Cholecystitis Show A normal white blood cell count is 4,500 to 10,000 cells/µL. The patient's reports show an elevated WBC count, which indicates leukocytosis. Pain in the right upper quadrant, fever, indigestion, and leukocytosis are the clinical manifestations of cholecystitis. Cirrhosis is manifested by jaundice, peripheral edema, peripheral neuropathy, and skin lesions such as spider angiomas. Abdominal pain, shortness of breath, and flushing are the characteristics of pancreatitis. Pancreatic cancer is associated with nausea, dull abdominal pain, loss of appetite, and rapid weight loss. Cholelithiasis Cholelithiasis is manifested by severe abdominal pain accompanied by tachycardia, dyspnea, and prostration. Pancreatitis is manifested by abdominal pain accompanied by cyanosis, flushing, and dyspnea. Abdominal pain, accompanied by nausea, vomiting, restlessness, and diaphoresis, is characteristic of cholecystitis. Liver cirrhosis is manifested by fatigue, jaundice, peripheral edema, and ascites formation. pt B Trientine is a chelating agent and would not be effective for treating patient B with cholecystitis. Cholecystitis is inflammation of the gallbladder, which causes pain, increased secretions, and muscle spasms. Therefore patients with cholecystitis are prescribed nonsteroidal antiinflammatory drugs for pain relief and anticholinergics like dicyclomine to relieve spasms and decrease the secretions. Cirrhosis, like in patient A, is associated with pruritus, and hydroxyzine is given to relieve skin irritation. Wilson's disease, like in patient C, is caused by accumulation of copper in the body. D-penicillamine is an antidote for copper and used to treat Wilson's disease. Patients with acute pancreatitis, like patient D, have severe abdominal pain and are prescribed spasmolytics, such as nitroglycerin. Jaundice, Steatorrhea, Dark amber urine, and Bleeding tendencies Manifestations of obstructed bile flow in a patient with cholelithiasis include jaundice, dark, amber urine, which foams when shaken, clay-colored (not dark, tarry) stools, pruritus, intolerance for fatty foods (nausea, sensation of fullness, anorexia), bleeding tendencies, and steatorrhea. Dark, tarry stools are not a manifestation of obstructed bile flow; clay stools are. Which of the following factors may be associated with the development of cholelithiasis? Select all that apply. 3 A familial or genetic tendency appears to play a role in the cholelithiasis, but this may be partially related to familial nutrition habits (excessive dietary cholesterol intake) and sedentary lifestyles. The highest frequency of gallstone production lies among the American-Indian and Mexican-American populations. Development of gallstones is not related to smoking or normal weight loss. Which factor is considered a risk factor in the development of cholelithiasis? 2 In pregnancy, hormone levels (progesterone and estrogen) are altered, which delays muscular contraction of the gallbladder and decreases the rate of bile emptying, thus increasing the risk for cholelithiasis. Similarly, hormonal changes and hormonal replacement therapy make women over 40 years, not under, more susceptible to the development of cholelithiasis. Obese women, not those with a low BMI, are at a high risk of developing cholelithiasis because of impaired fat metabolism and increased cholesterol. Anemia is not associated with the development of gallstones. Which finding is expected in a patient who has a liver function abnormality? 4 Alkaline phosphatase is an enzyme found in the liver, kidneys, and bones. An increase in serum levels of alkaline phosphatase indicates a liver function abnormality. An increased level of WBCs indicates inflammation or infection. When the liver is not functioning normally, the level of lactate dehydrogenase and aspartate aminotransferase are increased, not decreased. A
patient with cholecystitis has jaundice and icterus. These signs are typical of which type of cholecystitis? 2 Patients with chronic cholecystitis are more likely to have jaundice and icterus caused by obstruction of bile flow, causing increased circulating levels of bilirubin. Patients with acute cholecystitis present with abdominal pain. Acalculous cholecystitis and calculous cholecystitis are both types of acute cholecystitis. The patient is evaluated for use of extracorporeal shockwave lithotripsy for treatment of cholelithiasis. What findings should the nurse notify the health care provider about? 4 A patient scheduled for extracorporeal shockwave lithotripsy should have normal gallbladder function, so poor gallbladder function should be reported. A BMI of 27 indicates normal weight, which is necessary for this procedure. Upper abdominal pain is expected in a patient who has gallstones. A patient with cholesterol-based stones is an appropriate candidate for this procedure. A patient diagnosed with acalculous cholecystitis asks the nurse how the
gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? 4 This type of gallbladder inflammation is associated with hypovolemia. Although this type of gallbladder inflammation is associated with sepsis, it is not an indicator that sepsis is developing. Fibrotic and contracted gallstones are associated with chronic cholecystitis. The presence of acalculous cholecystitis is not an indicator that pancreatic disease has developed. A patient is undergoing extracorporeal shockwave
lithotripsy. The patient complains of pain in the abdomen. What action by the nurse is appropriate? 4 The patient may experience pain during extracorporeal shockwave lithotripsy when the stones are breaking up and moving. This is not an indication to reposition the patient. The patient will not be placed under conscious sedation. The interventionist would not stop the procedure. Which medication would be administered after extracorporeal shock wave lithotripsy (ESWL) for treatment of cholelithiasis, in order to dissolve remaining stone fragments? 4 Ursodeoxycholic acid is administered to dissolve remaining fragments of stones after ESWL. Ketorolac, morphine, and bethanechol are not indicated for dissolution of stones. A patient scheduled for a cholecystectomy because of gallstones causing cholecystitis reports a pain level of 4 on a 0-to-10 pain scale. Which analgesic
medication does the nurse anticipate will be prescribed for the patient? 1 Ketorolac may be used for mild to moderate pain. Acute biliary pain requires opioid analgesia, such as morphine or hydromorphone. In the past, meperidine was the drug of choice for acute biliary pain because it was thought to cause fewer spasms of the sphincter of Oddi, which blocks bile flow. However, this drug breaks down into a toxic metabolite and can cause seizures, especially in older adults. All opioids may cause some degree of sphincter spasm. Which patient characteristics are risk factors for cholelithiasis? Select all that apply. 1 The risk for developing gallstones increases with age. Obesity increases the risk for cholelithias is due to impaired fat metabolism or increased cholesterol. Diabetes mellitus increases the chances of cholelithiasis due to higher levels of fatty acids. Neither depression nor vitamin deficiency cause cholelithiasis; they do not interfere with bile production and storage. The nurse is teaching a patient with gallbladder disease about diet
modification. Which meal does the nurse suggest to the patient? 3 Turkey is an appropriate low-fat selection for this patient. Steak, french fries, fried chicken, and sausage are too fatty, and eggs are too high in cholesterol for a patient with gallbladder disease. The nurse understands that which patient is at highest risk for developing gallstones? 2 Both obesity and altered hormone levels increase a woman's risk for developing gallstones. Men are at lower risk than women for developing gallstones. Although pregnancy increases the risk for a woman to develop gallstones, this woman's thin frame lessens that risk. A patient with an external transhepatic biliary catheter has had a reduction in drainage. What does this finding indicate? 1 A reduction in drainage of an external transhepatic biliary catheter indicates that the catheter is not working. A reduction in drainage would not be related to the decrease in biliary secretions. It would not indicate that the patient needs to change positions. The patient does not need to take medication. What elevated blood level indicates inflammation in a patient diagnosed with cholecystitis? 1 The white blood cell count is indicative of inflammation. The lactate dehydrogenase, serum alkaline phosphate, and aspartate aminotransferase are significant for abnormalities in the liver. The nurse is preparing a patient for a magnetic resonance cholangiopancreatography (MRCP) scan. Which contrast medium does the nurse tell the patient will be administered prior to the procedure? 4 The oral or IV contrast material gadolinium is given before an MRCP scan. Gadolinium does not contain iodine; therefore, it does not carry the risk for an allergic reaction. Ketorolac, morphine, and meperidine are not helpful in MRI; these drugs are analgesics. The patient has severe biliary obstruction. What type of surgery does the nurse anticipate this patient requiring in order to explore the ducts for patency? 1 Patients with severe biliary obstruction whose ducts will need to be explored will need a traditional cholecystectomy. A transhepatic biliary catheter placement is not a surgical procedure to treat cholecystectomy. A laparoscopic cholecystectomy or natural orifice transluminal endoscopic surgery will not provide visualization of the ducts. A
patient who has cholesterol-based gallstones and good gallbladder function is interested in nonsurgical management options for this condition. Which other factor must be present for this patient to be a candidate for a nonsurgical approach? 1 Patients who undergo extracorporeal shock wave lithotripsy must be of normal weight and have cholesterol-based, smaller gallstones and good gallbladder function. Iodine is not used in this procedure. The presence of infection and serum cholesterol levels are not factors to consider in candidates for this procedure. Which patients are suitable candidates for extracorporeal shock wave lithotripsy (ESWL) to treat gallstones? Select all that apply. 1 ESWL is used for patients who have small stones and for those who are not good surgical candidates. Patients who are within normal weight range, have cholesterol-based stones, and good gallbladder function are suitable candidates for this procedure. ESWL is not used for patients with severe biliary obstruction or cancer of the gallbladder. A patient reports fever, yellowing of the skin and eyes, clay-colored stools, and dark urine. The nurse suspects further testing will reveal which condition?
4 Fever, yellowing of the skin and eyes, clay-colored stools, and dark urine are symptoms of chronic cholecystitis. These symptoms occur when repeated episodes of cystic duct obstruction cause chronic inflammation. Peritonitis is an infection of the peritoneal cavity in which the patient presents with a hard, distended abdomen. Patients with malnutrition are underweight for their height and have low albumin. Patients with a vitamin deficiency do not display these symptoms; symptoms are always dependent upon the vitamin in which the patient is deficient. A female patient is scheduled for a cholecystectomy by natural orifice transluminal endoscopic surgery. Which area is most commonly used for inserting the endoscope during this procedure? 2 Surgical removal of the gallbladder in women is most often accomplished via the vagina because it is easily decontaminated with betadine or other antiseptic, and it allows easy access into the peritoneal cavity. The surgeon makes a small internal incision through the cul-de-sac of Douglas, between the rectum and uterine wall, to access the gallbladder. The mouth and rectum do not provide easy access into a woman's peritoneal cavity. The umbilicus is used for removing the gallbladder in laparoscopic cholecystectomy. A patient with an internal/external biliary drainage tube contacts the health care provider's office to report jaundice and leakage around the catheter site. What instructions should the nurse provide? 1 A patient with jaundice or leakage around the tube insertion should reconnect the tube to drainage. Ursodeoxycholic acid is not indicated. The patient does not need to go to the emergency department. The patient will not need to have the bilirubin level checked. A patient receiving chenodiol acid for cholelithiasis has just received teaching about the medication. What statement by the patient indicates that the teaching was effective? 1 The patient should contact the health care provider if diarrhea occurs. The medication can only be taken for 2 years. The patient should take chenodiol acid with milk or food, not on an empty stomach. The patient will need to have a gallbladder ultrasound every 6 months for the first year of therapy, not 2 months. What labs should the nurse review for a patient suspected of having cholecystitis? Select all that apply. 3 Liver function, white blood cells, and alkaline phosphate are often elevated in patients with cholecystitis. Hematocrit and platelets are not often abnormal, and therefore are not diagnostic. The nurse is providing postoperative teaching to a patient scheduled for a laparoscopic cholecystectomy. What instructions should be included? 1 High-fat foods, if resumed, will need to be introduced one at a time to determine how the patient will tolerate the foods. Sutures are not used; glue and Steri-Strips are used for this procedure. The patient should be able to resume normal activities within 1 week, not 4 weeks. The patient will be able to eat regular food not long after surgery. What are risk factors for cholecystitis? Select all that apply. 1 Pregnancy, prolonged fasting, and family history of gallstones are all risk factors for cholecystitis. Men and African Americans are not at increased risk for cholecystitis. The nurse suspects that a patient may have acute pancreatitis as evidenced by which group of laboratory results? 3 Elevated lipase is more specific to a diagnosis of acute pancreatitis. Many pancreatic and nonpancreatic disorders can cause increased serum amylase levels. Bilirubin and alkaline phosphatase levels will be increased only if pancreatitis is accompanied by biliary dysfunction. Usually, calcium and magnesium will be increased and BUN increased, not decreased, in acute pancreatitis. The nurse is caring for a patient with acute pancreatitis. The patient is complaining of shortness of breath and orthopnea. The patient's vital signs are: blood pressure 140/80, pulse 110, oxygen saturation 90% on room air, and temperature 99.8° F. What complication does the nurse suspect? 3 Patients should be assessed frequently for pleural effusions and other respiratory complications. The patient has multiple symptoms of pleural effusion. The patient does not exhibit symptoms of hemorrhage, paralytic ileus, or pancreatic infection. After receiving a change-of-shift report, which patient does the nurse plan to assess
first? 1 Acute respiratory distress syndrome is a possible complication of acute pancreatitis. The dyspneic patient is at greatest risk for rapid deterioration and requires immediate assessment and intervention. The patient with cholecystitis and the patient with an elevated temperature will require further assessment and intervention, but these are not medical emergencies requiring the nurse's immediate attention. The older adult patient's glucose level will require intervention but, again, is not a medical emergency. The patient presents to the emergency department with severe abdominal pain. The nurse is reviewing the patient's lab results. What laboratory findings would prompt the nurse to suspect a diagnosis of acute pancreatitis? Select all that apply. 2 A patient with acute pancreatitis will have an increased serum amylase, decreased serum calcium, and increased alanine aminotransferase. Patients will have an increased, not decreased, bilirubin. Patients will have an increased, not decreased, serum glucose level. A patient is diagnosed with pancreatic cancer. Which is a common complication that the patient can develop? 4 The patient with pancreatic cancer is at a higher risk for developing venous emboli. This occurs because necrotic products of the pancreatic tumor have thromboplastic properties which, in turn, cause a hypercoagulable state. Decreased mobility and extensive surgical manipulation are also responsible for this infection. Dyspepsia (indigestion) and eructation (belching) are not common complications associated with pancreatic cancer. Which factors increase the risk of developing pancreatic cancer? Select all that apply. 2 Pancreatic cancer is an abnormal growth in the pancreas. Cirrhosis, cigarette smoking, and chronic pancreatitis cause chronic irritation of the pancreatic tissue, increasing the risk for pancreatic cancer. Aging and vitamin deficiencies are not risk factors associated with pancreatic cancer. A patient who
has just undergone a Whipple procedure for pancreatic cancer has frank blood and an increased output from the biliary drainage tubes. What action by the nurse is priority? 1 The surgeon should be contacted because frank blood with increasing output may indicate a disruption or leakage of the anastomosis site. Documenting the output should not be done until after the surgeon is contacted. Clamping the NG tube is not indicated. Assessing the vital signs should be done after the surgeon is contacted. Which is a priority nursing assessment for the patient with severe acute pancreatitis? 2 The majority of deaths in patients with acute pancreatitis result from irreversible shock, so the nurse should observe the patient closely for signs of shock. Pneumonia, fever, and pain may also occur, but are not immediately life threatening. A patient hospitalized with pancreatitis is being discharged with home health services.
The patient is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the patient's strength? 1 Limiting the patient's activities to one floor of the home will prevent tiring the patient with stair-climbing. Taking a PRN sleeping medication may not necessarily increase the patient's strength level or conserve strength; also, the patient may not be experiencing difficulty sleeping. Arranging for a nutritional consult or placing the patient on PRN nasal oxygen will not necessarily result in an increase in the patient's strength level or conserve strength; no information suggests that the patient has any history of breathing difficulties. The nurse is caring for a patient with chronic pancreatitis. What assessment findings are related to this disease process? Select all that apply. 2 Jaundice, polydipsia, and polyphagia are manifestations observed in chronic pancreatitis. Jaundice occurs because of chronic inflammation in the biliary tract; bile cannot drain into the small intestines. Excessive thirst (polydipsia) and an increased appetite (polyphagia) occur because the patient has chronic organ dysfunction and develops diabetes mellitus (of which both symptoms are common). Diarrhea is not a symptom of chronic pancreatitis. Weight loss occurs in chronic pancreatitis. Which symptom of chronic pancreatitis also occurs with acute pancreatitis? 2 Abdominal pain occurs with both types of pancreatitis, although pain intensity does vary between the two. Ascites, loss of exocrine function, and protein malabsorption occur only with chronic pancreatitis. Which enzyme is responsible for the release of vasoactive peptides, bradykinin, and a plasma kinin? 4 Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known as kallidin. These substances cause vasodilation and increased vascular permeability, compounding the hemorrhagic process. Lipase enzyme is involved in enzymatic fat necrosis. Trypsin activates elastase, which dissolves elastic fibers of the blood vessels and ducts. Which possible complication of chronic pancreatitis presents as a painful, palpable mass in the left upper quadrant? 4 Patients with chronic pancreatitis may develop an abscess or pseudocyst, which causes a painful, palpable mass in the left upper quadrant. Ascites produce dullness on abdominal percussion. Cholecystitis causes jaundice and biliary colic. Steatorrhea is a fatty, foul-smelling stool. A patient who has had acute mid-epigastric pain for 3 days has elevated glucose, bilirubin, serum lipase, and a threefold increase in alanine aminotransferase. The serum amylase is normal. What does the nurse suspect about the possible
cause of this patient's pain? 3 The patient has elevated glucose, bilirubin, lipase, and alanine aminotransferase, which indicate pancreatitis with hepatobiliary involvement. Serum amylase levels may have been elevated and returned to normal, since they increase in 12 to 24 hours of onset and remain elevated only 2 to 3 days. A threefold or greater rise in alanine aminotransferase indicates acute biliary pancreatitis. What dietary suggestions are indicated for a patient who is in the healing phase after acute pancreatitis? Select all that apply. 1 Patients in the healing phase after acute pancreatitis should have bland, low-fat foods and small, frequent meals. Patients should have a high, not low, carbohydrate diet and a high, not low, protein diet. The nurse is providing discharge teaching to a patient who is being discharged home after
hospitalization for acute pancreatitis. Which statement by the patient indicates a need for further teaching? 1 Patients recovering from pancreatitis should avoid caffeine, chocolate, and other gastrointestinal stimulants. Fat-soluble vitamins may be prescribed. Patients should avoid alcohol, which could trigger a return of symptoms. The diet should be high in carbohydrates and protein and low in fats. The nurse is attempting to position a patient having an acute attack of pancreatitis in the most comfortable position possible. Which position is appropriate for
this patient? 3 The side-lying position with the knees drawn up has been found to relieve abdominal discomfort related to acute pancreatitis. No evidence suggests that supine position, sitting up in a chair, or high Fowler's position have any effect on abdominal discomfort related to acute pancreatitis. A patient reports severe mid-epigastric pain radiating to the left flank and back. The nurse notes generalized jaundice and a gray-blue discoloration of the patient's abdomen and periumbilical area. The nurse suspects which cause of acute pain in this patient? 1 Patients with acute pancreatitis will have severe mid-epigastric pain that radiates to the left side and back and may have generalized jaundice and a gray-blue discoloration caused by pancreatic enzyme leakage into the cutaneous tissue. Biliary colic and cholecystitis will present with right-sided abdominal pain. Patients with gastroenteritis will have generalized discomfort. The nurse is caring for a patient diagnosed with acute pancreatitis who has had increased pain and guarding along with the following vital signs: blood pressure 108/60, pulse 125, temperature of 103.8°F, and an O 2 saturation of 95% on 2 L via nasal cannula. The nurse suspects the patient has a pancreatic abscess. After contacting the health care provider, what should the nurse do first? 4 Pancreatic drainage needs to be performed as soon as possible to prevent sepsis. Reassessing vital signs should be done after the patient is prepared for drainage. Placing the patient in a supine position is not indicated. After ensuring everything is in order for the health care provider, acetaminophen may be administered, but it is not priority. The nurse is teaching a patient with chronic pancreatitis about pancreatic-enzyme replacement therapy. Which statement by the patient indicates a correct understanding of the teaching? 4 Patients who cannot swallow pancreatic enzyme capsules may break them open and spread the contents over applesauce, mashed fruit, or rice cereal. They should be taught to drink a large amount of water to make sure the enzymes do not remain in the mouth. Mixing the enzymes with high-protein foods results in the enzymes breaking the protein down into a watery substance. Contents should not be chewed or crushed because this will destroy the delayed-release coating. When caring for a patient with pancreatic cancer who is having severe pain, which intervention is the priority? 4 High doses of opioid analgesics are given for pancreatic cancer pain without regard for drug dependency because of the poor prognosis. Reassurance, supplementation, and adjunctive pain management should all be used, but are not the top priority. The nurse is assessing a patient's alcohol intake to determine whether it is the underlying cause of the patient's attacks of pancreatitis. Which question does the nurse ask to elicit this information? 2 Asking the patient about his or her alcohol intake is the only way that will allow the patient to provide information in the patient's own words and to the extent that the patient wishes to provide it. Asking the patient if he or she binge drinks may tend to put the patient on the defensive rather than provide the desired information. It has not yet been determined whether the patient engages in binge drinking. What interventions are necessary in a patient with acute pancreatitis who is at risk for paralytic ileus? Select all that apply. 4 It is important to determine if the patient has passed gas or stool. It is also important to make sure the NG tube is functioning. Enteral feedings are not indicated in patients at risk for paralytic ileus. A saline enema would not be administered. Pain medication cannot be decreased by the nurse. The patient recently diagnosed with acute pancreatitis complains of severe pain despite intravenous narcotic pain
medication. Into which position should the nurse assist the patient in order to help decrease pain? 3 The side-lying position may decrease the abdominal pain of pancreatitis. Prone, supine, and high Fowler's positions are not indicated to decrease pain in pancreatitis. Which is the primary risk factor for chronic calcifying
pancreatitis? 1 Alcoholism is the primary risk factor for chronic calcifying pancreatitis. Cholecystitis is a risk factor for chronic obstructive pancreatitis. Metabolic disturbances and viral infection are risk factors for acute pancreatitis, not chronic calcifying pancreatitis. Which symptom presents in a patient with acute pancreatitis and indicates complications?Nausea and vomiting occur in 85% of patients. Acute pancreatitis may also present without abdominal pain but with symptoms of respiratory failure, confusion, or coma. Low-grade to moderate fever is not uncommon in acute pancreatitis. Tachycardia and hypotension, mild jaundice, and pleural effusion may be found.
Which of the following is a common complication of a patient with acute pancreatitis?Pseudocysts. Pseudocysts are sacs of fluid that can develop on the surface of the pancreas. They're a common complication of acute pancreatitis, thought to affect around 1 in 20 people with the condition.
What are the manifestations of acute pancreatitis?The most common symptoms of acute pancreatitis include: suddenly getting severe pain in the centre of your tummy (abdomen) feeling or being sick. a high temperature of 38C or more (fever)
Which of the following is the most common cause of acute pancreatitis?Gallstones — Gallstones (including microlithiasis) are the most common cause of acute pancreatitis accounting for 40 to 70 percent of cases [14]. However, only 3 to 7 percent of patients with gallstones develop pancreatitis [15,16].
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Which symptom presents in a patient with acute pancreatitis and indicates complications Quizlet
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