Chapter 44: Assessment and Management of Patients with Biliary Disorders

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients:

cannot tolerate high-glucose concentration.

cholelithiasis

gallstones in the gallbladder

A nurse cares for a client with interstitial pancreatitis. What client teaching will the nurse include when planning care for the client?

"Inflammation is confined to only the pancreas."

In most cases, serum amylase and lipase levels are elevated within 24 hours of the onset of the 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.

A nurse cares for a client who is post op cholecystectomy due to the development of cholesterol stones. The client asks the nurse, "Why did I develop these stones?" What is the nurse's best response?

"The stones formed from a component in the bile and are caused by bile acid and fat abnormalities in the bloodstream."

A very ill client 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 term?

Choledochostomy

A nurse manager prepares teaching for staff nurses who care for clients with diabetes. Which statements will the nurse manager include when discussing the differences between the endocrine and exocrine functions of the pancreas? Select all that apply.

"Internal secretion of hormones is the function of the endocrine pancreas." "The endocrine pancreas secretes hormones through a ductless gland." "The exocrine pancreas secretes hormones from excretory ducts." "The exocrine pancreas secretes pancreatic enzymes into the GI tract."

ERCP

endoscopic retrograde cholangiopancreatogram

Lipase

enzyme that breaks down fat

Amylase

enzyme that breaks down starch

A patient has been admitted to the intensive care unit with a diagnosis of acute pancreatitis. Which of the following laboratory values will the nurse prioritize when gauging the course of his disease? Select all that apply.

White blood cells (WBCs) Amylase Lipase

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

Weight loss

A nurse is caring for a client admitted with acute pancreatitis. Which nursing action is most appropriate for a client with this diagnosis?

Withholding all oral intake, as ordered, to decrease pancreatic secretions

Diabetes mellitus resulting from

dysfunction of the pancreatic islet cells is treated with diet, insulin, or oral antidiabetic agents.

A nursing student has been assigned to care for a client with pancreatic cancer. The student is aware that the risk for pancreatic cancer is most directly proportional to

Age

Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis?

Pancreatic necrosis

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy?

Assessing the color of the sclera every shift

A client who had developed jaundice 2 months earlier 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 symptom would the nurse expect this client to have?

Bile-stained vomiting

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired?

Carbohydrate digestion

A nurse discusses risk factors of cholelithiasis with a client. Which risk factors will the nurse include in the teaching? Select all that apply.

Changes in weight Cystic fibrosis Diabetes Obesity

Which term most precisely refers to the incision of the common bile duct for removal of stones?

Choledocholithotomy

A client with calculi in the gallbladder is said to have

Cholelithiasis

A client has a tumor of the head of the pancreas. What clinical manifestations will the nurse assess? Select all that apply.

Clay-colored stools Dark urine Jaundice

Which dietary modification is used for a client diagnosed with acute pancreatitis?

Elimination of coffee

Which is a gerontological consideration associated with the pancreas?

Increased amount of fibrous material

When caring for a client with acute pancreatitis, the nurse should use which comfort measure?

Positioning the client on the side with the knees flexed

A client with acute pancreatitis reports muscle cramping in the lower extremities. What pathophysiology concept represents the reason the client is reporting this?

Tetany related to hypocalcemia

Trypsin

breaks down proteins

tetany

constant muscle contraction

A client who is 24 hours post op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms?

"Apply a heating pad to your shoulder for 15 minutes hourly as needed."

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

"The tube allows the gastrointestinal tract to rest."

A client is instructed to follow a low-fat diet after an inflammatory attack of the gallbladder. Which vitamins or other acids will the nurse recommend the client supplement due to the client's dietary restrictions? Select all that apply.

A D K Essential fatty acids

cholecystectomy

surgical removal of the gallbladder

A patient is admitted to the hospital with a possible common bile duct obstruction. What clinical manifestations does the nurse understand are indicators of this problem? (Select all that apply.)

Clay-colored feces Pruritus Jaundice

Hypocalcemia may occur in acute pancreatitis because,

when auto digestion of the pancreas occurs, calcium binds to fatty acids and calcium is decreased in the blood. This is a potentially life-threatening complication of pancreatitis and needs to be immediately addressed.

The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of:

Serum lipase

pancreatitis

inflammation of the pancreas

A nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply.

"The pancreas develops fibrous material with age." "The pancreas develops fatty deposits with age." "The pancreas decreases secretion of enzymes with age." "The pancreas decreases bicarbonate secretion with age."

Management of a patient with ascites includes nutritional modifications and diuretic therapy. Which of the following interventions would a nurse expect to be part of patient care? Select all that apply.

Aldactone, an aldosterone-blocking agent would be used. Daily salt intake would be restricted to 2 grams or less. The diuretic will be held if the serum sodium level decreases to <134 m Eq/L.

What concepts does the nurse understand about gerontologic considerations related to acute pancreatitis? Select all that apply.

As the client ages, there is an increased mortality rate for acute pancreatitis. As the client ages, there is an increased risk for the development of multiple organ dysfunction syndrome. As the client ages, the pattern of complications related to acute pancreatitis changes.

A nurse cares for a client who is post op open cholecystectomy. Upon assessment, the nurse notes the client's abdomen feels firm to palpation. What is the nurse's priority action?

Contact the health care provider

The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition?

ERCP

A nurse is planning care for a client with acute pancreatitis. Which client outcome does the nurse assign as the highest priority?

Maintaining normal respiratory function

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should the nurse administer to the client before surgery?

Packed red blood cells

One difference between cholesterol stones (left) and the stones on the right are that the ones on the right account for only 10% to 25% of cases of stones in the United States. What is the name of the stones on the right?

Pigment

A client recovers from an episode of gallbladder inflammation and the client's diet is advanced from a low-fat liquid diet. Which meals will the nurse recommend to the client? Select all that apply.

Roasted chicken, mashed potatoes, and green beans. Marinated lean steak, steamed rice, and roasted zucchini. Oatmeal with a cooked fruit compote and hot tea.

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

Self-digestion of the pancreas by its own proteolytic enzymes

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status?

To avoid inflammation of the pancreas

A client is admitted to the health care center with severe abdominal pain rated 10 on a 1-to-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 goal after administration of this mediation?

To increase the client's pain threshold

The nurse knows that the client with cholelithiasis can have a nutritional deficiency. The obstruction of bile flow due to cholelithiasis can interfere with the absorption of

Vitamin A

This example of cholesterol gallstones (left side of picture) is the result of decreased bile acid synthesis and increased cholesterol synthesis in the liver, which in turn, form stones. Cholesterol stones account for what percentage of cases of gallbladder disease in the United States?

75%

A central venous catheter is inserted for a client being treated for acute pancreatitis. Which of the following would the nurse need to monitor closely?

Pressure measurements

Which is the most common report by clients with pancreatitis?

Severe, radiating abdominal pain

A nurse is preparing a client for endoscopic retrograde cholangiopancreatography (ERCP). The client asks what this test is used for. Which statements by the nurse explains how ERCP can determine the difference between pancreatitis and other biliary disorders? Select all that apply.

"It can evaluate the presence and location of ductal stones and aid in stone removal." "It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts."

When secondary diabetes develops in a client with chronic pancreatitis,

, the client experiences increased appetite, thirst, and urination.

A patient is receiving pharmacologic therapy with ursodeoxycholic acid or chenodeoxycholic-cholic acid for treatment of small gallstones. The patient asks the nurse how long the therapy will take to dissolve the stones. What is the best answer the nurse can give?

6 to 12 months

A nursing student has learned about many collaborative interventions to achieve pain relief for clients with acute pancreatitis. Which of the following are appropriate? Choose all that apply.

Encourage bed rest to decrease the client's metabolic rate. Teach the client about the correlation between alcohol intake and pain. Withhold oral feedings to limit the release of secretin.

The patient admitted with acute pancreatitis has passed the 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?

High-carbohydrate, low-protein, low-fat diet

When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor?

History of pancreatitis

A nurse cares for a client with a disorder of the endocrine function of the pancreas. Which hormones or enzymes may be impacted by this disorder? Select all that apply.

Insulin Glucagon Somatostatin

The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms?

Place the client in semi-Fowler's position.

A nurse cares for a client who is post op open cholecystectomy and has a T-tube in place. Which clinical situation will the nurse notify the health care provider about as a possible complication of the surgery?

Significantly reduced bile output from the T-tube.

Serum electrolyte levels (calcium, potassium, and magnesium) are low.

in acute pancreatitis

Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

Pancreatitis

Interstitial pancreatitis is characterized by

diffuse enlargement of the pancreas due to inflammatory edema confined only to the pancreas itself; normal function returns after about 6 months.

Insulin, glucagon, and somatostatin are

hormones released by the endocrine function of the pancreas. An impairment impacting endocrine function will impact all of these hormones.

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

7 months

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes?

Dysfunction of the pancreatic islet cells

The nurse cares for a client with gallstones that need to be removed but is not a surgical candidate or endoscopic candidate. What procedure does the nurse recognize as being a possible treatment option for the client?

ESWL

A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority?

Impaired nutrition: less than body requirements

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN?

Measure blood glucose concentration every 4 to 6 hours

A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm the diagnosis of acute pancreatitis?

Pain with abdominal distention and hypotension

A client is admitted to the health care center with hyperglycemia, a 15-pound weight loss, and reports of vague upper and midabdominal pain that increases in intensity at night. The client' health history indicates alcoholism, smoking of a pack of cigarettes daily, and diabetes for the past 20 years. Upon examination the nurse finds swelling in the feet and abdominal ascites. Based on the clinical manifestations, which condition is the most likely diagnosis?

Pancreatic carcinoma

Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis?

Providing intensive insulin therapy

A client is treated for gastrointestinal problems related to chronic cholecystitis. What pathophysiological process related to cholecystitis does the nurse understand is the reason behind the client's GI problems?

Reduced or absent bile as a result of obstruction impacts digestion.

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client?

Relieving abdominal pain

A 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 board-like and no bowel sounds are detected. What is the major concern for this patient?

The patient has developed peritonitis.

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk?

Use incentive spirometry every hour.

Pain, jaundice, and weight loss are considered Other signs include rapid, profound, and progressive weight loss as well as vague upper or midabdominal pain or discomfort unrelated to any gastrointestinal function that is often difficult to describe

classic signs of pancreatic carcinoma.

Lipase and amylase are

enzymes released by the exocrine function of the pancreas and are not directly impacted by endocrine function.

ESWL

extracorporeal shock wave lithotripsy uses shock waves to break up gallstones for their removal and does not involve surgery or endoscopy

Necrotizing pancreatitis is life-threatening and

tissue necrosis occurs within the pancreas as well as the surrounding glands.

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:

yellow sclerae.