1 / 34

Chapter 62

Chapter 62. Care of Patients with Problems of the Biliary System and Pancreas. Mrs. Kreisel MSN, RN NU130 Adult Health Summer 2011. Hepatobiliary Anatomy. Acute Cholecystitis. Acute cholecystitis is the inflammation of the gallbladder. Calculous cholecystitis.

lynton
Download Presentation

Chapter 62

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 62 Care of Patients with Problems of the Biliary System and Pancreas Mrs. Kreisel MSN, RN NU130 Adult Health Summer 2011

  2. Hepatobiliary Anatomy

  3. Acute Cholecystitis • Acute cholecystitis is the inflammation of the gallbladder. • Calculous cholecystitis. • Cholelithiasis (gallstones) usually accompanies cholecystitis. • Acalculous cholecystitis inflammation can occur in the absence of gallstones.

  4. Gallstones

  5. Chronic Cholecystitis • Repeated episodes of cystic duct obstruction result in chronic inflammation • Pancreatitis, cholangitis • Jaundice • Icterus • Obstructive jaundice • Pruritus

  6. Clinical Manifestations • Flatulence, dyspepsia, eructation, anorexia, nausea and vomiting, abdominal pain • Biliary colic • Murphy’s sign • Blumberg’s sign • Rebound tenderness • Steatorrhea

  7. Nonsurgical Management • Nutrition therapy—low-fat diet, fat-soluble vitamins, bile salts • Drug therapy—opioid analgesic such as morphine or hydromorphone, anticholinergic drugs, antiemetic • Extracorporeal shock wave lithotripsy • Percutaneous transhepatic biliary catheter insertion

  8. Surgical Management • Laparoscopic cholecystectomy • Standard preoperative care • Operative procedure • Postoperative care: • Free air pain result of carbon dioxide retention in the abdomen • Ambulation • Return to activities in 1 to 3 weeks

  9. Traditional Cholecystectomy • Standard preoperative care • Operative procedure • Postoperative care: • Opioids via patient-controlled analgesia pump • T-tube • Antiemetics • Wound care

  10. Traditional Cholecystectomy (Cont’d) • Care of the T-tube • NPO • Nutrition therapy

  11. Cancer of the Gallbladder • Anorexia, weight loss, nausea, vomiting, general malaise, jaundice, hepatosplenomegaly; chronic, progressively severe epigastric or right upper quadrant pain • Poor prognosis • Surgery, radiation, chemotherapy

  12. Acute Pancreatitis • Serious and possibly life-threatening inflammatory process of the pancreas • Necrotizing hemorrhagic pancreatitis • Lipolysis • Proteolysis • Necrosis of blood vessels • Inflammation • Theories of enzyme activation

  13. Autodigestion

  14. Complications of Acute Pancreatitis • Hypovolemia • Hemorrhage • Acute renal failure • Paralytic ileus • Hypovolemic or septic shock • Pleural effusion, respiratory distress syndrome, pneumonia • Multisystem organ failure • Disseminated intravascular coagulation • Diabetes mellitus

  15. Clinical Manifestations • Generalized jaundice • Cullen’s sign • Turner’s sign • Bowel sounds • Abdominal tenderness, rigidity, guarding • Pancreatic ascites • Significant changes in vital signs

  16. Laboratory Assessment • Lipase • Trypsin • Alkaline phosphatase • Alanine aminotransferase • WBC • Glucose • Calcium

  17. Acute Pain • Interventions include: • The priority for patient care to provide supportive care by relieving symptoms, decrease inflammation, and anticipate and treat complications • Comfort measures to reduce pain including fasting and drug therapy • Endoscopic retrograde cholangiopancreatography

  18. Nonsurgical Management • Fasting and rest • Drug therapy • Comfort measures • Endoscopic retrograde cholangiopancreatography (ERCP)

  19. Surgical Management • Preoperative care—NG tube may be inserted • Operative procedures • Postoperative care: • Monitor drainage tubes and record output from drain. • Provide meticulous skin care and dressing changes. • Maintain skin integrity.

  20. Imbalanced Nutrition: Less Than Body Requirements • Interventions include: • NPO in early stages • Antiemetics for nausea and vomiting • Total parenteral nutrition • Small, frequent, moderate- to high-carbohydrate, high-protein, low-fat meals • Avoidance of foods that cause GI stimulation

  21. Chronic Pancreatitis • Progressive destructive disease of the pancreas, characterized by remissions and exacerbations • Nonsurgical management includes: • Drug therapy • Analgesic administration • Enzyme replacement • Insulin therapy • Nutrition therapy

  22. Pancreatic Abscess • Most serious complication of pancreatitis; always fatal if untreated • High fever • Blood cultures • Drainage via the percutaneous method or laparoscopy • Antibiotic treatmentalone does not resolve abscess

  23. Pancreatic Pseudocyst • Complications: hemorrhage, infection, bowel obstruction, abscess, fistula formation, pancreatic ascites • May spontaneously resolve • Surgical intervention after 6 weeks

  24. Insulinoma • Most common type of neuroendocrine pancreatic tumor • Benign tumors of the islets of Langerhans that cause excessive insulin secretion and subsequent hypoglycemia • Management—removal of tumor

  25. Pancreatic Carcinoma • Nonsurgical management: • Drug therapy • Radiation therapy • Biliary stent insertion

  26. Surgical Management • Preoperative care: • NG tube may be inserted • TPN typically begun • Operative procedure may include Whipple procedure

  27. Surgical Management (Cont’d) • Postoperative care: • Observe for complications • GI drainage monitoring • Positioning • Fluid and electrolyte assessment • Glucose monitoring

  28. Whipple ProcedureThree anastomoses that constitute the Whipple procedure: Choledochojejunostomy, pancreaticojejunostomy, & gastrojejunostomy

  29. NCLEX TIME

  30. Question 1 A patient with chronic cholecystitis is complaining of pruritus, clay-colored stools, and voiding dark, frothy urine. Which laboratory analysis is a priority in the nurse’s assessment of this patient? • Liver function tests • Total bilirubin • Lipase level • White blood cell count

  31. Question 2 Which patient is more likely to develop gallstones? • 55-year-old African-American male with a history of diabetes mellitus • 62-year-old American-Indian female • 45-year-old Caucasian female with a family history of gallstones • 60-year-old obese, Mexican-American female with a history of diabetes mellitus

  32. Question 3 The nurse notes jaundice and bluish discoloration of the abdomen and flank in the patient complaining of abdominal pain of sudden onset that radiates to the left shoulder. Based on these symptoms, what intervention should be the priority for this patient? • Passage of a nasogastric tube • Observation for delirium tremens • Pain relief • Relief from vomiting

  33. Question 4 About how any Americans are affected by acute pancreatitis? • 10,000 • 30,000 • 50,000 • 80,000

  34. Question 5 In the care of a patient with acute pancreatitis, which assessment parameter requires immediate nursing intervention? • Heart rate 105 beats/min • Blood pressure 110/82 mm Hg • Respiratory rate 28 breaths/min • Serum glucose 136 mg/dL

More Related