Disorders of the Biliary Tract
The nurse expects what physical finding in a patient with cholecystitis? -Spider angioma -Flapping tremors -Abdominal rigidity -Grey Turner's sign
Abdominal rigidity Physical findings in patients with cholecystitis are abdominal rigidity and tenderness in the right upper quadrant. A spider angioma is a manifestation of liver cirrhosis wherein the patient has a small, dilated blood vessel with a red center and branching of the blood vessel. Flapping tremors are seen in patients with hepatic encephalopathy, which is characterized by rapid flexion and extension movements when asked to stretch the hand. Grey Turner's sign is a manifestation of acute pancreatitis characterized by bluish discoloration of the flanks.
The nurse should recommend what type of diet for a patient with acute cholecystitis? -Low-fat -Low-protein -Low-calcium -Low-carbohydrate
Low-fat Cholecystitis is inflammation of the gallbladder. Fats contribute to gallstone formation, worsening the inflammation; therefore, patients with cholecystitis should consume a low-fat diet. A diet low in protein is given to patients with kidney or liver disease. Patients with cholecystitis should be given a diet rich in calcium and carbohydrates.
During a follow-up visit, the nurse finds that the condition of a patient with cholelithiasis has improved. Which food included in the patient's diet most likely facilitated the improvement? -Butter -Yogurt -Cheese -Skim milk
Skim milk Skim milk is rich in calcium and low in fat. Patients with cholelithiasis should consume a diet rich in calcium and fiber and low in fat. Butter, yogurt, and cheese are rich in fats. Fat-rich foods should not be consumed by patients with biliary tract disease such as cholelithiasis or cholecystitis.
The nurse suspects that a patient with cholelithiasis has developed choledocholithiasis. Increases in which assessment finding support the nurse's suspicion? (select all that apply) -Bilirubin -Creatinine -Platelet count -Body temperature -Alkaline Phosphates
Bilirubin and Body temperature Choledocholithiasis is manifested by jaundice caused by elevated levels of bilirubin, fever, and chills. Creatinine levels are elevated in kidney diseases. The platelet count is increased in allergic reactions, infection, and splenectomy. The alkaline phosphatase level is elevated in liver diseases.
The nurse recalls that which substance is involved in the development of cholelithiasis? -Albumin -Calcium -Sodium -Globulin
Calcium Cholelithiasis occurs due to an imbalance in the system that maintains calcium, bile salts, and cholesterol in a solution form, thereby resulting in precipitation. Albumin, sodium, and globulin are not involved in the formation of cholelithiasis
The nurse recalls that which condition is associated with acalculous cholecystitis? -Cholangitis -Choledolithiasis -Diabetes mellitus -Acute pancreatitis
Diabetes mellitus Acalculous cholecystitis is an inflammatory process that occurs in the absence of obstruction and is associated with diabetes mellitus. Cholangitis and choledolithiasis are complications of cholelithiasis, not acalculous cholecystitis. Acute pancreatitis is not associated with acalculous cholecystitis
While caring for a patient with gallbladder disease, the nurse notes that the patient experiences frequent episodes of severe vomiting. What is appropriate to be included in the patient's plan of care? (select all that apply) -Monitor vital signs. -Rinse the mouth daily. -Perform gastric decompression. -Place the patient on a low-fat diet. -Instruct the patient to gargle with salt water before every meal.
Monitor vital signs, perform gastric depression, and place the patient on a low fat diet The nurse should monitor for the patient's vital signs to reduce the risk of any complications. It may be necessary to insert a nasogastric tube and use gastric decompression for patients with severe nausea and vomiting. Because the patient is vomiting frequently, the nurse should rinse the patient's mouth every two hours to provide comfort. Consuming fat may stimulate the gallbladder; the patient should be placed on a low-fat diet. Water high in salt content is an emetic and may provoke vomiting. Therefore the nurse should not instruct the patient to gargle with salt water.
The nurse identifies that a patient is at risk for developing cholelithiasis based on the patient's history of what? -Antibiotic use -Vasodilator therapy -Anticholinergic therapy -Oral contraceptive use
Oral contraceptive use Oral contraceptives affect cholesterol production, thereby resulting in gallbladder cholesterol saturation, which causes gallbladder diseases such as cholelithiasis. Antibiotics, vasodilators, and anticholinergics do not affect cholesterol production and metabolism.
The nurse is providing discharge instructions to a patient that has undergone a laparoscopic cholecystectomy. What is appropriate for the nurse to include in the teaching? (select all that apply) -Record daily weights. -Eat foods rich in fatty acids. -Eat a heavy meal during lunch. -Add fiber-rich foods to the diet. -Eat small meals and two to three snacks each day.
Record daily weights and Add fiber-rich foods to the diet. Eat small meals and two to three snacks each day Foods rich in fiber and calcium should be included in the diet to prevent constipation and hypocalcemia. Patients should record their weight daily because sudden weight loss causes formation of gallstones. Therefore the nurse recommends that the patient record his or her weight daily. It is helpful to eat three small meals and two or three snacks daily rather than three large meals to help reduce the flow of bile after the surgery. Eating fat-rich foods will stimulate the release of bile. Therefore the patient should consider eating light meals.
A patient who has undergone laparoscopic cholecystectomy reports difficulty breathing. The nurse suspects that which patient activity is contributing to this difficulty? -Resting in the supine position -Sleeping for prolonged periods -Performing isometric exercises -Performing deep-breathing exercises
Resting in the supine position Carbon dioxide used to inflate the abdominal cavity for laparoscopic cholecystectomy may result in breathing difficulty by irritating the phrenic nerve and diaphragm. To counteract this, the patient should not be placed in the supine position, to help to move the gas pocket away from the abdomen. Prolonged sleep does not cause breathing difficulty in the patient after the surgery. Isometric exercises help strengthen muscles and do not result in breathing difficulty. Deep-breathing exercises relieve stress and can do not cause difficulty breathing.
The nurse recalls that which surgical instrument is used preoperatively in a patient who will be undergoing an open cholecystectomy? -Biliary stent -Laparoscope -Catheter with wire basket -Transhepatic biliary catheter
Transhepatic biliary catheter Open cholecystectomy involves the removal of the gallbladder through a right subcostal incision. A transhepatic biliary catheter is used preoperatively in patients who are undergoing an open cholecystectomy. A transhepatic biliary catheter is inserted for palliative care when inoperable liver, pancreatic, or bile duct carcinoma obstructs the bile flow. A laparoscope is an instrument inserted during laparoscopic procedures. Biliary stents and catheters with wire baskets are used during endoscopy.
The nurse recalls that bile salts in the body help with what function? -Protein metabolism -Vitamin absorption -Glucose metabolism -Ammonia elimination
Vitamin absorption Bile salts help in the absorption of vitamins and the digestion of food. Proteases are the enzymes that metabolize proteins. Glucose is metabolized by the liver, and ammonia is eliminated by the kidneys.
The nurse provides education to a patient about laparoscopic cholecystectomy. Which statement made by the patient indicates the need for further teaching? -"Small punctures will be made into my abdomen." -"I may be discharged the same day as the surgery." -"I will have work restrictions for 4 to 6 weeks after the surgery." -"An instrument with a camera attached is inserted into the abdomen."
"I will have work restrictions for 4 to 6 weeks after the surgery." Laparoscopic cholecystectomy is a minimally invasive surgery that involves removal of the gallbladder. Postoperative pain is minimal, and the patient can resume his or her work within one week of the surgery. The procedure involves making small punctures into the abdomen through which an instrument called a laparoscope is inserted. The patient is discharged on the day of surgery or a day after. The laparoscope has a camera attached to it, which is inserted through the punctures.
When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include? -Do not return to work or normal activities for three weeks. -Bile-colored drainage probably will drain from the incision. -A lower-fat diet may be tolerated better for several weeks. -Keep the bandages on and the puncture site dry until it heals.
A lower fat diet might be better tolerated Although the usual diet can be resumed, a low-fat diet usually is better tolerated for several weeks following surgery. Normal activities can be resumed gradually as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery, and the patient can shower.
Which condition is associated with the formation of stones in the gallbladder? -Biliary colic -Cholangitis -Cholecystitis -Cholelithiasis
Cholelithiasis Cholelithiasis is the formation of stones in the gallbladder. The pain associated with cholelithiasis is called biliary colic. Cholangitis is inflammation of bile ducts. Inflammation of the gallbladder is called cholecystitis.
A patient comes to the emergency room with acute abdominal pain after eating a large fast-food meal. The physician takes a history of events while the nurse draws blood to assess for liver function and white blood cell count. What should the nurse tell the patient is the most likely next step in the evaluation? -Administration of antibiotics -Insertion of a nasogastric tube -Transport to the operating room -Transport to radiology for an ultrasound scan
Transport to radiology for an ultrasound scan Abdominal ultrasound is a hallmark diagnostic test for the identification of gallstones, which the health care team will want to rule out in this patient. Antibiotics may be indicated if the white blood cell count is elevated, but a full diagnostic evaluation should be completed before starting antibiotic therapy. Insertion of a nasogastric tube may be indicated pending information from further workup, and surgical therapy may be indicated once the appropriate diagnostic tests have been reviewed.
A patient reports abdominal pain and passing of greasy stools with foul odor. What does the nurse suspect is the cause of the patient's condition? -Absence of bile in the small intestine -Hindered bile flow into the duodenum -Presence of dissolved bilirubin in urine -Absence of bile salts in the duodenum
Absence of bile salts in the duodenum Abdominal pain and greasy and foul-smelling stools are characteristics of steatorrhea. Absence of bile salts in the duodenum prevents emulsion and digestion of fats resulting in excretion of fats in the feces, thereby giving it a characteristic greasy appearance. The absence of bile in the small intestine causes fat intolerance. Hindrance or absence of bile flow into the duodenum results in obstructive jaundice. Soluble bilirubin in the urine produces dark amber-colored urine, which is a manifestation of bile flow obstruction.
The nurse provides information to a student nurse about endoscopic retrograde cholangiopancreatography (ERCP). Which statement made by the student nurse indicates the need for further teaching? -"It allows visualization of biliary system." -"The electrodiathermy knife cuts up the stone." -"An electrodiathermy knife is attached to the endoscope." -"Oral dissolution therapy is used in conjunction with this procedure."
"Oral dissolution therapy is used in conjunction with this procedure." Oral dissolution therapy is used along with extracorporeal shock-wave lithotripsy (ESWL) for facilitating removal of disintegrated gallstones. It is not used with endoscopic retrograde cholangiopancreatography (ERCP). ERCP allows visualization of the biliary system. The electrodiathermy knife, which is attached to the endoscope, is used to cut the gallstone, thereby leaving the stone in the duodenum so that it passes into the stool.
The nurse is providing postoperative care to a patient who underwent open cholecystectomy three days ago. Which finding during the nurse's assessment should prompt the nurse to notify the primary health care provider? -Tolerance of a full-liquid diet -Oral temperature of 101.8° 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 660 mL
Oral temp of 101.8 An oral temperature of 101.8º F on the third postoperative day indicates a possible infection and requires further evaluation and modification of the nursing plan of care. Tolerating a full liquid diet and pain at a level of 5 on a 0 to 10 scale are appropriate outcomes at this time. Although fluid intake is low, it is in balance with the output; therefore, it would not be as high a priority as the increased temperature.
What gallbladder change is associated with an acute attack of cholecystitis? -A fistula -Scarring -Occlusion of the cystic duct -Inflammation of the biliary duct
Scarring During an acute attack of cholecystitis, the gallbladder becomes scarred. Fistulas, occlusion of the cystic duct, and inflammation of the biliary duct are complications associated with chronic cholecystitis and cholelithiasis.
The nurse is preparing education for a group of student nurses about endoscopic retrograde cholangiopancreatography (ERCP). Which information is appropriate for the nurse to include in the teaching? -An endoscope is passed into the stomach. -ERCP allows visualization of the stomach. -The endoscope leaves the stone in the duodenum. -ERCP is performed to create a stoma in the gallbladder. -The stent associated with ERCP can be changed after a few months.
The endoscope leaves the stone in the duodenum and the stent associated with ERCP can be changed after a few months An endoscope used in endoscopic retrograde cholangiopancreatography (ERCP) has an electrodiathermy knife attached to it, which cuts the stone and leaves it in the duodenum for easy elimination through the stool. The stent associated with ERCP can be removed or changed after a few months. ERCP involves the passage of an endoscope into the duodenum and allows visualization of the biliary system. Cholecystostomy is the surgical procedure that creates a stoma in the gallbladder.
The nurse reviews medication prescriptions for four patients. The nurse should question which patient's prescription? pt A: cirrhosis treated with hydroxyzine pt B: choleycititis treated with trientine pt C: Wilson's disease treat with D-Penicilliamine pt D: acute prancreatitis treated with nitroglycerin
pt B Trientine is a chelating agent and would not be effective for treating patient B with cholecystitis. Cholecystitis is inflammation of the gallbladder, which causes pain, increased secretions, and muscle spasms. Therefore patients with cholecystitis are prescribed nonsteroidal antiinflammatory drugs for pain relief and anticholinergics like dicyclomine to relieve spasms and decrease the secretions. Cirrhosis, like in patient A, is associated with pruritus, and hydroxyzine is given to relieve skin irritation. Wilson's disease, like in patient C, is caused by accumulation of copper in the body. D-penicillamine is an antidote for copper and used to treat Wilson's disease. Patients with acute pancreatitis, like patient D, have severe abdominal pain and are prescribed spasmolytics, such as nitroglycerin.
A patient is diagnosed with chronic cholecystitis. The nurse expects what assessment finding? -Urticaria -Flatulence -Indigestion -Weight loss
Flatulence Chronic cholecystitis is an obstruction of the gallbladder, which is manifested by flatulence, dyspepsia, and heartburn. Urticaria and weight loss are characteristics of acute pancreatitis. Indigestion is a manifestation of acute cholecystitis.
Which type of monitoring should the nurse include in the care plan of a patient with cholecystitis? -Monitoring gums for bleeding -Monitoring blood glucose levels -Monitoring serum albumin levels -Monitoring serum creatinine levels
Monitor gums for bleeding Cholecystitis is associated with decreased production of prothrombin, a clotting factor, thereby putting the patient at risk of bleeding. Common bleeding sites are mucous membranes of the gums, mouth, and nose, as well as injection sites. A patient with cholecystitis does not show alterations in blood glucose, serum albumin, and serum creatinine levels.
A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy? -Low-grade fever of 100 o F and dehydration -Abscess in the right upper quadrant of the abdomen -Multiple obstructions in the cystic and common bile duct -Activated partial thromboplastin time (aPTT) of 54 seconds
Activated partial thromboplastin time (aPTT) of 54 seconds An aPTT of 54 seconds is above normal and indicates insufficient clotting ability. If the patient had surgery, significant bleeding complications postoperatively are very likely. Fluids can be given to eliminate the dehydration, the abscess can be assessed, and the obstructions in the cystic and common bile duct would be relieved with the cholecystectomy.
The nurse is caring for a patient four days after the patient experienced food poisoning. Admission assessment findings include abdominal pain associated with restlessness, elevated liver enzyme levels, increased direct and indirect bilirubin levels, and an increased white blood count. The nurse suspects what diagnosis? -Liver cirrhosis -Acute liver failure -Bile flow obstruction -Hepatic encephalopathy
Bile flow obstruction Bile duct blockade obstructs bile flow and results in inflammation of the biliary ducts, thereby increasing the white blood cell count. Due to obstruction, the passage of bilirubin for further metabolism is hindered and the serum levels of direct and indirect bilirubin become elevated. Bile duct blockade is also accompanied with increased levels of liver enzymes. An increased level of aldosterone is a sign of liver cirrhosis, resulting in the formation of ascites. Jaundice, encephalopathy, and coagulation abnormalities are the manifestations of acute liver failure. Hepatic encephalopathy is associated with elevated levels of ammonia in the blood.
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 Bleeding is the major immediate postoperative complication after cholecystectomy. Bowel obstruction and dehydration are potential risks, but they would not be immediate risks after the procedure. Infection is a risk after any surgical procedure, but bleeding is a more immediate priority after cholecystectomy
A patient experiences severe pain in the right upper quadrant of the abdomen, increased heart rate, and shortness of breath. The nurse suspects that the consumption of what food items caused the patient's symptoms? -Cheese -Buttermilk -Hamburger -Sugar cookie -Carbonated beverage
Cheese and Hamburger Pain in the right upper quadrant of the abdomen accompanied by tachycardia and dyspnea are the manifestations of cholelithiasis. The pain worsens after eating high-fat meals. Burgers and cheese are high in fat and likely precipitated the attack. Cookies and soft drinks are high in carbohydrates. Buttermilk is low in fat.
A patient presents with pain in the right side of the upper quadrant, a body temperature of 101° F, and indigestion. The laboratory reports show a white blood cell count (WBC) of 14,000 cells/µL. The nurse suspects that the patient is experiencing which condition? -Cirrhosis -Pancreatitis -Cholecystitis -Pancreatic cancer
Cholecystitis A normal white blood cell count is 4,500 to 10,000 cells/µL. The patient's reports show an elevated WBC count, which indicates leukocytosis. Pain in the right upper quadrant, fever, indigestion, and leukocytosis are the clinical manifestations of cholecystitis. Cirrhosis is manifested by jaundice, peripheral edema, peripheral neuropathy, and skin lesions such as spider angiomas. Abdominal pain, shortness of breath, and flushing are the characteristics of pancreatitis. Pancreatic cancer is associated with nausea, dull abdominal pain, loss of appetite, and rapid weight loss.
The nurse recalls that patients with cholelithiasis experience pruritus due to what reason? -The solubility of bilirubin in urine -The deposition of bile salts in tissues -The bile not flowing into the duodenum -The decreased absorption of vitamin K
Deposition of bile salts in skin tissues Pruritus is manifested by itching and is caused by deposition of bile salts in skin tissues. Solubility of bilirubin in the urine results in amber-colored urine that foams on shaking; it does not result in pruritus. When bile does not flow into the duodenum, it accumulates in the systemic circulation and results in obstructive jaundice, not pruritus. Vitamin K is an important element in the clotting pathway. Its decreased absorption may cause clotting problems, resulting in bleeding.
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 to 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 inserted to drain any fluids or effusion.
Gallbladder is removed through 1 to 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. Laparoscopic cholecystectomy involves making 1 to 4 punctures on the abdominal wall, and the gall bladder is removed using laparoscope and grasping forceps. This procedure is done under anesthesia. The patient can be discharged in a day or two because the recovery is fast. This procedure does not involve incisions.
The nurse provides education to a patient about postoperative care after an open cholecystectomy. Which statement made by the patient indicates the need for further teaching? -"I should consume a low-fat diet." -"I am permitted to resume weightlifting." -"I am permitted to engage in sexual intercourse." -"It is important to perform deep-breathing exercises."
I am permitted to resume weight lifting Patients who have undergone open cholecystectomy should not lift heavy weights for up to four to six weeks after surgery. An open cholecystectomy is not associated with dietary restrictions; however, a low-fat diet is recommended. Sexual activities are not contraindicated in a patient who has undergone open cholecystectomy. Deep-breathing exercises help relieve stress, keep the lungs clear, and avoid atelectasis after surgery.
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 -Irritation of the phrenic nerve -Carbon dioxide that was used in surgery
Irritation of the phrenic nerve and Carbon dioxide that was used in surgery The carbon dioxide that is used to inflate the abdomen during surgery may not be released or absorbed by the body and can irritate the phrenic nerve and diaphragm. This is the reason for breathing difficulty and the most common cause of shoulder pain following a cholecystectomy. Other conditions, such as myocardial infarction, pericarditis after surgery, and a gallstone left in the gall bladder, may also cause shoulder pain but are less common causes of right shoulder pain in this situation.
A patient with cholecystitis receives a prescription for cholestyramine in powdered form. The nurse should provide the patient with what medication instruction? -Avoid mixing the medication with water. -Avoid taking the medication with fruit juice. -Take the medication directly from the container. -Mix the medication with four to six ounces of milk.
Mix the medication with four to six ounces of milk. Cholestyramine is an antihistamine that effectively treats pruritus. The powdered form of cholestyramine should be mixed with four to six ounces of milk to ensure adequate absorption. Cholestyramine can be taken along with fruit juices and water. The powdered form of cholestyramine medication should be taken by mixing with milk or juice, not directly from the container.
A patient returns to the surgical center 10 days after a cholecystectomy for his postoperative checkup. His wife is with him and is asking whether she should be concerned about having cholelithiasis as well. What is the most appropriate response by the nurse? -Obesity increases the risk, especially in women. -Pregnancy is not a risk factor for cholelithiasis in women. -The incidence of cholelithiasis is lower in women than in men. -Gender differences in the incidence decrease after 40 years of age
Obesity increases the risk, especially in women Obesity causes increased secretion of cholesterol in bile, increasing the prevalence of cholelithiasis. Gender differences in the incidence of cholelithiasis decrease after 50 years of age. Pregnancy is a high risk factor for cholelithiasis, and multiparous women have the greatest risk of all. Cholelithiasis is more common in women than in men.
The nurse is providing care to a patient with cholecystitis that is experiencing severe nausea and vomiting. The nurse should include what intervention? -Encouraging exercise -Assisting with ambulation -Assisting with repositioning -Providing oral care every two hours
Providing oral care every two hours Patients with cholecystitis may have severe nausea and vomiting. Therefore the nurse should give frequent oral care to the patient to avoid discomfort. Encouraging exercise, assisting with ambulation, and repositioning are not interventions that address the problem of severe nausea and vomiting.
The nurse finds that a patient with cholelithiasis is experiencing severe itching. The laboratory findings reveal a 2.1 mg/dL bilirubin level. The nurse expects that which medication will be prescribed? -Nadolol -Lactulose -Vasopressin -Cholestyramine
Cholestyramine Bilirubin levels in a healthy individual are between 0.3 and 1.9 mg/dL. The patient's laboratory reports indicate hyperbilirubinemia, which results in jaundice. Moreover, the patient has severe itching, which is a sign of pruritus. Pruritus that is accompanied by jaundice is treated with cholestyramine. Nadolol is a beta blocker used for patients with cirrhosis to reduce bleeding from varices. Lactulose is used for relieving constipation. Vasopressin is a vasoconstrictor drug that controls bleeding from the varices and maintains hemostasis.
The nurse is caring for a patient with gallstones and expects what assessment finding? -Tachycardia -Hypotension -Hyperglycemia -Clay-colored stools
Clay-colored stools The presence of gallstones results in bile flow obstruction, which is manifested by fever, clay-colored stools, and dark urine. Tachycardia and hypotension are the clinical manifestations of acute pancreatitis. Hyperglycemia is seen in patients with chronic pancreatitis.
A patient who is receiving treatment for cholelithiasis experiences severe nausea and six episodes of vomiting. The nurse identifies that which intervention will be beneficial to the patient? -Administrating lactulose -Administrating rifaximin -Performing gastric decompression -Performing endotracheal intubation
Gastric decompression Gastric decompression is performed to remove the gastric contents via a nasogastric tube to prevent aspiration of food contents and reduce the incidence of nausea and vomiting. Lactulose is a laxative and is used to treat constipation. Rifaximin is an antibiotic prescribed for patients with hepatic encephalopathy. Endotracheal intubation is a means of providing ventilation to the patient.
The nurse is teaching a student nurse about postoperative care for a patient that has undergone laparoscopic cholecystectomy. Which statements made by the student nurse indicate the need for further teaching? (select all that apply) -"I will monitor for bleeding." -"I will encourage the patient to practice deep breathing." -"I will most likely need to administer narcotics for pain control." -"The patient will use a bedside commode for the first 24 hours after surgery." -"The patient will need to return to the office in 7 to 10 days for removal of stitches."
"I will most likely need to administer narcotics for pain control.", "The patient will use a bedside commode for the first 24 hours after surgery.", and "The patient will need to return to the office in 7 to 10 days for removal of stitches." With laparoscopic cholecystectomy, there are small incisions that are covered by small adhesive bandages that can be removed in about five days. The stitches dissolve over time. Patients who have undergone laparoscopic cholecystectomy can usually walk to the bathroom, so there is no need for a bedside commode. Postoperative pain can usually be controlled with over-the-counter pain relievers. A cholecystectomy may result in changes in prothrombin time and may cause bleeding. Therefore the nurse should monitor for bleeding. Deep-breathing exercises should be encouraged to prevent postoperative pneumonia and to help relieve the patient's discomfort.
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've vomited several times." 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 -Risk for fluid volume deficit related to nausea and vomiting -Acute pain related to inflammation and blockage of the biliary tract
Acute pain related to inflammation and blockage of the biliary tract Acute pain is the priority problem at the moment. Acute pain can and should be managed immediately before other nursing care activities are carried out. Managing the patient's pain helps the nurse in achieving other care goals. Impaired skin integrity is not currently a problem because the patient has not yet had surgery. Anxiety related to deficient knowledge of diagnostic studies is a lower priority and may be addressed after pain is managed. After the patient's pain is managed, nausea, vomiting, and decreased fluid intake should be the next problems addressed.
The nurse notes that a patient is scheduled for a gallbladder removal. The patient will sign a consent form for what procedure? -Splenectomy -Cholecystectomy -Cholecystojejunostomy -Pancreaticoduodectomy
Cholecystectomy Cholecystectomy is the surgical removal of the gallbladder. Splenectomy is removal of the spleen. Cholecystojejunostomy is a surgical formation of means of communication between the gallbladder and jejunum. Pancreaticoduodectomy involves removal of the pancreas, gallbladder, and other organs.
A patient reports abdominal pain. Upon assessment, the nurse finds the presence of tachycardia and prostration. Which condition does the nurse suspect that the patient is experiencing? -Pancreatitis -Cholecystitis -Cholelithiasis -Liver cirrhosis
Cholelithiasis Cholelithiasis is manifested by severe abdominal pain accompanied by tachycardia, dyspnea, and prostration. Pancreatitis is manifested by abdominal pain accompanied by cyanosis, flushing, and dyspnea. Abdominal pain, accompanied by nausea, vomiting, restlessness, and diaphoresis, is characteristic of cholecystitis. Liver cirrhosis is manifested by fatigue, jaundice, peripheral edema, and ascites formation.
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 Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. Nothing by mouth status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis. Enteral feedings should not be needed, and avoiding dietary cholesterol is not used to treat cholelithiasis.
A patient suffering from cholelithiasis underwent a cholecystectomy. What dietary advice will the nurse give this patient? (select all that apply) -Limit intake of water. -Have a high-fiber diet. -Have the same diet as before. -Have small but frequent meals. -Avoid or keep fats to a minimum.
Have a high-fiber diet, Have small but frequent meals, and Avoid or keep fats to a minimum. Having a high-fiber diet helps in the smoother passage of stools and prevents constipation. Having small and frequent meals helps digestion and prevents nausea. Fats are harder to digest. After cholecystectomy, it is essential that the patient has an adequate intake of water, around 2500 to 3000 mL per day. The patient should not have the usual foods that he or she used to consume; modifications are needed to facilitate easy digestion of food in the absence of the gallbladder.
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 not lift heavy weights for a few days. -I should have only a liquid diet for the first week.
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. After the procedure, the diet should be high in fiber and low in fat. Having mild shoulder pain after cholecystectomy is common due to diaphragmatic irritation. After cholecystectomy, it is essential that the patient doesn't lift heavy weights so that abdominal pressure doesn't increase. The patient can bathe and shower normally after a couple of days. The patient doesn't need to follow a liquid diet.
What dietary recommendation should the nurse give to a patient with chronic gallbladder disease? -Include dairy products. -Maintain a low-protein diet. -Include fat-soluble vitamins. -Increase the intake of refined cereals.
Include fat soluble vitamins Patients with chronic gallbladder diseases have a deficiency of fat-soluble vitamins. Therefore the nurse should include fat-soluble vitamins in the patient's diet plan. Dairy products are rich in saturated fats, which are contraindicated for patients with gallbladder disease because dairy stimulates the gallbladder, causing pain. A low-protein diet is given to patients with kidney disease because improper functioning of the kidneys reduces the ability to excrete the nitrogenous waste. As a result, these substances accumulate in the brain, leading to neurologic complications. Refined cereals have less fiber content. However, patients with gallbladder disease require a diet high in fiber because fiber is known to reduce the risk of developing gallstones, thereby preventing complications.
What is appropriate for the nurse to include when teaching a student nurse about open cholecystectomy? -It involves insertion of a T-tube following surgery. -It involves insertion of a needle into the core of the tumor. -It involves resection of the proximal pancreas and duodenum. -It involves administration of an embolic agent through a catheter.
It involves insertion of a T-tube following surgery Open cholecystectomy involves removal of the gallbladder through an abdominal incision. The T-tube facilitates drainage from the common bile duct into an external collection device. The T-tube is then discontinued, and the insertion point heals spontaneously. Radiofrequency ablation involves insertion of a needle into the core of the tumor and is performed on patients with liver cancer. The Whipple procedure is used in pancreatic cancer and involves resection of the proximal pancreas and duodenum. Administration of an embolic agent through the catheter into the artery near the tumor is done in chemoembolization, which is a treatment option for patients with liver cancer.
A patient has been diagnosed with cholelithiasis. The nurse will monitor for manifestations of obstructed bile flow, including which of these? (select all that apply) -Jaundice -Steatorrhea -Dark, tarry stools -Dark, amber urine -Bleeding tendencies
Jaundice, Steatorrhea, Dark amber urine, and Bleeding tendencies Manifestations of obstructed bile flow in a patient with cholelithiasis include jaundice, dark, amber urine, which foams when shaken, clay-colored (not dark, tarry) stools, pruritus, intolerance for fatty foods (nausea, sensation of fullness, anorexia), bleeding tendencies, and steatorrhea. Dark, tarry stools are not a manifestation of obstructed bile flow; clay stools are.
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. -Place patient in shock position. -Instruct not to do deep breathing. -Place the patient in Sims' position.
Maintain a low fat diet, Monitor for any bleeding, Place the patient in Sim's position After cholecystectomy, it is important to follow dietary restrictions. A diet low in fat decreases the workload of the liver. Bleeding is a complication after the procedure; hence the nurse should monitor it. It is important to position the patient in Sims' position to facilitate gas pockets moving away from the diaphragm. Encourage deep breathing along with movement and ambulation to help expand the lungs and promote ventilation. The patient need not be put in shock position; it does not contribute to recovery.
The nurse is providing immediate post-procedural care to a patient who underwent endoscopic retrograde cholangiopancreatography (ERCP). Which actions by the nurse are beneficial to the patient? (select all that apply) -Providing oral foods -Observing for signs of bleeding -Maintaining the patient on bed rest -Observing for any change in body temperature -Encouraging the patient to drink plenty of fluids
Observing for signs of bleeding and Maintaining the patient on bed rest Observing for any change in body temperature Patients who undergo endoscopic retrograde cholangio-pancreatography (ERCP) are at risk of developing infection, bleeding, and pancreatitis. Therefore the nurse should observe for signs of bleeding, encourage bed rest, and monitor for changes in body temperature. Gag reflex is absent after the surgery, and the nurse should wait for the gag reflex to return before providing food particles through the mouth. Although the intake of fluids is beneficial, it is not an immediate care intervention to be provided after ERCP with papillotomy.
The nurse provides education to a student nurse about cholecystitis management. Which statement made by the student nurse indicates the need for further teaching? -"Ketorolac is prescribed to reduce abdominal pain." -"Octreotide is prescribed to reduce smooth muscle spasms." -"Nasogastric intubation is performed to relieve nausea and vomiting." -"A cholecystostomy is performed to remove pus from the gallbladder."
Octreotide is prescribed to reduce smooth muscle spasms. Anticholinergics, such as dicyclomine, are used to reduce the smooth muscle spasms associated with cholecystitis, not octreotide. Ketorolac is an analgesic used to relieve pain. Cholecystostomy is a procedure in which a hole is created in the gallbladder to facilitate insertion of a tube that drains pus from the gallbladder. Nasogastric intubation is performed to remove gastric contents, which may stimulate the gallbladder and cause nausea and vomiting.
A patient's cholecystitis worsens overnight, and the patient is taken for a laparoscopic cholecystectomy. Upon returning to the medical-surgical unit, the patient begins to complain of shoulder pain, rated as an 8 out of 10 on the pain scale, and mild difficulty breathing. Which is the nurse's most appropriate action? -Administer supplemental oxygen. -Page the physician to report the patient's change in condition. -Reassure and reposition the patient, and administer ordered analgesics. -Perform an immediate electrocardiogram because this could be a sign of an impending cardiac event.
Reassure and reposition the patient, and administer ordered analgesics. Referred pain to the shoulder and dyspnea are common postoperative complaints after laparoscopic cholecystectomy because the carbon dioxide gas used to inflate the abdomen cannot be released or absorbed by the body. The patient should be repositioned to move the gas pocket away from the phrenic nerve and the diaphragm to alleviate these symptoms, and the patient should be reassured that this event is expected. Analgesics can be administered to treat the pain. Supplemental oxygen is not indicated in this situation and requires a physician's order. This expected complaint should be documented in the patient's medical record, but the nurse likely does not need to alert the physician unless interventions fail to relieve the symptoms. Referred shoulder pain can be one sign of an impending cardiac event; however, it is an expected complaint after this procedure and is likely not life-threatening.
The patient's ultrasound scan reveals acute cholecystitis. The patient is fearful of undergoing surgery and wants to try conservative management before consenting to a laparoscopic cholecystectomy. What orders should the nurse expect the physician to place in preparation for conservative management? (select all that apply) -A regular diet -Repeat complete blood count -Immediate insertion of a nasogastric tube -2 mg intravenous hydromorphone every 6 hours as needed for pain -4 mg intravenous ondansetron every 6 hours for nausea and vomiting
Repeat complete blood count, 2 mg intravenous hydromorphone every 6 hours as needed for pain, and 4 mg intravenous ondansetron every 6 hours for nausea and vomiting Conservative management for acute cholecystitis focuses on symptom management and observation for complications. A complete blood count monitors the white blood cell count; if elevated, this could signal infection. Patients with acute cholecystitis frequently have pain and may be treated with an intravenous opioid such as hydromorphone, and nausea and vomiting are other common symptoms that are frequently relieved with antiemetics. A regular diet is not indicated because these patients are initially required to fast. Insertion of a nasogastric tube may be indicated if the patient's condition worsens or if nausea and vomiting persist after the administration of antiemetics.
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 within one week. -Eat a low-fat diet for several weeks after the surgery. -Keep the bandages on the puncture sites for three days. -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 within one week, Eat a low-fat diet for several weeks after the surgery, and Report any bile-colored drainage or pus from any incision. After a laparoscopic cholecystectomy, the nurse should instruct the patient to gradually resume normal activities, usually within one week. The nurse should also instruct the patient to have liquids for the rest of the day and eat light meals for a few days. The amount of fat in the postoperative diet depends on the patient's tolerance of fat. A low-fat diet may be helpful if the flow of bile is reduced (usually only in the early postoperative period) or if the patient is overweight. Sometimes the patient is instructed to restrict fats for four to six weeks. Otherwise, no special dietary instructions are needed other than to eat nutritious meals and avoid excessive fat intake. The bandages are to be removed the day after the surgery. Patients need to report any bile-colored drainage or pus from any incision. Patients who undergo a laparoscopic cholecystectomy will not have a T-tube present.
When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements? -Vitamin A -Vitamin D -Vitamin E -Vitamin K -Vitamin B
Vitamin A, D, E, K Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat soluble and thus would need to be supplemented in a patient with biliary obstruction. Vitamin B is water soluble and would not be recommended for a patient with biliary obstruction.
