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Med Surg 1 > care of patients with problems of the biliary system > Flashcards

care of patients with problems of the biliary system Flashcards

1
Q

cholecystitis

A

inflammation of the gallbladder

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2
Q

acute cholecystitis symptoms

A
  • persistent epigastric or RUQ pain. lasting >8hr
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3
Q

acute cholecystitis physical exam

A

may be febrile or afebrile; usually localized gallbladder tenderness

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4
Q

acute cholecystitis ultrasongraphy

A
  • gallstones in gallbladder
  • may have perichikecystic fluid
  • may not have cbd dilation
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5
Q

acute cholecystitis lab studies

A
  • normal or elevated wbc count

- may have normal or midley elevated LFT values

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6
Q

chronic cholecystitis symptoms

A

persustent recurrent ruq pain

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7
Q

chronic cholecystitis physical exam

A

afebrile

- may have localized tenderness over a palpable gallbladder

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8
Q

chronic cholecystitis ultrasound

A

stones in gallbladder

  • thickened gallbladder wall
  • advanced cases contracted gallbladder
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9
Q

chronic cholecystitis lab studies

A

normal WBC count; may have mild elevation in LFT values

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10
Q

cholecystitis history

A
  • Diet and foods; diet high in fat, high in calories, low in fiber, and high in refined carbs places the patients at high risk for developing gallstones
  • Does intake of certain foods cause PAIN?
  • GI symptoms with fatty foods like flatulence (gas), dyspepsia (heartburn), eructation (belching), anorexia, nausea, vomiting, and abdominal pain
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11
Q

physical assessment s/s cholesysitis

A
  • Abdominal pain
  • Rebound tenderness and deep palpation performed by primary health care provider, may indicate peritoneal inflammation
  • Chronic cholecystitis symptoms: jaundice, clay-colored stools, and dark urine from biliary obstruction, icterus, steatorrhea (fatty stools)
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12
Q

cholecystitis lab assessment

A 
***Increased WBC
Alkaline phosphatase
***AST- elevated
***LDH- elevated 
***Serum bilirubin levels- elevated
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13
Q

cholecystitis diagnostic test

A

X-rays
Ultrasound- best test
ERCP or MRCP
hematobillary- visulaized gallbladder

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14
Q

cholecystitis analyze cues

A
  • acute or persistent pain due to gallbladder inflammation and or gallstones
  • weight loss due to decreased intake because of pain, nausea and anorexia
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15
Q

cholecystitis generate solutions

A
  • Avoid fatty foods, withhold food and fluid if nausea and vomiting occur
  • IV therapy
  • ***Ketorolac (potent NSAID) used for mild to moderate pain= can cause GI bleeds
  • Antiemetics for nausea
  • IV antibiotic therapy
  • **Oral bile acid dissolution or gallstone-stabilizing agents Extracorporeal shock wave lithotripsy (ESWL) to break up gallstones
  • Percutaneous transhepatic biliary catheter (drain) to open the blocked duct(s)
  • ***Cholecystectomy- surgical removal of the gallbladder
  • ***Teach patient about post-cholecystectomy syndrome symptoms (PCS)
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16
Q

cholecystits outcomes

A
  • Report control of abdominal pain, as indicated by self-report and pain scale measurement
  • Have adequate nutrition available to meet metabolic needs
17
Q

acute pancreatitis patho

A
  • Can be life-threatening inflammation of pancreas
  • Autodigestion and fibrosis of pancreas
  • caused by exsessive pancreatic enzymes
18
Q

complications of acute pancreatitis

A
  • hemorrhage
  • acute kidney failure
  • paralytic illius
  • hypovolemic shocl
  • ARD
  • pneuomonia
  • atlectasis
  • type 2 diabetes
19
Q

acute pancreatitis hisotry

A

Collect history after pain is controlled
Ask about *alcohol usage and medical problems
Any abdominal surgical interventions
Any recent viral infections
Over the **counter medications (opioids and steroids)

20
Q

acute pancreatitis physical assessment & s/s

A

Severe abdominal pain, often mid-epigastric or LUQ
Relief of pain by assuming the fetal position or by sitting upward and bending forward
**Generalized Jaundice
***Gray-blue discoloration of abdomen and periumbilical area
Peritonitis, paralytic ileus, pancreatic ascites

21
Q

acute pancreatitis lab

A

**Amylase: elevated
**Lipase: elevated
Serum bilirubin and alkaline phosphatase: elevated
ALT: elevated
WBC: elevated
ESR: elevated
calcium and magnesium: decreased

22
Q

acute pancreatitis diagnostic procedures

A
  • abdominal ultrasound
  • contrast-enhanced ct
  • abdominal xray
23
Q

acute pancreatitis prioritize hypothesis

A
  • Severe acute pain due to pancreatic inflammation and enzyme leakage
  • Weight loss due to inability to ingest food and absorb nutrients
24
Q

acute pancreatitis managing pain

A
  • Severe continuous ”boring” abdominal pain is the most common symptom of pancreatitis!
  • Main focus of nursing care is aimed at pain control by interventions that decrease GI tract activity, which *decreases pancreatic stimulation
  • Fasting and rest, drug therapy, and comfort measures used to **decrease pain
25
Q

acute pancreatitis promoting nutrtion

A
  • **NPO status maintained in early stages of pancreatitis
  • Antiemetics prescribed for nausea and vomiting
  • Patients with severe pancreatitis who are unable to eat for 24-48 hours will need jejunal **tube feeding, patient should be weighed daily
  • Once food is tolerated, patient should ***small, frequent, moderate to high carb, high-protein, low-fat meals, food should be bland with little spice, avoid caffeine containing foods and alcohol
  • ***Monitor the patient beginning to resume oral food intake for nausea, vomiting, and diarrhea (if any of these symptoms occur, notify the PCP immediately)
  • Nutritional supplements may be used to ***boost caloric intake, doctor may prescribe vitamin and mineral supplements
26
Q

acute pancreatitis outcome

A
  • has control of abdominal pain

- has adequate nutrition

27
Q

chronic pancreatitis patho

A
  • Progressive destructive disease of pancreas characterized by remissions and exacerbations
  • Inflammation and fibrosis of tissue contribute to pancreatic insufficiency
28
Q

chronic pancreatitis assessment

A 
Abdominal pain
Ascites
Respiratory compromise
***Steatorrhea and gray color
Weight loss
****Jaundice
****Dark urine
Polyuria, polydipsia, polyphagia
29
Q

chronic pancreatitis managing acute persistent pain

A

Initially opioid analgesia is used more frequently, but dependency may occur, so nonopioid analgesics may be considered

30
Q

maintain adequate nutrition chronic pancreatitis

A
  • Pancreatic enzyme replacement therapy (PERT)- standard of care to prevent malnutrition, malabsorption, and excessive weight loss; drug therapy to decrease gastric acid may be prescribed (such as PPIs)
  • Same treatment as acute pancreatitis; patient often avoids food intake to avoid pain; TPN or TEN, including vitamin and mineral replacement
31
Q

chronic pancreatitis prevent disease recurrance

A
  • Registered dietitian nutritionist teaches the patient long-term dietary management
  • Foods high in carb and protein assist in the healing process, avoid foods high in fat because it causes or increases diarrhea
    Alcohol cessation
32
Q

chronic pancreatitis surgical management

A

Surgery is not a primary treatment for chronic pancreatitis, may be indicated for ongoing abdominal pain, incapacitating relapses of pain, or complications such as pancreatic abscess or pancreatic pseudocyst

33
Q

pancreatic cancer

A
  • Difficult to diagnose
  • Treatment has limited results
  • 5-year survival rates are low
  • VTE is a common complication
34
Q

risk factors for pancreatic cancer

A
  • obestity
  • chronic pancreatitis
  • diabetses
  • chirrohis
  • smoking
35
Q

pancreatic cancer asssessment

A

Slow, vague presentation
**Jaundice (late, advanced disease)
***Icterus
Weight loss
Anorexia, nausea, vomiting
No specific lab tests are diagnostic of pancreatic cancer, however, **serum amylase and **lipase levels and **alkaline phosphatase are increased, elevated carcinoembryonic antigen **(CEA) and billirubin will increase
Abdominal ultrasound and contrast-enhanced CT are most commonly used

36
Q

pancreatic cancer interventions

A
  • Chemotherapy
  • Radiation
  • Surgery
  • Complete surgical resection of the pancreatic tumor is the most effective treatment, but only used when patients have small tumors
  • Partial pancreatectomy- preferred surgery for tumors smaller than 3 cm in diameter, depending on location and length of time since diagnosis
  • For larger tumors, the surgeon may perform a radical pancreatectomy or the Whipple procedure (pancreaticoduodenectomy)

Med Surg 1 (25 decks)

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