Ch. 54- Care of Patients with Problems of the Biliary System and

Complete the sentence.

The typical cause of acute cholecystitis is gallstone obstruction in the ____ duct.

• cystic duct

• common bile duct

S/S of acute cholecystitis?

• URQ pain

• fever and chills

• nausea and vomiting

• excessive gas

Answer explanation

•Pain triggered by high-fat meal or high-volume meal

•Pain that radiates from RUQ to right shoulder

Late

1.  steatorrhea, jaundice, clay-colored stools and dark urine yellowing sclera (icterus)

Which are the patient at highest risk for cholecystitis?

• female

• >40 years of age

• obesity

• fertile women

• DM type 1

Answer explanation

˜Risk Factors

•Being Female.

•Pregnancy: Fertile

•Hormone therapy.

•Older age:  > Forty

•Being Native American or Hispanic.

•Obesity:  Fat

•Losing or gaining weight rapidly.

•Diabetes

Which patient is more likely to develop gallstones?

• 45-year-old Caucasian female with a family history of gallstones

• 55-year-old African-American male with a history of diabetes mellitus

• 62-year-old Hispanic/Latino female with a history of irritable bowel syndrome

• 60-year-old obese, American-Indian female with a history of diabetes mellitus

Answer explanation

Risk factors for developing gallstones include female gender, obesity, family history of gallstones, diabetes mellitus, American-Indian and Caucasian descent, rapid change in weight, and advanced age. More risk factors increase the likelihood of developing gallstones.

A patient with chronic cholecystitis reports pruritus, clay-colored stools, and voiding dark, frothy urine. Which laboratory analysis is a priority in the nurse’s assessment of this patient?

• Lipase level

• Total bilirubin

• Liver function tests

• WBC count

Answer explanation

Excess circulating bilirubin present with chronic cholecystitis is responsible for pruritus and changes in stool and urine color. Cholecystitis is associated with several risks including hepatic disease, pancreatitis, and peritonitis. Monitoring liver function, pancreatic laboratory values, and white blood cell counts is also very important.

Nutrition management for cholecystitis?

• high fiber diet

• low fat diet

• small, frequent meals

• high protein diet

Two most common causes of acute pancreatitis?

• drinking excessive alcohol

• gallstones

• eating excessive amounts of sugar

• overdosing insulin

S/S of acute pancreatitis?

• upper abdominal pain that radiates

• abdominal tenderness

• fever

• tachycardia

• nausea/vomiting

Complications of acute pancreatitis?

• hypovolemia

• hemorrhage

• chronic kidney failure

• paralytic ileus

• shock

Answer explanation

˜-Hypovolemia

˜-Hemorrhage

˜-Acute kidney failure

˜-Paralytic ileus

˜-Hypovolemic

    or septic shock

˜Pleural effusion, respiratory distress syndrome, pneumonia

˜Multisystem organ failure

˜Disseminated intravascular coagulation

˜Diabetes mellitus

Page 1191- Table 54.3-

In the care of a patient with acute pancreatitis, which assessment parameter requires immediate nursing intervention?

• Heart rate of 105 beats/min

• Serum glucose of 136 mg/dL

• Blood pressure of 102/76 mm Hg

• Respiratory rate of 28 breaths/min

Answer explanation

The patient with pancreatitis may develop pulmonary complications, pleural effusions, pulmonary infiltrates, and acute respiratory failure or ARDS.

Increases in respiratory effort is an important assessment variable in the care of a patient with pancreatitis.

Patients may also be hyperglycemic and hypovolemic. Assessing and treating endocrine function of the pancreas and perfusion variables are also important.