Jaundice
Key Points
- Jaundice is yellow discoloration of the skin and sclera caused by excess bilirubin.
- Bilirubin is generated from hemoglobin breakdown as red blood cells are processed.
- New-onset jaundice requires prompt provider notification and cause-focused evaluation.
- Clinical framing is prehepatic (hemolytic), hepatic (hepatocellular), and posthepatic (obstructive) jaundice.
- Adult hemolytic etiologies include medication effects, hemoglobin disorders, infection, transfusion complications, marrow failure, and autoimmune hemolysis.
Pathophysiology
As older red blood cells break down, bilirubin is produced and normally processed by the liver. When bilirubin processing or flow is impaired, bilirubin accumulates and visible yellow discoloration appears in the skin and sclera.
Jaundice is a manifestation pattern rather than a single disease, so nursing priorities center on identifying and monitoring the underlying cause.
Classification
- Hemolytic (prehepatic) jaundice: Bilirubin burden increases before hepatic processing; adult causes include penicillin effect, sickle cell disease, thalassemia, Escherichia coli infection, transfusion complications, bone marrow failure, and autoimmune conditions.
- Hepatocellular (hepatic) jaundice: Liver-cell dysfunction impairs bilirubin handling; causes include infection, alcohol-related liver disease, hereditary or autoimmune disorders, and cancer.
- Obstructive (posthepatic) jaundice: Biliary outflow obstruction limits bilirubin excretion; most commonly from common bile duct stone, with additional causes including strictures, cancer, and drug-induced cholestasis.
Nursing Assessment
NCLEX Focus
New-onset jaundice is an escalation cue; do not delay reporting while monitoring trend changes.
- Assess visible yellowing trend in skin and sclera.
- Assess for progression or worsening of discoloration and associated condition change.
- If hemolytic pattern is suspected, trend ordered hemolysis-related studies and clinical triggers.
- Track vital signs and overall clinical status while the underlying cause is clarified.
- Reinforce immediate reporting of new or worsening jaundice findings.
Nursing Interventions
- Notify the provider promptly for new-onset jaundice.
- Perform serial reassessment of skin/scleral color and overall condition trend.
- Support ordered cause-directed diagnostics and treatment planning.
- Educate the patient that jaundice reflects an underlying process requiring follow-up and monitoring.
Pharmacology
| Drug Class | Role in Care | Key Nursing Considerations |
|---|---|---|
| Cause-directed therapy | Treats underlying hemolytic, hepatic, or obstructive process | Match medication strategy to confirmed etiology and reassess response trend. |
| Supportive symptom therapy | Adjunct control of related symptom burden as ordered | Does not replace etiology-focused management; continue escalation monitoring. |
Clinical Judgment Application
Clinical Scenario
An adult patient develops new yellow sclera and progressive skin yellowing over two days during hospitalization.
- Recognize Cues: New bilirubin-pattern discoloration of skin and sclera.
- Analyze Cues: Findings suggest jaundice requiring immediate etiology-focused evaluation.
- Prioritize Hypotheses: Determine whether pattern is prehepatic, hepatic, or posthepatic.
- Generate Solutions: Escalate findings, begin trend monitoring, and support ordered diagnostic workup.
- Take Action: Report promptly, reassess frequently, and document progression/worsening cues.
- Evaluate Outcomes: Underlying cause is identified and jaundice progression stabilizes or improves.
Related Concepts
- liver-failure - Hepatic dysfunction is a common pathway for jaundice manifestation.
- liver-cirrhosis - Chronic liver injury can progress to jaundice during decompensation.
- hepatitis - Hepatic inflammation frequently presents with jaundice.
- cholecystitis - Obstructive biliary patterns can present with jaundice cues.