Concepts Exam #3 Ch 59

Question 1

Patients at most risk for acute cholecystitis and gallstones have these four Fs:

Answer 1

FEMALE
FORTY
FAT
FERTILE

Question 2

Acute Pancreatitis

Answer 2

Serious, and at times, life threatening inflammation of the pancreas.

Question 3

Trypsin

Answer 3

Pancreatic enzymes that cause direct toxic injury to the pancreatic cells resulting from the obstructive damage. P1218

Question 4

Grey turners sign

Answer 4

Grey-blue coloration of abdomen

Question 5

Chronic Cholecystitis Signs and symptoms

Answer 5

Jaundice
Icterus
Pruritis

Question 6

Acute Cholecystitis

Answer 6

Jaundice
Icterus
Pruritis

Question 7

What is the most reliable indicator that peristalsis has returned after surgery?

Answer 7

Passing flatus or having a stool. Bowel sounds is not reliable.

Question 8

icterus

Answer 8

yellow discoloration of sclera

Question 9

pruritis

Answer 9

itching or burning sensation

Question 10

Biliary Colic

Answer 10

Produced by obstruction of the cystic duct of the gallbladder or movement of one or more stones.

Question 11

How often do we monitor blood glucose for diabetics that are on TPN?

Answer 11

Check q2-4h.

Question 12

Grey Turner’s Sign

Answer 12

Located on the flanks (Grey-TURNer’s sign is located when you TURN towards your flank)

Question 13

Cullen’s Sign

Answer 13

Located around the umbilicus (cU llen’s sign is located around the U mbilicus)

Question 14

Nursing Alert for Laparoscopic Cholecystectomy

Answer 14

Asses patient’s oxygen saturation level frequently until the effects of the anesthesia have passed. Remind patient to perform deep-breathing exercises every hour.

Question 15

What is the most reliable indicator that peristalsis has returned after surgery?

Answer 15

Passing flatus or having a stool. Bowel sounds is not reliable.

Question 16

Risk factors for gall stones (Four Fs)

Answer 16

Female
Fourty
Fat
Fertile

Question 17

Diet for gall stone patient

Answer 17

Low fat diet, no fried foods/butter

Question 18

Acute Cholecystitis

Answer 18

Two types. Calculous cholecystitis- chemical irritation and inflammation from gallstones
Acalculous cholecystitis- inflammation without gallstones

Question 19

Cholelithiasis

Answer 19

Gall stones

Question 20

Pancreas location

Answer 20

behind the stomach

Question 21

Pancreas functions

Answer 21

Endocrine and exocrine (insulin)

Question 22

Labs and diagnostics for Pancreatitis

Answer 22

Everything is elevated! Except calcium and magnesium.

Amylase, lipase, trypsin, elastase, glucose, bilirubin, ALT, AST, leukocytes –all elevated.

Question 23

How often do you monitor respiratory status with patient with acute pancreatitis

Answer 23

Monitor resp. status q4-8h. Fluid overload can be detected by assessing for weight gain, listening for crackles, and observing for dyspnea.

Question 24

How to assess for signs/symptoms of hypocalcemia

Answer 24

Assess for Chvostek’s and Trousseaus’s signs. These tests cause muscle spasms after stimulating the assoc. nerves.

Question 25

Signs/Symptoms of Chronic Pancreatitis

Answer 25

Intense abdominal pain, abdominal tenderness, ascites, possible left upper quadrant mass, respiratory compromise manifested by adventitious or diminished breath sounds, dyspnea, or orthopnea; Steatorrhea (excretion of abnormal quantities of fat with feces, gray/pale stools; weight loss, jaundice, dark urine, polyuria, polydipsia, polyphagia.

Question 26

How often do we monitor blood glucose for diabetics that are on TPN?

Answer 26

Check q2-4h.

Question 27

Roles of collaborative health care team for patient with pancreatitis

Answer 27

Manage Pain
Maybe home care
Education on pain relief, nutrition, absence of alcohol and smoking
Teach to Call physician if any abdominal pain occurs or jaundice, clay colored stools or dark urine occurs after discharge.

Question 28

Complications of acute pancreatitis

Answer 28

Hypovolemia
Hemorrhage
Acute kidney failure
Paralytic ileus

Question 29

Prevention of Exacerbations of Chronic Pancreatitis

Answer 29

Avoid caffeine, alcohol, and nicotine; eat bland low-fat, high-protein and moderate-carbs; avoid spices; rest frequently; take pancreatic enzymes; eat small meals and snacks high in calories.

Question 30

How to detect early signs of hypovolemia and prevent shock

Answer 30

Monitor for hypotension, tachycardia, decreased vascular pressures with a pulmonary artery catheter (Swan-Ganz Cath), decreased urine output.

Question 31

Symptoms to notify physician of after pancreatitis patient starts eating food again…

Answer 31

Nausea, vomiting, and diarrhea. Again, call doctor immediately if this occurs

Question 32

Pancreatic Abscess

Answer 32

Most serious complication of pancreatitis
ALWAYS fatal if untreated
High fever
Blood Cultures
Drainages via percutaneous treatment
Antibiotics

Question 33

Pancreatic cancer

Answer 33

Large and invade the entire tail and body of pancreas
Venous thromboembolism is a common complication
5-year survival rate

Question 34

Whipple Procedure

Answer 34

Surgical manipulation and is used most often to treat cancer of the head of the pancreas

Question 35

Three anastomoses that constitute the Whipple Procedure:

Answer 35

Choledochojejunostomy, Pancreaticojejunostomy, and gastrojejunostomy.

Question 36

A client had an open whipple procedure for pancreatic cancer. Nursing interventions…

Answer 36

Monitor and document the clients NG tube drainage
Assess the abdomen for s/s peritonitis
Monitor the clients HCT and HGB
Check the clients blood glucose frequently