Iggy Biliary System

The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant?

Monitor closely for infection because of the immunosuppressive medication.

Priority Decision: An 82-yr-old man is admitted with an acute attack of diverticulitis. What is most important for the nurse to include in his care?

Monitor for signs of peritonitis.

The patient has persistent and continuous pain at McBurney's point. The nursing assessment reveals rebound tenderness and muscle guarding with the patient preferring to lie still with the right leg flexed. What should the nursing interventions for this patient include?

NPO status in preparation for possible appendectomy

What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis?

Providing adequate nutritional intake

The patient comes to the emergency department (ED) with intermittent crampy abdominal pain, nausea, projectile vomiting, and dehydration. The nurse suspects a GI obstruction. Based on the manifestations, what area of the bowel should the nurse suspect is obstructed?

Proximal small intestine

During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in the teaching?

Report any bile-colored or purulent drainage from the incisions.

In report, the nurse learns that the patient has a transverse colostomy. What should the nurse expect when providing care for this patient?

Semi-formed stools in a pouch with the need to monitor fluid balance

The occurrence of acute liver failure is most common in which situation?

Use of acetaminophen with alcohol abuse

A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in this patient's plan of care?

position the patient on the side with the head of the bed elevated 45 degrees for pain relief.

When assessing a patient with acute pancreatitis, the nurse would expect to find

severe left upper quadrant (LUQ) or midepigastric pain.

During the healing phase of pancreatitis diet indication

small, frequent, moderate- to high- carbohydrate, high-protein, low-fat meals. Protein shakes can be provided to supplement the diet

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this clients plan of care to reduce discomfort?

Maintain nothing by mouth (NPO) and administer intravenous fluids.

Priority Decision: During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do?

Maintain the patient's airway and prevent aspiration of blood.

A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse?

"Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?"

Incisional cholecystectomy post-op

- Normal post-op assessments, pain management - Respiratory care is a priority due to location of incision (underneath diaphragm) - Fluid and electrolyte balance - Assess JP drainage or T-tube - Skin care if drain is present - Early ambulation - Gradual increase in diet when bowel sounds return progressing to low fat diet

Incisional cholecystectomy

- Right subcostal incision is made, about 4-5 inches in length - Occasionally, a T-tube is placed in common bile duct during surgery when the duct is explored - Complications of incisional cholecystectomy (pneumonia, pneumothorax, infection)

On examining a patient 8 hours after having surgery to create a colostomy, what should the nurse expect to find?

A brick-red, puffy stoma that oozes blood

A patient with advanced cirrhosis has a nursing diagnosis of imbalanced nutrition: less than body requirements related to anorexia and inadequate food intake. What would be an appropriate midday snack for the patient

A fresh tomato sandwich with salt-free butter

A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse?

A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile.

When a patient returns to the clinical unit after an abdominal-perineal resection (APR), what should the nurse expect the patient to have?

A perineal wound, drains, and a stoma

A nurse cares for a client who presents with tachycardia and prostration related to biliary colic. Which actions should the nurse take? (Select all that apply.)

Contact the provider immediately.b. Lower the head of the bed.

The patient returned from a 6-week mission trip to Somalia with complaints of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted?

Hepatitis E (HEV)

A nurse assesses a client who is recovering from an open Whipple procedure. Which action should the nurse perform first?

Assess the clients endotracheal tube with 40% FiO2.

Priority Decision: The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe?

Assist the patient to the bathroom

A nurse teaches a client who is recovering from acute pancreatitis. Which statements should the nurse include in this clients teaching? (Select all that apply.)

Attend local Alcoholics Anonymous (AA) meetings weekly. Use cooking spray when you cook rather than margarine or butter. We can talk to your doctor about a prescription for nicotine patches.

The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (select all that apply)?

Avoid nicotine Eat bland foods Observe stools for steatorrhea

Which conditions contribute to the formation of abdominal ascites?

Blood flow through the portal system is obstructed, which causes portal hypertension

What is a risk factor associated with cancer of the pancreas?

Cigarette smoking

A nurse assesses a client who is recovering from a Whipple procedure. Which assessment finding alerts the nurse to urgently contact the health care provider?

Complications of a Whipple procedure include secretions that drain from a fistula and peritonitis.

Which etiologic manifestations occur in the patient with cirrhosis related to esophageal varices?

Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension

A nurse prepares to discharge a client with chronic pancreatitis. Which question should the nurse ask to ensure safety upon discharge?

Do you have a one- or two-story home?

The patient experienced a blood transfusion reaction. What is the best explanation the nurse can give to the patient to explain the cause of the hemolytic jaundice that occurred?

Due to increased breakdown of RBCs that causes elevated serum unconjugated bilirubin

What is a nursing intervention that is indicated for a male patient following an inguinal herniorrhaphy?

Elevating the scrotum with a scrotal support

The nurse plans teaching for the patient with a colostomy, but the patient refuses to look at the nurse or the stoma, stating, "I just can't see myself with this thing." What is the best nursing intervention for this patient?

Encourage the patient to share concerns and ask questions.

A male patient who is scheduled for an abdominal-perineal resection (APR) is worried about his sexuality. What is the best nursing intervention for this patient?

Explain that physical and emotional factors can affect sexual function but not necessarily the patient's sexuality.

Acalculous cholecystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this condition (select all that apply)?

Fasting Parenteral nutrition. Prolonged immobility

Recovering from acute pancreatitis diet

Fat is restricted, but not Na+

Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care?

Have up to four small abdominal incisions covered with small dressings

A nurse cares for a client with acute pancreatitis. The client states, I am hungry. How should the nurse reply?

Have you passed any flatus or moved your bowels?

. The patient has peritonitis, which is a major complication of ruptured appendix. What treatment should the nurse plan to include?

IV fluid replacement

What manifestation in the patient does the nurse recognize as an early sign of hepatic encephalopathy?

Impaired computational skills

Of the following characteristics, identify those that are most commonly associated with cholelithiasis (select all that apply).

Obesity Age over Multiparous female Hereditary gallbladder disease estrogen or oral contraceptives

A nurse assesses a client with cholelithiasis. Which assessment findings should the nurse identify as contributors to this clients condition? (Select all that apply.)

Obesity, pregnancy, and diabetes are all risk factors for the development of cholelithiasi

A nurse assesses a client who is recovering from a Whipple procedure. Which clinical manifestations alert the nurse to a complication from this procedure? (Select all that apply.)

Substernal chest pain Shortness of breath Lack of bowel sounds or flatus Urine output of 20 mL/6 hr

A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge?

Supportive care that is appropriate for all patients with severe liver damage is indicated.

chronic and acute cholecystitis s/s

Temperature of 100.1 F (37.8 C) Positive Murphys sign Upper abdominal pain after eating

Pancreatic enzyme replacement therapy should be taken when?

The enzymes should be taken immediately before eating meals or snacks.

. A nurse plans care for a client who has acute pancreatitis and is prescribed nothing by mouth (NPO). With which health care team members should the nurse collaborate to provide appropriate nutrition to this client? (Select all that apply.)

The nurse should collaborate with the registered dietitian, clinical pharmacist, and health care provider to plan and implement the more appropriate nutritional interventions.

Post cholecystectomy diet indication

clients need a nutritious diet without a lot of excess fat; otherwise a special diet is not recommended for most clients.

A patient with an obstruction of the common bile duct has clay-colored fatty stools among other manifestations. What is the pathophysiologic change that causes this clinical manifestation?

Absence of bilirubin and bile salts in the small intestine prevents conversion to urobilinogen and fat emulsion and digestion

In discussing long-term management with the newly diagnosed patient with alcoholic cirrhosis, what should the nurse advise the patient?

Abstinence from alcohol is the most important factor in improvement of the patient's conditio

A nurse cares for a client with end-stage pancreatic cancer. The client asks, Why is this happening to me? How should the nurse respond?

I dont know. I wish I had an answer for you, but I dont.

The patient with a new ileostomy needs discharge teaching. What should the nurse plan to include in this teaching?

If leakage occurs, promptly remove the pouch, clean the skin, and apply a new pouch.

A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a splenorenal shunt. As a result of this procedure, what should the nurse expect the patient to experience?

Improved hemodynamic function and renal perfusion

Combined with clinical manifestations, what is the laboratory finding that is most commonly used to diagnose acute pancreatitis?

Increased serum amylase

When caring for a patient with autoimmune hepatitis, the nurse understands that what about this patient is different from the patient who has viral hepatitis?

Is treated with corticosteroids or other immunosuppressive agents

The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse explain to the patient about this test?

It is noninvasive and is a very reliable method of detecting gallstones.

Patient-Centered Care: To treat a cirrhotic patient with hepatic encephalopathy, lactulose, rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient's family wants to know why the laxative is ordered. What is the best explanation the nurse can give to the patient's family?

It traps ammonia and eliminates it in the feces.

What must the nurse do to care for a T-tube in a patient following a cholecystectomy?

Keep the tube supported and free of kinks.

A nurse assesses a client who has cholecystitis. Which clinical manifestation indicates that the condition is chronic rather than acute?

Light-colored stools; Jaundice, clay-colored stools, and dark urine are more commonly seen with chronic cholecystitis.

What should the nurse teach the patient with diverticulosis to do?

Maintain a high-fiber diet and encourage fluid intake of at least 2 L daily.

What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis?

Malabsorption and diabetes mellitus

What treatment for acute cholecystitis will prevent further stimulation of the gallbladder?

NPO with NG suction

What treatment measure is used in the management of the patient with acute pancreatitis?

Nasogastric (NG) suction to prevent gastric contents from entering the duodenum

During the incubation period of viral hepatitis, what should the nurse expect the patient to report?

No symptoms except diagnostic results

The patient has a diagnosis of a biliary obstruction from gallstones. What type of jaundice is the patient experiencing, and what serum bilirubin results would be expected?

Obstructive jaundice with elevated unconjugated and conjugated bilirubin

Malnutrition can be a major problem for patients with cirrhosis. Which nursing intervention can help to improve nutrient intake?

Oral hygiene before meals and snacks

Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis

Pancreatic abscess

A nurse cares for a client who is recovering from an open Whipple procedure. Which action should the nurse take?

Place the client in semi-Fowlers position.

The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What is the most likely diagnosis the nurse should expect for this patient?

Primary sclerosing cholangitis

Pts with cholelithiasis should avoid foods high in fat and cholesterol

high in fat and cholesterol

The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply)?

hypokalemia & renal function

When is ERCP indicated in pancreatitis?

may be performed when pancreatitis is related to gallstones

Risk factors for pancreatic cancer include?

obesity, older age, high intake of red meat, and cigarette smoking.

A nurse cares for a client who has obstructive jaundice. The client asks, Why is my skin so itchy? How should the nurse respond?

the normal flow of bile into the duodenum is blocked, allowing excess bile salts to accumulate on the skin.

A nurse cares for a client who is recovering from laparoscopic cholecystectomy surgery. The client reports pain in the shoulder blades. How should the nurse respond?

Ambulating in the hallway twice a day will help.

In Whipple procedure for treatment of cancer of the pancreas, what anatomic structure is completely resected that will affect the patient's nutritional status?

Duodenum adjoining the pancreas