MS Exam 3: Chapter 59
what are the four Fs that are most at risk for acute cholecystitis and gallstones?
-female -forty -fat -fertile
what laboratory values are associated with acute pancreatitis?
-increased amylase -increased lipase
what is a HIDA (hepatobiliary) scan?
-performed to visualize the gallbladder and determine patency of the biliary system -a radioactive tracer or chemical is injected IV
what are the risk factors for pancreatic cancer?
-smoking -red meat (steak)
what is the palliative care for pancreatic cancer?
-try to prevent the spread of pancreatic cancer -pain management -chemo and radiation
what are the risk factors for cholecystitis?
-women -aging -American Indian, Mexican, or caucasian -obesity -rapid weight loss or prolonged fasting -increased cholesterol
what are the imaging assessments for acute pancreatitis?
-abdominal US -CT scan is better
what is the surgical management for pancreatic cancer?
-Operative procedure may include Whipple procedure -Surgery is only done with small tumors
what are the non-surgical interventions for acute pancreatitis?
-ABCs -consult respiratory therapy -hydrate them with IV fluids if it is mild -pain control: may need PCA -drug therapy: primary drug class is opioids -fasting (NPO): may need IV calcium (watch for Trousseau's and Chovstek's) and magnesium; may need NG tube -rest -if caused by gallstones they could have emergent ERCP (if ERCP is unsuccessful, they may need a lap chole)
what are the causes of acute pancreatitis?
-Cause is not known in many cases, but can occur because of gallstones, trauma, obstruction, hyperparathyroidism, renal failure, ulcers- peritonitis, smoking, cystic fibrosis, familial, alcoholism, and drugs -Happens after holidays and vacations (due to increased drinking) and several months after childbirth
why are laparoscopic cholecystectomies more common than traditional?
-Complications are not common. -Patient recovery is quicker. -Postoperative pain is less severe.
what assessments need to be done for acute pancreatitis?
-Constant abdominal pain (intense, boring pain- feeling that it is going through the body, may be in fetal position) -Jaundice -Gray-blue color on abdomen and flanks -Vital signs may show signs of shock (elevated temp, tachycardia, decreased BP) -Assess lungs, bowel sounds, abdomen (tender?), and ask if they have been binge drinking
what is pancreatic cancer?
-Difficult to diagnose -Treatment has limited results -Low survival rates (discovered in late stages) -Primary (starts in the pancreas) or secondary (starts in the breast, lung, etc and spreads to the pancres) -Grows rapidly -Pancreatic cancer presents slow and vague
what is cholecystitis?
-Inflammation of the gallbladder -Most cases are acute
A client has undergone the Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which precautionary measures does the nurse implement to prevent potential complications? Select all that apply. a. Check blood glucose often. b. Check bowel sounds and stools. c. Ensure that drainage color is clear. d. Monitor mental status. e. Place the client in the supine position.
A, B, D
the nurse will include what post-op teaching when caring for the client who is preparing to undergo endoscopic cholecystectomy? select all that apply. a. you'll have a small, midline abdominal incision b. you can't eat or drink for a few days after the procedure c. you won't be able to return to regular activity for several weeks d. generally the pain associated with this procedure is minimal e. this procedure has a low incidence of infection f. the hospital stay after this procedure is typically 3-4 days
A, D, E
A client who had been hospitalized with pancreatitis is being discharged with home health services. The client is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the client's strength? a. Limiting the client's activities to one floor of the home b. Instructing the client to take an as-needed (PRN) sleeping medication at night c. Arranging for the client to have a nutritional consult to assess the client's diet d. Asking the health care provider for a request for PRN nasal oxygen
A
After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? a. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min b. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain c. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography d. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL (13.1 mmol/L)
A
Which diagnostic results lead the nurse to suspect that a client may have gallbladder disease? a. Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall b. Decreased WBC count, visualization of calcified gallstones, increased alkaline phosphatase c. Increased WBC count, visualization of noncalcified gallstones, edema of the gallbladder wall d. Decreased WBC count, visualization of noncalcified gallstones, increased alkaline phosphatase
A
A client has developed acute pancreatitis after also developing gallstones. Which is the highest priority nursing instruction for this client to avoid further attacks of pancreatitis? a. "You may need a surgical consult for removal of your gallbladder." b. "See your health care provider (HCP) immediately when experiencing symptoms of a gallbladder attack." c. "If you have a gallbladder attack and pain does not resolve within a few days, call your health care provider." d. "You'll need to drastically modify your alcohol intake."
B
The nurse expects that which client will be discharged to the home environment first? a. Older obese adult who has had a laparoscopic cholecystectomy b. Middle-aged thin adult who has had a laparoscopic cholecystectomy c. Middle-aged thin adult with a heart murmur who has had a traditional cholecystectomy d. Older obese adult with chronic obstructive pulmonary disease (COPD) who has had a traditional cholecystectomy
B
The nurse suspects that which client is at highest risk for developing gallstones? a. Obese male with chronic obstructive pulmonary disease b. Obese female receiving hormone replacement therapy c. Thin male with a history of coronary artery bypass grafting d. Thin female who has recently given birth
B
the community nurse is talking with four clients who have reported digestive concerns. which client does the nurse recognize as most likely to experience gallstone production? select all that apply. a. 23-year-old Caucasian vegetarian who is a dancer b. 35-year-old American Indian who works in construction c. 48-year-old Canadian who manages a fast-food restaurant d. 59-year-old Asian American who is an investment banker e. 64-year-old Mexican American who resides with grandchildren
B, E
A client diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? a. "This may be an indication that you are developing sepsis." b. "The gallstones are present, but have become fibrotic and contracted." c. "This type of gallbladder inflammation is associated with hypovolemia." d. "This may be an indication of pancreatic disease."
C
A client has been discharged to home after being hospitalized with an acute episode of pancreatitis. The client, who is an alcoholic, is unwilling to participate in Alcoholics Anonymous (AA), and the client's spouse expresses frustration to the home health nurse regarding the client's refusal. What is the nurse's best response? a. "Your spouse will sign up for the meetings only when he is ready to deal with his problem." b. "Keep mentioning the AA meetings to your spouse on a regular basis." c. "I'll get you some information on the support group Al-Anon." d. "Tell me more about your frustration with your spouse's refusal to participate in AA."
C
A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? a. Measure intake and output every shift. b. Do not administer food or fluids by mouth. c. Administer opioid analgesic medication. d. Assist the client to assume a position of comfort.
C
The nurse is assessing a client who has recurrent attacks of pancreatitis and is concerned about possible alcohol abuse as an underlying cause of these attacks. To elicit this information, what will the nurse do initially? a. Ask the client about binge drinking. b. Question the client whether drinking increases on weekends. c. Provide privacy and use the CAGE questionnaire (Cut down, Annoyed by criticism, Guilt about drinking, and Eye-opener drinks) d. Ask the client's spouse to describe the client's drinking
C
The nurse is teaching a client with gallbladder disease about diet modification. Which meal does the nurse suggest to the client? a. Steak and French fries b. Fried chicken and mashed potatoes c. Turkey sandwich on wheat bread d. Sausage and scrambled eggs
C
The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results? a. Deceased calcium, elevated amylase, decreased magnesium b. Elevated bilirubin, elevated alkaline phosphatase c. Elevated lipase, elevated white blood cell (WBC) count, elevated glucose d. Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium
C
the hospice nurse is caring for a client with pancreatic cancer who has been given 2-3 months to live. what is the appropriate nursing response when the client's wife states, "I know he's going to get better."? a. use therapeutic silence and say nothing b. your spouse will die in 2-3 months c. let's talk about how you're feeling about your spouse's prognosis d. if your spouse adheres to the entire treatment plan, recovery is possible
C
which teaching will the nurse provide when discharging a client with chronic pancreatitis? a. weight reduction and daily exercise regimen b. constipation precautions, including daily laxative use c. dietary adjustments to include avoiding high-fat food, caffeine, and alcohol d. relaxation techniques and stress management
C
A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? a. Carbohydrates b. High fat c. High fiber d. Protein
D
A client with acute cholecystitis is admitted to the medical-surgical unit. Which nursing activity associated with the client's care will be appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? a. Assessing dietary risk factors for cholecystitis b. Checking for bowel sounds and distention c. Determining precipitating factors for abdominal pain d. Obtaining the admission weight, height, and vital signs
D
The nurse is attempting to position a client having an acute attack of pancreatitis in the most comfortable position possible. In which position does the nurse place this client? a. Supine, with a pillow supporting the abdomen b. Up in a chair between frequent periods of ambulation c. High-Fowler's position, with pillows used as needed d. Side-lying position, with knees drawn up to the chest
D
The nurse is caring for a client recently diagnosed with type 1 diabetes mellitus who has had an episode of acute pancreatitis. The client asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response? a. "The diabetes could be related to your obesity." b. "Look online for general information about diabetes." c. "Do you consume alcohol on a frequent basis?" d. "Type 1 diabetes can occur when the pancreas is affected or destroyed by disease."
D
The nurse is preparing to instruct a client with chronic pancreatitis who is to begin taking pancrelipase (Cotazym). Which instruction does the nurse include when teaching the client about this medication? a. Administer pancrelipase before taking an antacid. b. Chew tablets before swallowing. c. Take pancrelipase before meals. d. Wipe your lips after taking pancrelipase.
D
what does the biliary system include?
Liver, gallbladder, and pancreas
what are the S&S of gallstones?
Many people with gallstones have no symptoms until there is an obstruction (painful)
what is the action alert for paralytic ileus?
because paralytic (adynamic) ileus is a common complication of acute pancreatitis, prolonged NG intubation may be necessary. assess frequently for the return of peristalsis by asking the patient if he or she has passed flatus or had a stool. the return of bowel sounds is not reliable as an indicator of peristalsis return; passage of flatus or a bowel movement is the most reliable indicator
what can an obstruction of the biliary system (gallstones) lead to?
cholecystitis and pancreatitis
what type of procedure is done for an acute gallbladder infection?
could be emergent cholecystectomy or done the following day
what is the action alert for acute pancreatitis?
for the patient with acute pancreatitis, monitor his or her respiratory status every 4-8 hours or more often as needed and provide oxygen to promote comfort in breathing. respiratory complications such as pleural effusions increase patient discomfort. fluid overload can be detected by assessing for weight gain, listening for crackles, and observing for dyspnea. carefully monitor for S&S of respiratory failure
what are some complications of acute cholecystitis?
ischemia, infection, necrosis, gangrene, perforation, and peritonitis
what do you need for life-threatening pancreatitis?
need invasive hemodynamic monitoring (arterial line, CVP)
what is the function of the biliary system?
promotes food digestion (secretes enzymes & other substances)
what is postcholecystectomy sydnrome (PCS)?
repeated abd or epigastric pain with vomiting and/or diarrhea that may occur several weeks to months after surgery
what is the diet for post-op cholecystectomy?
some can go back to usual diet, others have to avoid high-fat foods (abd. Pain & diarrhea)
what is the best initial diagnostic tool for cholecystitis?
ultrasound of RUQ
what other diagnostic assessments can be used for cholecystitis?
•Ultrasonography •HIDA Scan •ERCP
what is NOTES (natural orifice transluminal endoscopic surgery)?
-minimally invasive surgical procedure for cholecystitis -removal or repair of organs
what are the S&S of pancreatic cancer?
-Jaundice may be the first sign -Hepatomegaly -Clay-colored stools -Urine is dark and frothy -Itchy skin (jaundice- bile salt collection causes itch) -Fatigue -Ascites -Abdominal pain (vague, dull, or nonspecific that radiates into the back) -N/V -glucose intolerance
what is acute pancreatitis?
-Life-threatening -Inflammation of the pancreas -Can be mild (edema, inflammation) or severe (bleeding, fibrosis, tissue death, respiratory S&S, & necrotizing hemorrhagic pancreatitis)
what is the pre-op care needed for pancreatic cancer surgery?
-NG tube may be inserted -TPN typically begun
The priority collaborative problems for patients with cholecystitis include:
-Weight loss due to pain, nausea, and inflammation -Acute pain due to cholecystitis
The priority collaborative problems for patients with acute pancreatitis include:
-acute pain due to pancreatic inflammation and enzyme leakage. -weight loss due to inability to ingest food and absorb nutrients.
what is the non-surgical management for pancreatic cancer?
-drug therapy -radiation therapy
how can you prevent a gallbladder episode?
-encourage patients to avoid fatty foods -if they have N/V withhold food (NPO) -give them opioids (morphine, dilaudid) or toradol (NSAID)- can damage kidneys (dose is less for older adults due to this) -give antiemetics -antibiotics possibly -lithrotripsy (shock wave that breaks up gallstones)
what are the S&S of cholecystitis?
-episodic or vague upper abdominal pain or discomfort that can radiate to the right shoulder -pain triggered by high-fat or high-volume meal -anorexia -N/V -dyspepsia -eructation (belching) -flatulence -feeling of abd fullness -rebound tenderness -fever -jaundice, clay-colored stools, dark urine, steatorrhea
what are the complications of acute pancreatitis?
-jaundice -hyperglycemia -if total destruction of pancreas patient may develop type 1 diabetes -pulmonary complications (pleural effusions, atelectasis, pneumonia) -multisystem organ failure -respiratory distress -pulmonary failure (responsible for more than half of all deaths) -issues with coagulation -shock -hypovolemia -decreased renal perfusion -acute renal failure -paralytic ileus
A client has just been diagnosed with pancreatic cancer. The client's upset spouse tells the nurse that they have recently moved to the area, have no close relatives, and are not yet affiliated with a church. What is the nurse's best response? a. "Maybe you should find a support group to join." b. "Would you like me to contact the hospital chaplain for you?" c. "Do you want me to try to find a therapist for you?" d. "Do you have any friends whom you want me to call?"
B
Which set of assessment findings indicates to the nurse that a client may have acute pancreatitis? a. Absence of jaundice, pain of gradual onset b. Absence of jaundice, pain in right abdominal quadrant c. Presence of jaundice, pain worsening when sitting up d. Presence of jaundice, pain worsening when lying supine
D
the nurse closely monitors the client with acute pancreatitis for which life-threatening complication? a. jaundice b. type 1 DM c. abdominal pain d. disseminated intravascular coagulation (DIC)
D
what is the primary endocrine disorder of the pancreas?
DM
