GERD & Gallbladder (ATI)

A nurse is assessing a client who has an obstruction of the common bile duct resulting from chronic cholecystitis. Which of the following findings should the nurse expect? A. Fatty stools B. Straw-colored urine C. Tenderness in the left upper abdomen D. Ecchymosis of the extremeties

A. Fatty stools Chronic cholecystitis occurs after several bouts of acute cholecystitis. Repeated episodes of inflammation result in fibrotic and contracted gallbladder. Bc of inflammation in gallbladder, bile needed to absorb fat and fat-soluble vitamins is unable to enter bowel, resulting in steatorrhea. Urine would be dark colored, pain would be in the right upper quadrant of the abdomen that can radiate to the back or the right scapular area. Bile is absorbed by blood-skin and mucous membranes develop jaundice.

A nurse is caring for a client who is postoperative following a cholecystectomy and reports pain. Which of the following actions should the nurse take? (Select all that apply.) A. Offer the client a back rub. B. Remind the client to use incisional splinting. C. Identify the client's pain level. D. Assist the client to ambulate. E. Change the client's position.

A. Offer the client a back rub. B. Remind the client to use incisional splinting. C. Identify the client's pain level. E. Change the client's position. Nonpharmacological comfort measures improves pain management, also includes repositioning, imagery, and distraction. Holding a pillow against incision when moving, turning, or coughing can help pt w/ self-management of pain. Always determine severity of pain, use standard scale in this case. If the pt is in pain the nurse should implement interventions to help w/ pain before assisting pt to ambulate.

A nurse is instructing a client who has GERD about positions that can help minimize the effects of reflux during sleep. Which of the following statements indicates to the nurse that the client understands the instructions? A. "I will lie on my left side to sleep at night." B. "I will lie on my right side to sleep at night." C. "I will sleep on my back with my head flat." D. "I will sleep on my stomach with my head flat."

B. "I will lie on my right side to sleep at night." Sleeping in right side-lying positions helps reduce manifestations of nighttime reflux. The pt can also elevate the head of the bed about 15 cm (6 in) on blocks. Left side-lying is unlikely to reduce manifestations of nighttime reflux, lying supine or prone interferes w/ esophageal clearance and worsens manifestations of reflux.

A nurse is providing teaching for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). The client asks about foods he should avoid eating. Which of the following foods should the nurse tell him to avoid? A. Nonfat milk B. Chocolate C. Apples D. Oatmeal

B. Chocolate Pt should avoid foods that reduce pressure on lower esophageal sphincter (fatty and fried foods, chocolate, caffeine, alcohol, and carbonated drinks). Low fat foods (nonfat milk, apples, oatmeal) increase pressure on lower esophageal sphincter and help reduce symptoms of GERD.

A nurse is providing care for a client who had a laparoscopic cholecystectomy. Which of the following is an appropriate nursing action? A. Place the client in a supine position postoperatively. B. Encourage ambulation once fully awake. C. Offer the client ice cream postoperatively. D. Instruct the client not to lift over 4.5 kg (10 lb)

B. Encourage ambulation once fully awake. Promotes absorption of CO2 used during procedure, minimizing pt discomfort. Nurse should check for nausea before ambulating and administer an anti-emetic med if necessary. Pt should be in Semi-Fowler's position to promote lung expansion. If needed, nurse can use lateral or Sims' position for pt who is unconscious to prevent aspiration. Nurse should offer foods low in fat to prevent nausea and vomiting, and foods high in carbs and protein to provide adequate nutrition. Pt should not lift more than 2.3 kg (5 lb) after surgery.

A nurse is caring for a client who has just returned from the PACU after a traditional cholecystectomy. In which of the following positions should the nurse place the client? A. Prone B. Semi-Fowler's C. Supported Sims' D. Dorsal recumbant

B. Semi-Fowler's The nurse should expect a prescription to place pt in semi-Fowler's position to facilitate lung expansion as well as coughing and deep breathing. This position places minimal stress on abdomen and increases comfort.

A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan? A. Include foods high in starch and proteins. B. Include foods high in fiber. C. Avoid foods high in fat. D. Avoid foods high in sodium.

C. Avoid foods high in fat. Pt with chronic cholecystitis has intolerance to fatty foods. Foods high in starch, protein, fiber, and sodium do no affect episodes of biliary colic.

A nurse is caring for a client who is postoperative following an open cholecystectomy. Which of the following actions should the nurse take when caring for the client's Jackson-Pratt (JP) drain? A. Measure the drainage every hour for the first 8 hr postoperative. B. Secure the drain to the client's bed sheet. C. Expel the air from the JP bulb after emptying to re-establish suction. D. Remove the JP drain when the drainage has ceased, covering the opening with sterile gauze.

C. W/ drainage and air removed and the bulb tightly closed, the system works to exert gentle negative pressure, facilitating the removal of accumulated fluid from the surgical area.

A nurse is caring for a client who has suspected cholecystitis. The nurse should expect the client's urine to appear which of the following colors? A. Pale yellow B. Greenish-brown C. Red D. Dark and foamy

D. Dark and foamy Dark and foamy urine indicates the kidneys are filtering excess bilirubin from the blood. Pale yellow = healthy and hydrated, greenish-brown = unexpected, red = urinary tract bleeding.

A nurse is admitting a client to the surgical unit from the PACU following a cholecystectomy. Which of the following assessments is the nurse's priority? A. Bowel sounds B. Surgical dressing C. Temperature D. Oxygen Saturation

D. Oxygen Saturation The priority action the nurse should take when using the airway, breathing, circulation approach to pt care is to access pt's O2 sat. The nurse should check the pt's airway, listen to breath sounds, and check pulse ox to assess for respiratory depression.