The nurse is caring for a patient with liver disease. When assessing the patient's laboratory values, the nurse should:
a. disregard the level of conjugated bilirubin.
b. assess the indirect serum bilirubin.
c. call the provider immediately if the direct bilirubin is elevated.
d. be aware that unconjugated bilirubin is harmless.
B
Bilirubin enters the circulation bound to albumin and is unconjugated. This portion of the bilirubin is reflected in the indirect serum bilirubin level. Accumulation of unconjugated bilirubin is toxic to cells. In the liver, bilirubin is conjugated with glucuronic acid. Conjugated bilirubin is soluble and excreted in bile. Some conjugated bilirubin returns to the blood and is reflected in the direct serum bilirubin level.
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