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04.04 Total Bilirubin

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Overview

  1. Total bilirubin
    1. Normal Value Range
    2. Pathophysiology
    3. Special considerations
    4. Elevations in Total bilirubin

Nursing Points

General

  1. Normal values
    1. 0.1-1.2 mg/dL
  2. Patho
    1. Breakdown product of RBCs
      1. Specifically heme (iron portion of hemoglobin)
    2. Transported to liver
      1. Bound with bile
      2. Excreted via GI tract and kidneys
    3. Conjugated
      1. Water soluble
    4. Unconjugated
      1. Not able to excrete it
      2. Carried to liver via albumin
      3. Conjugated in liver
  3. Special Considerations
    1. Submit in green top tube
    2. Usually submitted with liver function tests
  4. Elevated Total Bilirubin
    1. Newborn jaundice
      1. Treated with phototherapy
      2. Liver tumors
      3. Liver disease
        1. Cirrhosis
        2. Hepatitis
        3. Alcoholism
      4. Cholecystitis
      5. Biliary obstruction

Assessment

  1. Assess patients for jaundice or icterus, or changes in color of stool (clay colored)

Therapeutic Management

  1. Phototherapy for newborns, as they are unable to properly breakdown bilirubin
  2. Treat primary cause of liver/gallbladder disease

Nursing Concepts

  1. Lab Values
  2. Gastrointestinal/Liver Metabolism

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Video Transcript

In this lesson we’re going to take a look at total bilirubin

Bilirubin is a marker that we use to take a look at liver function. The normal value is in 0.1 to 1.2 mg per deciliter, and it’s often measured with direct bilirubin. In order to understand why we measure it, we need to look at how it works.

So we have all these millions of red blood cells in your body, and eventually they don’t work anymore, and they need to be broken down. Part of that breakdown means that heme, the iron-containing compound in red blood cells, needs to be broken down, and what facilitates this is bilirubin.

Bilirubin comes in two forms. It comes in conjugated, and unconjugated. Conjugated bilirubin means that it’s water-soluble, and that means that it can be transported out of the body most of the time by the digestive system. The unconjugated form is not water-soluble. So what happens is the unconjugated bilirubin is sent to the liver, and is then converted to conjugated bilirubin, and then that excreted out through the digestive system.

Now a problem that we run into is that when the liver stops functioning appropriately, you get this buildup of bilirubin because it can’t be broken down by the liver. So what ends up happening is your patient can experience things like jaundice, or icterus, which is a yellowing of the white portion of the eye. Essentially, bilirubin is an indicator of liver dysfunction, and we should take a closer look at our patients that have high bilirubin to see what’s going on with your liver.

Bilirubin is often included with liver function tests, and sometime some larger chemistries , and you’re going to send these off to the lab in a green top tube.

You’re going to see elevations of total bilirubin in patients that have some sort of liver disease, so they could have alcoholic cirrhosis, or different type of hepatitis, whether an infection or viral. You’re also going to see it in cases where the gallbladder is affected, so cholecystitis or biliary obstruction. You’re also going to see it in cases of liver tumors, or in cases where red blood cells are being broken down too fast, so you might see this in certain autoimmune diseases. You’re going to see it most prevalently in newborn jaundice.

Unfortunately newborns don’t have the ability to properly break down that bilirubin like they should. So we do things like this, which is called phototherapy. Bilirubin is extremely susceptible the light, and break down easily under photons, or light therapy. So we very commonly will use for the therapy for extremely jaundiced patients. Decreased levels of bilirubin are ideal, so you will rarely see a total bilirubin of less than 0.1.

For our nursing concept with total bilirubin, we’re looking at the lab values of our gastrointestinal and liver metabolism, so that’s why.

So let’s recap.

Normal values for total bilirubin are 0.1 to 1.2 mg per deciliter.

Bilirubin is required for the process of breaking down heme, and then it sent to the liver to be excreted.

If you have a buildup of bilirubin, it indicates that there’s a problem with the system. So you’ll probably need to take a look at the liver and see what’s going on with it.

Bilirubin is very sensitive to light, so that’s why we use phototherapy for treating newborn jaundice.

Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

Read more

  • Question 1 of 5

The client is scheduled for a cholangiogram. Which of the following pre-procedure nursing tasks can the nurse expect to perform? Select all that apply.

  • Question 2 of 5

The nurse is working in a postpartum unit caring for 4 mothers and 5 babies. Which of the following newborn bilirubin levels are MOST concerning? Select all that apply.

  • Question 3 of 5

A nurse is caring for a three day old, full-term infant who requires phototherapy for increased levels of bilirubin in the body. Which of the following nursing diagnoses is most appropriate for this infant? Select all that apply.

  • Question 4 of 5

The nurse is caring for a two-day-old baby who requires phototherapy for a bilirubin level of 13 mg/dL. During phototherapy, the nurse should monitor for which of the following? Select all that apply.

  • Question 5 of 5

The nurse is caring for a client with jaundice. The provider orders labs. Which of the following labs would the nurse NOT expect to be ordered?

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