Hemolytic Disease of the Newborn 1.

Prevention of Hemolytic Disease of the newborn is extremely important and prevention of the condition begins in pregnancy. What preventive measures could be taken by the mother to prevent further complication especially Rhnegative mothers who have had a pregnancy with/are pregnant with a Rh-positive infant . a. Administration of Rh immune globulin b. Vitamin K for the formation of prothrombin c. Peripheral blood morphology d. Direct Coombs test

2. Mothers are given Rh immune globulin at 28 weeks during pregnancy and within 72 hours
after delivery. What is the effect of Rh immune globulin in the mothers system that is given during these instances.

a. Acts as vaccination b. Creates compatibility between the Rh factor of the mother and infant c. Prevents anemia for the infant.
d. Prevents sensitization to the D antigen

3. ABO incompatibility is also a problem faced in the Hemolytic disease of the Newborn besides Rh Incompatibility which could be prevented through Rh immune globulin. Which of the following infants are the least likely to be affected by ABO incompatibility? a. Postterm Infant b. Preterm Infant c. Full term Infant d. Infant whose mother has not developed sensitization

4. With the destruction of Fetal RBC jaundice develops due to the increase of bilirubin in the blood. However it is not evident at birth. Jaundice develops after 24 hours. Which among the following infants are more jaundiced? a. Bottle fed infants

b. Breastfed infants c. Full term infants d. Post term infants 5. Other complications may arise which may compound or aggravate the infants condition. The metabolic disorder most likely to occur is: a. Diabetes b. Dwarfism c. Hypoglycemia d. Hyperglycemia 6. Mrs. Stevens and her child are Rh Incompatible. She asked whether she could breastfeed her child. What is the proper response to this query? a. I will ask the paediatrician whether your child can be fed or not. b. No you cant, because the child will not be able to properly digest your breastmilk. c. Yes, you can early feeding is encouraged. d. No you cant it will worsen the infants condition.

7. Mrs. Steves child is undergoing Phototherapy because of Hemolytic Disease. During Phototherapy Mrs. Stevens covers the eyes of her infant with cotton balls. As the nurse what is the most appropriate thing to do in this situation? a. Not do anything, and allow Mrs. Stevens to cover the eyes of her child b. Ask Mrs. Stevens to remove the covering. c. Refer the situation to the doctor d. Ask Mrs. Stevens whether she has fed her child. 8. During your nursing rounds Mrs. Collins is worried that her childs feces is green. You reassure her by saying: a. Ill report this to the doctor immediately. b. Its normal for an infant undergoing phototherapy to have that color of feces.

c. Just continue feeding her to make the color of her feces return to normal. d. Lessen the length of time for phototherapy, the color of her feces will eventually return to normal. 9. Hemolysis which is the destruction of red blood cells occur in infants with Hemolytic Disease of the Newborn, can eventually cause which manifestation of a complication in the newborn? a. Respiratory Distress Syndrome b. Hypoglycemia c. Hemorrhage d. Hydrops fetalis

10.If phototherapy, hydration and close monitoring of serum bilirubin levels is insufficient and bilirubin levels still begin to rise, exchange transdusion may be employed. What should you as the nurse do first? a. Withdraw a small amount of the infants blood. b. Take the hematocrit, bilirubin, electrolytes, glucose determination and blood culture from the last specimen. c. Catheterize the umbilical vein d. Aspirate the babys stomach

Answers with Rationale:

1) A. It is important to prevent the formation of Rh antibody in the mother, giving Rh immune globulin works by binding any fetal red cells with the D
antigen before the mother is able to produce an immune response and form anti-D IgG. Vitamin K for the formation of prothrombin is related to Hemmorhagic Disease of the new born, Peripheral blood morphology and Direct Coombs test are Diagnostic exams for Hemolytiv Disease of the newborn.

2) D. Prevention of sensitization to the D antigen, prevents the mother from forming antibodies that go against the infants red blood cells. 3) B. Preterm infants are least likely to be affected if there is ABO Incompatibility with the mother. This is because the receptor sites for anti-A or anti-B sites present do not appear until late in fetal life. Postterm and Fullterm babies are more likely to be affected, Rh sensitization does not affect ABO incompatibility. 4) B. Pregnanediol, the breakdown product of progesterone, can interfere with the conjugation of indirect bilirubin. This is excreted in breast milk until high levels of progesterone that were present in pregnancy are decreased usually 24-48 hours after birth. 5) C. The infant uses its glucose stores to maintain metabolism in the presence of anemia, which occurs after Fetal RBC is broken down, this process can cause progressive Hypoglycemia, worsening the initial problem. 6) C. Early feeding is one of the therapeutic managements of Hemolytic disease of the newborn. Bilirubin ir removed from the body by being incorporated into feces. Therefore the sooner bowel elimination begins, the sooner bilirubin is removed. Early feeding therefore stimulates bowel peristalsis and accomplishes this. 7) A. Covering the infants eyes is a must. Eye dressings or cotton balls can be firmly secured in place by an infant mask. Continuous exposure to bright lights may be harmful to the newborns retina. 8) B. The stools of an infant are bright green, if the infant is undergoing phototherapy because of the excessive bilirubin being excreted caused by the therapy. 9) D. Hemolysis leads to elevated bilirubin levels and profound anemia can cause high-output heart failure, with pallor, enlarged liver and/or spleen, generalized swelling, and respiratory distress. The prenatal manifestations are known as hydrops fetalis; in severe forms this can include petechiae and purpura. The infant may be stillborn or die shortly after birth.

10) D. Before the procedure the infants stomach is aspirated to prevent or minimize the risk for aspiration from the manipulation involved.