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