Nursing Care of the Patient with a Disorder of the Gallbladder.
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Transcript of Nursing Care of the Patient with a Disorder of the Gallbladder.
Who is at Risk?
Higher in women: multiparous, over 40 Sedentary lifestyle Familial tendency Obesity Treatment with estrogen therapy
Pathophysiology of Acute Cholecystitis
Obstruction of cystic duct blocks flow of bile backs up in the GB leading to ischemia of GB mucosa or wall
Inflammation may follow GB becomes edematous during acute attack, distended with bile or pus gangrenous
Clinical Manifestations of Acute Cholecystitis
Usually begins with a biliary colic attack Epigastric pain that radiates to the right
shoulder and scapula.
What precipitates a biliary colic attack?
What are additional signs and symptoms?
Pathophysiology of Cholelithiasis
Symptoms occur when one of the stones block the common bile duct.
Stones are made of: Cholesterol Pigments
Clinical Manifestations of Cholelithiasis
Sudden severe RUQ Pain biliary colic Symptoms related to bile obstruction such as:
• Jaundice• Dark orange and foamy urine• Steatorrhea and clay-colored stools• Pruritus
If the patient was displaying all the
symptoms of cholelithiasis,
which one is most important
to intervene?
Complications Gangrenous cholecystitis
Pancreatitis
Rupture of the gallbladder
Biliary Cirrhosis
Peritonitis
Treatment and Nursing Care Control Pain
Analgesics - Morphine Anticholinergic – Bentyl or Atropine
Maintain fluid and electrolyte balance IV fluids
Prevent GB stimulation NPO with NG suctionNPO with NG suction
Control of Infection Antibiotics
Treatment and Nursing Care
Relieve Pruritis Bile acid Sequestrants
Cholestyramine (Questran) and hydroxyzine (Atarax)
Treatment and Nursing CareNutrition
Once the acute attack is over – patient is placed on low fat diet Cooked fruits Lean meats Non-gas forming vegetables, mashed potatoes, rice
The patient should be taught to AVOID which foods?
Treatment and Nursing CareNonsurgical Approaches
Stone Removal Techniques: ERCP with sphincterotomy
Mechanical extracorporeal shock-wave lithotripsy
Treatment and Nursing CareMedical Dissolution Therapy
Used for patients who are a poor risk for surgery and mildly symptomatic
May take 6 months to 2 years Medications:
Chenodial Ursodiol (Actigall)
Cholesterol solvents Methyl tertiary terbutyl ether (MTBE)- infusion via tube
directly into the gallbladder
Treatment and Nursing CareSurgery
Laparoscopic cholecystectomy * treatment of choice
* gallbladder removed through four puncture holes
Treatment and Nursing CareSurgery
Incisional / Open cholecystectomy * Removal of GB through right subcostal incision * T tube inserted into CBD
Treatment and Nursing CarePost-op Care
Relieve post-op pain
Assess respiratory status
Wound care
Drains
Treatment and Nursing CarePost-op
Improve nutritional status – resume diet and fat back in diet in small increments.
Medications: Fat-soluble vitamins
Vitamins A,D,E,K
Bile salts
Post-op Teaching
When to call the doctor Severe pain Obstruction – stool and urine changes, jaundice,
pruritis Infection
Diet Activity Drains