Biliary Tract Problems
When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include? A. A lower-fat diet may be tolerated better for several weeks B. Do not return to work or normal activities for three weeks C. Bile-colored drainage probably will drain from the incision D. Keep the bandages on and the puncture site dry until it heals
Answer: A lower-fat diet may be tolerated better for several weeks Rationale: Although the usual diet can be resumed, a low-fat diet usually is better tolerated for several weeks following surgery. Normal activities can be resumed gradually as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery and the patient can shower.
A patient presents with acute upper quadrant pain radiating to the back that the patient rates as a 10 on a 1-to-10 pain scale. The patient says, "I'm nauseated, and I've vomited several times." The diagnosis is cholecystitis with cholelithiasis. Which collaborative nursing diagnosis does the nurse recognize as the highest priority? A. Impaired Skin Integrity related to the surgical incision B. Anxiety related to knowledge deficit of diagnostic studies C. Acute Pain related to inflammation and blockage of the biliary tract D. Risk for Fluid Volume Deficit related to nausea and vomiting
Answer: Acute Pain related to inflammation and blockage of the biliary tract Rationale: Acute pain is the priority problem at the moment. Acute pain can and should be managed immediately before other nursing care activities are carried out. Managing the patient's pain help the nurse achieving other care goals. Impaired skin integrity is not currently a problem because the patient has not yet had surgery. Anxiety related to deficient knowledge of diagnostic studies is a lower priority and may be addressed after pain is managed. After the patient's pain is managed, nausea, vomiting, and decreased fluid intake should be the next problems addressed. Text Reference - p. 1037
The nurse caring for a patient who has undergone cholecystectomy should monitor the patient for which major immediate postoperative complication? A. Infection B. Bleeding C. Dehydration D. Bowel obstruction
Answer: Bleeding Rationale: Bleeding is the major immediate postoperative complication after cholecystectomy. Bowel obstruction and dehydration are potential risks, but they would not be immediate risks after the procedure. Infection is a risk after any surgical procedure, but bleeding is a more immediate priority after cholecystectomy. Text Reference - p. 1040
The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient? A. Prevent all oral intake B. Control abdominal pain C. Provide enteral feedings D. Avoid dietary cholesterol
Answer: Control abdominal pain Rationale: Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. Nothing by mouth status may be needed if the patient will have surgery, but will not be used for all patients with cholelithiasis. Enteral feedings should not be needed and avoiding dietary cholesterol is not used to treat cholelithiasis.
A patient is advised to undergo laparoscopic cholecystectomy. The patient asks the nurse what exactly this procedure means. What are the points that a nurse can include in this explanation? Select all that apply. A. Gallbladder is removed through 1-4 small punctures on the abdominal wall. B. Gallbladder is removed through an incision made on the right subcostal region. C. The procedure is done with a laparoscope and grasping forceps under anesthesia. D. The patient can be discharged on the day of operation or the next and resume his work after a week. E. The gallbladder is removed through an incision on the abdomen, and a catheter is inserted to drain any fluids or effusion.
Answer: Gallbladder is removed through 1-4 small punctures on the abdominal wall, The procedure is done with a laparoscope and grasping forceps under anesthesia, and The patient can be discharged on the day of operation or the next and resume his work after a week. Rationale: Laparoscopic cholecystectomy involves making 1-4 punctures on the abdominal wall, and the gall bladder is removed using laparoscope and grasping forceps. This procedure is done under anesthesia. The patient can be discharged in a day or two, as the recovery is fast. This procedure does not involve incisions. Text Reference - p. 1038
A patient suffering from cholelithiasis underwent a cholecystectomy. What dietary advice will the nurse give this patient? Select all that apply. A. Have a high-fiber diet. B. Limit intake of water. C. Have small but frequent meals. D. Avoid or keep fats to the minimum. E. Have normal diet as before.
Answer: Have a high-fiber diet, Have small but frequent meals, and Avoid or keep fats to the minimum. Rationale: Having a high-fiber diet helps in the smoother passage of stools and prevents constipation. Having small and frequent meals helps digestion and prevents nausea. Fats make it harder to digest. After cholecystectomy, it is essential that the patient has an adequate intake of water, around 2500-3000 mL per day. The patient should not have the usual foods that he/she used to consume; modifications are needed to facilitate easy digestion of food in the absence of the gall bladder. Text Reference - p. 1039
A patient has undergone cholecystectomy. What postoperative care should the nurse perform for this patient? Select all that apply. A. Maintain a low-fat diet. B. Monitor for any bleeding. C. Instruct not to do deep breathing. D. Place patient in shock position. E. Place the patient in Sims' position.
Answer: Maintain a low-fat diet, Monitor for any bleeding, and Place the patient in Sims' position. Rationale: After cholecystectomy, it is important to follow dietary restrictions. A diet low in fat decreases the workload of the liver. Bleeding is a complication after the procedure; hence the nurse should monitor it. It is important to position the patient in Sims' position to facilitate gas pockets moving away from the diaphragm. Encourage deep breathing along with movement and ambulation to help expand the lungs and promote ventilation. The patient need not be put in shock position; it does not contribute to recovery. Text Reference - p. 1040
The nurse is providing postoperative care to a patient who underwent open cholecystectomy 3 days ago. Which finding during the nurse's assessment should prompt the nurse to notify the primary health care provider? A. Tolerance of a full-liquid diet B. Oral temperature of 101.8° F C. Report of pain at a level 5 on a scale of 0 to 10 D. An 8-hour fluid intake of 680 mL and an output of 660 mL
Answer: Oral temperature of 101.8° F Rationale: An oral temperature of 101. 8º F on the third postoperative day indicates a possible infection and requires further evaluation and modification of the nursing plan of care. Tolerating a full liquid diet and pain at level of 5 on a 0 to 10 scale are appropriate outcomes at this time. Although fluid intake is low, it is in balance with the output; therefore it would not be as high a priority as the increased temperature. Text Reference - p. 1040
Which clinical manifestation of pain does the nurse expect to identify in a patient who has cholecystitis? A. Left flank pain with intermittent exacerbations B. Right lower quadrant pain with rebound tenderness C. Right upper quadrant pain radiating to the patient's back D. Epigastric pain that intensifies when the patient is lying down
Answer: Right upper quadrant pain radiating to the patient's back Rationale: The pain of cholecystitis is in the region of the gallbladder (right upper quadrant), which is inflamed as a result of infection and irritation from bile. The pain may be referred to the right shoulder and scapula. Left flank pain with intermittent exacerbations may be caused by renal calculi. Right lower quadrant pain with rebound tenderness may be related to acute appendicitis, Crohn's disease, or peritonitis. Epigastric pain that intensifies when the patient is lying down may be related to gastroesophageal reflux disease or hiatal hernia. Text Reference - p. 1037
