Biliary disorders chapter 50

cigarette smoking, exposure to industrial chemicals or toxins diet high in fat, meat, or both

A 68-year-old woman has undergone a Whipple procedure as a potentially curative intervention for pancreatic cancer. What factors in her medical history might you imvestigate to determine her risk factors for developing this disease?

Maintenance of normal respiratory function

A nurse planning patient pancreatitis. Which of the following patient outcomes does the nurse assign as the highest priority?

pulmonary

Percutaneous cholecystectomy has been used in the treatment and diagnosis of acute cholecystitis in patients who are poor risks for any surgical procedure or for General anesthesia. What type of patients fit these conditions? Patients with sepsis or severe cardiac, Renal,_______ or liver failure

Clay colored feces, pruritis, Jaundice

A patient is admitted to the hospital with a possible common bile duct obstruction. What clinical manifestations does the nurse understand our indicators of this problem?

x-ray, ultrasonography, CT scans, and/or MRI of the abdomen. radioisotope liver scan CBC, electrolytes, liver function tests (LFTs). and clotting times, as well as blood cultures.

A 52-year-old man has been hospitalized following a motor vehicle crash with intestinal and liver injuries requiring surgery. He underwent a bowel resection and liver repair that has been complicated by postoperative and GI bleeding requiring multiple blood transfusions. His hospitalization has also been complicated by sepsis. He presents today with fever, nausea vomiting, and right upper quadrant pain What tests might you expect to be ordered?

stones, abscesses

A nurse is preparing a patient for an endoscopic retrograde cholangiopancreatography (ERCP). The patient asks what this test is used for. Which of the following statements made by the nurse explains how ERCP can determine the difference between pancreatitis and other biliary disorders? It can evaluate the presence and location of ductal ______ and aid in stone removal., b) It can assess the anatomy of the pancreas and the pancreatic and biliary ducts., d) It can detect unhealthy tissues in the pancreas and assess for ______ and pseudocysts

Weight loss

What is a major concern for the nurse when caring for a patient with chronic pancreatitis?

Airway and breathing

With acute pancreatitis: _________are always the priority assessment. Acute pancreatitis produces retroperitoneal edema, elevation of the diaphragm, pleural effusion, and inadequate lung ventilation. Intra-abdominal infection and labored breathing increase the body's metabolic demands, which further decreases pulmonary reserve and can lead to respiratory failure. Maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

30

A nurse should monitor blood glucose levels for patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as an adequate to sustain normal brain function?

electrolytes

A patient admitted with severe epigastric abdominal pain radiating to the back is vomiting complaining of difficulty breathing. Upon assessment, the nurse determines that the patient is experiencing tachycardia and hypotension. Administer pain-relieving medication., a) Administer __________, c) Administer plasma., d) Assist the patient to a semi-Fowler's position.

Pancreatic carcinoma

A patient is admitted to the health care center with hyperglycemia, a 15-pound weight loss, and complaints of vague upper and midabdominal pain that increases in intensity at night. His health history record indicates that he is an alcoholic, smokes a pack of cigarettes daily, and has had diabetes for the past 20 years. On examination, the nurse finds swelling in his feet and abdominal ascites. Based on the clinical manifestations, which of the following most likely to be the diagnosis?

To increase the patient's pain threshold

A patient is admitted to the health care center with severe abdominal pain rated at 10 on a 1-10 scale, tachycardia, hypertension, and muscle spasms. The nurse immediately administers morphine sulfate 4 mg slow intravenous pyelogram (IVP) as ordered. The nurse plans for which of the following goals following the administration of this mediation?

Endoscopic ultrasound EUS

Identify small tumors and facilitates find needle aspiration biopsy.

Acute cholecystitis

If a gallstone obstructs the cystic duct , the gallbladder becomes distended, inflamed, and eventually infected which is called what?

sclera

If bile is not draining properly, an obstruction is probably causing bile to be forced back into the liver and bloodstream. Because jaundice may result, the nurse should assess the color of the_______.

carbon dioxide

If pain occurs in the right shoulder or scapular area (from migration of the _________used to insufflate the abdominal cavity during the procedure), the nurse may recommend using a heating pad for 15 to 20 minutes hourly, sitting up in a bed or chair, or walking

aspirin

If pain occurs in the right shoulder or scapular area (frommigration of the carbon dioxide used to insufflate the abdominal cavity during the procedure), the nurse may recommend a heating pad for 15 to 20 minutes hourly. Use of a pillow or binder over the incision may reduce pain during repositioning The nurse educates the patient about avoiding use of________, nonsteroidal mediations and other agents for pain that can alter coagulation and other biochemical processes.

Calculous cholecystitis

If the patient undergoes an abdominal uitrasound revealing gallbladder wall abnonmaltties (thickening) but no gallstones, what diagnosis might be causative of his symptoms?

both an open as well as laparoscopic

Ifshe undergoes a surgical intervention , would you instruct her about an open laparotomy, a laparoscopic procedare, or both?

trauma

In men, pancreatitis is most commonly linked to alcoholism, peptic ulcer, or_______ and in women it is most commonly linked to biliary tract disease.

Endoscopic retrograde cholangiopancreatography

Visualizes the biliary structure.

Chart 50-3

Name four clinical signs for predicting the severity of pancreatitis and associated mortality.

Pancreatic necrosis

_________is a major cause of morbidity and mortality in patients with acute pancreatitis. Shock and MODS may occur with acute pancreatitis. Tetany is not a major cause of morbidity and mortality in patients with acute pancreatitis.

4-6 weeks

Brenda needs to know that dietary fat restriction is usually lifted after the biliary ducts dilate to accommodate bile once held by the gallbladder how long will this take?

intra-abdominal

A patient is scheduled for an outpatient laparoscopic Coley cystectomy. Because the patient will only be at the hospital for less than a day, intensive education is necessary. What should the nurse include in the education? Because of the short hospital stay with uncomplicated laparoscopic Coley cystectomy it is important to provide patient education about managing postop pain and reporting signs and symptoms of________ complications, including loss of appetite, vomiting, pain, distention of the abdomen, and temperature elevation.

Hemorrhage, vascular collapse, and hepatorenal

Once she has had the surgery, to what immediate postoperative complications must yoiu be alert? What assessment strategies are used to monitor for the development of complications?

With acute pancreatitis

A low-fat diet, with small frequent meals, should be initiated after control of symptoms. It not an immediate priority

Skipping meals out of fear of painful attacks

A patient who has been having recurrent attacks of severe abdominal pain over the past few months informs the physician about a 25-pound weight loss in the last year. The nurse attributes which of the following as the most likely cause of this weight loss?

Choledochostomy

A very ill patient with acute cholecystitis is scheduled for surgery. The surgeon plans to create an incision in the common bile duct to remove stones. The nurse correctly documents this surgery in the electronic medical record using which of the following terms? This procedure is reserved for the patient with acute cholecystitis who may be too ill to undergo a surgical procedure. It involves making an incision in the common duct, usually to remove stones

Mild pancreatitis

Acute pancreatitis ranges from mild to severe._______ is characterized by edema and inflammation confined to the pancreas. Minimal organ dysfunction is present. Severe pancreatitis is characterized by local blood vessel damage and possibly bleeding and thrombosis.

Estrogens

Brenda is being medicated with chenodeoxycholic acid. What education should the nurse provide to Brenda about the decreased effectiveness of the drug when taken in conjunction with certain items? This medication may not be effective if taken with dietary cholesterol,_______, or oral contraceptives.

Trypsin

Aides in protein digestion. Which is secreted by the pancreas and is a digestive enzyme.

Lipase

Aides in the digestion of fats. And is secreted by the pancreas and is a digestive enzyme.

24 to 48

Although recovery from laparoscopic cholecystectomy is rapid, patients are drowsy afterward. The patient must have assistance at home during the first ________hours including transportation home. The nurse would ensure that patient has support at until she has recovered from the anesthesia completely and from the surgeryitself.

Hi in fact, as well as eggs, cream, pork, fried foods, cheese, ranch dressings, gas farming vegetables, and alcohol.

As foods are added to Brenda's diet, she needs to know that she should avoid what type of foods?

ERCP with sphincterotomy

Because Brenda symptoms continue to recur she is scheduled for gallbladder surgery. Brenda is scheduled for a laparoscopic Colecystectomy under General Anesthesia. The physician determines that the common bile duct may be obstructed by a gallstone. What should be performed prior to the surgery? If the common bile duct is thought to be obstructed by a gallstone an_________ maybe performed to explore the duct before laparoscopy.

Gallbladder

Bile is stored in the______

Analgesics antibiotics, IV fluids, nasogastric suctioning

Brenda a 33-year-old obese mother of four is diagnosed as having acute gallbladder inflammation. She is 5'4" tall and weighs 190 pounds. The physician decides to delay surgical intervention until Brenda is acute symptoms subside. What does a nurse anticipate that Brenda's initiall course of treatment will probably consist of?

acute pancreatitis

Coffee and spicy foods increase pancreatic and gastric secretions. A high-carbohydrate, low-fat, and low-protein diet should be implemented. With pts with _______

pain management

Describe two evidence-based preventive interventionsfor postoperative care. Evidence-based preventive interventions for postoperative care for the patient with pancreatic cancer include________ via PCA, use ofa pain scale to monitor pain assessing nutrition, use of specialty mattresses, providing education regarding drainage systems, monitoring serum glucose levels, and administering insulin as prescribed

pancreatic cancer

Diabetes, chronic pancreatitis, and hereditary pancreatitis are also associated with________. The pancreas can also be the site of metastasis from other tumors, so the nurse would query the patient regarding cancer elsewhere

Amylase

Digestive enzymes are secreted by the pancreas,________ aids in the digestion of carbohydrates.

malabsorption syndrome

During whipple procedure: It is important to note and report changes in vital signs, arterial blood gases and pressures, pulse oximetry, laboratory values including blood glucose, and urine output. The nurse must also consider the patient's compromised nutritional status and risk of bleeding Depending on the type of surgical procedure performed,__________ and diabetes melitus are likely, the nursemust address these issues during acute and long-term patient care.

enzymes

Gallstones enter the common bile duct and lodge at the ampulla of Vater, obstructing the flow of pancreatic juice or causing a reflux of bile from the common bile duct into the pancreatic duct, thus activating the powerful________ within the pancreas.

knowledge

How would you educate amd prepare the patient for nonsurgical interventions? To educate the patient for nonsurgical interventions, the nurse would first assess the patient's existing ______ base regarding the interventions, as well as his willingness to learn. The nurse would educate the patient and family about any prescribed medications and dietary recommendations.

With acute pancreatitis

IV fluid replacement of fluid and electrolytes should begin immediately due to loss of fluid in the bod If hypotension is evident, plasma should be administered to maintain BP within an acceptable range for the patient. Fluids are administered IV and may be accompanied by infusion of blood or blood products to maintain blood volume and to prevent or treat hypovolemic shock.

biliary tract

In women, pancreatitis is most commonly linked to_______ disease.

symptomatic gallstones

Laparoscopic cholecystectomy is the standard for therapy of________. If the common bile duct is thought to be obstructed by a gallstone, an ERCP with sphincterotomy may be performed to explore the duct before laparoscopy. With the laparoscopic approach, surgical risks have decreased, along with the length of hospital stay and the long recovery period required after standard surgical cholecystectomy. Although cholecystectomy through traditional surgical approaches has largely been replaced by laparoscopic cholecystectomy, in rare instances, it may still be necessary.

lipase

Lipase is an enzyme secreted by the pancreas for the purpose of digesting fats. Increased levels of______ appear in the blood stream when the pancreas is damaged.

With acute pacreatitis

Low serum calcium and magnesium levels may occur and require prompt treatment. The nurse maintains the patient in a semi-Fowler's position to decrease pressure on the diaphragm by a distended abdomen increase respiratory expansion.

pancreatic carcinoma

Pain, jaundice, and weight loss are considered classic signs of_________. Other signs include rapid, profound, and progressive weight loss as well as vague upper or midabdominal pain or discomfort unrelated to any gastrointestinal function and it is often difficult to describe. It is often more severe at night and is accentuated when lying supine. The formation of ascites is common. An important sign is the onset of symptoms of deficiency: glucosuria, hyperglycemia, and abnormal glucose tolerance. Therefore, diabetes may be an early sign of carcinoma of the pancreas.

inflammation

Pancreatic secretion is increased by food and fluid intake and may cause______ of the pancreas.

autodigestion

Pancreatitis, or inflammation of the pancreas, is commonly described as_______ of the pancreas. It is thought that the pancreatic duct becomes temporarily obstructed, accompanied by increased secretion of the exocrine enzymes of the pancreas. These enzymes enter the bile duct, where they are activated and, along with bile, back up into the pancreatic duct and cause pancreatitis.

Edema and inflammation

Patient is diagnosed with mild acute pancreatitis. What does the nearest understand is characteristic of this disorder?

The patient has developed peritonitis

Patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding the abdomen is bored like and no bowel sounds are detected. What is the major concern for this patient?

pancreatectomy

Postoperative management of patients who have undergone a_________ or a pancreaticoduodenectomy is similar to the management of patients after extensive gastrointestinal or biliary surgery. An NG tube with suction and parenteral nutrition allows the Gl tract to rest while promoting adequate nutrition.

dissolution

Regarding stone removal by instrumentation, the ERCP procedure is particularly useful in diagnosis and treatment of patients who have symptoms after biliary tract surgery, patients with intact gallbladders, and patients for whom surgery is particularly hazardous. Stone fragmentation may occur by means of intracorporal laser pulse technology, or by extracorporeal shockwave therapy (ESWL). ESWL is used in some centers for patients with common bile duct stones who may not be surgical candidates and, sometimes in combination with ______ therapy.

trypsin

Self-digestion of the pancreas by its own proteolytic enzymes, principally________, causes acute pancreatitis. Of patients with acute pancreatitis , 80 % had undiagnosed chronic pancreatitis.

acute pancreatitis

Serum amylase and lipase levels are used in making the diagnosis of__________. Serum amylase and lipase levels are elevated within 24 hours the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but serum lipase levels may remain elevated for a longer period, often days longer than amylase. Urinary amylase levels also become elevated and remain elevated longer than serum amylase levels.

pancreatitis

Severe abdominal pain is the major symptom of______ that causes the patient to seek medical care. The pain occurs in the midepigastrium. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed Pain is frequently acute onset, occurring 24 to 48 hours after a very heavy meal alcohol ingestion; it may be diffuse and difficult to localize.

Multipara, obese, and over 40

Statistics show that there is a greater incidence of gallbladder disease for women who are: three things.

30-50

The capacity of the gallbladder for bile storage is ________ML

Insulin, glucagon, Somatostatin

The endocrine secretions of the pancreas are three things.

bile pigments

The excretion of bile pigments by the kidneys makes urine very dark. The feces, no longer colored with_______, are grayish (like putty) or clay colored.

Secretin

The major stimulus for increased bicarbonate secretion from the pancreas is________

Bile duct injury

The most serious complication after a laparoscopic Colecystectomy is _________

blood stream

The nurse educates the patient on the rationale behind an increased serum lipase level. Increased lipase appears in the______ following damage to the pancreas.

ultrasonography

The patient is admitted to the hospital with possible Cholelithiasis. What diagnostic test of choice was a nurse prepare for the patient for?

6 to 12 months

The patient is receiving pharmacological therapy with ursodeoxycholic acid or chenodeoxycholic acid for treatment of small gallstones. The patient asked the nurse how long the therapy will take to dissolve the stones what is the best answer the nurse can give?

glucosuria

The patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? An abnormal glucose tolerance test , ________, hyperglycemia

cholecystitis

The patient should avoid eggs, cream, pork, fried foods, cheese, rich dressings, gas-forming vegetables, and alcohol. It is important to remind the patient that fatty foods may induce an episode of________. Cooked fruits, rice or tapioca, lean meats, mashed potatoes, non- gas-forming vegetables, bread, coffee, or tea may be eaten as tolerated.

pancreas

The patient will be NPO as all oral intake is withheld to inhibit stimulation of the______ and its enzymes.

To avoid inflammation of the pancreas

The physician has written the following orders: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) for a new patient admitted with pancreatitis. The nurse attributes which of the following as the cause for NPO status?

Calculus cholecystitis

This is the cause of more than 90% of cases of acute cholecystitis.

pigment stones

This method of treatment is generaly indicated for patients who refuse surgery or for whom surgery is contraindicated. Patients with significant, frequent symptoms, cystitic occlusion, or _______are not candidates for pharmacologic therapy.

chronic pancreatitis

Weight loss is a major problem in_________: More than 80 % of patients experience significant weight loss, which is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack.

support at home

What infonmation should you collect regarding the patient's home situation before she is discharged?

Cheese

Which foods should be avoided following acute gallbladder inflammation?

Serum lipase

The nurse should assess for an important early indicator of acute pancreatitis. What prolonged and elevated level will the nurse determine is an early indicator?

laprascopy

Visualizes the pancreas via endoscopy.

respiratory status

Assessment should focus on the patient's________. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The other nursing actions are also important, but are not as high a priority as ensuring adequate ventilation.

duct obstruction

The nurse would explain the procedures, their preparation, and expected recovery. Likely outcomes would be at least partial resolution of the problem without the risks of open or laparoscopic surgery. Education regarding pain management as well as monitoring for signs and symptoms indicating complications like stone reoccurrence and ______ would be essential The nurse emphasizes the importance of keeping follow-up appointments and reminds the patient and family of impt of participating in health promotion activities.

High carbohydrate, low protein, low fat diet

The patient admitted with acute pancreatitis has passed acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond?

acute pancreatitis

Nausea and vomiting are common in_______ The emesis is usually gastric origin, but may also be bile stained. Fever, jaundice, mental confusion, and agitation may also occur

hemodynamic

The nurse closely monitors the patient in the ICU after surgery, in the immediate postoperative period, arterial lines are used for_______ monitoring, and mechanical ventilator may be used. For whipple procedure.

small radiolucent

What medication regimen might be used, especially ifthe patient is asymptomatic? asymptomatic patients with cholelithiasis could use pharmacologic therapy, including ursodeoxycholic acid (UDCA (URSO, Actigall) and chenodeoxycholic acid (Chenodiol or CDCA [Chenix]), which have been used to dissolve _________ gallstones composed primarily of cholesterol

Serum amylase

A patient comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out possible acute pancreatitis. The nurse would expect the diagnosis to be confirmed with which of the following elevated laboratory tests?

abdominal x-ray, ultrasonography, cholescintigraphy, cholecystography

A 35-year-old woman has been experiencing more frequent, recurrent episodes of mid epigastric pain. She visits her physician, who states that her symptoms suggest possible gallstones What tests do you expect her to undergo to evaluate for this problem?

laparoscopic cholecystectomy

A patient discharged following a_______ calls the surgeon's office complaining of severe right shoulder pain 24 hours after surgery. Which of the following statements is the correct information for the nurse provide to this patient? This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort.

The tube will allow the gastrointestinal (GI) tract to rest.

A patient has a nasogastric (NG) tube for suction and is NPO following a pancreaticoduodenectomy. Which of the following explanations made by the nurse is the major purpose of this treatment?

cholecystography

Although________ has been replaced by ultrasonography as the test of choice, it is still used if ultrasound equipment is not available or if the ultrasound results are inconclusive. Endoscopic retrograde cholangiopancreatography (ERCP) permits direct visualization of structures that previously could be seen only during laparotomy Percutaneous transhepatic cholangiography (PTC) is rarely used for diagnostic purposes alone due to themulitude of other less-invasive and reliable imaging studies. PTC is reserved for those pts whom an ERCP may be d/t previous surgery involving the biliary tract

ERCP

An______ can determine the difference betweern pancreatitis and other biliary disorders and is generally used in chronic pancreatitis. It is particularly useful in diagnosis and treatment of patients who have symptoms after biliary tract surgery, patients with intact gallbladders, and patients for whom surgery is particular hazardous. It can be used to assist with the removal of stones.

ERCP

An_______ is a useful tool in providing anatomic details about the pancreas and biliary ducts. It can evaluate the presence and location of ductal stones and detect changes in the anatomy of the patient with pancreatitis such as obstruction in the pancreatic duct, tissue necrosis due to premature release of pancreatic enzymes, and assess for abscesses and pseudocysts and atrophy of the glands in the body.

Cholescintigraphy

In this procedure a radioactive agent is administered IV. It is taken up by the hepatocytes and excreted rapidly through the biliary tract. The biliary tract is then scanned, and images of the gallbladder and biliary tract are obtained. This test is more expensive than ultrasonography, takes longer to perform, and exposes the patient to radiation It is not used when ultrasonography is not conclusive such as in acalculous cholecystitis

continuous nasogastric drainage

Maintain________ if paralytic ileus, nausea and vomiting, or abdominal distention is present. Report unrelieved pain or increasing intensity of pain Assist the patient to assume positions of comfort, turn and reposition every 2 hours Use nonpharmacologic interventions for relieving pain (e.g,relaxation, focused breathing, diversion) Listen to patient's expression of pain experience.

Pancreatic necrosis

Major cause of morbidity and mortality in patients with acute pancreatitis is_________

increasing

Morphine, fentanyl, and hydromorphone act by depressing the central nervous system and thereby______ the patient's pain threshold.

hypocalcemia

Muscle twitching and finger numbness indicate_________, a potential complication of acute pancreatitis. Calcium may be prescribed to prevent or treat tetany, which may result from calcium losses into retroperitoneal (peripancreatic) exudate. The other data indicate other complications of acute pancreatitis, but are not indicators of electrolyte imbalance.

lipase

Normal serum______ is 114-286 units/L. So, the patient's serum lipase level is at an increased level at 560units/L Levels double with acute pancreatitis and may remain elevated for up to 14 days afterward.

hemorrhage

Normally, these remain in an inactive form until the pancreatic secretions reach the lumen of the duodenum Activation of the enzymes can lead to vasodilation, increased vascular permeability, necrosis, erosion, and__________.

shock

Nursing management includes nutritional, pain, skin, and respiratory management. The patient will be NPO and may need supplemental nutrition and intravenous fluids. Respiratory status and pain will be closely monitored and addressed, as well as skin integrity. Antibiotics may be prescribed if infection is present. Complications of acute pancreatitis include fluid and electrolyte disturbances, necrosis of the pancreas, and ______

abdominal mass

The most prominent symptom of acute pancreatitis is sev mid-epigastric abdominal pain that is generally more seve after meals. The pain may be accompanied by abdominal distention, palpable_________, decreased peristalsi and vomiting that fails to relieve the pain or nausea. Oth clinical manifestations may include abdominal ecchymosis fever, jaundice, mental confusion, agitation, hypotension, tachycardia, cyanosis, clammy skin, acute renal failure, respiratory distress, hypoxia, hypocalcemia, hyperglycemia, and disseminated intravascular coagulation (DIC).

Gallstones

The nurse identifies which item in the patient's health history as a risk factor for development of acute pancreatitis?

6 to 12 months

Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones?

Cholecystogram, cholangiogram

Visualizes the gallbladder and bile duct.

Celiac axis arteriography

Visualizes the liver and pancreas.

inflammatory process

What are your priority nursing diagnoses for this patient? Priority nursing diagnoses for this patient would include Acute pain and discomfort related to__________ Infection related to surgical procedures evidenced by fever Risk for imbalanced nutrition, less than body requirements, related to nausea and vomiting Risk of fluid imbalance related to nausea and vomiting

The nurse would provide the patient information regarding postoperative complications, including pain in written and verbal formats. Thenurse would educate the patient and family on reporting signs and symptoms of intra-abdominal complications, including loss of appetite, vomiting, pain, distention of the abdomen, and temperature elevation. The current recommendation for pain management is the use of opioids, with assessment for their effectiveness and altering therapy if pain is not controlled or increased

What information should you provide about expectations for postoperative pain and other complications, and what mstructions should you provide to the patient about pharmacologic and nonpharmacologic pain mamagement strategies?

Cholescintigraphy

What is the next most likely test that could be done to detenmine his diagnosis?________ is used successfully in the diagnosis ofacute cholecystitis or blockage of a bile duct

peritoneal cavity

What should the nurse assess for postoperatively in order to prevent complications? Indicators of infection, leakage of bile into the ________, obstruction of bile drainage.

secretin

When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? Encouraging bedrest to decrease the metabolic rate, withholding oral feedings to limit the release of______, administering parental opioid analgesics as ordered.

Clay-colored stools

Which of the following is clinical manifestation of cholelithiasis?

Fluid and electrolyte

_________disturbances are common complications because of nausea, vomiting, movement of fluid from the vascular compartment to the peritoneal cavity, diaphoresis, fever, and the use of gastric suction. The nurse assesses the patient's fluid and electrolyte status by noting skin turgor and moistness of mucous membranes. The nurse weighs the patient daily and carefully measures fluid intake and output, including urine output, nasogastric secretions, and diarrhea.

Acute pancreatitis

________affects people of all ages, but the mortality rate associated with acute pancreatitis increases with advancing age. The pattern of complications changes with age. Younger patients tend to develop local complications; the incidence of multiple organ failure increases with age, possibly as result of progressive decreases in physiologic function of major organs with increasing age.

Amylase

_______is derived from the pancreas, liver, and salivary glands. It is responsible for changing starch to sugar.

ERCP

_______is rarely used in the diagnostic evaluation of acute pancreatitis because the patient is acutely ill; however, it may be valuable in treating gallstone pancreatitis.

Metformin

_______should be withheld for 48 hrs following administration of intravenous contrast. There are no restrictions for the other medications following intravenous contrast administration.

laparoscopic cholecystectomy

İfshe is found to have gallstones , what intervention do you expect her to undergo ? Approximately 80 % of the patients with acute gallbladder inflammation achieve remission with rest, IV fluids, nasogastric suction, analgesia, and antibiotic agents Unless the patient's condition deteriorates, surgical intervention is delayed just until the acute symptoms subside (usually within a few days). At this time, the patient should undergo a___________

Serum Billirubin level greater than 1.0

A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review?

lithotripsy, MTBE

75-year-old man has confirmed cholelithiasis. He also has many other chronic medical conditions, including coronary artery disease, heart failure, and chronic obstructive pulmonary disease. He has been evaluated for treatment by an internist and a surgeon Surgical treatment of cholelithiasis is not appropriate at this time. What options exist for this patient if he is symptomatic? Numerous nonsurgical options are available for the treatment of a symptomatic patient with cholelithiasis. These treatments include dietary management, and attempting to remove the stones by dissolution therapy, instrumentation, and _______. Several methods have been used to dissolve gallstones by infusion of a solvent (monoctanoin or methyl tertiary butyl ether _______) into the gallbladder. This method of dissolution of stones is rarely used due to its lack of success, potential side effects, and recurence rate of up to 50 %

Self-digestion of the pancreas by its own proteolytic enzymes

A nurse is teaching a patient about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the patient correctly identifies which of the following conditions as a cause of acute pancreatitis?

Bile-stained vomiting

A patient who had developed jaundice 2 months previous is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptonm would the nurse expect this patient to have?

Muscle twitching and finger numbness

The nurse identifies a potential collaborative problem of electrolyte imbalance for a patient with severe acute pancreatitis. Which of the following assessment findings would alert the nurse to an electrolyte imbalance associated with acute pancreatitis?

Severe abdominal pain

The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. What does the nurse expect was the reason the patient came to the hospital?

To reduce gastric and pancreatic secretions

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason?

2 hours

The nurse is planning care for a patient following arn incisional cholecystectomy for cholelithiasis. Which of the following interventions is the highest nursing priority for this patient? Assisting the patient to turn, cough, and deep breathe every_______

acute pancreatitis

The nurse promptly reports decreased BP and reduced urine output, which indicate hypovolemia and shock or renal failure. The treatment goals for_______ focus on relieving pain, maintaining circulatory and flui volume, and decreasing the production of pancreatic enzymes.

Metformin

The nurse reviews the patient's home medication list. Which of the following medications does the nurse plan to hold for 48 hours following administration of intravenous contrast material?

bed rest

The nursing interventions carrying the greatest priority for this patient initially would be pain management. The nurse would perform the following interventions Using a pain scale, assess pain level at baseline, before and after administration of analgesic medications Administer morphine, fentanyl, or hydromorphone frequently, as prescribed, to achieve level of pain acceptable to patient. Maintain the patient on________.

Frequent changes of positions

When the nurse is caring for a patient with acute pancreatitis what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions?

Elimination of coffee

Which dietary modification is utilized for a patient diagnosed with acute pancreatitis?

Frequent vomiting leading loss of fluid volume

Which of the following conditions in a patient with pancreatitis makes it necessary for the nurse to check fluid intake and output, hourly urine output, and monitor electrolyte levels?

NPO

Which of the following diets, as ordered by the physician, will the nurse plan to include in the plan of care for the acute pancreatitis patient?

Assessing the color of the sclera every shift

Which of the following interventions should be included in the plan of care for a patient who has undergone a cholecystectomy?

Pancreatic necrosis

Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis?

duodenum, yellow

Why does Jaundice occur in patients with gallbladder disease? The bile, which is no longer carried in to the________, is absorbed by the blood and gives the skin and mucous membranes a______ color.