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Nursing Care of the Patient with a Disorder of the Gallbladder

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Nursing Care of the Patient with a Disorder of the Gallbladder * * * * * * What is the difference in the two disorders? Who is at Risk? Higher in women: multiparous ... – PowerPoint PPT presentation

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Title: Nursing Care of the Patient with a Disorder of the Gallbladder


1
Nursing Care of the Patient with a Disorder of
the Gallbladder
2
Cholecystitis and Cholelithiasis
What is the difference in the two disorders?
3
Who is at Risk?
  • Higher in women multiparous, over 40
  • Sedentary lifestyle
  • Familial tendency
  • Obesity
  • Treatment with estrogen therapy

4
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

5
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?

6
Pathophysiology of
Cholelithiasis
  • Symptoms occur when one of the stones block the
    common bile duct.
  • Stones are made of
  • Cholesterol
  • Pigments

7
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

8
If the patient was displaying all the symptoms of
cholelithiasis,which one is most important to
intervene?
9
Complications
  • Gangrenous cholecystitis
  • Pancreatitis
  • Rupture of the gallbladder
  • Biliary Cirrhosis
  • Peritonitis

10
Diagnostic Studies
  • Ultrasound
  • Must be NPO
  • ERCP (Endoscopic Retrograde Cholangiopancreatograp
    hy)

11
Additional Laboratory Tests
  • Laboratory tests
  • WBC count
  • Serum bilirubin

12
Treatment and Nursing Care
13
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 suction
  • Control of Infection
  • Antibiotics

14
Treatment and Nursing Care
  • Relieve Pruritis
  • Bile acid Sequestrants
  • Cholestyramine (Questran) and hydroxyzine
    (Atarax)

15
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?

16
Treatment and Nursing CareNonsurgical Approaches
  • Stone Removal Techniques
  • ERCP with sphincterotomy
  • Mechanical extracorporeal
  • shock-wave lithotripsy

17
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

18
Treatment and Nursing CareSurgery
  • Laparoscopic cholecystectomy
  • treatment of choice
  • gallbladder removed through four
  • puncture holes

19
Treatment and Nursing CareSurgery
  • Incisional / Open cholecystectomy
  • Removal of GB through right subcostal
  • incision
  • T tube inserted into CBD

20
Treatment and Nursing CarePost-op Care
  • Relieve post-op pain
  • Assess respiratory status
  • Wound care
  • Drains

21
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

22
Post-op Teaching
  • When to call the doctor
  • Severe pain
  • Obstruction stool and urine changes, jaundice,
    pruritis
  • Infection
  • Diet
  • Activity
  • Drains

23
How do you know they are getting better?
24
The End
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