7/30/2019 Cholecystitis Cholelithiasis Outline

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HOLECYSTITIS/CHOLELITHIASIS OUTLINE:

A. CHOLELITHIASIS- gallstonesB. CHOLECYSTITIS- Inflammation of the lining of the gallbladder, assoc, w/ obstructionC. PRECIPATATING FACTORS

a. Obesityb. Sedentary lifestylec. Family dispositiond. Postmenopausal women on estrogen therapy

D. ETIOLOGYa. Unknownb. Preceipation of calcium, bile salts, cholesterolc. Bile stasis 7 obstruction

E. S/S CHOLECYSTITIS/CHOLELITHIASISa. Indigestionb. RUQ pain- shoulder pain- referredc. N&V, dyspepsia, flatulence, N&V, diaphoresis, erunctation, feeling of fullnessd. Jaundicee.

Increased WBC w/ tachycardia 7 dehydration

f. Increased serum 7 urinary amylaseg. Increased liver enzymes 7 bilirubinh. Steatorrheai. Feverj. Sausage shaped massk. Murphys sign- palpation of costal margin yields pain w/ deep inspirationl. Blumbergs sign- guarding w/ rebound tenderness

F. LABS & DIAGNOSTICSa. Abdominal ultrasoundb. ERCPc. Choleangiographyd. WBCe. Amylasef. Liver enzymes & bilirubin

G. COMPLICATIONSa. Gangeranous cholecystitisb. Pancreatitisc. Abscessd. Peritonitise. Fistulasf. Biliary cirrhosisg. Cholangitis-infection of common bile ducth. Carcinoma

H. COLLABORATIVE & NSG CAREa. CONSERVATIVE THERAPY

i. Encourage pt eat frequent sm low fat mealsii. Admin fat-sol vitamins & bile salts when gallstones causing obstructioniii. NPO when N&V; NG w/ sxn when severe

7/30/2019 Cholecystitis Cholelithiasis Outline

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b. DRUGSi. Opiods

ii. Anticholinergics& antispasmodicsiii. Antiemeticsiv. Bile salts- actigal, decholinv. Vit A, D, E, Kvi. Cholestyramine (questran)

c. SURGERYi. Percutaneous transhepatic catheter- to decompress hepatic duct allows bile flow

ii. Cholecystectomy1. Pre-op

a. Teach cough/deep bx, turning, early ambulationb. Teach splint incision while cough

2. Laparoscopic procedurea. Post-op

i. Early ambulationii. Return to normal activities in 1-3wks

3. Traditional- requires T-tube insertion into biliary ducts to maintain patencya. Post-op

i. Administer IV opiodsii. Administer antiemeticsiii. Advance diet from liquid to solidiv. Manage t-tube:

1. Keep t-tube below level of gallbladder2. Assess characteristics drainage3. Report drainage >1000mL in 24hrs4. Assess foul & purulent drainage & report5. Assess insertion site6. Do not clamp or irrigate tube without D.O7. Maintain patency of t-tube8. Place semi-fowlers9. Assist early ambulation10.Teach to observe for brown stools 7-10dys

I. NURSING INTERVENTIONSa. I.D those at riskb. Acute interventions

i. Relief of painii. Relief of nauseaiii. Comfort 7 supportiv. Fluid & e-lyte balance

1. Oral & nasal hygiene if NPO w/ NG sxnv. Assess s/s obstruction: jaundice, puritis, steatorrheavi. Assess infection