HDN RH factor – feedback (LUIS)
1. Pathophysiology and its relationship to the symptoms, diagnostic evaluation and treatment in your words (15 marks) (350 – 400 words)
Explain in your own words the relationship between the pathophysiology, symptoms, diagnostic evaluation and treatment as explained in the assigned video/podcast.
Hemolytic disease of the newborn is a condition in which a newborns red blood cells are broken down through lysis because the mother’s blood has antibodies that attack the newborns blood. This results in hydrops fetalis which is the fluid accumulation from breakdown of RBCs which leads to severe heart failure and build-up of fluid in two or more areas of the baby. Symptoms in the baby are edema, yellowing of the skin and sclera, enlarged organs, and lethargy.
It is important to note that hemolytic disease of the newborn, usually doesn’t occur in the first pregnancy because the mother’s body has not experienced mixing of different Rh blood types, so no defences are armed against the first baby’s blood except for IgM antibodies but this does not cross the placenta. However, in the second pregnancy with an RH+ baby, the mother is sensitized and has created IgG antibodies this time, which will target the RH+ baby and the antibodies are small enough to cross the placenta and breakdown the Baby’s blood. Signs and symptoms in the mother usually don’t occur in the first pregnancy but much like the mom in the podcast, during the second pregnancy, the mom may experience symptoms like a still baby or a feeling of dread amongst other symptoms.
diagnostic evaluation includes an extensive history and regular blood tests.
diagnostic evaluation includes a direct Coombs test to see of any anti RH antibodies were attached to the newborns RBCS, or an indirect Coombs test on the mother blood to detect the presence of anti RH antibodies in response to baby’s RH positive blood type.
other diagnostics may include Rosette test or Kleihauer-Betke acid elution to see if mom’s body had started to produce antibodies against the baby’s blood. another recommendation is early ABO group and RHD factor determination with an indirect anti globulin test
treatments include Rhogam which creates antibodies that tricks the mom’s body into believing she already made antibodies against her baby’s RH+ RBC. Rhogam is recommended for pregnancies beyond the first as a preventative measure, Moreso over treatment, to avoid hemolytic disease of the newborn in the future.
2. Gaps in content (5 marks). (250-300 words)
During your efforts to comprehend the interconnections among various facets of the assigned condition, were there any noticeable gaps in the content or potential additions that could have been included to enhance your understanding of the topic?
The project was very well done and there were not many gaps because the information was clear and laid out however, some personal gaps for me were how there was a production of IgM antibodies during the first exposure to an RH+ baby but IgG antibodies in the second exposure. I am also curious in finding out what other signs and symptoms the mom may be expressing when there is hemolytic disease of the newborn occurring, because we have a lot of signs and symptoms for the baby. If there is any, we can look for cues or clues in our practice like the ER or the NICU for example. A little more explanation of how the Rosette test or the Kleihauer-Betke acid elution test work and where a mom may be able to get these tests would be a great addition. It would also be interesting to understand when these tests should be done and what are the indication for each respectively. Also, it would have been interesting to try and understand why the DR. or the nurses missed the Rhogam shot during the second pregnancy.
3. One teaching-learning strategy that supported or hindered your learning and why (5 marks). (250-300 words)
Describe one teaching-learning strategy implemented by your peers that supported or hindered your learning. Provide a rationale for your response (5 marks).
A strategy that supported my learning was that the presentation was in a podcast format. I really enjoyed listening to different voices and a podcast is super convenient because you can listen to it over and over to gain a better understanding and write notes. I also enjoyed the podcast because it was portable, and I could listen to it anywhere like the gym or on my way home. I enjoyed listening to the Dr, the mom, and the interviewer have an open conversation and dialogue about hemolytic disease of the newborn. Part of the podcast and rubric that I also enjoyed was incorporating the case study and the concerns of the mom relating to the hemolytic disease of the newborn. This allowed for a dialogue and real concerns we can incorporate into our own practices. The podcast itself was also a good teaching and learning strategy because everyday people, moms, dads, and healthcare workers can listen to a presentation of hemolytic disease of the newborn. They can listen to these podcasts at home or wherever they can because it is accessible on the phone and on the computers. All in all, the podcast was a great strategy that I will use in the future and recommend it to all my patients.
4. ONE change that you recommend and why (5 marks). (250-300 words)
If you had an opportunity to make ONE change to the assigned video to further improve its content and/or creativity, what change would you propose?
Overall, I felt like although the podcast was super-efficient and portable, I am more of a visual and audio learner combined. It was difficult to picture the antibodies attacking the baby, the direct and indirect coombs tests as well as the other tests. However, the project was to choose one method so I can’t fault the project, it was very well done. In terms of the information provided, maybe there could have been more dialogue from the mom asking questions related to her journey trying to figure out Hemolytic disease of the newborn (RH factor). For example, mom could have asked more questions relating to how we can better prepare her or other moms in the future when health literacy may be a challenge. Maybe mom could have asked how we can incorporate teaching and learning better from admission to discharge and at what stages during pregnancy certain test should be done at, so future moms don’t slip through the cracks. Maybe having a panel of different moms speaking could facilitate and highlight how we as nurses and doctors can improve with our prenatal and post-natal care. Overall, the information provided was good and based in evidence informed practice, there isn’t much I would change.
5. One example of content integration into your practice (15 marks) (350 – 400 words)
Provide an example of how you would integrate the information that you learned from the assigned video into your future practice.
One way I would integrate this project in my own practice would be to recommend more podcasts for my patients on this topic. I see myself working on a medsurge floor to start. However, I would like to specialize down the road and try NICU nursing and end up in ER nursing. Therefore, this content will be super helpful for my patients who are at risk for hemolytic disease of the newborn. I could recommend this podcast or others on HDN to mothers, for a more concise and researched comprehension of what the pathophysiology, signs and symptoms, diagnostics, and treatment options are considered I may not be the best person to explain this to a patient. Or perhaps I could even watch these podcasts in the future to refresh my memory and present this information to my patients.
If I were ever to work with a population of mothers such as the NICU, I would now be able to educate the moms on the signs and symptoms of a baby who, was exposed to moms’ antibodies, like jaundice, edema, and lethargy. I could also explain to mom the need for Rhogam and do some patient teaching on the matter.
In the ER, the signs, and symptoms I learned about in a baby with hemolytic disease, will also allow me to critically think and to suspect HDN.
Finally, if I ever work with a population of moms, I will make sure to thoroughly review her discharge plan or her plan of care to not miss any important tests and education. For example, making sure the mother gets her Rhogam shots and understands what it is for. Making sure she has access to a clinic where she can get her blood work done. I also want her to teach back to me what hemolytic disease of the newborn is, how she can prevent it, what tests are available to her, and where she can get the resources, she requires.
Overall, the pathophysiology, signs and symptoms, diagnostic tests, and treatments embedded in the podcast will make me a better nurse in any future practice setting area.