The practical nurse (PN) is assigned to initiate intensive phototherapy in the postpartum unit for a 36-hour-old neonate, born at 38 weeks of gestation, who has been diagnosed with severe hyperbilirubinemia. Arrange the following nursing actions in the correct chronological sequence to safely and effectively implement this therapy.
- 1Verify the medical prescription and confirm the neonate's identity using two facility-approved identifiers.
- 2Undress the neonate completely, leaving only a minimally sized diaper in place.
- 3Close the neonate's eyelids gently and secure opaque protective eye shields.
- 4Position the neonate in the incubator and adjust the light source to the manufacturer's recommended distance.
- 5Activate the phototherapy unit, measure the irradiance level at the skin surface, and report the readings to the registered nurse (RN).
Answer
The correct sequence is to first verify the prescription and identity, then undress the neonate, apply the protective eye shields, position the neonate and adjust the lights, and finally activate the unit, measure the irradiance, and report to the RN.
The correct sequence prioritizes client safety and therapeutic efficacy. Verification of the prescription and identity is always the first action. Next, undressing the infant prepares them for maximum skin exposure, which is necessary for effective bilirubin breakdown. Crucially, the opaque eye shields must be applied before the lights are turned on to prevent retinal damage. Proper positioning of the infant and equipment ensures the light covers the target area without causing thermal harm. Finally, turning the lights on, measuring irradiance at the skin level, and reporting the data to the RN confirms the delivery of the prescribed therapeutic dose and adheres to the PN scope of practice.
Step-by-Step Solution
Key Concept
Safe initiation sequence for neonatal phototherapy within the PN scope of practice