Biliary
The nurse recognizes which as risk factors for cholecystitis? a. obesity b. male c. female d. African American decent e. European descent
A, C, E
What clinical markers are used in the evaluation of Ranson's Criteria when determining the severity of acute pancreatitis? Select all that apply. a. White blood cell count greater than 16,000/mL b. Rise in hematocrit level greater than 10% c. Fluid sequestration greater than 3 L d. Glucose greater than 200 mg/dL e. Age less than 20 years
A, D
The nurse caring for a patient who has undergone cholecystectomy should monitor the patient for which major immediate postoperative complication? Infection Bleeding Dehydration Bowel obstruction
Bleeding
Key Points about Gallbladder Disease
Bile breaks down fats Bile makes stool brown A Lap chole is one of the most common procedures performed in the US Prognosis after gallbladder removal is great - so just take it out already!
A client with a history of chronic pancreatitis presents to the hospital for admission. The nurse should expect to find which clinical manifestations on assessment? Select all that apply. a. Decreased respiratory rate b. Stable blood pressure c. Clay-colored stools d. Epigastric and left upper quadrant pain e. Steatorrhea
C, D, E
A patient is diagnosed with acute pancreatitis. When providing dietary teaching, what are the points that a nurse should tell the patient? Select all that apply. Consume a low-fat diet. Avoid consuming alcohol. Limit fluid intake. Consume a high-carbohydrate diet. Avoid caffeine intake
Consume a low-fat diet. Avoid consuming alcohol. Consume a high-carbohydrate diet.
Oral Cholecystogram (OCG)
Contrast dye is ingested by patient night before exam and GB structure and function is examined via X-Ray -fast for 4-6 hours before
What questions related to ETOH use are most important for the nurse to ask patient Nancy upon admission to the med surg unit?
Day and time of last drink How much she drinks per day How long (years) has she been using ETOH Support system
The nurse reviews a patient's laboratory values and recognizes which finding as an indication of resolution of acute pancreatitis? Increasing hemoglobin level Falling serum bilirubin level Decreasing serum amylase level Increasing serum alkaline phosphatase level
Decreasing serum amylase level
Acute Pancreatitis Interventions
Diet: • May have NG tube for stomach decompression • Hydrate with IV fluids, replace electrolyte imbalances • Nutrition is a huge concern: often start TPN • Bedrest • Treat pain with narcotics - Morphine • Administer antacids and histamine receptor blocking agents • When ready to begin eating - Small frequent, high carb, high protein, low fat meals - Teach patient to avoid alcohol - Teach patient s/s of biliary obstruction
Chronic ETOH: Assessment Findings
Dullness over liver Peripheral edema Ascites Weight gain Anorexia, nausea Gynecomastia Caput Medusae Spider angioma Dyspnea Pleural effusions Orthostatic hypotension Jaundice
Coagulation
Elevated PT and thrombocytopenia Risk for GI bleed PPIs and/or H2 blockers Esophageal varices Avoid NG placement Recall from our hematology lecture - BLEEDING PRECAUTIONS
Acute pancreatitis assessment
Epigastric pain in LUQ Radiates to back or shoulder blades Pain worsens when eating high fat content food Abdominal fullness, bloating, indigestion Fever, tachycardia, hypotension Cullen's sign Grey Turner's Sign WBC, Bilirubin, BUN, AST/ALT Amylase and Lipase!!!! indicative of pancreatitis if elevated CT Scan
The nurse is planning discharge teaching for a patient after a laser laparoscopic cholecystectomy. The nurse explains to the patient about self-care at home. Which statements of the patient indicate that the patient has understood the discharge teachings? Select all that apply. I cannot bathe or shower for 10 days. I can have normal food that is low in fat. I may have mild shoulder pain for a week. I should have only a liquid diet for the first week. I should not lift heavy weights for a few days.
I can have normal food that is low in fat. I may have mild shoulder pain for a week. I should not lift heavy weights for a few days.
Which bed assignment would the admission nurse implement for a client being admitted from the emergency department with acute pancreatitis? Surgical floor in a private room Medical floor in a semi-private room by the nurse's station Coronary cardiac care unit Intensive care unit
ICU
Which statement best reflects the difference between acute and chronic pancreatitis? The pain from acute pancreatitis is less intense than from chronic pancreatitis. Fluid replacement therapy is required only for treatment of acute pancreatitis. Once a client has been diagnosed with acute pancreatitis, it will progress rapidly to chronic pancreatitis regardless of the response to treatment intervention. Damage to the pancreas can be reversed in acute pancreatitis whereas with chronic pancreatitis both exocrine and endocrine function are compromised.
Last one
A patient has undergone cholecystectomy. What postoperative care should the nurse perform for this patient? Select all that apply. Maintain a low-fat diet. Monitor for any bleeding. Instruct not to do deep breathing. Place patient in shock position. Place the patient in Sims' position.
Maintain a low-fat diet. Monitor for any bleeding. Place the patient in Sims' position.
A nurse is reviewing risk factors with a client who has cholecystitis. The nurse should identify that which of the following as a risk factor for cholecystitis?
Obesity
Which clinical presentation is seen in both acute and chronic pancreatitis? Edema Hyponatremia Hypercalcemia Pain
Pain
Anatomy of pancreatic cancer
Pathophysiology Most tumors arise from exocrine cells Tumor can start in the head, body or tail Spreads quickly Complication: Thrombophlebitis
Liver damage
Portal Hypertension (chronic) Varices Splenomegaly Hepatomegaly Ascites Labs - Elevated LFT's (mild to severe: AST/ALT/ALP/Bilirubin) Clotting disorders (acute and chronic) Hepatic Encephalopathy (acute and chronic) Ammonia
A patient with pancreatic cancer is in the outpatient cancer center to receive radiation therapy. The nurse knows that radiation therapy for patients with pancreatic cancer is most often to: Relieve pain Reduce ascites Increase survival time Inhibit tumor metastasis
Relieve pain
The nurse is providing discharge instructions to a patient and caregiver, following a laparoscopic cholecystectomy. Which of these measures will be included in the discharge counseling? Select all that apply. Resume normal activities gradually. Keep the bandages on the puncture sites for three days. Eat a low-fat diet for several weeks after the surgery. Report any bile-colored drainage or pus from any incision. Empty and measure the contents of the bile bag from the T tube every day.
Resume normal activities gradually. Eat a low-fat diet for several weeks after the surgery. Report any bile-colored drainage or pus from any incision.
Acute pancreatitis
Severe cause pancreatitis has a mortality rate of 15-30% Inflammation of the pancreas Associated with activation of pancreatic enzymes in the pancreas rather than the duodenum Results in autodigestion of the pancreas May be one attack or recurrent, but does resolve for most Can lead to end-organ involvement (heart, lungs, and kidneys)
Ascites treatment
Sodium restriction Furosemide and Spironolactone Abstinence from ETOH if applicable Paracentesis
Diagnostic Evaluation - Imaging/tests
Ultrasound (US) - Highly accurate, noninvasive, inexpensive Oral Cholecystogram (OCG) - Radiographic procedure, take iodine tablets HIDA scan • Utilizes radioactive tracer (follows path to see if it slows down) Tests Endoscopic retrograde cholangiopancreatography (ERCP) ... uses a CT scan Magnetic resonance cholangiopancreatography (MRCP).... uses MRI
A nurse is reviewing a new prescription for chenodiol with a client who has Cholelithiasis. Which of the following information should the nurse include in the teaching?
This medication dissolves gallstones gradually over a period of two years
Once a t-tube is clamped or removed the patient's stool will return to a normal brown color in about one week. A) Fact B) Fiction
A Clay colored without bile so it will be back to normal after
The Whipple Procedure
(Radical pancreaticoduodenectomy) Is a resection of... head of the pancreas the duodenum portion of the jejunum partial or total gastrectomy removal of gallbladder +/- the spleen Anastamosis of pancreatic duct, common bile duct, and stomach to the jejunum
Pancreatic cancer is associated with poor prognosis because there is no screening test available and few early symptoms. A) Fact B) Fiction
A
The most important labs to diagnose pancreatitis are amylase and lipase .A) Fact B) Fiction
A
Treatment of cholecystitis
Acute Chole: Dietary modification Drug Therapy for symptoms Analgesics (Demerol) Abx Antiemetic Antispasmotics Cholecystectomy Laparoscopic chole Open chole ("traditional approach") Treat Cholelithiasis Extracorporeal shock wave lithotripsy Dissolution Therapy Oral agents- Chenodeoxycholic acid (Chenodiol)- Ursodiol (Actigall) Or by direct injection into common bile duct
At 0200 am, a patient comes to the ER with sudden and severe pain in the left upper quadrant of the abdomen and radiating to the back. Pain is aggravated by eating and is not relieved by vomiting. What priority action should the nurse take in this situation? Avoid oral intake of food Give small, frequent oral feedings. Avoid giving spicy and fat-containing food. Identify food products that aggravate the pain and encourage the patient to avoid them.
Avoid oral intake of food
A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take? A. Instruct the client to chew the medication before swallowing B. Offer a glass of water following medication administration C. Administer the medication 30 min before meals D. Sprinkle the contents on peanut butter
B
It is normal to drain about 2500 mL of bile from a t-tube in 24 hours. A) Fact B) Fiction
B
The nurse should assess CIWA for all patients diagnosed with pancreatitis .A) Fact B) Fiction
B -not all pancreatitis pts are alcohol abusers
People with acute pancreatitis usually have difficulty maintaining a normal blood glucose level. A) Fact B) Fiction
B chronic is more likely to have trouble with BS
The most specific laboratory result in the patient with acute pancreatitis is an elevation in which lab? a. serum bilirubin b. serum lipase c. serum trypsin d. serum lactase
B (10-140) avg
The nurse is providing discharge teaching for a client who is postoperative following a laparoscopic cholecystectomy. Which of the following instructions should the nurse include?
B: Resume a diet of choice C: Cleanse the puncture site using mild soap and water E: Report nausea and vomiting to the surgean
Symptoms and effects of alcoholism
Brain -memory -mood swings -dementia Esophageal -bleeding esophageal varices Lungs -breathing difficulties -lower level of nitric oxide Liver -swollen -cirrhosis -hepatitis Heart -irregular heart rate -strokes -high BP Muscular -weakness -muscle wasting Pancreas -pancreastitis Stomach -stoamch ulcers -chronic gastritis -vomiting
A nurse is assessing a client who has pancreatitis. Which of the following findings should the nurse identify as a manifestation of pancreatitis? A. Generalized cyanosis B. Hyperactive bowel sounds C. Gray-blue discoloration of the skin around the umbilicus D. Wheezing in the lower lung fields
C
What nutritional concern will the nurse expect to find in a client who has chronic pancreatitis? a. Weight gain b. Denies nausea c. Weight loss d. Stabilized weight pattern with different food preferences
C
A patient who underwent a cholecystectomy is now complaining of pain referred to his right shoulder. What is the most probable cause for this pain? Select all that apply. Myocardial infarction Pericarditis after surgery Gallstone left accidentally Carbon dioxide that was used in surgery Irritation of the phrenic nerve
Carbon dioxide that was used in surgery Irritation of the phrenic nerve
Surgical Management of Pancreatic Cancer
Clients with small tumors confined to the head of the pancreas are candidates for surgery. Pre-op concern: nutritional status Surgery can possibly be curative, it is very aggressive Whipple procedure
A patient underwent pancreaticoduodenectomy (Whipple procedure) for pancreatic cancer. What are the instructions that the nurse should include when giving dietary advice to this patient? Select all that apply. Consume a low-fat diet. Consume a low-carbohydrate diet. Consume a high-calorie diet. Consume a diet high in proteins. Patient may resume normal diet without any restrictions.
Consume a low-fat diet. Consume a high-calorie diet. Consume a diet high in proteins.
The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient? Prevent all oral intake Control abdominal pain Provide enteral feedings Avoid dietary cholesterol
Control abdominal pain
The nurse receives a patient from the operating room after he undergoes a Whipple procedure. The nurse recognizes that this procedure is indicated for the patient who has which disorder? a. acute pancreatitis b. peritonitis c. cholecytitis d. pancreatic cancer
D
Caput Medusae
Dilated veins around the umbilicus, associated with cirrhosis of the liver.
A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding?
Direct bilirubin 2.1 mg/dL
5 F's - Risk of Gallbladder Disease
Female Fat (BMI >30) Fertile (premenopausal) Fair (Caucasian) Forty
Alcohol withdrawal
GABA - major inhibitory neurotransmitter is suppressed with chronic heavy alcohol use creating dependence Withdrawal from alcohol leads to CNS excitement Symptoms Peak 24-36 hours Risky drinking: -Men: > 4 drinks/occasion; >14 drinks/week -Women: >3 drinks/occasion; >7drinks/week CAGE Cut down, Annoyed, Guilty, Eye Opener
Pancreatic Cancer Discharge Teaching
Get affairs in order -Make a will, make funeral arrangements, make amends with family/friends Physical support -Home care, Hospice care, hospital bed Emotional support: -Help the patient find meaning -Refer to support groups, councilor -Give the number to ACS: 1-800-ACS-2345
Cholelithias
Inflammation or infection of the gallbladder from gallstones Pain is caused by blockage of ducts Symptoms may be self-limiting - if stone moves & no longer blocking flow Can progress to cholecystitis Gallstones Often caused by gallstones (also infection, obesity, immobility, estrogen therapy, trauma, long-term fasting, dehydration) Complications -Necrosis & gangrene of the gallbladder -Perforation &/or peritonitis -Sepsis
The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention should the nurse expect to include in the patient's plan of care? Immediately start enteral feeding to prevent malnutrition Insert a nasogastric (NG) tube and maintain nothing by mouth (NPO) status to allow the pancreas to rest Initiate early prophylactic antibiotic therapy to prevent infection Administer acetaminophen (Tylenol) every four hours for pain relief
Insert a nasogastric (NG) tube and maintain nothing by mouth (NPO) status to allow the pancreas to rest
Chronic Pancreatitis Assessment Findings
LUQ Abdominal pain • Continuous, burning, gnawing, • Intense exacerbations/remissions • Jaundice • N/V • Eventual loss of exocrine function - Steatorrhea and foul smelling stools - Weight loss (muscle wasting) from fat malabsorption • Signs and symptoms of diabetes - Polyuria - Polydipsia - Polyphagia
Liver
Largest solid organ in the body Cleanse your blood Produce digestive enzymes: bile Stores energy in the form of sugar: glycogen Supports clot formation: Bile is essential for vitamin K absorption and is created in the liver. If liver does not produce enough bile, clotting factors cannot be produced
Treatment for pancreatic cancer
Often Palliative, not curative Prevent tumor spread Increase quality of life (Decrease pain) Non-Surgical management Opioid analgesics Chemotherapy Radiation Therapy
The nurse is providing postoperative care to a patient who underwent open cholecystectomy 3 days ago. Which finding during the nurse's assessment should prompt the nurse to notify the primary health care provider? Passing flatus, but no BM Oral temperature of 101.3° F Report of pain at a level 5 on a scale of 0 to 10 An 8-hour fluid intake of 680 mL and an output of 560 mL
Oral temp of 101.3
Palliative Surgery for Pancreatic Cancer
Palliative Surgery: Biliary Drainage of common bile duct: Biliary Drain (external or internal) Monitor and change dressing PRN
A client with chronic pancreatitis may require which type of assistive therapy? Pancreatic enzyme replacement therapy Plasmapheresis Mechanical ventilation Hyperbaric oxygen therapy
Pancreatic enzyme replacement therapy
Pancreatic disease key points
Pancreatitis is VERY painful Not everyone with pancreatitis is an alcohol abuser Believe that the patient is in pain if they say so. Intervene to treat the pain. Rest the bowel to treat pancreatitis. Pancreatitis prognosis: Often recurrent Pancreatic cancer: Often aggressive
Assessment findings
Symptoms vary person to person and in intensity and frequency Indigestion or chest pain after eating fatty or fried foods Episodic colicky pain -Epigastric or RUQ -Can radiate to back and right shoulder Belching Nausea/vomiting + Murphy's sign RUQ tenderness Fever Flatulence Signs of biliary obstruction: -Jaundice .......Icterus = yellowing of the sclera Pruritis Dark amber urine (bilirubinuria) Clay colored stools Steatorrhea
Portal HTN
The liver becomes hard and resistance to blood flow increases in the portal vein Blood backs up into the gastric and esophageal veins leading to varices Blood backs up into the spleen causing splenomegaly and thrombocytopenia (pooling of blood causes this) Protein-rich fluid leaks from the vascular space into the abdominal cavity causing ascites
Open cholecystectomy
Used when gallbladder too large or disease too extensive for laparoscopic removal Expect a hospital stay from 2 to 5+ days -Routine post-op nursing care -Advance diet once patient begins to pass flatus -Care for/teach client about T-tube (if present)
Safety with ETOH withdrawal
What safety precautions should be part of Nancy's careplan while in the hospital? Bed low, bell in reach Ring for assistance OOB - R/t new environment - R/t neuro withdrawal symptoms (confusion, agitation) - R/t possible neuro changes from vitamin deficiency - R/t risk of bleeding from liver impairment - R/t sedative use Bed assignment close to nursing station Frequent rounding/safety checks Consider 1:1 sitter/video monitor
A nurse is completing preoperative teaching for a client who is scheduled for a laprascopic cholecystectomy. Which of the following should be included in the teaching?
You might have shoulder pain after surgery
Diagnostic labs
__AST/__- Aspartate aminotransferase _ALT___- alanine aminotransferase Alkaline Phosphatase (__ALP__) ... all elevated Serum Amylase Bilirubin levels -Reveals obstructed bile flow through common bile duct WBC may be elevated Enzymes released from the liver - increased levels indicate obstructed bile ducts
Which causes are associated with chronic pancreatitis? Select all that apply. Hyperlipidemia Cystic fibrosis Spicy food indigestion Hereditary disorders of the pancreas Hypercalcemia
a, b, d, e
lipase
pancreatic enzyme necessary to digest fats
Nursing care of a client with a T-Tube
tube placed in the bile duct for drainage into a small pouch (bile bag) on the outside of the body Positioning of T-tube: Inspect site: Do not irrigate, aspirate, or clamp a T-tube without an MD order Monitor drainage: first a little bloody then the green brownish color of bile Clamp the T-tube when ordered to aid fat digestion Assess stool If client is discharged with the T-tube, provide teaching regarding cleaning site daily 500-1,000 ml per day is normal... people get a t tube after surgery or to resolve a blocked bile duct from a gallstone... and it can be removed after
Clinical manifestations of pancreatic cancer
• Depend on the site of origin/metastases • Often asymptomatic • Common signs/symptoms - Vague back or abd pain - initial symptom - Jaundice - late sign, common first symptom - Anorexia/weight loss - Ascites - Leg or calf pain from DVT
Cause of pancreatitis
• Exact mechanism unknown • Alcohol use/abuse!!!!! • Presence of gallstones!!!! • Trauma!!!! • Other: • Bacterial or viral infection • Drug induced: -Thiazide diuretics - Steroids - Oral contraceptives • Duodenal ulcer - perforates • Hyperlipidemia
Lap cholecystectomy
• Removal of gallbladder through 2-4 laparoscopic puncture sites • Done as outpatient surgery • Routine Post-op nursing care - Assess for/ explain shoulder pain (bc they pump you with carbon dioxide in the abdomen from surgery so walking can help) - 3-4 L of carbon dioxide to inflate abdomen - Early ambulation promotes absorption • Can resume activities/work within a few days Discharge teaching • Low fat diet as tolerated for 6 months, then re-introduce fats gradually • VNA visit to f/u care with t-tube, if needed
A nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching?Select all that apply A. "I plan to eat small, frequent meals" B. "I will eat easy-to-digest foods with limited spice" C. "I will use skim milk when cooking" D. "I plan to drink regular cola." E. "I will limit alcohol intake to 2 drinks per day."
A, B, C
The nurse is caring for a client with acute pancreatitis. What complications should the nurse monitor for in the critical client? Select all that apply. a. Hemorrhage b. Gallstone development c. Multiple organ failure d. Pleural effusion e. Osteoporosis
A, C, D
A patient presents with acute upper quadrant pain radiating to the back that the patient rates as a 10 on a 1-to-10 pain scale. The patient says, "I'm nauseated, and I just vomited." The diagnosis is cholecystitis with cholelithiasis. Which collaborative nursing diagnosis does the nurse recognize as the highest priority? Impaired Skin Integrity related to the surgical incision Anxiety related to knowledge deficit of diagnostic studies Acute Pain related to inflammation and blockage of the biliary tract Risk for Fluid Volume Deficit related to nausea and vomiting
Acute Pain related to inflammation and blockage of the biliary tract
A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? A. Pain in right upper quadrant radiating to right shoulder B. Report of pain being worse when sitting upright C. Pain relieved wit defecation D. Epigastric pain radiating to left shoulder
D
A nurse is reviewing the admission laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? A. Decreased blood lipase level B. Decreased blood amylase level C. Increased blood calcium level D. Increased blood glucose level
D
The nurse correlates which clinical manifestation with cholecystitis? a. retroperitoneal pain b. absence of bowel sounds c. diarrhea d. RUQ pain
D
The nurse is providing client teaching on pancreatic enzyme replacement therapy. What should the nurse tell the client this therapy is used to treat? a. Decreased insulin level b. Inflammation and obstruction c. Pseudocyst d. Malnutrition and malabsorption
D
The nurse should question the administration of which medication in the patient admitted with cholecystitis? a. acetaminophen b. demerol c. ibuprofen d. morphine
D
Which clinical manifestation of pain does the nurse expect to identify in a patient who has cholecystitis? Left flank pain with intermittent exacerbations Right lower quadrant pain with rebound tenderness Right upper quadrant pain radiating to the patient's back Epigastric pain that intensifies when the patient is lying down
Right upper quadrant pain radiating to the patient's back
Post-op Whipple procedure
Routine post-op complications Monitor drains Monitor for s/s of peritonitis Monitor for fluid/ electrolytes/blood loss Glucose monitoring
A patient with cancer of the head of the pancreas is admitted to the hospital. What are the manifestations that a nurse might expect to find in this patient? Select all that apply. Clay-colored stools Itching and irritation of the skin Swelling of the face and extremities Ulcers on the back and abdomen Extreme pain in the upper abdomen that may radiate to the back
Clay-colored stools Itching and irritation of the skin Extreme pain in the upper abdomen that may radiate to the back
A patient with cholelithiasis is scheduled to go to the OR to have the gallbladder removed. Which patient assessment should the nurse report to the surgeon before transferring the patient to the OR? Low-grade fever of 100 degrees F and dehydration Abscess in the right upper quadrant of the abdomen Activated partial thromboplastin time (aPTT) of 54 seconds Multiple obstructions in the cystic and common bile duct
Activated partial thromboplastin time (aPTT) of 54 seconds Avg is 30-40 seconds and 60-80 on heparin
Medication Protocols: Acute ETOH Withdrawal
1.Benzodiazepine protocol lorazepam or Librium IV or PO based on CIWA scoring (Mild, mod, severe) 2.Phenobarbital protocol Phenobarb standard dosing IM/IV initially then followed by PO for several days
Gallbladder
- Located RUQ, under the liver - Part of biliary tract- Primary function: • Store and concentrate bile • Serves as a reservoir for bile when it is not being used by digestive tract - Release bile vis cystic duct to small intestine to assist in breaking down foods- Cholelithiasis: gallstones
3 anastomoses after whipple procedure
- gastrojejunal - choeldochojejunal/ hepaticojejunal - pancreaticojujunal
Normal pancreas function
-The pancreas secretes insulin when blood glucose levels are greater than 100 mg/dl Endocrine function Insulin & glucagon Exocrine Digestive enzymes and fluids
Spider angioma
-red center with radiating red legs -up to 2 cm -can be raised
The nurse assesses for which finding in a patient with a positive Cullens sign? a. periumbilical bruising b. rebound tenderness c. RUQ pain with radiation to shoulder d. flank bruising
A
You should only take Pancrease with meals or large snacks. A) Fact B) Fiction
A
Reglan (Metocloperimide) is contraindicated in treating nausea associated with acute pancreatitis. A) Fact B) Fiction
A -bc it increases peristalsis and you are npc so this is bad
After a cholecystectomy, the body no longer makes bile. A) Fact B) Fiction
B
A patient is advised to undergo laparoscopic cholecystectomy. The patient asks the nurse what exactly this procedure means. What are the points that a nurse can include in this explanation? Select all that apply. Gallbladder is removed through 1-4 small punctures on the abdominal wall. Gallbladder is removed through an incision made on the right subcostal region. The procedure is done with a laparoscope and grasping forceps under anesthesia. The patient can be discharged on the day of operation or the next and resume his work after a week. The gallbladder is removed through an incision on the abdomen, and a catheter is left in place to drain any fluids or effusion.
Gallbladder is removed through 1-4 small punctures on the abdominal wall. The procedure is done with a laparoscope and grasping forceps under anesthesia. The patient can be discharged on the day of operation or the next and resume his work after a week.
Chronic Pancreatitis Interventions
Manage pain (Morphine) • Chronic pain physical manifestations Strict NPO for exacerbations • TPN, electrolyte replacements • Bedrest and histamine blockers • When ready to start eating again - Maintain small, frequent, low fat, high protein, high carb - Avoid caffeine, ETOH, fatty meals, tobacco - Administer pancreatic enzymes Pancrealipase (Pancrease) to aid in digestion and absorption of nutrients!!!! • Support for glucose management and control
Cancer of the pancreas
Most deadly cancer Incidence -Rare - only 2-4% of all cancers Possible Causes: -Cigarette smoking -Diet: ^ protein, ^ fat, nitrate food additives -Family hx of pancreatic ca -? Race
Assessing ETOH withdrawal s/s with CIWA-Ar
Nausea/Vomiting Tremor Sweats Anxiety Agitation Headache Orientation Hallucinations -Tactile -Auditory -Visual Delirium Tremens (DTs) are rare (about 5%) and potentially fatal complication of ETOH withdrawal. Like ETOH withdrawal syndrome, usually starts 2-4 days after the last drink.
Tests for Pancreatic Cancer
No specific blood test to diagnose Liver enzymes elevated amylase, lipase, alk phosphatase, bilirubin Elevated CA 19-9 CT scan: solid vs cyst mass Biopsy for definitive diagnosis -needle aspiration -endoscopic retrograde cholangiopancreatography (ERCP)
Hepatic Encephalopathy
central nervous system dysfunction resulting from liver disease; frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma Ammonia is absorbed in the GI tract Ammonia build up in the blood is neurotoxic When the liver fails, ammonia levels rise leading to temporary or permanent brain damage (encephalopathy) Symptoms include confusion, impaired attention, tremor (asterixis when severe), somnolence, agitation, coma Recall from pathopharm 1...Lactulose - can help bring ammonia levels down
Asterixis (liver flap)
spastic jerking of hands held in forced extension
