated
bilirubin

Unconjugate

18.56

0.6-10.5

d bilirubin

mg/dl

mg/dl

Increased

An abnormal
accumulation of
bilirubin in the blood
caused by the poor
function of the liver

Conjugated

1.59

0-0.6

bilirubin

mg/dl

mg/dl

Increased

Increase destruction of
RBC resulting in
increase unconjugated
and conjugated
bilirubin
30

Date performed: August 28, 2016

COMPLETE BLOOD COUNT
BLOOD

RESULT

COMPONENT

NORMAL

INTER-

VALUE

PRETATION

13-19g/dl

Decrease

SIGNIFICANCE

S
Hemoglobin

11.0 g/dl

Decrease
hemoglobin will result
to decrease of
oxygen supply to the
body due to bilirubin
in the bloodstream
that is trying to get
out

White

Blood

17.9

Cells (WBC)

4.5-10.5 x

Increase

10 9/ L

Increase WBC
signifies infection in
the body.

Hematocrit

33%

42-59%

Decrease

Decrease hematocrit
indicates that the
mass of RBC is
decrease

31

Date performed: August 29, 2016

BILIRUBIN TEST

TEST
Neonatal

NORMAL

INTER-

VALUE

PRETATION

1.0-10.5

Increased

RESULT
25.5 mg/dl

Bilirubin

SIGNIFICANCE

mg/dl

Increase
destruction of RBC
resulting in increase
unconjugated and
conjugated bilirubin

Unconjugated

24 mg/dl

bilirubin

0.6-10.5

Increased

mg/dl

An abnormal
accumulation of
bilirubin in the blood
caused by the poor
function of the liver

Conjugated
bilirubin

1.50 mg/dl

0-0.6 mg/dl

Increased

Increase
destruction of RBC
resulting in increase
unconjugated and
conjugated bilirubin

32

Date performed: August 30, 2016

BILIRUBIN TEST
NORMAL
TEST

RESULT

INTERPRETATION

SIGNIFICANCE

VALUE
Neonatal

11.10

1.0-10.5

Bilirubin

mg/dl

mg/dl

Increased

Increase
destruction of
RBC resulting in
increase
unconjugated
and conjugated
bilirubin

Unconjugated

10.9 mg/dl

bilirubin

0.6-10.5

Increased

mg/dl

An abnormal
accumulation of
bilirubin in the
blood caused by
the poor function
of the liver

Conjugated
bilirubin

0.20 mg/dl

0-0.6

Normal

mg/dl

33

D. COURSE IN THE WARD

Patients Name: RSL
Admitted: 08/28/2016

VITAL SIGNS

ASSESSMENT

CLINICAL
EXAMINATION
PROCEDURES
FEEDING
MEDICATION

Date of
Confinement:
08/28/2016
Temp: 36.8 C
HR: 134 bpm
RR: 39 cpm
With slightly
yellowish skin
color and sclera
with good
sucking reflex
afebrile
with negative (-)
adventitious
breath sounds
upon
auscultation on
both bilateral
lung fields

Bilirubin Test
Complete Blood
Count
Phototherapy
Breastfeeding with
SAP
AMPICILLIN
150mg IV every 12

Sex: Female
Weight: 2770 grams
Day 1
08/29/2016

Day 2
08/30/2016

Temp: 36.5 C
HR:131 bpm
RR:42 cpm
With slightly
yellowish skin
color and
sclera
with good
sucking reflex
afebrile
with negative (-)
adventitious
breath sounds
upon auscultation
on both bilateral
lung fields
Bilirubin Test

Temp: 36.3 C
HR: 130 bpm
RR: 38 cpm
With slightly
yellowish skin
color and
sclera
with good
sucking reflex
afebrile
with negative (-)
adventitious
breath
sounds
upon auscultation
on both bilateral
lung fields

Phototherapy
Breastfeeding
with SAP
Continue
medication

Phototherapy
Breastfeeding with
SAP
Continue
medication

(6-6)
CEFOTAXIME
150mg IV every 12
(12-12)
AMIKACIN
30mg IV once a
day (OD)
HEALTH
Proper
Proper
suctioning of
breastfeeding
EDUCATION FOR

Teaching
regarding risk
34

THE MOTHER

sections

techniques

of infection

E. PRIORITIZATION OF THE PROBLEM

1st

Risk

for

fluid Fluid, electrolyte, and nutrition management is

imbalance related to important because most infants in a neonatal

prolonged exposure intensive care unit (NICU) have shifts of fluids
to phototherapy as between intracellular, extracellular, and vascular
evidenced

by

dry compartments. Therefore, careful attention to fluid

skin

and electrolyte balance is essential. If inappropriate

fluids are administered, serious morbidity may result
from fluid and electrolyte imbalances. Inadequate
attention to nutrition in the neonatal period leads to
growth failure, osteopenia of prematurity and other

2nd

Risk

complications (Ambalavanan, MD, 2014).

injury Milder degrees of hyperbilirubinemia not leading to a

for

related to abnormal clinical presentation of acute encephalopathy may

blood

profile

as also be neurotoxic and cause less severe long-term

evidenced
increase

by complications. This remains controversial; however,

bilirubin if there are bilirubin concentrations at which subtle

level of 1.59mg/dl
3rd

Risk

for

breakdown

cerebral injury can occur, the thresholds are

unknown (Barrington et. al, 2016).

skin Preserving the skin integrity of the neonate is
related important to maintain the function of the skin, protect
35

to prolonged use of against potential wounds and avoid skin disorders in

phototherapy

the future (Kennedy, 2013).

36