Sherpath #1: Hepatobilliary -> Cholelithiasis/Cholecystitis

During assessment of a patient for suspected cholelithiasis with biliary colic, a positive response to which question posed by the nurse would support the diagnosis?

"Do you have pain after consuming a high-fat meal?" The pain related to cholelithiasis and biliary colic is often precipitated by consumption of a high-fat meal.

The nurse is completing patient education for a patient to be discharged after undergoing an open cholecystectomy. Which statement by the patient indicates effective teaching by the nurse?

"I should not be carrying the laundry baskets upstairs." Heavy lifting should be avoided for 4 to 6 weeks after an open cholecystectomy.

Which statement made by the student nurse when caring for a patient who has had an open cholecystectomy requires correction?

"I will teach the patient to resume normal activities in 2 weeks." A patient who had an open cholecystectomy has a subcostal incision and will need to be instructed to wait 6 weeks to resume normal activities.

A patient who has undergone laparoscopic cholecystectomy asks the nurse about getting up and taking a shower. Which response by the nurse would be appropriate?

"It is best to do a bedside bath because you want to keep the dressing dry" The patient should not get the incisions wet for a few days after the procedure until the primary health care provider allows it. A bed bath is a solution for cleaning the patient without getting the incisions wet.

The nursing instructor asks the student nurse caring for a patient who has undergone open cholecystectomy with placement of a T tube to explain the reason for placement of the T tube. Which statement by the student indicates accurate understanding?

"The T tube ensures patency of the bile duct and allows excess bile to drain until edema decreases." The body's response to surgery is inflammation. The area around the bile duct will be inflamed after an open cholecystectomy. The T tube provides a means of draining the excess bile, since the gallbladder is no longer is available for storage.

The nurse is caring for a patient with cholecystitis. The patient is concerned and wants to know why the pain is worse after eating a cheeseburger brought in by the family. What is the nurse's best response?

"This is common. Pain tends to worsen a few hours after a high-fat meal." Fat intolerance is common with cholelithiasis because increased bile production is needed to break down fats in the diet. Pain tends to worsen about 3 to 6 hours after a high-fat meal has been consumed.

The nurse is teaching a patient being treated for cholecystitis about the anticholinergic medication that has just been prescribed. Which information provided by the nurse accurately describes the use of this medication for cholecystitis?

"This medication will decrease gastrointestinal (GI) secretions and reduce gallbladder spasms." Anticholinergic drugs have a drying effect and will decrease GI secretions, as well as gallbladder spasms.

A female patient scheduled for a laparoscopic cholecystectomy tells the nurse she is frightened because she has heard from others that the abdominal distention and pain after the surgery are severe. Which care team recommendation will best help alleviate distention?

"We will help you walk in the hall to decrease distention." Ambulation helps dissipate the carbon dioxide introduced during the surgical procedure. The patient should be assisted, since she will be recovering from surgery.

The nurse is reviewing the laboratory reports of four patients in a general medical-surgical unit. Based on the laboratory data, which patient is most likely to have cholelithiasis/cholecystitis?

A patient with cholelithiasis/cholecystitis will have a slightly elevated white blood cell (WBC) count, as well as elevated liver enzyme levels, including total bilirubin and alkaline phosphatase. The amylase level is elevated as well, indicating a possible stone lodged in the pancreatic duct.

The nurse is caring for a patient receiving nonoperative treatment for cholelithiasis. The nurse enters the patient's room, and the family asks how the patient will be kept comfortable, since surgery is not an option. Which nursing interventions will address the family's concerns?

Administer opioid analgesics. turn and reposition client Provide the patient with a low-fat diet.

The nurse is preparing to administer an injection to a patient being treated for obstructive choledocholithiasis. The patient has been having severe episodes of nausea and vomiting and has a temperature of 100.2° F and bleeding gums. Which actions taken by the nurse will reduce potential complications from the injection?

Apply gentle pressure to the injection site The nurse should apply gentle pressure after the injection to minimize bleeding at the injection site. Choose a 23-gauge needle to administer the medication The nurse should use the smallest needle possible when administering an injection to a patient who has a bleeding risk.

A 55-year-old obese African American woman has been admitted for a cholecystectomy to treat cholecystitis. The patient asks the nurse what factors might have predisposed her to cholecystitis. Which factors would the nurse mention?

Being female Women have a higher incidence of cholelithiasis/cholecystitis. Being overweight Obesity is a risk factor for cholelithiasis/cholecystitis. Over the age of 40 People over the age of 40 have a greater risk of developing cholelithiasis/cholecystitis.

Treatments for Cholelithiasis?

Bile Acids - can dissolve gallstones ERCP with Sphincterotomy - ERCP with a sphincterotomy (clipping the sphincter of Oddi that connects the common bile duct to the duodenum) allows visualization of the biliary system, dilation of duct strictures, stent placement, and stone removal. Extracorporeal Shock-wave Lithotripsy (ESWL) - ESWL uses high-energy shock waves to break up gallstones. Drug Therapy Nutritional Therapy

what drugs dissolve gallstones.

Cholesterol solvents such as cholestyramine

What would be the best collaborative care intervention for a patient admitted for treatment of an acute episode of cholecystitis who reports dry skin and severe itching?

Cholestyramine is a cholesterol solvent that binds bile in the small intestine for fecal elimination. It prevents bile from being reabsorbed and irritating the skin.

4 risk factors for gall bladder disease?

Female, Forty, Fertile, and Fat.

The nurse is caring for a patient who is returning from the endoscopy lab after undergoing an endoscopic retrograde cholangiopancreatography (ERCP). What should the nurse assess before the patient resumes eating?

Gag reflex An endoscopy involves application of a numbing spray to the back of the throat to facilitate scope movement down the throat. The nurse should ensure that the patient has an intact gag reflex to prevent aspiration.

Diagnostic Studies for Cholelithiasis/Cholecystitis

Gallbladder Ultrasound Examination Endoscopic Retrograde Cholangiopancreatography (ERCP) Percutaneous Transhepatic Cholangiography (PTC) Laboratory Test

Which nursing interventions will be most effective to alleviate nausea and vomiting by decreasing gallbladder stimulation in a patient with cholecystitis?

Insert a nasogastric tube A nasogastric tube will decrease gastric distention and in turn decrease stimulation to the gallbladder. Establish NPO (nothing by mouth) status for the patient Establishing NPO status for the patient decreases bile release and in turn decreases gallbladder stimulation.

Laboratory Tests for Cholelithiasis/Cholecystitis

Laboratory tests reveal elevated liver enzyme and pancreatic enzyme levels, increased white blood cell (WBC) count, elevated direct and indirect bilirubin levels, and urinary bilirubin content.

A patient in the recovery room after laparoscopic cholecystectomy reports severe bloating and abdominal discomfort. Which nursing intervention would best address this patient's concern?

Place the patient in the Sims' position Bloating and abdominal discomfort are common after a laparoscopic cholecystectomy because of the carbon dioxide used by the health care provider to visualize the abdominal cavity during the procedure. The Sims' position helps move the gas pocket away from the diaphragm.

A patient presents to the emergency department and reports frequent small light-colored stools and fever. On examination, the nurse notes jaundice of the skin and sclera and a white blood cell (WBC) count of 15,000 /μL. An ultrasound examination indicates the patient has a dilated common bile duct with gallstones. What is the priority nursing intervention for this patient?

Prepare the patient for an endoscopic retrograde cholangiopancreatography (ERCP) The patient has symptoms of an obstruction in the common bile duct, so the nurse will prepare the patient for an ERCP, which allows the surgeon to visualize and remove the stone.

A patient who is not a candidate for surgery is admitted to the hospital with acute cholecystitis and severe nausea and vomiting. Which collaborative care intervention will help maintain fluid and electrolyte balances?

Start an intravenous infusion of lactated Ringer's solution Giving the patient intravenous fluids will help restore and maintain fluid and electrolyte balances affected by nausea and vomiting.

The nurse is assessing a patient who has arrived in the emergency department complaining of severe upper abdominal pain after eating a cinnamon roll. The nurse notes yellowing of the sclera and skin and dark amber-colored urine. What does the nurse suspect has occurred?

The patient has developed an obstruction in the common bile duct by a gallstone. Jaundice (yellowing of the sclera and skin) occurs when the common bile duct becomes obstructed and bilirubin accumulates in the skin. It also causes dark amber-colored urine to form as a result of bilirubin spilling into the urinary tract.

Drug Therapy for cholelithiasis?

analgesics including morphine to manage pain related to gallstone movement or inflammation Anticholinergics to decrease spasms of the gallbladder Fat-soluble vitamins, which are not absorbed because of fat malabsorption Bile salts to bind excess bile Cholestyramine (a resin that binds to bile salts, increasing their excretion; used to treat pruritus)

Choledocolithiasis is Clinical manifestations of choledocolithiasis are

total obstruction of the bile duct is present due to blockage of bile flow and include steatorrhea, pruritus, dark amber-colored urine, bleeding tendencies, and jaundice.

Cholelithiasis is

gallbladder stones or gallstones, is the most common disease affecting the biliary system.

Symptoms of chronic cholecystitis include a

history of fat intolerance, dyspepsia, heartburn, and flatulence.

where do gall stones get stuck usually

lodged in the neck of the gallbladder or in the cystic duct

most common type of gallstones

mixed cholesterol stones

Cholecystitis is most commonly associated with?

obstruction in the gallbladder.

why does cholelithiasis develop?

the balance that keeps cholesterol, bile salts, and calcium in solution is altered so that these substances precipitate Stasis of bile in the gallbladder can lead to cholecystitis.

Cholecystitis is

the inflammation (acute or chronic) of the gallbladder and can occur with or without gallstones usually associated with cholelithiasis