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학습 자료 둘러보기 →A total serum bilirubin of 25 mg/dL in a 4-day-old newborn is a medical emergency. This level exceeds the exchange transfusion threshold regardless of gestational age, indicating a high risk for kernicterus.
The immediate priority is to prepare for an exchange transfusion. This procedure rapidly removes bilirubin and maternal antibodies from the circulation. Nursing responsibilities include ensuring NPO status, verifying informed consent, and preparing O-negative, cross-matched blood.
Do not delay preparation for exchange transfusion to escalate phototherapy. At this critical level, phototherapy alone cannot lower bilirubin fast enough to prevent acute bilirubin encephalopathy, which presents with lethargy and poor feeding.
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