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NSG 210 Test 3 Study Guide

If pts do not tolerate enteral switch to parenteral if

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Unformatted text preview: m amylase & lipase Dx: includes abdominal x ­ray, ultrasound, ERCP, MRCP Abdominal x ­ray: may be used to rule out other causes of s/s; gallstones are not very visible on x ­ray Ultrasonagraphy: of the RUQ is the best dx test b/c it is rapid, accurate & can be used in pts w/ liver disease & jaundice. It also doesn’t expose pts to radiation. It is most accurate if the pt fasts overnight so that the gallbladder is distended Endoscopic retrograde cholangiopancreatography (ERCP): permits direct visualization of structures through a fiberoptic endoscope inserted through the esophagus into the duodenum. Pre ­procedure: pt is NPO 6 ­8 hrs before. Moderate sedation/general anesthesia is used. Pt is positioned in high ­fowlers. Post ­procedure: nurse monitors VS, return of the gag reflex & ax for s/s of perforation or infection Carlton Note: ERCP is not used predominantly as dx tool, but it is more of a tx tool b/c of complications. MRCP is much safer & has less complications Magnetic resonance cholangiopancreatography (MRCP): uses IV contrast w/ no iodine before an MRI scan. Pt should be asked about allergies/hx of hives Nonsurgical Tx: includes drug & nutrition therapy, ESWL, percutaneous transhepatic biliary catheter, ERCP Nutritional Therapy: 80% of pts w/ acute gallbladder inflammation achieve remission w/ rest, IV fluids, NG suction, analgesia & antibiotic agents. The diet required immediately after an episode is limited to low ­fat liquids, cooked fruits, lean meats, non ­gas ­forming veggies, bread, mashed potatoes, etc. Drug Therapy: includes opioids, anti ­emetics, antibiotics & UDCA/CDCA  ­Opioids: Morphine & Dilaudid are the drugs of choice for controlling pain. Toradol may be better for the elderly population. Demerol is not used as much any more. NOTE: This is accd to CARLTON. It says the complete opposite in the book on pg 1173.  ­Antiemetics: may be given to help GI s/s  ­Broad ­spectrum antibi...
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