JAUNDICE

JAUNDICE

Introduction:

          Jaundice refers to the yellow appearance of the skin, sclera and mucous membranes resulting from an increased bilirubin concentration in body fluids.

Definition:

          It is the yellowish discoloration of the skin mucous membrane and sclera that result from the high level of unconjugated bilirubin in the tissue and plasma upto more than 2mg / dl.

Classification:

1) Haemolytic jaundice:

          This result from increased destruction of red blood cells or their precursor in the marrow.

2) Hepatocellular jaundice:

          This result from an inability of the liver to transport bilurubin into the bile.

3) Cholestatic Jaundice:

          In unreceived cholestins jaundice tends to become progressively more and more severe because conjugated bilirubin in unable to enter the bile concentric and passes back into the blood and also because there is a failure of ceramic of an unconjugated bilirubin arriving at the liver cells.

Aetiology:

          The cause of jaundice may be described according to the location of pathologic change it may occur because of a problem.

1. Outside the river: Resulting into unconjugated hyperbilirubinemia.
2. In the liver – Resulting in conjugated hyperbilirubinemia with predominating conjugated bilirubin.
3. Increased hepatic circulation
4. Decreased hepatic excretion of Bilirubin
5. Decreased liver cell uptake of bilirubin due to decreased risumelin (transport protein)
6. Increased cell facility.

Clinical Manifestation

Ø      Yellow Sclera

Ø      Yellowish skin

Ø      Clay – colored feces

Ø      Tea colored urine

Ø      pruritis

Ø      Fatigue

Ø      Anorexia

Investigation

Ø      A – Detail history collection

Ø      B – Physical examination

Ø      C - Laboratory investigation

Ø      Hemoglobin (decreases)

Ø      Peripheral smear

Ø      Reticuloyte count increases

Ø      Coomb’s test

Ø      Liver function test

Ø      Ultra sonography

Ø      Serum albumin

Ø      Urine analysis

Treatment

Ø      Oral cholestyramine

Ø      Antiohistamine

Ø      Phenobarbital

Nursing Management:

Ø      The client should be observed closely for development of Jaundice.

Ø      Check the sclera doing for the development of yellow coloration.

Ø      Regular monitoring of the vital signs

Ø      Eyes should be covered with pads to protect from high intensity of light.

Ø      Urination is checked for frequency of amount and colour.

Ø      Any behavioural changes, convulsion or shygishness should be noted and reported.

Complication:

Ø      Acute Liver failure

Ø      A plastic Anaemia

Ø      Chronic liver disease

Ø      Cirrhoesis of liver

Ø      Primary hepato cellular carcinoma

Nursing Diagnosis:

Ø      Impaired skin intensity related to pruritis

Ø      Disturbed body image related to yellowing of skin and sclera.

Ø      In affective health maintenance related to lack of knowledge of jaundice.

Ø      Increased body temperature related to fever.

HEATH EDUCATION

Ø      Explain the patient about disease aspect during his all doubt.

Ø      Explain to drink more water and not to eat contaminated food.

Ø      Explain  patient to keep environment clean.

Ø      Safe disposable of excreta.

Ø      Explain to patient to washed hand properly before meal and after toileting.

Ø      Explain to patient to use well sterilized syringes and needle.

Ø      Tell to the patient to avoid smoking.

PREVENTION AND CONTROL:

Ø      Proper controls within the home.

Ø      Safe drinking water

Ø      Proper hand washing after toileting.

Ø      Avoiding smoking.

Ø      Safe blood transfusion.

Ø      Avoidance of contaminated food.

Ø      cleanliness of community.

Ø      Safe disposed of excreta

Ø      Control of flies.

Ø      Precautioning measures has to be taken to use syringes and needle.

On assessment patient looks discomfort,  patient complaints of itching	Impaired skin integrity related to praritus	To maintain proper skin integrity	- Assess the condition - Change the bed linear and bed sheet if necessary - Give skin care to the patient - Provide bed bath (sponge) with warm water - Advise or instruct to the patient to avoid itching - Keep the skin dry - Administer medication as prescribed by physical
On assessment pt skin and sclera look yellowish	Distributed bodyimage related to yellowing of skin and sclera		- provide psychological support - Explain about disease aspect and way skin and schedule is yellow. - Administer medication as prescribed by physician - Provide education about to maintain skin colour

On assessment pt looking pale and having chills	Increased body temperature related to fever	To bring normal temperature	- Provide comfortable position - Provide tapid sponging - Provide antiphyretic  as prescribed by physician. - Provide psychological support - Advice to drink plenty of oral fluid.
Patient asking about disease	Knowledge difficult related to disease aspect	Clarify doubts	- Explain pt about disease aspect - Explain prevention and clarify doubt. - Explain what are complication of disease - Provide health education - Administer medication as prescribed by physician - Provide Psychological support.