Transcript Interference to Nutritional Needs Due to Degeneration and

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Cholecystitis
◦ Acute
 Cholelithiasis
 Acalculous cholecystitis
 Calculous cholecystitis
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Pathophysiology
◦ Abnormal metabolism of cholesterol and bile salts
◦ Decreased gallbladder-emptying rates
◦ Changes in bile concentration or bile stasis w/in
gallbladder
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Cholangitis
◦ Ascending
◦ supporative
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Chronic cholecystitis
◦ Repeated episodes
◦ Complications of pancreatitis and cholangitis
◦ S/S: jaundice, pruritus, clay-colored stools, dark
urine
◦ Risk factors: Genetic relationship, cholesterollowering meds, age (>60), type I DM, rapid wgt
loss, low-calorie or liquid protein diets, etoh abuse,
white women, Native Americans, Mexican American,
pregnancy (to name but a few-your book has more)
◦ Assessment – see key features of cholecystitis chart
63-1
◦ Lab tests: nothing specific for gallbladder disease,
tests look for ruling out other diseases.
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Interventions
◦ Diet therapy (see table 63-1)
◦ Drug therapy – pain, antiemetics
◦ Percutaneous Transhepatic Biliary Catherization
 Under fluoroscopy
 Used for inoperable situations or for unstable high risk
surgical candidates
◦ Surgery – laparoscopic most common now
 Same day surgery
 Short recovery period
 Back to normal activities in 1-3 weeks
◦ Traditional method for cholecystectomy
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Far greater chance for complications
Need for T-tube, JP drains (see chart 63-2 and 3)
Slower recovery
May require home visits by RN
Risk for postcholecystectomy syndrome
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Acute
◦ Necrotizing form dangerous, high mortality
◦ Understand endocrine and exocrine functions of the organ
(great chart pg 1403, figure 63-2)
◦ Complications
 See table 63-2
 Why might you see these problems occur? Understand the
pathophysiology of what happens.
◦ Risk factors – etoh most common followed by obstruction
◦ Physical assessment
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Jaundice
Cullen’s sign
Turner’s sign
No bowel sounds
Rigid abdomen = perforation, peritonitis
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Labs
◦ Amylase – when is it helpful, accurate to dx?
◦ Lipase – more specific, more accurate.
◦ Other tests to dx biliary obstruction (note that these
don’t indicate pancreatitis)
◦ Tests done to identify fat necrosis
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Interventions
◦ Nonsurgical
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Resting the bowel, TPN
Meds: pain control, give gi tract chance to rest
Comfort measures
ERCP – when is this done?
◦ Surgical
 Laparoscopic cholecystectomy
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Chronic
◦ The acute form done over and over and over again
◦ Type is defined by why the patient gets the attack
 Calcifying pancreatitis – etoh
 Obstructive pancreatitis – guess
◦ Does the chronic form of the disease have the same
manifestations as the acute form? What is the
same, what is different?
◦ How is your nursing care changed when dealing
with the chronic form vs the acute form?
◦ See chart 63-8 for prevention of exacerbations
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Term includes both gastric and duodenal ulcers
Too much acid, violation in integrity of mucous
coating over stomach wall, H. pylori
What are those things that cause acid to be
secreted? These are the things you need to teach
your patient about re: change in lifestyle.
Complications
◦ Hemorrhage
 How can you tell an upper gi bleed from a lower gi bleed?
An old bleed from a fresh one?
 Perforation
 Pyloric obstruction – not common
 Intractable disease
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Risk factors
◦ Nsaid usage, theophylline (when is this used?), steroids
(remember these pesky little buggers?)
◦ Genetics
◦ H. pylori
◦ Caffeine products, lots and lots of them
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Physical assessment – see chart 59-4
◦ Dyspepsia (another word for your vocab.)
◦ Pain: upper epigastrium with localization to L of midline
relieved with food; R of epigastrium 90 min. to 3 hours
after eating.
 Exacerbating foods, meds.
◦ Vomiting
◦ Orthostatic bp changes
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Labs
◦ H&H
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Dx tests
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EGD
IgG serologic testing
Urea breath test
Stool test
Interventions – see chart 59-5
◦ Drug therapy – what are the differences btwn these?
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Antibiotics
Proton pump inhibitors
H2 receptor antagonists
Prostaglandin analogues
Antacids
Mucosal barrier fortifiers
◦ Diet therapy
◦ Alternative medicine
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Nonsurgical management
◦ Endoscopic therapy
◦ Acid suppression (didn’t we already cover this?)
 Add somatostatin to your med list
◦ NG tube (what’s the difference btwn using this for an
ulcer vs to treat pancreatitis?)
◦ Saline lavage
◦ Management of perforation
◦ Management of obstruction
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Surgical management
◦ Gastrectomy
◦ Gastroenterostomy
◦ Vagotomies
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Dumping syndrome – see diet table 59-2
Reflux gastropathy
Delayed gastric emptying
Afferent loop syndrome
Recurrent ulceration
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You had care of the surgical patient back in
Nursing 2. If you need to review that material
to refresh it, you had best do so.
See chart 59-7 for home care assessment
What do you need to teach this person now
that they have had surgery?
Can you figure out how all of these diseases
are linked? If so, you will know how I will
approach teaching this material in class.