Chapter 50: Assessment and Management of Patients With Biliary Disorders

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?

Acute pain related to biliary spasms

The nurse should assess for an important early indicator of acute pancreatitis. What prolonged and elevated level would the nurse determine is an early indicator?

Serum lipase

A client with calculi in the gallbladder is said to have

Cholelithiasis

Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit? A. Cholelithiasis B. Pancreatitis C. Choledocholithiasis

Pancreatitis rationale: Hypotension is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity.

Abdominal guarding is present. A rigid or board-like abdomen may develop and is generally an ominous sign, usually indicating...

peritonitis

Manifestations in acute pancreatitis?

1) Nausea and vomiting are common -emesis bile stained* 2) Fever, jaundice, mental confusion, and agitation may also occur.

A client admitted with severe epigastric abdominal pain radiating to the back is vomiting and reports difficulty breathing. Upon assessment, the nurse determines that the client is experiencing tachycardia and hypotension. Which actions are priority interventions for this client? Select all that apply.

1) Administer pain-relieving medication 2) Administer electrolytes 3) Administer plasma 4) Assist the client to a semi-Fowler position

Which statements will the nurse manager include when discussing the differences between the endocrine and exocrine functions of the pancreas?

1) "Internal secretion of hormones is the function of the endocrine pancreas." 2) "The endocrine pancreas secretes hormones through a ductless gland." 3) "The exocrine pancreas secretes hormones from excretory ducts." 4) "The exocrine pancreas secretes pancreatic enzymes into the GI tract."

What are some collaborative interventions to achieve pain relief for clients with acute pancreatitis?

1) Encourage bed rest to decrease the client's metabolic rate. 2) Teach the client about the correlation between alcohol intake and pain. 2) NPO to limit the release of secretin.

Choledochotomy

incision into the common bile duct

There are two major types of gallstones: those composed predominantly of __________ and those composed primarily of _________.

pigment; cholesterol

The treatment goals for acute pancreatitis focus on...

relieving pain, maintaining circulatory and fluid volume, and decreasing the production of pancreatic enzymes.

A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment?

"The tube allows the gastrointestinal tract to rest."

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client?

"This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort."

Clinical manifestations of common bile duct obstruction include...

-very dark colored urine -clay colored feces -jaundice -pruritus

Increased appetite and thirst may indicate that a client with chronic pancreatitis has developed diabetes mellitus. Which of the following explains the cause of this secondary diabetes?

Dysfunction of the pancreatic islet cells

A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. What would the nurse expect to find?

Elevated serum and urine amylase, lipase, and liver enzyme levels accompany significant pancreatitis -If the common bile duct is obstructed, bilirubin level is elevated -Blood glucose levels and white blood cell counts can be elevated -Serum electrolyte levels (calcium, potassium, and magnesium) are low.

When the nurse is caring for a patient with acute pancreatitis, what intervention can be provided in order to prevent atelectasis and prevent pooling of respiratory secretions?

Frequent changes of positions

__________ is indicative of a bile duct obstruction.

Jaundice

A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN?

Measure blood glucose q 4 to 6 hrs

Assessment findings associated with pancreatitis include

Pain with abdominal distention, hypotension, tachycardia, fatty diarrhea

Because clients with pancreatitis cannot tolerate high-glucose concentrations, total parental nutrition (TPN) should be used cautiously with them. Which of the following interventions has shown great promise in the prognosis of clients with severe acute pancreatitis?

Providing intensive insulin therapy

A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client?

Relieving abdominal pain

What is is the major stimulus for increased bicarbonate secretion from the pancreas?

Secretin

What two lab tests are used to make the diagnosis of acute pancreatitis?

Serum amylase and lipase concentrations

Weight loss is a major problem in chronic pancreatitis. More than 80% of clients experience significant weight loss, which is usually caused by...

Skipping meals out of fear of painful attacks or secondary to anorexia

The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . What does the nurse attribute as the reason for NPO status?

To avoid inflammation of the pancreas (Pancreatic secretion is increased by food and fluid intake)

The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason?

To reduce gastric and pancreatic secretions

The digestion of protein is aided by

Trypsin

A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for?

Ultrasonography

Cholecystitis

acute inflammation of the gallbladder

The digestion of carbohydrates is aided by

amylase

Mild acute pancreatitis is characterized by...

edema and inflammation -Minimal organ dysfunction is present, and return to normal function usually occurs within 6 months.

A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function?

30 mg/dL

The client with cholelithiasis has what clinical manifestations?

clay-colored stools and excruciating upper right quadrant pain that radiates to the back or right shoulder

A cholecystogram is used to view the?

gallbladder and bile duct

Choledocholithiasis

gallstone in the common bile duct

A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. What would be an appropriate intervention to prevent complications associated with the respiratory system?

semi-Fowler's position rationale: decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion

A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?

Administering morphine I.V. as ordered rationale: Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.