Symptom: Yellowing of Skin or Eyes

Initial Grading Reminder

N/A

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you ever had issues with your liver in the past? Is this yellowing a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Where did you notice the yellowing? In your eyes, skin, or tongue?

Grade the symptom

N/A

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have severe abdominal (belly) pain or sleepiness? Are you feeling foggy?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with any yellowing should be seen.

    Patients with the red-flag symptoms should be seen immediately.

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    Nursing Assessment of Potential Causes

    Hepatotoxicity - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient appear fatigued or listless?
    • Does the patient appear jaundiced?
    • Does the patient appear diaphoretic?
    • Does the patient have any ascites?
    • Change in energy level?
    • Change in skin color? Yellowing?
    • Change in stool color (paler)?
    • Change in urine color (darker/tea colored)?
    • Abdominal pain: specifically, right upper quadrant pain?
    • Bruising or bleeding more easily?
    • Fevers?
    • Change in mental status?
    • Increased sweating?
    • Elevation in LFTs
      • AST/SGOT
      • ALT/SGPT
      • Bilirubin (total/direct)
    • Alteration in GI function
    • Symptoms such as abdominal pain, ascites, somnolence, and jaundice
    • Other potential causes (viral, drug toxicity, disease progression)

    Differential Diagnosis

    What do you suspect is the cause of yellowing of the skin or eyes?