Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia. Conditions like liver. Bilirubin is a yellow substance your body creates when red blood cells break down. She found a passion in the ER and has stayed in this department for 30 years. It implies that the rapid breakdown of red blood cells caused high levels of bilirubin. Here are four (4) nursing care plans and nursing diagnoses for Hyperbilirubinemia (Neonatal Jaundice): ADVERTISEMENTS Deficient Knowledge Risk For Injury (CNS Involvement) Risk For Injury secondary to exchange transfusion Risk For Injury secondary to phototherapy 1. This content is owned by the AAFP. Assess the family situation and support systems.Parents need guidance throughout the infants hospitalization to help to prepare them for this new experience. Explain the reason behind the need for IV Ig administration if this is prescribed. The liver cannot clear the blood of bile pigments that result from the normal postnatal destruction of red blood cells. Biliary atresia. 8. Review rationale for specific hospital procedures/therapeutic interventions (e.g., phototherapy, exchange transfusions) and changes in bilirubin levels, especially if the neonate must remain in the hospital for treatment while the mother is discharged.This assists parents in understanding the importance of therapy, keep parents informed about the infants status and promotes informed decision-making. Other signs of pathologic jaundice are: Difficult to awaken, changes in sensorium, Before bilirubin production (Unconjugated jaundice), Reabsorption of a large hematoma or a clotted blood under the skin, After bilirubin production (usually due to blockage), Physiology. St. Louis, MO: Elsevier. Light therapy also known as phototherapy, light therapy helps by changing the structure of the excess bilirubin in the patients skin to allow for its excretion through the urine and stool. American Family Physician. Parents need an explanation of the rationale for phototherapy and why their infant needs it. Hence, diagnostics will focus on liver function tests and pathology. Mayo Clinic. (2008, October). Wong RJ, et al. For mild jaundice, the condition may subside within two to three weeks. Cholangitis is diagnosed clinically by the classic symptoms of fever, pain, and jaundice, known as Charcot'striad. Kim, M.-S., Chung, Y., Kim, H., Ko, D.-H., Jung, E., Lee, B. S., Hwang, S.-H., Oh, H.-B., Kim, E. A.-R., & Kim, K.-S. (2020). Copyright 2023 American Academy of Family Physicians. /Home phototherapy programs are being used for newborns with mild to moderate physiological jaundice. Imaging will help identify this. The mother will identify signs/symptoms requiring prompt notification of the healthcare provider. Pre-hepatic causes suggests that the raised bilirubin level can be explained by a problem in the processes involved before bilirubin is transported to the liver. In the past, hemolytic disease of the newborn was most often caused by an Rh blood type incompatibility. Chronic alcohol use may result in fatty liver (steatosis), hepatitis, and cirrhosis, with varying levels of jaundice. Jaundice is not a common presenting complaint in adults. Nowadays, home phototherapy is very popular due to the importance of preventing mother-infant separation and continuity of care at home (Morrison, 2021). The nursing team may use a fiber optic blanket and place it under the baby if advised by the physician. In: Current Diagnosis & Treatment: Pediatrics. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Paul Martin R.N. These post-hepatic causes can be divided into intrinsic or extrinsic obstruction of the duct system (Table 2).8, Cholelithiasis, or the presence of gallstones in the gallbladder, is a relatively common finding in adult patients, with or without symptoms of obstruction.15 Obstruction within the biliary duct system may lead to cholecystitis, or inflammation of the gallbladder, as well as cholangitis or infection. Hyperbilirubinemia is a condition that occurs when bilirubin accumulates beyond normal levels in the blood. Some mothers provided reasons contributing to poor attendance. These allow the infant to be held, reducing the risk of eye damage. Kaplan, M., Zimmerman, D., Shoob, H., & Stein-Zamir, C. (2019, November 19). To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. First-line serum testing in a patient presenting with jaundice should include a complete blood count (CBC) and determination of bilirubin (total and direct fractions), aspartate transaminase (AST), alanine transaminase (ALT), -glutamyl transpeptidase, and alkaline phosphatase levels. Jaundice in an adult patient can be caused by a wide variety of benign or life-threatening disorders. Jaundice Nursing Management Definition Jaundice is a symptom or syndrome characterized by increased bilirubin concentration in blood. If phototherapy fails to keep the total serum bilirubin at acceptable levels to prevent kernicterus, an exchange transfusion may be indicated. Treatments to lower the level of bilirubin in your baby's blood may include: Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. Jaundice happens when there's too much bilirubin, a yellow-orange substance, in your blood. Epstein-Barr virus infection (infectious mononucleosis) occasionally causes transient hepatitis and jaundice that resolve as the illness clears.1,8, Alcohol has been shown to affect bile acid uptake and secretion, resulting in cholestasis. yellow. Hepatitis A is usually a self-limited illness that presents with acute onset of jaundice. phototherapy. Abdominal pain. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Explain what jaundice is, the two main types/ causes of infant jaundice (physiologic and pathologic) and how it affects the vital organs such as the liver. In instances of ABO and Rh incompatibility, administration of IV Ig is beneficial to reduce the serum levels of the antibodies in the blood of the infant. Ultrasonography is typically the first test ordered, because of its lower cost, wide availability, and lack of radiation exposure, which may be particularly important in pregnant patients. This occurs when the liver is unable to excrete bilirubin. Provide appropriate referral for a home phototherapy program, if necessary.The lack of available support systems and education may necessitate visiting nurses to monitor the home phototherapy program. completely entire skin in. Jaundice - Hepatic and Biliary Disorders - MSD Manual Professional Edition Procedures are usually laparoscopic. Exchange transfusion may also be prescribed in babies with extremely high bilirubin levels. 2. Saunders comprehensive review for the NCLEX-RN examination. Ascites. Feeding more frequently will provide your baby with more milk and cause more bowel movements, increasing the amount of bilirubin eliminated in your baby's stool. Chen, H.-N., Lee, M.-L., & Tsao, L.-Y. If left untreated, the bilirubin can then spread into the brain, where it causes long-term damage, which includes cerebral palsy, mental retardation, sensory difficulties, delayed speech, poor muscle coordination, learning difficulties, and enamel hypoplasia or yellowish-green staining of teeth, and even death. The infants pediatrician makes a referral for home care based on the newborns health, bilirubin levels (generally between 10 to 14 mg/dL), evidence of jaundice, and the familys suitability for complying with the home program. Acute viral hepatitis may cause the levels of ALT to rise several thousand units per liter. Impaired skin integrity related to hyperbilirubinemia. Hyperbilirubinemia: Nursing Process (ADPIE) | Osmosis Here are four (4) nursing care plans and nursing diagnoses for Hyperbilirubinemia (Neonatal Jaundice): Neonatal jaundice is the main reason for admission from home to a neonatal unit. Pre-hepatic. Pale, clay-colored stool bilirubin also gives the patients stool a yellowish color. Feb. 5, 2020. 1. Nursing Diagnosis: Hyperthermia related to elevated serum bilirubin levels as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse. Provide adequate ventilation in the room. Abdominal pain is the most common presenting symptom in patients with pancreatic or biliary tract cancers.2 Even something as nonspecific as depression may be a presenting complaint in patients with chronic infectious hepatitis and in those with a history of alcoholism.3,4, Occasionally, patients may present with jaundice and some extrahepatic manifestations of liver disease. Assess dietary intake and nutritional status. National Institute of Diabetes and Digestive and Kidney Diseases. Jaundice in the Adult Patient | AAFP We and our partners use cookies to Store and/or access information on a device. Physiologic Have the infant To expose the. Assess the patients readiness to learn, misconceptions and blocks to learning. As the newborn is usually at home at the time of the bilirubin peaking, much of the onus for detecting the development of severe hyperbilirubinemia and evaluating the success of breastfeeding falls on the parents and community medical services (Kaplan et al., 2019). Accessed April 2, 2018. To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and administration details. Picco MF (expert opinon). To minimize the stress of the patient and her family by using appropriate diversional therapy. Bilirubin is transported from the plasma to the liver for conjugation and excretion.1. Chacham, S., Kumar, J., Dutta, S., & Kumar, P. (2019, April-June). St. Louis, MO: Elsevier. When red blood cells die, they break down into heme and globin. 2004;114:297. Prehepatic causes of jaundice include hemolysis and hematoma resorption, which lead to elevated levels of unconjugated (indirect) bilirubin. Risk Factors Hemolytic jaundice Transfusion reaction Hemolytic anemia Severe burns Autoimmune hemolytic anemia Hepatocellualr jaundice Hepatitis This bilirubin is not soluble and is referred to as unconjugated bilirubin. In some cases, a more invasive procedure may be done including magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Aynalem, S., Abayneh, M., Metaferia, G., Demissie, A. G., Gidi, N. W., Demtse, A. G., Berta, H., Worku, B., Nigussie, A. K., Mekasha, A., Bonger, Z. T., McClure, E. M., Goldenberg, R. L., & Muhe, L. M. (2020). The word jaundice comes from the French word jaune, which means yellow. Primary sclerosing cholangitis, another rare cholestatic entity, is more common in men; nearly 70 percent of patients also have inflammatory bowel disease. Maternal and Child Health Nursing (NCLEX Exams), Medical and Surgical Nursing (NCLEX Exams), Pharmacology and Drug Calculation (NCLEX Exams), Acute Respiratory Distress Syndrome Nursing Care Plan. When should my baby have a follow-up visit? The level of bilirubin (severity of jaundice) will determine the course of treatment. Many neonates are readmitted with extreme hyperbilirubinemia or bilirubin encephalopathy at or around day five and had been discharged as healthy from birth hospitalization. Refer the patient to physiotherapy / occupational therapy team as required. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. RN, BSN, PHNClinical Nurse Instructor, Emergency Room Registered NurseCritical Care Transport NurseClinical Nurse Instructor for LVN and BSN students. Breast milk jaundice occurs in breastfed newborns between the first and third day of life but peaks by day 5 to 15, with a decline occurring by the third week of life (Morrison, 2021).