A patient in the icteric phase of hepatitis asks the nurse, "Why are my stools no longer brown?" How should the nurse respond?
1. "Your liver isn't making any of the substance that makes stools brown.".
2. "The bilirubin that causes the coloration is going into your blood and turning your skin yellow.".
3. "It is being released into your bloodstream and turning your blood darker red.".
4. "The answer is not known. More research is needed regarding this question.".
2
Rationale 1: The stools are light brown or clay colored because bile pigment is not excreted through the normal fecal pathway. Instead, the pigment is excreted by the kidneys.
Rationale 2: The icteric (jaundiced) phase usually begins 5 to 10 days after the onset of symptoms. Inflammation of the liver and bile ducts prevents bilirubin from being excreted into the small intestine. Serum bilirubin levels are elevated, causing yellowing of the skin and mucous membranes.
Rationale 3: The blood is not turned darker when bilirubin levels are elevated.
Rationale 4: The cause of this phenomenon is known.
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