Slight elevated phosphate levels would indicate an obstruction IF UNTREATED

Slight elevated phosphate levels would indicate an

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Slight elevated phosphate levels would indicate an obstruction IF UNTREATED often can resolve in 1-4 days Chronic Cholecystitis o Have the intermittent pain off and on that have the biliary colic o Send for a consult to have the gallbladder removed Acute o Severe URQ pain, nausea, vomiting, fever 13
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NURS400: Chapters 39-42 Exam #5 If they have Jaundice d/t obstruction bilirubin levels will be high Urine will be dark Stool will be clay-like, gray Elderly Considerations They don’t show obvious S/S May not have fever or high WBCs HIGH RISK FOR INFECTIONS Murphy’s Sign To illicit: palapate under R subcostal area, the area would be very tender and would have rebound tenderness (brief respiratory response) Get an accurate assessment, ask about their diet, will need to r/o Cardiac, when did you last eat? How long does the pain go on? Have you ever had the pain before? Have you had your gallbladder removed? Have you had any alcohol to drink? Diagnostic Findings Abdominal X-ray o Simple, quick, non-invasive, r/o other diagnoses o Normally can’t see gallstones on an x-ray though so it doesn’t r/o Abdominal Ultrasound 14
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NURS400: Chapters 39-42 Exam #5 o 95% accuracy o Diagnostic procedure of choice o If the patient is not in an acute crisis Have them NPO after midnight to give them a chance to have the bile fill up and then run the test Endoscopic Retrograde Cholangiopancreatography (ERCP) o Provides a direct visualization into the hepatobiliary system o Can retrieve small stones with this o Can dilate the sphincter of Odie o NPO before test and after no food and fluids until gag reflex returns HIGH RISK FOR ASPIRATION o Monitor for Respiratory and CNS depression o Monitor for S/S of infection and perforation Percutaneous Transhepatic Cholangiography o This test is helpful to determine whether or not the patient is experiencing Jaundice d/t liver dx or d/t an obstruction o Injects dye into the biliary tract directly o Performed under moderate sedation Successful when the physician extracts bile After procedure the patient will try to remove as much dye as possible by aspirating to prevent seepage of dye in the peritoneum o Prior: NPO Need to check coagulation studies (PT, PTT, INR) Assess medications (on anticoagulants?) ABX are often administered d/t risk for infection o After: AT RISK FOR PERITONITIS o Monitor for S/S Collaborative Care Overall goal is to achieve acute gallbladder remission In acute phase: Rest NPO, IV fluids, may need an NG tube Pain Medications IV ABX After acute phase: LOW FAT DIET; clear liquids 1 st , then progress Avoid fatty foods, gas producing foods, and alcohol Surgical management is typically the best choice Laparoscopic Cholecystectomy SURGICAL TX OF CHOICE Done as same day surgery 15
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NURS400: Chapters 39-42 Exam #5 3-4 incisions Blow belly up with CO2 gas for visualization If they have an infection or perforation converts the laproscopic procedure into an open procedure Make sure you have consents for laproscopic and open
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  • Spring '14
  • AmyG.Bufford
  • chronic hepatitis, chronic liver failure

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