NURSING DIAGNOSIS: Altered comfort: pruritus

related to stimulation of itch receptors in the skin by bile acid metabolites that accumulate in the blood as a result of bile flow obstruction.

Desired Outcome
The client will experience relief of pruritus as evidenced by:
  1. verbalization of same
  2. no scratching or rubbing of skin.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for the following:
    1. reports of itchiness
    2. persistent scratching or rubbing of skin.
  2. Instruct client in and/or implement measures to relieve pruritus:
    1. apply cool, moist compresses to pruritic areas
    2. apply emollient creams or ointments frequently to prevent dryness
    3. add emollients, cornstarch, or baking soda to bath water
    4. use tepid water and mild soaps for bathing
    5. pat skin dry after bathing, making sure to dry thoroughly
    6. maintain a cool environment
    7. encourage participation in diversional activity
    8. utilize relaxation techniques
    9. utilize cutaneous stimulation techniques (e.g. massage, pressure, vibration, stroking with soft brush) at sites of itching or acupressure points
    10. encourage client to wear loose cotton garments and avoid clothes or blankets made from wool
    11. administer the following medications if ordered:
      1. antihistamines (e.g. diphenhydramine, hydroxyzine [Atarax])
      2. bile acid sequestering agents (e.g. cholestyramine).
  3. Consult appropriate health care provider (e.g. clinical nurse specialist, physician) if above measures fail to alleviate pruritus or if the skin becomes excoriated.