Nurse Farrah is providing care for Kristoff who has jaundice. Which statement indicates that the nurse understands the rationale for instituting skin care measures for the client?
A. "Jaundice is associated with pressure ulcer formation."
B. "Jaundice impairs urea production, which produces pruritus."
C. "Jaundice produces pruritus due to impaired bile acid excretion."
D. "Jaundice leads to decreased tissue perfusion and subsequent breakdown."
Correct Answer: C. “Jaundice produces pruritus due to impaired bile acid excretion.”
Jaundice is a symptom characterized by increased bilirubin concentration in the blood. Bile acid excretion is impaired, increasing the bile acids in the skin and causing pruritus. Patients with jaundice often nominate pruritus as their most troublesome symptom to control and the symptom that has the most negative influence on their quality of life. The presence of pruritus can cause severe sleep deprivation resulting in lassitude, fatigue, depression, and suicidal ideation
Option A: Jaundice is not associated with pressure ulcer formation. However, edema and hypoalbuminemia are. Itching in patients with primary biliary cirrhosis may be severe in the early stages of the disease when bile salt concentrations are low but cease to be a significant symptom when liver failure and cholestasis is advanced.
Option B: Consequently bile salts emerged as the primary causative agents in pruritus. This was supported by the observation that feeding bile salts to cholestatic patients worsened pruritus, intradermal injection of bile salts in healthy volunteers caused local itching, and administration of anion exchange resins to bind luminal bile salts decreased itching intensity.
Option D: Jaundice itself does not lead to decreased tissue perfusion. Histamine is the principal mediator of allergic reactions and is released by mast cells and circulating basophils. Bile salts, particularly chenodeoxycholate and deoxycholate, stimulate the release of histamine from mast cells and plasma histamine concentrations are increased in pruritic patients.
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