Chapter 58 Gallbladder and Pancreatic Disorders
The nurse is teaching a female patient about cholecystectomy via a natural orifice transluminal endoscopic surgery (NOTES). What statement by the patient indicates that the teaching has been effective? "I will only have two small scars." "I can still have gallstones after this procedure." "This procedure will repair, not remove, my gallbladder." "A small incision will be made in my vagina to access my gallbladder."
"A small incision will be made in my vagina to access my gallbladder." The patient will have a small incision made in the vagina to access the gallbladder. The patient will have no scars. The patient should not have gallstones after the procedure. The procedure is to remove, not repair, the gallbladder.
The nurse is teaching a patient who is being discharged home after hospitalization for acute pancreatitis. Which statement by the patient indicates a need for further teaching? "I may have caffeine and chocolate in moderation." "I may need to take fat-soluble vitamins and other supplements." "I should avoid alcohol even after symptoms resolve." "I will consume a diet high in carbohydrates and protein and low in fats."
"I may have caffeine and chocolate in moderation." Patients recovering from pancreatitis should avoid caffeine, chocolate, and other gastrointestinal stimulants. Fat-soluble vitamins may be prescribed. Patients should avoid alcohol, which could trigger a return of symptoms. The diet should be high in carbohydrates and protein and low in fats.
The nurse is teaching a patient about extracorporeal shockwave lithotripsy. What statement by the patient indicates a need for further teaching? "I will sit in 12 inches of water." "The stones will pass through my digestive system." "The shockwaves will turn the big stones into small stones." "I may need to take ursodeoxycholic acid after this procedure."
"I will sit in 12 inches of water." The patient will lay on a water filter pad, not sit in 12 inches of water, during extracorporeal shockwave lithotripsy. The stones will pass through the digestive system. The shockwaves will turn the big stones in the small stones. The patient may need to take medication after the procedure.
A patient who underwent a traditional cholecystectomy is concerned that the drainage in the Jackson-Pratt drain is now green. What statement by the nurse is most appropriate? "It is normal for the first 24 hours." "The drain may need to be repositioned." "Why don't we have you roll on your other side?" "I'm going to take a small sample and send it to the lab."
"It is normal for the first 24 hours." It is normal to have green bile drainage and serosanguinous fluid for the first 24 hours after a Jackson-Pratt drain is placed in a surgery. The drain should not need to be repositioned. The patient does not need to be rolled to the other side. It is not necessary to take a sample to send to the lab.
The nurse is assessing a patient's alcohol intake to determine whether it is the underlying cause of the patient's attacks of pancreatitis. Which question does the nurse ask to elicit this information? "Do you usually binge drink?" "Do you tend to drink more on holidays or weekends?" "Tell me more about your alcohol intake." "Estimate how many episodes of binge drinking you do in a week."
"Tell me more about your alcohol intake." Asking the patient about his or her alcohol intake is the only way that will allow the patient to provide information in the patient's own words and to the extent that the patient wishes to provide it. Asking the patient if he or she binge drinks may tend to put the patient on the defensive rather than provide the desired information. It has not yet been determined whether the patient engages in binge drinking.
The nurse is caring for a patient recently diagnosed with type 1 diabetes mellitus who has had an episode of acute pancreatitis. The patient asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response? "The diabetes could be related to your obesity." "What has your doctor told you about your disease?" "Do you consume alcohol on a frequent basis?" "Type 1 diabetes can occur when the pancreas is destroyed by disease."
"Type 1 diabetes can occur when the pancreas is destroyed by disease." Telling the patient that type 1 diabetes can occur when the pancreas is destroyed by disease is the only response that accurately describes the relationship of the patient's diabetes to pancreatic destruction. Type 2, not type 1, diabetes is usually related to obesity. Asking the patient what the provider has said is an evasive response by the nurse and does not address the patient's question. Many factors could produce acute pancreatitis other than alcohol consumption.
Which symptom of chronic pancreatitis also occurs with acute pancreatitis? Abdominal pain Ascites Loss of exocrine function Protein malabsorption
Abdominal pain Abdominal pain occurs with both types of pancreatitis, although pain intensity does vary between the two. Ascites, loss of exocrine function, and protein malabsorption occur only with chronic pancreatitis.
The nurse is caring for a patient who has been admitted multiple times for pancreatitis. The patient has inflammation and fibrosis of the tissue and diminished pancreatic function. What assessment is priority for this patient? Nicotine use Family support Alcohol consumption Adherence to prescribed medication regimen
Alcohol consumption Alcoholism is a common risk factor for pancreatitis. Nicotine use assessment is not necessary. Family support is important but is not priority. Adherence to the prescribed medication regimen is important but not priority.
The patient diagnosed with acute pancreatitis has a positive Chvostek's sign. What action by the nurse is priority? Assess the serum calcium level. Evaluate the sclera for jaundice. Contact the health care provider. Administer PRN pain medication.
Assess the serum calcium level. Chvostek's sign is an indication of hypocalcemia; therefore, the calcium level should be assessed. Evaluating the sclera for jaundice is not indicated. The priority intervention is not to contact the health care provider. Pain medication is not indicated.
A patient reports fever, yellowing of the skin and eyes, clay-colored stools, and dark urine to the nurse. What do these symptoms indicate? Peritoniti Malnutrition Vitamin deficiency Chronic cholecystitis
Chronic cholecystitis Fever, yellowing of the skin and eyes, clay-colored stools, and dark urine are symptoms of chronic cholecystitis. These symptoms occur when repeated episodes of cystic duct obstruction cause chronic inflammation. Peritonitis is an infection of the peritoneal cavity in which the patient presents with a hard, distended abdomen. Patients with malnutrition are underweight for their height and have low albumin. Patients with a vitamin deficiency do not display these symptoms; symptoms are always dependent upon the vitamin in which the patient is deficient.
A patient who has undergone a laparoscopic cholecystectomy reports mild postoperative abdominal bloating and discomfort. Which nursing action is correct? Administer an opioid analgesic medication. Encourage the patient to ambulate in the hall. Notify the provider of possible peritonitis. Withhold oral fluids until these symptoms have passed.
Encourage the patient to ambulate in the hall. Early ambulation can help promote absorption of the carbon dioxide used to insufflate the abdomen. Signs of continued CO2 retention are abdominal bloating and discomfort. Opioid analgesics are not recommended for mild pain. The patient would have severe discomfort and a rigid abdomen if peritonitis were present. The patient does not require oral fluid restriction.
Which drug is often used as a contrast medium in a magnetic resonance imaging (MRI) scan? Ketorolac Morphine Gadolinium Meperidine
Gadolinium The oral or IV contrast material gadolinium is given before an MRI scan. Gadolinium does not contain iodine; therefore, it does not carry the risk for an allergic reaction. Ketorolac, morphine, and meperidine are not helpful in MRI; these drugs are analgesics.
A patient who has acute pancreatitis has a positive Chvostek's sign. Which condition does this assessment finding indicate? Dehydration Fluid overload Hyperkalemia Hypocalcemia
Hypocalcemia Patients with pancreatitis may develop hypocalcemia, which may be indicated by a positive Chvostek's sign. It does not indicate dehydration, fluid overload, or hyperkalemia. Testing for Chvostek's sign involves tapping the face just below and in front of the ear to trigger facial twitching of one side of the mouth, nose, and cheek.
Which symptoms manifested by a patient with acute pancreatitis indicate complications? Select all that apply. Vertigo Jaundice Depression Darkened urine Clay-colored stools
Jaundice Darkened urine Clay-colored stools Acute pancreatitis occurs because of an inflammation of the pancreas. The enzymes released by the pancreas cause autolysis of the pancreatic tissue. Jaundice, darkened urine, and clay-colored stools indicate complications of acute pancreatitis. Jaundice occurs because of an obstruction in the biliary tract, where bile cannot be absorbed into the gastrointestinal tract. Bile salts accumulate in the skin, causing a yellowish discoloration. An increase in serum bilirubin due to the biliary obstruction causes darkened urine. Stools become clay-colored because of an obstruction in the biliary tract. Vertigo and depression are not symptoms of acute pancreatitis.
A patient is undergoing extracorporeal shockwave lithotripsy. The patient complains of pain in the abdomen. What action by the nurse is appropriate? Reposition the patient Prepare for conscious sedation Ask the interventionist to stop the procedure Let the patient know this is normal when the stones are breaking up and moving
Let the patient know this is normal when the stones are breaking up and moving The patient may experience pain during extracorporeal shockwave lithotripsy when the stones are breaking up and moving. This is not an indication to reposition the patient. The patient will not be placed under conscious sedation. The interventionist would not stop the procedure.
Which enzyme is involved in enzymatic fat necrosis of the endocrine and exocrine cells of the pancreas? Lipase Trypsin Elastase Killikrein
Lipase The lipase enzyme is involved in enzymatic fat necrosis of both the endocrine and exocrine cells of the pancreas. Trypsin activates elastase, which dissolves the elastic fibers of the blood vessels and ducts. Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known as kallidin.
The nurse expects that which patient will be discharged to the home environment first? Older obese adult who has had a laparoscopic cholecystectomy Middle-aged thin adult who has had a laparoscopic cholecystectomy Middle-aged thin adult with a heart murmur who has had a traditional cholecystectomy Older obese adult with chronic obstructive pulmonary disease (COPD) who has had a traditional cholecystectomy
Middle-aged thin adult who has had a laparoscopic cholecystectomy The combination of patient age, a thin frame, and the type of procedure performed will determine that the middle-aged thin patient who had a laparoscopic cholecystectomy will be discharged first. Although the older obese patient who had a laparoscopic cholecystectomy will have a faster discharge time than one with a traditional cholecystectomy, the patient's obesity and age probably will require a longer stay. A traditional cholecystectomy will always require a longer recovery time. The older obese patient with a history of COPD will likely have a more lengthy recovery because of associated breathing problems.
A patient who has cholesterol-based gallstones and good gallbladder function is interested in nonsurgical management options for this condition. Which other factor must be present for this patient to be a candidate for a nonsurgical approach? Ability to tolerate iodine Absence of infection Low serum cholesterol Normal weight
Normal weight Patients who undergo extracorporeal shock wave lithotripsy must be of normal weight and have cholesterol-based, smaller gallstones and good gallbladder function. Iodine is not used in this procedure. The presence of infection and serum cholesterol levels are not factors to consider in candidates for this procedure.
The nurse suspects that which patient is at highest risk for developing gallstones? Obese male with a history of chronic obstructive pulmonary disease Obese female on hormone replacement therapy Thin male with a history of coronary artery bypass grafting Thin female who has recently given birth
Obese female on hormone replacement therapy Both obesity and altered hormone levels increase a woman's risk for developing gallstones. Men are at lower risk than women for developing gallstones. Although pregnancy increases the risk for a woman to develop gallstones, this woman's thin frame lessens that risk.
A patient with acute cholecystitis is admitted to the medical-surgical unit. Which nursing activity associated with the patient's care will be best for the nurse to delegate to the unlicensed assistive personnel (UAP)? Assessing dietary risk factors for cholecystitis. Checking for bowel sounds and distention. Determining precipitating factors for abdominal pain. Obtaining the admission weight, height, and vital signs.
Obtaining the admission weight, height, and vital signs. Obtaining height, weight, and vital signs are included in the education for the unlicensed assistive personnel (UAP) and usually is included in the job description for these staff members. Assessment, checking bowel sounds, and determining precipitating factors for abdominal pain require broader education and are within the scope of practice of licensed nursing staff.
A patient newly diagnosed with pancreatic cancer has had worsening jaundice for several months, and the tumor can be felt as a firm, fixed mass in the left upper abdominal quadrant. What type of management is typical for this type of cancer? Curative No treatment Palliative Preventive
Palliative This patient has signs of late-stage pancreatic cancer. Treatment is generally palliative and may be used to prevent metastasis. It is not usually curative.
A patient with chronic pancreatitis linked to alcoholism tells the nurse that absolute abstention from alcohol is impossible, but states an intention to consume only one alcoholic beverage a day. Which response by the nurse is correct? Ask the patient's family to remove all alcohol from the home. Recommend that the patient contact an alcoholic support group. Suggest that the patient wean from daily alcohol use gradually. Tell the patient that continued use of alcohol will likely be fatal.
Recommend that the patient contact an alcoholic support group. Patients who have pancreatitis should not consume any alcohol and, if alcohol abuse is a problem, should be referred to a support group that can assist with their addiction. Asking the family to remove alcohol from the home does not address the patient's addiction. Patients who are addicted generally cannot wean themselves off of alcohol and must not drink if they have pancreatitis. Telling the patient that this behavior will be fatal is threatening, not therapeutic, and does not address the patient's addiction.
A patient who has undergone an open cholecystectomy 12 hours prior has a Jackson-Pratt (JP) drain. The nurse empties the drainage and notes bile-stained serosanguineous fluid. Which nursing action is correct? Contact the provider to report a possible surgical infection. Notify the provider that the patient may have a perforation of the bile duct. Raise the drainage system above the site of insertion to minimize blood loss. Record the amount and color of the fluid and continue to monitor the patient.
Record the amount and color of the fluid and continue to monitor the patient. JP drainage is generally serosanguineous and is expected to be bile-stained for the first 24 hours after surgery. The color of the fluid does not represent infection, perforation, or excessive blood loss. It is never correct to raise the drainage system above the insertion site because this can cause backup of bile into the surgical site and increase the risk for infection.
What finding is priority for a patient who has just undergone an open cholecystectomy? Output of 25 mL/hr Reddened incision site Pain of 7/10 at the incision site Respiratory rate of 8 breaths/minute
Respiratory rate of 8 breaths/minute The patient does not have an adequate respiratory rate. This needs to be addressed immediately. Output should be greater than 30 mL/hr; however, that does not take precedence over a respiratory rate of 8 breaths/min. Redness at the incision site is normal right after surgery. Pain is important but not priority.
The nurse is attempting to position a patient having an acute attack of pancreatitis in the most comfortable position possible. In which position does the nurse place this patient? Supine, with a pillow supporting the abdomen Up in a chair between frequent periods of ambulation High Fowler's position, with pillows used as needed Side-lying position, with knees drawn up to the chest
Side-lying position, with knees drawn up to the chest The side-lying position with the knees drawn up has been found to relieve abdominal discomfort related to acute pancreatitis. No evidence suggests that supine position, sitting up in a chair, or high Fowler's position have any effect on abdominal discomfort related to acute pancreatitis.
A patient who has acute pancreatitis is ordered to receive ranitidine. The nurse explains that this drug is given for which purpose? To alleviate pain caused by the release of pancreatic enzymes To decrease gastric acid secretion that often occurs with pancreatitis To improve the patient's ability to absorb food as the disease is resolving To minimize the side effects of other medications used to treat pancreatitis
To decrease gastric acid secretion that often occurs with pancreatitis Histamine receptor antagonists are given to decrease gastric secretions during episodes of pancreatitis. They do not alleviate pain caused by pancreatic enzymes. They do not improve food absorption and do not minimize side effects of other drugs used to treat pancreatitis.
The nurse is teaching a patient with gallbladder disease about diet modification. Which meal does the nurse suggest to the patient? Steak and French fries Fried chicken and mashed potatoes Turkey sandwich on wheat bread Sausage and scrambled eggs
Turkey sandwich on wheat bread Turkey is an appropriate low-fat selection for this patient. Steak, French fries, fried chicken, and sausage are too fatty, and eggs are too high in cholesterol for a patient with gallbladder disease.
A female patient is scheduled for a cholecystectomy by natural orifice transluminal endoscopic surgery (NOTES). Which area is most commonly used for inserting the endoscope during this procedure? Mouth Vagina Rectum Umbilicus
Vagina Surgical removal of the gallbladder in women is most often accomplished via the vagina because it is easily decontaminated with betadine or other antiseptic, and it allows easy access into the peritoneal cavity. The surgeon makes a small internal incision through the cul-de-sac of Douglas, between the rectum and uterine wall, to access the gallbladder. The mouth and rectum do not provide easy access into a woman's peritoneal cavity. The umbilicus is used for removing the gallbladder in laparoscopic cholecystectomy.
What elevated blood level indicates inflammation in a patient diagnosed with cholecystitis? White blood cell count Lactate dehydrogenase Serum alkaline phosphate Aspartate aminotransferase
White blood cell count The white blood cell count is indicative of inflammation. The lactate dehydrogenase, serum alkaline phosphate, and aspartate aminotransferase are significant for abnormalities in the liver.
After receiving a change-of-shift report on these patients, which patient does the nurse plan to assess first? Young adult patient with acute pancreatitis who is dyspneic and has a respiratory rate of 34-38 breaths/min Adult patient admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain Middle-aged patient who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography (ERCP) Older adult patient who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL
Young adult patient with acute pancreatitis who is dyspneic and has a respiratory rate of 34-38 breaths/min Acute respiratory distress syndrome is a possible complication of acute pancreatitis. The dyspneic patient is at greatest risk for rapid deterioration and requires immediate assessment and intervention. The patient with cholecystitis and the patient with an elevated temperature will require further assessment and intervention, but these are not medical emergencies requiring the nurse's immediate attention. The older adult patient's glucose level will require intervention but, again, is not a medical emergency.