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What is cholecystitis?
- INFALMMATION OF THE GALLBLADDER, USUALLY RELATED TO A STONE
- aeb rt upper quad pain
How do gall stones exacerbate themselves?
- choledocholithiasis: Passage of stone
What are the risks for developing stones?
- MORE COMMON IN WOMEN BEFORE MENOPAUSE THAN MEN; BUT INCIDENCE INCREASES IN AGE IN WOMEN.
- INCIDENCE HIGHER IN NATIVE AMERICANS & WHITES.
- Familial tendency.
- Sedentary lifestyle/OBESITY.
- Impaired fat metabolism.
- Increased cholesterol/Dietary habits.
- DIABETICS, PREGNANT/MULTIPAROUS/BCP.
*Fat, fertile, 40yrs old.
What types of stones are there?
- Pigment stones
What are some concerns with cholesterol stones?
- Stones form when bile becomes supersaturated with cholesterol.
- Cholesterol crystals precipitate.
- Crystals congregate and form a hard stone.
- Inflammation can happen VERY quickly.
Usually look yellow.
Concerns for chronic cholecystitis?
- 1. Repeated bouts of acute cholecystitis
- 2. Gallstones usually present
- 3. Pancreatitis/cholangitis
- For both, #1 diagnostic is ultrasound.
- For both, increases risk for DIC?
- Can also be caused by IV drug abuse, alcoholism, et al.
Symptoms of gallbladder disease?
- Yellow stools, pain, jaundice, dark colored urine (liver failure) think obstruction.
- Murphy's Sign: Reluctance to inhale because of pain.
Where might you have refered pain for gallbladder disease?
In those in whom an inflamed tender gallbladder lies above the rib margin, the emergence of the gallbladder in inspiration may cause them to arrest inspiration when the gallbladder descends to encounter your hand compressing the right upper quadrant.
Nursing interventions for gallbladder disease?
- •GASTRIC DECOMPRESSION (Don't use water flushes. Maintaining patency can be difficult).
- •IV THERAPY (NPO)
- •ANTIEMETICS: will have n/v
- •ANALGESICS: will not tolerate pain Rx very well.
- •ANTIBIOTICS: preop, prophylactic.
- •DIET MODIFICATIONS: low fat. duh. No cheese, no chocolate.
What are some non-surgical methods for removing stones?
- •DISSOLUTION THERAPY(UROSDEOXYCHOLIC ACID): is a drug.
- •ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP): claw which goes through mouth to grab the buggers. Lt side lying.
- •LITHOTRIPSY: Ultrasonic radiation which breaks up stones into smaller chunks which can be passed. Must be prone. Not entirely painless. Will not damage other tissue. Maybe.
Route for laproscopic cholendoscopic removal of gallstones
Possible nursing diagnoses for gallbladder disease?
- FLUID VOLUME DEFICIT
- IMPAIRED SKIN INTEGRITY RELATED TO SURGICAL INCISON AND TUBES.
- INEFFECTIVE BREATHING PATTERNS/GAS EXCHANGED RELATED TO PAIN AT INCISION SITE AND ABDOMINAL DISTENTION.
- ALTERATION IN NUTRITION
- ALTERATION IN COMFORT:PAIN
- Alteration in mobility due to discomfort
Nursing interventions for impaired gas exchange?
- Airway maintenance:
- Breathing exercises