Explain the rational for the treatment of acute cholecystitits with the following interventions.

Explain the pathophysiologic changes that can cause these signs and symptoms associated with common bile duct obstruction.

A.    Clay colored stools

B.    Dark urine

C.    Steatorrhea

D.    Jaundice

E.    Pain with fatty food intake

The patient’s abdominal ultrasound reveals several stones in the common bile duct and gallbladder. He is admitted to the medical-surgical unit and placed on nothing by mouth (NPO) status and scheduled to undergo endoscopic retrograde cholangiopancreatography (ERCP) that afternoon.

6.     Explain the rational for the treatment of acute cholecystitits with the following interventions.

A.    NPO with possible NG suction

B.    Antibiotics (which route)

C.    Antispasmodics

7.     Define ERCP and indication for it based on this patient’s status.

8.     Which results are abnormal, and what do they reflect?

The patient then undergoes ERCP and the stones and bile are released, but imaging indicates a stone is still within the cystic duct and gallbladder. A surgeon was consulted and a laparoscopic cholecystectomy was ordered.

9.     List four to five preoperative orders that will likely need to be done before the patient goes to surgery.

10.  If he had a laparoscopic cholecystectomy, which discharge instruction would the nurse advise the patient: (explain the rational for the correct choice).

a.     Keep the incision areas clean and dry for at least a week

b.     Report he need to take pain medication for shoulder pain

c.     Report any bile-colored or purulent drainage from the incisions

d.     Expect some postoperative nausea and vomiting for a few days

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