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Difficulty: MediumAnte/Intra/Postpartum and Newborn Care

A 48-hour-old term neonate with hyperbilirubinemia is prescribed conventional phototherapy. The practical nurse is assigned to initiate the treatment in the newborn nursery. Arrange the following actions the nurse should take to safely begin the therapy in the correct chronological order.

  1. 1Verify the neonate's identity against the phototherapy prescription using two identifiers.
  2. 2Remove the neonate's clothing, ensuring only a well-fitting diaper remains in place.
  3. 3Gently close the neonate's eyes and securely apply opaque protective eye shields.
  4. 4Place the neonate in the bassinet positioned at the specified distance under the light unit.
  5. 5Turn on the phototherapy light unit and document the exact time the therapy was initiated.

Answer

The correct chronological sequence is: verify the neonate's identity, remove clothing except the diaper, apply opaque eye shields, place the neonate in the bassinet under the lights, and finally turn on the unit and document the start time.
The chronological sequence prioritizes safety and efficacy. Verification of the right patient and prescription must occur first. Next, maximizing skin exposure by removing clothes (except the diaper) ensures the therapy will be effective. Crucially, opaque eye patches must be applied while the neonate is away from the light source to prevent accidental retinal exposure. Only after the neonate is fully prepped and protected should they be placed under the unit and the lights activated. Finally, documentation provides a legal and clinical record of the start time.

Step-by-Step Solution

1
Verify the neonate's identity against the phototherapy prescription.
Confirmation that the correct treatment is being given to the right patient.
Safety protocols dictate that patient verification must always precede the initiation of any clinical procedure.
2
Remove the neonate's clothing, leaving only a well-fitting diaper.
The neonate's skin is adequately exposed.
Phototherapy relies on light absorption through the skin to isomerize bilirubin into an excretable form; clothing blocks this process.
3
Close the neonate's eyes and apply opaque protective eye shields.
The neonate's eyes are completely covered and protected.
Continuous exposure to phototherapy lights can cause severe retinal damage if the eyes are not shielded prior to treatment.
4
Place the neonate in the bassinet under the light unit.
The neonate is properly positioned for the therapy.
The patient must be physically situated in the designated therapeutic environment once preparations are complete.
5
Turn on the light unit and document the initiation time.
Therapy actively begins and is officially recorded.
Turning on the lights starts the clinical intervention, and immediate documentation ensures accurate tracking of therapy duration.

Key Concept

Safe Initiation of Newborn Phototherapy
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Topics

Ante/Intra/Postpartum and Newborn Care

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