Download Care of the Client with Disorders of the Gallbladder

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Transcript
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, 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
Diagnostic Studies

Ultrasound

Must be NPO
 ERCP (Endoscopic Retrograde
Cholangiopancreatography)
Additional Laboratory Tests
 Laboratory
tests
* WBC count
* Serum bilirubin
Treatment and Nursing Care

Control Pain



Maintain fluid and electrolyte balance


IV fluids
Prevent GB stimulation


Analgesics - Morphine
Anticholinergic – Bentyl or Atropine
NPO with NG suction
Control of Infection

Antibiotics
Treatment and Nursing Care

Relieve Pruritis

Bile acid Sequestrants

Cholestyramine (Questran) and hydroxyzine
(Atarax)
Treatment and Nursing Care
Nutrition

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 Care
Nonsurgical Approaches

Stone Removal Techniques:
 ERCP with sphincterotomy

Mechanical extracorporeal
shock-wave lithotripsy
Treatment and Nursing Care
Medical 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 Care
Surgery

Laparoscopic cholecystectomy
* treatment of choice
* gallbladder removed through four
puncture holes
Treatment and Nursing Care
Surgery

Incisional / Open cholecystectomy
* Removal of GB through right subcostal
incision
* T tube inserted into CBD
Treatment and Nursing Care
Post-op Care

Relieve post-op pain

Assess respiratory status

Wound care

Drains
Treatment and Nursing Care
Post-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

How do you know they
are getting better?
The End