Medical and Nursing Management of Jaundice

I. Definition

• Jaundice is a symptom or syndrome characterized by increased bilirubin concentration in blood. It is classified as hemolytic, hepatocellular, or obstructive.

II. Risk Factors

Hemolytic jaundice
• Transfusion reaction
• Hemolytic anemia
• Severe burns
• Autoimmune hemolytic anemia

Hepatocellualr jaundice
• Hepatitis
• Yellow fever
• Alcoholism

Obstructive jaundice
• Extrahepatic – obstruction may be caused by bile-duct plugging from gallstones, an inflammatory process, tumor or pressure from an enlarged gland.
• Intrahepatic – obstruction may result from pressure on channels from inflamed liver tissue or exudates.

III. Pathophysiology

Hemolytic jaundice
• Caused by increased destruction of red blood cells, results in the inability to excrete bilirubin as quickly as it forms.
Hepatocellular jaundice
• Results from the inability of diseased liver cells to clear normal amounts of bilirubin because of defective uptake, consumption or transport mechanisms.

Obstructive jaundice
• Causes bile deposition in the skin, mucous membranes, and sclera which results in characteristic yellow tinging of these structures.

IV. Assessment/Clinical Manifestations/Signs and Symptoms

• Dark, foamy urine due to increased bile in the urine
• Light or clay-colored stools due to lack of bile in the small bowel
• Pruritus due to increased bile acids in the skin
• Inability to tolerate fatty foods due to absence of bile in the small intestine
• Mild to severe illness with other symptoms such as anorexia, fatigue, nausea, weakness and possibly weight loss.

V. Medical Management

• Treat the underlying cause of jaundice (Hemolytic jaundice, hepatocellular jaundice and obstructive jaundice)

VI. Nursing Diagnosis

• Disturbed body image related to jaundice
• Impaired skin integrity related to hyperbilirubinemia.

VII. Nursing Management

• Assess and document degree of jaundice of skin and sclera.
• Intervene to reduce anxiety. Reinforce the health care provider’s explanation about the cause and expected outcome of jaundice, and encourage the client to express feelings and concerns about body-image changes.
• Promote adequate nutrition. Assess dietary intake and nutritional status. Encourage the client to adhere to a high-carbohydrate diet, with protein intake consistent with that recommended for hepatic encephalopathy.

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