NUR 114 #5 gallbladder

What allows bile to enter the intestine?

Relaxation of the sphincter

What is bile composed of?

Water and electrolytes (sodium, potassium, calcium, chloride, bicarbonate)

Function of glucagon?

Raise the blood glucose (secreted by pancreas)

What is cholecystitis?

Inflammation of the gallbladder

A/S of cholecystitis?

Pain, tenderness, rigidity of the upper right abdomen that may radiate to the midsternal area or right shoulder associated with nausea, vomiting, and inflammation

What is calculus cholecystitis?

A gallbladder stone obstructs bile outflow

What is a calculus cholecystitis?

Gallbladder inflammation without obstruction occurs after major surgery, orthopedic procedures, sever trauma, or burns

What is acalculous caused by?

Alterations in fluids & electrolytes & blood flow, bile stasis, and increased viscosity of the bile

What are pigment cholelithiasis (gallstones)?

Unconjugated pigments in the bile precipitate to form stones

Who’s at risk of getting pigment gallstones?

Patients with cirrhosis, hemolysis, and infections of biliary tract

How are pigment stones treated?

With surgery

What are cholesterol cholelithiasis?

Most common; occurs when there’s too much cholesterol in the bile, there’s not enough bile salts or lecithin to keep the cholesterol dissolved or when the gallbladder doesn’t empty effectively (bile stasis)

Risk factors?

Cystic fibrosis, diabetes, frequent changes in weight, estrogen therapy, obesity, rapid weight loss, women, fertile (pregnant)

How does biliary colic manifest?

Nausea and vomiting and noticeable several hours after a heavy meal

If a gallstone obstructs the cystic duct what happens to the gallbladder?

It becomes distended, inflamed, and eventually infected. Patient will have a fever, have a palpable mass, and have biliary colic

What are other symptoms of gallbladder disease?

Jaundice (bile is no longer carried to the duodenum), dark urine, putty/clay colored fences

What vitamins are they deficient in?

A,D,E,K

What vitamin is essential for blood clotting?

K

Diagnostics?

X ray, ultrasound (detects calculi), radionuclide imaging (diagnoses acute cholecystitis or blockage of a bile duct), ERCP (evaluate the presence and location of ductal stones)

What’s should be given before ERCP?

Sedation, anticholinergics, and glucagon

Nurses role during ERCP?

Monitor for respiratory and CNS depression, hypotension, over sedation, and vomiting, and postions the patient

Other medical management?

Lithotripsy, dissolution of gallstones, cholecystectomy (removal of the gallbladder)

Supportive therapy?

Iv fluids, suction, analgesia, antibiotics

Diet?

Low fat liquids, high protein, cooked fruits/rice/tapioca, lean meats, mashed potatoes, non gas forming veggies bread & coffee/tea

Gerontologic considerations?

May not present normal symptoms. They may show oliguria, hypotension, changes in mental status, tachycardia & tachypnea

Nursing interventions & education for after surgery?

Low fowlers, fluids, suction (nasogastric tube), soft diet, low fat (4-6 weeks), wound care, pain management (heating pad, sitting up), light exercise, avoid lifting <5 lbs, wound care, follow up (7-10 days after), s/s of infection

How does jaundice happen?

If bilirubin can’t be excreted

Clinical manifestations of pancreatitis?

Abdominal pain that may radiate to back, chest or flank area, fever, tachycardia, hypotension, abdominal tenderness, respiratory distress, and abdominal distention

What is Murphys sign?

Pain elicited when pressure is applied under the liver border at the right costal margin and client inhales deeply