MANAGEMNT OF JAUNDICE FOR NURSING STUDENT

1. MEDICAL SURGICAL
NURSING I
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2. JAUNDICE
(HYPERBILIRUBINAEMIA)
2024 COHORT
PRESENTED BY
KAREN NSANDU GIVA
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3. LEARNING OUTCOMES
Define jaundice
(hyperbilirubinaemia)
Describe the causes of jaundice
Explain the classification of
jaundice
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4. CT…
Explain the pathophysiology
Outline the clinical manifestations
Describe the investigations to be done
Discuss the management of jaundice.
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5. DEFINITION OF JAUNDICE
 It is a yellow discoloration of the skin and
sclerae that results from elevated levels of
bilirubin, which comes from the break
down products of haemoglobin (haem
part) that results from RBCs destruction.
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6. CAUSES/ PREDISPOSING
FACTORS
Physiologic (developmental)
factors in newborn babies
Excess production of bilirubin
Disturbed capacity of the liver
to secrete conjugated bilirubin
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7. CT..
Combined overproduction and under
secretion ( e.g. in sepsis)
Some disease states (hypothyroidism
as there is impaired metabolism)
Prematurity
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8. NORMAL PHYSIOLOGY
Bilirubin source-breakdown of
haemoglobin from old red blood
cells.
Soon after production of bilirubin, it
is insoluble in water hence called
unconjugated bilirubin (indirect).03/18/25
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9. CT..
The unconjugated bilirubin is
transported in the blood by binding
on to albumin.
In the liver, it is conjugated with
glucuronic acid in the presence of
Glucuronyl transferase, 03/18/25
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10. Ct..
To produce a highly soluble
substance, conjugated bilirubin,
which is then excreted in the bile
into the intestines.
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11. Cont…
In the intestine bacterial action
reduces the conjugated bilirubin
Then most of it is excreted in
stools as stercobilin, and small
amount in urine. 03/18/25
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12. CLASSIFICATION OF JAUNDICE
Jaundice can be caused by several
factors. These are classified into three:
– Pre-hepatic jaundice(haemolytic)
– Hepatic jaundice
– Post-hepatic jaundice (obstructive)
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13. Ct..
Pre-hepatic is also
known as Haemolytic
jaundice
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14. PRE-HEPATIC (HAEMOLYTIC
JAUNDICE)
During haemolysis there is
excess destruction of RBCs
resulting in release of large
amounts of indirect
(unconjugated) bilirubin. 03/18/25
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15. Ct…
This overloads the liver’s
conjugating ability and excess
unconjugated bilirubin accumulates
in the blood
 however, it cannot be excreted by
the kidneys. 03/18/25
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16. CT..
But the liver continues to
excrete normal amounts of
conjugated bilirubin in the
bile, as a result stools are
normal in colour.
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17. HAEMOLYTIC JAUNDICE CT’D
The bilirubin is water-insoluble but fat
soluble therefore able to cross the blood-
brain- barrier when high enough.
This causes Kernicterus in babies occurs
even soon after birth.
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18. CAUSES
 ABO blood group incompatibility
(commonest) e.g. in blood transfusion
 Rhesus blood group incompatibility
 Glucose-6-phosphate dehydrogenase
(G6PD) deficiency (is a non-immune
haemolytic disorder) 03/18/25
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19. Ct..
Congenital syphilis
Neonatal sepsis
Malaria
Sickle cell
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20. HEPATIC (HEPATOCELLULAR
JAUNDICE)
 Damage to the liver- loss of conjugating ability
 Blockage to outflow of conjugated bilirubin
(swelling of damaged cells which obstruct
small bile ducts).
 This lead to dark urine, and pale stools
(conjugated bilirubin leaks back into the blood
and is excreted by the urine instead.)
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21. ``````````
 Attributed to alteration in the liver`s ability to
take up bilirubin from the blood circulation or
excrete it into the bile.
 Mostly caused by diseased liver cells
(hepatocellular diseases)
 This compromises conjugating ability and there
is also blockage to outflow of conjugated
bilirubin 03/18/25
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22. .
 The conjugated bilirubin leaks back to
the circulation and is secreted in urine
leading to passage of darkish urine and
pale stools
 Common causes include hepatitis A & B,
liver cirrhosis, hepatocellular cancer
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23. Common Causes Cont…
Infections (malaria, typhoid)
Drugs e.g. Nevirapine
Toxins
Metabolic defects like Galactosaemia
(hereditary carbohydrate disorder where
enzymes for galactose metabolism is absent)
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24. POST-HEPATIC OBSTRUCTIVE
JAUNDICE
 Failure of bile to reach the duodenum due
to obstruction of the bile flow
 Obstruction to excretion of bilirubin through
the biliary system resulting in pale stools
and dark urine.
 Thus also called obstructive or cholestatic
jaundice 03/18/25
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25. Ct..
Causes:
liver damage (neonatal Hepatitis, congenital
infections)
Physical bile duct obstruction (e.g. biliary
atresia- congenital absence of duct ).
Gall stones
Enlarged TB lymph nodes 03/18/25
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26. Clinical manifestations/signs &
symptoms
Pre-hepatic jaundice
Weakness
There may be abdominal or back pain
Yellow discoloration of the skin/mucous
membrane
Normal stool and urine color 03/18/25
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27. Clinical manifestations/signs &
symptoms CTs..,
Hepatic jaundice
General body malaise, Anorexia
Low grade fever
Rt upper quadrant discomfort
Enlarged, tender liver
Dark urine, yellow discoloration of the
skin 03/18/25
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28. Clinical manifestations
Post Hepatic Jaundice
Colicky upper quadrant pain
Weight loss (carcinoma)
Yellow discoloration of the skin
Dark urine, light-colored stools
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29. CT..
Chills and fever which may suggest
gall stones
Hepatomegally
Visible and palpable gallbladder
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30. Diagnostic approach
 Clinical presentation
 Laboratory analysis of bilirubin levels
Normal values:
Blood Direct Bilirubin = 0.1 – 0.4mg/100ml
Blood Indirect Bilirubin = 0.2 – 0.7 mg/ml
Urine Bilirubin = none 03/18/25
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31. Common clinical manifestations
Depression
Anorexia
Skin irritation
Tendency to bleed easily due to a
fall in prothrombin level of blood
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32. Management
 Prognosis rather unpredictable
 Management is directed at relieving discomforts
and eliminating cause where possible
 Key interventions may include:
 Explore the possible cause and manage it
 Emotional support and reassurance
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33. .
Nursing interventions:
Explain disease condition in
simple terms to gain his/her
understanding and cooperation
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34. Overall Goal of nursing
interventions
Key interventions
Symptomatic approach
Multidisciplinary approach
Diet
Personal hygiene/safety precautions
Emotional support
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35. Nursing Management
The therapy is directed at preventing blood
unconjugated bilirubin from reaching neurotoxic
levels. Underlying causes such as sepsis must be
treated with prescribed antibiotics.
Assess and document degree of jaundice of skin
and sclera.
Provide psychological support to reduce anxiety.
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36.  Reinforce the doctor’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. 03/18/25
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37. Ct.
 Advice to pt for restrict fat intake
 Provide high protein diet
 High carbohydrate diet take roughage
for digestion
 Provide plenty of fluids, juices
 Give glucose water
 Maintain hydration status
 Maintain intake and output chart 03/18/25
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38. Ct..
 For itching skin give antihistamines such as
promethazine 25mg orally tds
 Antihistamine creams to reduce itching
 Diazepam 10mg Po/Im to promote relaxation
and sleep and reduce restlessness
 Vitamin supplements Vit B12 and vit K
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39. Ct..
 Watch patient for signs of haemorrhage
 Avoid pricking patient unnecessarily to
prevent bleeding
 Avoid IM injections whenever possible
 Cut fingernails
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40. Ct..
 Give health information to patient and family on
 Condition, cause and care and protection
 Educate on diet
 Taking fluids
 Skin protection
 Complications
 Prognosis
 Watch for signs of haemorrhage
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41. NURSING DIAGNOSIS
 Impaired skin integrity related to pururitis.
 Risk of haemorrhage related to disturbed
prothrombin factor
 Constipation related to disease process
 Abdominal pain related to disease
 Anxiety related to disease condition
 Altered nutrition less than body requirement
related to constipation & abdominal pain &
discomfort. 03/18/25
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42. QUESTIONS
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43. 03/18/25
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