Question Answered step-by-step CONCEPT: DIGESTION TOPIC: Choledocholithiasis Ms. G is a married… CONCEPT: DIGESTIONTOPIC: Choledocholithiasis Ms. G is a married woman who is admitted to your unit from the emergency department (ED). On arrival, you note that she is trembling and nearly doubled over severe abdominal pain. Ms. G indicates that she has severe pain in the right upper quadrant (RUQ) of her abdomen that radiates through to her mid back as a deep, sharp, boring pain. She is more comfortable walking or sitting bent forward rather than lying flat in bed. She admits to having had similar bouts of abdominal pain in the last month, but “none as bad as this.” She feels nauseated but has not vomited although she did vomit 3 days ago with a similar episode. Ms. G experienced an acute onset of pain after eating fried fish and chips at a fast-food restaurant earlier today. She is not happy to be in the hospital and she is grumpy that her daughter insisted on taking her to ED for evaluation.After orienting her to the room, you perform physical assessment. The findings are as follows: She is awake, alert, and oriented x 3, and she moves all her extremities well. She is restless, constantly shifting her position, and complains of fatigue. Breath sounds are clear to auscultation. Heart sounds are clear with no murmur or rub noted and with a regular rhythm. Her abdomen is slightly distended, slightly rigid, and very tender to palpation throughout, especially in the RUQ; bowel sounds are present. She reports having light-colored stools for 1 week. The client voids dark amber urine but denies dysuria. Skin and sclera are jaundiced. Admission vital signs are blood pressure 155/101 mm Hg, pulse of 117 betas/min, respiration of 23 breaths/min, and temperature of 100.2oF (37.8oC), SpO2 of 95% on 2 L of oxygen via nasal cannula.What structures are located on RUQ? When performing pain assessment, how do you assess the pain using the PQRST method?  Apply it here in this case.PQRST Ms. G’s abdominal ultrasound demonstrates several retained stones in the common bile duct and a stone-filled gallbladder. Ms. G is admitted to your floor, placed on nothing by mouth (NPO) status, and scheduled to undergo endoscopic retrograde cholangiopancreatography (ERCP). Describe ERCP and its purpose on Ms. G’s situation? Laboratory Test Results WBC                                                                                                                      12,800/mm3Hgb                                                                                                                         13.6 g/dLHct                                                                                                                          41%Platelets                                                                                                                  180,000/mm3ALT                                                                                                                          220 units/LAST                                                                                                                          275 units/LALP                                                                                                                          490 units/L Total bilirubin                                                                                                            5.1 mg/dLPT/INR                                                                                                                     13 sec/1.0Amylase                                                                                                                    52 units/LLipase                                                                                                                       25 units/LUrinalysis                                                                                                                  negative Interpret the laboratory test results.  What could be the clinical significance of those abnormal laboratory findings based on the client’s current condition? Ms. G undergoes the ERCP, and stones and bile are released; however, imaging reveals that a stone is still retained within the cystic duct and multiple stones remained within the gallbladder itself. A surgical consultation is obtained, and a laparoscopic cholecystectomy is planned. Identify preoperative preparations or orders that will likely need to be completed before Ms. G goes for surgery. (List at least 6).A.B.C.D.E.F. Ms. G undergoes a successful laparoscopic cholecystectomy the next morning. An intraoperative cholangiogram shows that the ducts are finally cleared of stones at the conclusion of the surgery. When she returns to the nursing unit, her stomach is soft but quite distended. Her daughter asks you whether anything is wrong. She also has an order for imipenem/cilastatin (Primaxin) 500 mg IV now, then every 6 hours  x 2 doses.   How will you respond to her question? Before you give the antibiotic, what will you assess?A.B.C.D. The next day, you prepare for the first dressing change as ordered by the surgeon. When you remove the tape the next day to change the dressing, you note that the skin is red and blistered underneath. Otherwise, she is doing well, her vitals are 125/77 mm Hg, heart rate of 74, respiratory rate of 16, and a temperature of 99.8oF (37.7oC), and SpO2 of 97% on room air. She even tolerated a light breakfast. To protect the blistered area from further damage, you apply a hydrocolloid dressing to the damaged skin.  What has Ms. G experienced, and what are the benefits of using a hydrocolloid dressing? What discharge teaching does Ms. G need?A.B.C.D.E.F. What are the most common complications that can occur after surgery? Please complete the table below.Postoperative ComplicationsAssessmentTreatmentNursing ResponsibilityDVT/PEcalf swelling, pain, rednessanticoagulantearly ambulation, sequential compression device                          Health Science Science Nursing Share QuestionEmailCopy link Comments (0)

Question Answered step-by-step CONCEPT: DIGESTION TOPIC: Choledocholithiasis Ms. G is a married… CONCEPT: DIGESTIONTOPIC: Choledocholithiasis Ms. G is a married woman who is admitted to your unit from the emergency department (ED). On arrival, you note that she is trembling and nearly doubled over severe abdominal pain. Ms. G indicates that she has severe pain in the right upper quadrant (RUQ) of her abdomen that radiates through to her mid back as a deep, sharp, boring pain. She is more comfortable walking or sitting bent forward rather than lying flat in bed. She admits to having had similar bouts of abdominal pain in the last month, but “none as bad as this.” She feels nauseated but has not vomited although she did vomit 3 days ago with a similar episode. Ms. G experienced an acute onset of pain after eating fried fish and chips at a fast-food restaurant earlier today. She is not happy to be in the hospital and she is grumpy that her daughter insisted on taking her to ED for evaluation.After orienting her to the room, you perform physical assessment. The findings are as follows: She is awake, alert, and oriented x 3, and she moves all her extremities well. She is restless, constantly shifting her position, and complains of fatigue. Breath sounds are clear to auscultation. Heart sounds are clear with no murmur or rub noted and with a regular rhythm. Her abdomen is slightly distended, slightly rigid, and very tender to palpation throughout, especially in the RUQ; bowel sounds are present. She reports having light-colored stools for 1 week. The client voids dark amber urine but denies dysuria. Skin and sclera are jaundiced. Admission vital signs are blood pressure 155/101 mm Hg, pulse of 117 betas/min, respiration of 23 breaths/min, and temperature of 100.2oF (37.8oC), SpO2 of 95% on 2 L of oxygen via nasal cannula.What structures are located on RUQ? When performing pain assessment, how do you assess the pain using the PQRST method?  Apply it here in this case.PQRST Ms. G’s abdominal ultrasound demonstrates several retained stones in the common bile duct and a stone-filled gallbladder. Ms. G is admitted to your floor, placed on nothing by mouth (NPO) status, and scheduled to undergo endoscopic retrograde cholangiopancreatography (ERCP). Describe ERCP and its purpose on Ms. G’s situation? Laboratory Test Results WBC                                                                                                                      12,800/mm3Hgb                                                                                                                         13.6 g/dLHct                                                                                                                          41%Platelets                                                                                                                  180,000/mm3ALT                                                                                                                          220 units/LAST                                                                                                                          275 units/LALP                                                                                                                          490 units/L Total bilirubin                                                                                                            5.1 mg/dLPT/INR                                                                                                                     13 sec/1.0Amylase                                                                                                                    52 units/LLipase                                                                                                                       25 units/LUrinalysis                                                                                                                  negative Interpret the laboratory test results.  What could be the clinical significance of those abnormal laboratory findings based on the client’s current condition? Ms. G undergoes the ERCP, and stones and bile are released; however, imaging reveals that a stone is still retained within the cystic duct and multiple stones remained within the gallbladder itself. A surgical consultation is obtained, and a laparoscopic cholecystectomy is planned. Identify preoperative preparations or orders that will likely need to be completed before Ms. G goes for surgery. (List at least 6).A.B.C.D.E.F. Ms. G undergoes a successful laparoscopic cholecystectomy the next morning. An intraoperative cholangiogram shows that the ducts are finally cleared of stones at the conclusion of the surgery. When she returns to the nursing unit, her stomach is soft but quite distended. Her daughter asks you whether anything is wrong. She also has an order for imipenem/cilastatin (Primaxin) 500 mg IV now, then every 6 hours  x 2 doses.   How will you respond to her question? Before you give the antibiotic, what will you assess?A.B.C.D. The next day, you prepare for the first dressing change as ordered by the surgeon. When you remove the tape the next day to change the dressing, you note that the skin is red and blistered underneath. Otherwise, she is doing well, her vitals are 125/77 mm Hg, heart rate of 74, respiratory rate of 16, and a temperature of 99.8oF (37.7oC), and SpO2 of 97% on room air. She even tolerated a light breakfast. To protect the blistered area from further damage, you apply a hydrocolloid dressing to the damaged skin.  What has Ms. G experienced, and what are the benefits of using a hydrocolloid dressing? What discharge teaching does Ms. G need?A.B.C.D.E.F. What are the most common complications that can occur after surgery? Please complete the table below.Postoperative ComplicationsAssessmentTreatmentNursing ResponsibilityDVT/PEcalf swelling, pain, rednessanticoagulantearly ambulation, sequential compression device                          Health Science Science Nursing Share QuestionEmailCopy link Comments (0)