Hyperbilirubinemia Nursing Care Plans Diagnosis and Interventions
Hyperbilirubinemia NCLEX Review and Nursing Care Plans
Hyperbilirubinemia is a condition that occurs when bilirubin accumulates beyond normal levels in the blood.
When red blood cells die, they break down into heme and globin.
Bilirubin is a yellowish substance that is derived from the heme part of red blood cells.
This bilirubin is not soluble and is referred to as unconjugated bilirubin.
Unconjugated bilirubin is transported to the liver by albumin for conjugation.
The liver binds it to an enzyme to make it water soluble so it can easily be excreted out of the body.
Conjugated bilirubin is excreted in bile to the biliary duct and intestines where it is further broken down to urobilinogen.
Urobilinogen is then excreted through urine and stool. However, some is reabsorbed into the system and is recycled by the liver.
Signs and Symptoms of Hyperbilirubinemia
High level of bilirubin in the blood can cause serious problems and several symptoms. Hyperbilirubinemia may manifest as follows:
- Icterus – also known as jaundice, icterus happens due to the build-up of bilirubin in the eyes, causing the sclera to have yellow discoloration
- Dark urine – bilirubin contributes to the yellow color of urine; less secretion of bilirubin due to its increased reabsorption can result to a dark-colored urine
- Pale, clay-colored stool – bilirubin also gives the patient’s stool a yellowish color. In hyperbilirubinemia, bilirubin excretion is reduced, therefore causing a pale-colored stool.
- Extreme fatigue
- Prodromal symptoms including abdominal pain, heartburn, bloating, and constipation are usually noted before jaundice is noted.
Causes of Hyperbilirubinemia
There could be different reasons for hyperbilirubinemia. The most common etiologies are as follows:
- Hemolytic anemia. The process of the breakdown of red blood cells is called hemolysis. Hemolytic anemia refers to the faster process of red blood cells breakdown. It usually occurs in blood cancers, autoimmune disease, or as a side effect of medications.
- Liver disease. Liver plays a vital role in the transport and excretion of bilirubin in the body. Conditions like liver cirrhosis, viral hepatitis, and fatty liver disease can prevent the liver in conjugating bilirubin.
- Bile duct obstruction. The conjugated bilirubin is taken by bile to the intestines through the bile ducts. Obstruction in this area can prevent bilirubin excretion.
- Lack of digestive bacteria in newborn. Neonatal jaundice may happen as a product of underdeveloped digestive system.
- Genetic disorder. Hereditary hemochromatosis and alpha-1 antitrypsin deficiency can indirectly cause liver impairment.
- Medications. Certain drugs, when taken long-term, can cause hyperbilirubinemia.
- Antibiotics like amoxicillin and ciprofloxacin
- Anticonvulsants like valproic acid
- Antifungals like fluconazole
- Oral contraceptives
- Statin drugs
Complications of Hyperbilirubinemia
- Brain damage. Symptoms suggesting brain involvement is a red flag. High levels of bilirubin can become toxic in the brain and cause kernicterus in newborn. It is characterized by seizure and brain damage that can lead to death.
- Ascites. Fluid accumulation in the abdomen can happen if hyperbilirubinemia is caused by liver cirrhosis.
- Hepatic encephalopathy. Brain involvement may happen when high levels of bilirubin in the blood reaches the brain.
- Portal hypertension. Bleeding in the esophagus and stomach can happen secondary to this.
Diagnosis of Hyperbilirubinemia
Diagnosis of hyperbilirubinemia usually begins with history taking and physical examination. In conjunction, the following diagnostic tests may be performed:
- Blood test – bilirubin levels, together with aminotransferase, and alkaline phosphatase are tested. This helps determine hepatocecullar dysfunction and levels can suggest the cause of high bilirubin levels. Blood testing helps direct the clinician to determine the need for further diagnostics.
- Urinalysis – a standard test to measure the amount of bilirubin excreted in the urine which can give clue to the cause or location of the problem.
- Imaging – ultrasonography is commonly done first to identify presence of anatomical obstruction. CT and MRI are alternatives depending on what the clinician is suspecting. In some cases, a more invasive procedure may be done including magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP).
- Liver biopsy – it is quite rare to require the need for liver biopsy. When performed, it helps identify other causes like Wilson’s disease, hemochromatosis, and Dubin-johnson syndrome.
The diagnosis of hyperbilirubinemia does not end in the determination of a raised bilirubin level. The cause is further identified as follows:
- Pre-hepatic. 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. It implies that the rapid breakdown of red blood cells caused high levels of bilirubin.
- Hepatic. As the name suggests, hyperbilirubinemia is caused by liver problems. Hence, diagnostics will focus on liver function tests and pathology.
- Post-hepatic. Hyperbilirubinemia can be explained by anatomical obstruction. Imaging will help identify this.
Treatment of Hyperbilirubinemia
- Symptomatic treatment. Treatment of hyperbilirubinemia relies on its cause. An adult with high bilirubin levels does not usually require treatment unless it is caused by viral hepatitis. Treatment is also based on the symptoms. Over-the-counter medications can alleviate most of the symptoms such as bloating, fever, and heartburn.
- Surgical intervention. Surgery is required in some instances when the cause of the elevated bilirubin levels is caused by structural anomalies. Procedures are usually laparoscopic.
- Treatment of Hyperbilirubinemia in a newborn. Phototherapy is a treatment wherein a baby is placed under a special blue spectrum light to reduce the bilirubin levels, while keeping the eyes protected. The nursing team may use a fiber optic blanket and place it under the baby if advised by the physician. Exchange transfusion may also be prescribed in babies with extremely high bilirubin levels. It is important to continue breastfeeding the baby even if he/she has jaundice.
Hyperbilirubinemia Nursing Diagnosis
Hyperbilirubinemia Nursing Care Plan 1
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of hyperbilirubinemia as evidenced by patient’s mother’s verbalization of “I want to know more about my baby’s diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient’s mother will be able to demonstrate sufficient knowledge of hyperbilirubinemia and its management.
|Nursing Interventions for Hyperbilirubinemia||Rationales|
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis of hyperbilirubinemia and to help the patient overcome blocks to learning.|
|Explain what hyperbilirubinemia is, and how it affects the vital organs such as the liver. Avoid using medical jargons and explain in layman’s terms.||To provide information on hyperbilirubinemia and its pathophysiology in the simplest way possible.|
|Inform the caregiver the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) for symptomatic relief of hyperbilirubinemia.||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.|
|Explain to the newborn’s mother what phototherapy is.||Phototherapy is a treatment wherein a baby is placed under a special blue spectrum light to reduce the bilirubin levels, while keeping the eyes protected. The nursing team may use a fiber optic blanket and place it under the baby if advised by the physician.|
|Educate the mother about the need for exchange transfusion for the baby before getting her consent.||Exchange transfusion may also be prescribed in babies with extremely high bilirubin levels.|
Hyperbilirubinemia Nursing Care Plan 2
Nursing Diagnosis: Fatigue related to elevated serum bilirubin levels as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion
Desired Outcome: The adult patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
|Nursing Interventions for Hyperbilirubinemia||Rationales|
|Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.|
|Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.||To gradually increase the patient’s tolerance to physical activity.|
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To allow the patient to relax while at rest. To allow enough oxygenation in the room.|
|Refer the patient to physiotherapy / occupational therapy team as required.||To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.|
Hyperbilirubinemia Nursing Care Plan 3
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.
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
|Nursing Interventions for Hyperbilirubinemia||Rationales|
|Assess the patient’s vital signs at least every 4 hours.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the fever-reducing drugs administered.|
|Remove excessive clothing, blankets and linens. Adjust the room temperature.||To regulate the temperature of the environment and make it more comfortable for the patient.|
|Administer the prescribed anti-pyretic medications.||Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.|
|Offer a tepid sponge bath.||To facilitate the body in cooling down and to provide comfort.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
More Hyperbilirubinemia Nursing Diagnosis
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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