Jaundice Nursing Management

Definition
  • Jaundice is a symptom or syndrome characterized by increased bilirubin concentration in blood. It is classified as hemolytic, hepatocellular, or obstructive.
Risk Factors
Hemolytic jaundice
  • Transfusion reaction
  • Hemolytic anemia
  • Severe burns
  • Autoimmune hemolytic anemia
Hepatocellualr jaundice
  • Hepatitis
  • Yellow fever
  • Alcoholism
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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.
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
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.
Medical Management
  • Treat the underlying cause of jaundice (Hemolytic jaundice, hepatocellular jaundice and obstructive jaundice)
Nursing Diagnosis
  • Disturbed body image related to jaundice
  • Impaired skin integrity related to hyperbilirubinemia.
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.