3.  Jaundice is the yellowish coloration of the skin, sclera, mucus membrane due to high concentration of bilirubin  Jaundice becomes clinically evident when the serum bilirubin level exceeds 2,5 mg\dl

4. Pathopysiology  Bilirubin result from break down of hemoglobin,unconjugated bilirubin transported to liver bound to albumine because insoluble in water and after that become conjugated bilirubin  Conjugated bilirubin is water soluble and secreted in to bile and then in to intestine, converted to urobilinogen and sterobilinogen

5.  Urobilinogen 20% reabsorbed in to portal circulation and rexcretedin to urine by kidney  Sterobilinogen excreted in to stool and give it yellow color  Mechanismof jaundice  Increase production of bilirubin  Decrease hepatocyte conjugation  Impaired delivery of B in to intestine

6. Mention types or classification of jaundice ?  Hemolytic jaundice (pre haepatic jaundice)  haepatic jaundice (hepatocellular jaundice)  Obstructive jaundice (post haepatic jaundice )

7. Hemolytic jaundice  Hemolytic jaundice resulting due to increase destruction of RBCs or hemolysis  Causes=-  Abnormal Hb, malaria and splenomegaly

8. Hepatic jaundice  Hepatic jaundice occurs due to in ability of damaged liver cells to clear normal amount of bilirubin from the blood  Causes =-  Hepatitis A,B, C,D and E  Yellow fever virus

9. Obstructive jaundice  Resulting due to occlusion of bile duct by gallbladder stone, inflamatory process and tumor such as carcenoma of the head of pancreas  This types characterizeby the following  Increase conjugated bilirubin  Urobilinogen in urine absent and stool pale or fatty

10.  Sings and symptoms =-  Yellowish color of skin and sclera  Itching  Diagnostic test =-  LFT,AbdU\S and CBC  MANAGEMENT =-  According to causes  Complication=-  Gallbladder stone and brain stem damage

11. Nursing process  Assessment =-  History of chief complain  Assess skin,sclera and mucus membrane  Abdominal examination  Assess patient knowledge

12. Nursing diagnosis  Impaired skin integrity R\L to increase bilirubin concentration  Goal =- maintain skin integrity  N implementation =-  Assess skin integrity  Bathing for the patient  Lubricate the skin daily  Administer prescribed medication  Reassess the skin