Pearson - Cholecystitis (inflammation)

A patient with right upper quadrant abdominal pain asks why an ultrasound is needed. Which statement should the nurse make in response to this patient?

"An ultrasound will show any stones in your gallbladder and tell us how it is emptying." Ultrasonography of the gallbladder is a noninvasive exam that can accurately diagnose cholelithiasis. More accurate than a CT scan, it also can be used to assess emptying of the gallbladder. The ultrasound will not determine the chemical makeup of the gallstones, it will not diagnose an infection, and it cannot determine how well the gallbladder is able to concentrate bile.

A patient with gallstones is concerned that insurance will not pay for an ultrasound but will pay for an x-ray. Which response by the nurse is accurate?

"An x-ray just shows the presence of gallstones, but an ultrasound also shows if the gallbladder is emptying."

The nurse reviews the reason a pregnant patient developed gallstones. Which patient statement indicates to the nurse that teaching has been successful?

"Pregnancy hormones have caused my gallbladder to empty slowly, leading to the development of gallstones." Biliary stasis, or slowed emptying of the gallbladder in response to hormonal stimulation, contributes to cholelithiasis. Stones do not form when the gallbladder empties completely, but in pregnancy this process is slowed, allowing for stone formation. The gallbladder does not produce bile; it stores it. Decreasing protein or increasing exercise during pregnancy will not prevent the biliary stasis.

The nurse teaches a patient about caring for a T-tube after having surgery to remove the gallbladder. Which information should the nurse provide the patient before discharge?

"You will see less drainage each day, until the duct fully heals." As healing occurs from the bile duct, bile drains from the tube; the amount of bile should decrease. Teach the patient to expect brown-green drainage and to notify the healthcare provider if drainage stops. Drainage is always expected, so there is no need to notify the surgeon if it is seen. The drainage will not turn yellow. The T-tube should never be milked to encourage drainage.

Gallstone ileus

A condition in which gallstones erode from the gallbladder, creating a fistula to the small bowel that may cause a bowel obstruction

The nurse prepares teaching material about gallbladder disease and includes obesity, certain medications, rapid weight loss, and dyslipidemia as modifiable risk factors. Which additional information about modifiable risk factors should the nurse include?

A low-fat diet reduces the risk of developing gallbladder disease. The nurse should promote a high-fiber diet, not a low-fiber diet. Hyperlipidemia, not hypolipidemia, is a risk factor for gallbladder disease. Although a low-carbohydrate diet is advised, a carbohydrate-free diet is not advised.

The nurse is caring for a patient experiencing symptoms of acute cholecystitis. Which part of the patient's anatomy should the nurse consider as being obstructed with a gallstone?

Acute cholecystitis usually occurs after a gallstone obstructs the cystic duct. The obstruction increases pressure within the gallbladder, leading to ischemia of the gallbladder wall and mucosa. Obstruction of the common bile duct is the cause of choledocholithiasis. Choledocholithiasis occurs due to blockage of flow from the gallbladder and liver ducts. Gallstone ileus is an obstruction of the small intestine by a large gallstone. The ampulla of Vater is located where the common bile duct and pancreatic duct come together. Blockage of the ampulla of Vater can cause choledocholithiasis and gallbladder pancreatitis.

A patient experiences pain in the upper right quadrant, which radiates to the right scapula and shoulder and becomes worse with movement and deep breathing. Which reason should the nurse suspect for this patient's pain?

Acute cholecystitis. During an acute gallbladder attack, the patient may complain of severe right upper quadrant pain that radiates to the right scapula and shoulder. The pain is often aggravated by movement and breathing.

Choledocholithiasis is a type of cholelithiasis in which at least one gallstone is present in the common bile duct as well as the gallbladder.

Biliary colic is the pain described in cholelithiasis. This pain is localized to the epigastrium and the right upper quadrant of the abdomen.

A pregnant patient is experiencing symptoms of cholelithiasis. Which risk factor for cholelithiasis should the nurse identify as being related to pregnancy?

Biliary stasis that occurs during pregnancy is a risk factor for this patient. Age and family history are additional risk factors; however, because of the patient's pregnancy, this is the most likely reason. Gallstone development occurs after a rapid weight loss and not a weight gain.

Cholecystitis is inflammation of the gallbladder. Clinical manifestations of cholecystitis include right upper quadrant pain that is present for 12 to 18 hours.

Cholelithiasis is the presence of gallbladder stones. In cholelithiasis, pain may last 30 minutes to 5 hours.

Commonly used medications for gallbladder disease include:

Cholestyramine (Questran), used for severe jaundice and accumulation of bile salts on the skin. Chenodiol (Chenix) and ursodiol (Actigall) to reduce cholesterol production in the liver. Opioid analgesics for pain relief during an attack of cholecystitis.

A pregnant patient is experiencing stabbing pain after eating a large meal, yellowing sclera, pale-colored stools, and intense itching. Which medication should the nurse anticipate to be prescribed?

Cholestyramine is used for severe jaundice and accumulation of bile salts on the skin. An opioid would be used for pain relief. Chenodiol and ursodiol reduce cholesterol production.

A pregnant patient is experiencing stabbing pain after eating a large meal, yellowing sclera, pale-colored stools, and intense itching. Which medication should the nurse anticipate to be prescribed?

Cholestyramine.

The pain associated with gallbladder disease can be severe. The interventions that can help include:

Discussing the relationship between fat intake and pain. Withholding oral food and fluids during periods of pain. Placing in Fowler position. Inserting a nasogastric tube as prescribed. Administering opioid analgesics as prescribed.

Following are aspects of gallbladder disease:

Following are aspects of gallbladder disease: Gallstones form due to the interaction between abnormal bile composition, biliary stasis, and inflammation of the gallbladder. Most gallstones are made primarily of cholesterol.Bile that is supersaturated with cholesterol precipitate out to form stones. Excess cholesterol in bile is associated with obesity, a high-calorie and high-cholesterol diet, and drugs that lower serum cholesterol levels.

Nutritional interventions for gallbladder disease include: Following low-carbohydrate, low-fat, high-protein diet. Avoiding fasting and very low-calorie diets. Moderately reducing caloric intake. Increasing activity.

Food intake may be limited during the acute phase of the disorder in order to avoid symptoms of fat intolerance and nausea and vomiting. A nasogastric tube may be inserted to maintain an empty stomach and relieve nausea and vomiting. Fat intake is limited because a high-fat diet is a precipitating factor in the development of gallstones

A patient experiences severe nausea and vomiting caused by acute cholecystitis. Which nonpharmacologic intervention should the nurse implement first?

Hold oral intake. Food intake is eliminated during an acute attack of cholecystitis. A nasogastric tube is prescribed and inserted to relieve nausea and vomiting. Dietary fat intake may be limited, especially if the patient is obese. If bile flow is obstructed, fat-soluble vitamins (A, D, E, and K) and bile salts may need to be administered.

The nurse is evaluating a patient who is recovering from a laparoscopic cholecystectomy. Which patient statement indicates to the nurse that goals for care have been achieved?

In this scenario, the patient statement about fresh vegetables indicates a good understanding of food choices

The nurse is assessing a patient who is experiencing sharp, stabbing pain in the right upper abdominal quadrant (RUQ) and vomiting after eating. Which finding should the nurse expect when conducting the interview?

Ingests a high-calorie, high-cholesterol diet. Excess cholesterol in bile is associated with obesity, a high-calorie and high-cholesterol diet, and drugs that lower serum cholesterol levels. when the cholesterol leaves the body from statins, that increases in the bile.

The nurse notes that a patient is prescribed a serum bilirubin level. Which symptom should the nurse expect to assess in this patient?

Jaundice of the skin and sclera of the eyes. Serum bilirubin evaluates obstructed bile in the biliary duct. A patient would experience jaundice, pain in the upper right quadrant and right scapula, and nausea. Stools would be light in color, not dark or tar colored.

A patient with cholelithiasis asks what can be done to avoid the development of future gallstones. Which response should the nurse provide?

Keep your weight within normal limits. A combination of genetics, body weight, and diet are known risk factors for gallstone disease. Maintaining a normal body weight will decrease the risk of future gallstones. There is no specific requirement to avoid alcohol with gallbladder disease. Neither increasing sleep nor decreasing stress will prevent the development of gallstones.

A patient recovering from a cholecystectomy with T-tube placement is prescribed nothing by mouth (NPO), a nasogastric (NG) tube, pain medication, minimal ice chips, and T-tube drainage measurement. Which assessment finding should cause the nurse to notify the healthcare provider?

Minimal drainage from the T-tube. The T-tube normally drains up to 500 mL in the first 24 hours after surgery; drainage decreases to less than 200 mL in 2-3 days and is minimal thereafter. Small amounts of NG drainage are expected, particularly after the patient eats ice chips. Tolerating ice chips is expected, particularly because the patient still has an NG tube in place. Pain is managed by a narcotic analgesic.

A patient with cholelithiasis has a gallstone lodged in the common bile duct. Which clinical manifestation should the nurse assess this patient?

Pale or clay-colored stools indicate a problem with the drainage of the biliary system. Bile salts are released into the stools by the liver, giving the stools a brown color.

The nurse is caring for a patient with acute cholecystitis. In which area should the nurse expect the patient to experience pain?

RUQ.

A patient experiences jaundice, nausea, and right upper abdominal quadrant and scapula pain. Which diagnostic test should the nurse anticipate being prescribed for this patient?

Serum bilirubin.

Older adults and their relation to gallbladder disease include:

Some adults will develop gallstone recurrence, a major long-term postoperative biliary complication. Some will also develop biliary dyskinesia, which is a common cause of surgical intervention for adults with gallbladder disease.

A patient experiencing right upper quadrant pain that has lasted for over 7 hours is diagnosed with cholecystitis. For which additional clinical manifestation should the nurse assess?

The clinical manifestations of cholecystitis include: Abrupt onset. Severe, steady pain generalized in RUQ of abdomen (tenderness and guarding). Pain that radiates to back, right scapula, and shoulder.Lasts 12-18 hours.Aggravated by movement and breathing. Anorexia, nausea, and vomiting. Chills and fever.

A patient with acute cholecystitis is being tested for possible pancreatitis. Which laboratory test should the nurse expect to be ordered?

Serum amylase and lipase. Gallstones can lead to pancreatitis. If the common duct is obstructed, pancreatic enzymes are unable to enter the small intestine, and pancreatitis becomes a potential complication. Serum amylase and lipase are measured to identify possible pancreatitis related to common duct obstruction. A CBC and serum bilirubin will also be ordered, but these are not specific tests for pancreatitis. A CBC may indicate infection and inflammation if the white blood cell count is elevated. Elevated direct (conjugated) bilirubin levels may indicate obstructed bile flow in the biliary duct system. An elevated indirect (unconjugated) bilirubin level may indicate a rise in red blood cell hemolysis (such as with sickle cell disease or transfusion reaction).

An adolescent is experiencing right upper quadrant abdominal pain, nausea, and vomiting after eating at a fast food restaurant. Which treatment should the nurse anticipate to be prescribed for this patient?

The clinical therapies indicated for treating episodes of biliary colic include administering antiemetics and analgesics, providing adequate rest and nutrition, and correcting electrolyte imbalances. Treatment is usually symptomatic, so surgical intervention or oral dissolution therapy is not necessary at this time. There is no acute infection, so IV antibiotics are not required.

A young adult patient who is experiencing symptoms of gallbladder disease believes the illness only affects older people. Which response should the nurse make to this patient?

There are many risk factors. Risk factors for developing gallbladder disease include: Having American Indian or Mexican American origin. Age. Family history of gallstones. Obesity. Rapid weight loss. Female sex. Biliary stasis. Conditions such as cirrhosis, sickle cell disease, leukemia, hyperlipidemia, or ileal disease or resection. Glucose intolerance.

A patient is experiencing symptoms of biliary colic. Which intervention should the nurse complete first?

To address gallbladder-related pain, the nurse needs to administer opioid narcotic analgesics as prescribed. A dietary consultation about a low-carbohydrate diet would address nutrition, not pain, as would administering vitamin supplements. A nasogastric tube may be necessary if the patient has nausea and vomiting but is more invasive and would be completed after pain relief was achieved.

Teaching points on pregnancy and gallbladder disease include:

Women who are pregnant are at greater risk for developing biliary stasis. Diseases of the gallbladder are the most common cause of hospitalization for the first year postpartum. The number of pregnancies and higher age at pregnancy are two risk factors for developing biliary sludge and gallstones. Being of female gender increases the risk for developing gallbladder disease.

Biliary dyskinesia

dysfunction of Sphincter of Oddi prevents bile release