Description

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