Assignment: Assessment and Management of Patients with Biliary Disorders
Assignment: Assessment and Management of Patients with Biliary Disorders
Case Study 1
- What additional procedure will be performed if the common bile duct is obstructed by a gallstone?
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)will be conducted to allow radiographic visualization of Bile ducts (El Nakeeb et al., 2015). It is an invasive procedure which involves the insertion of a lighted endoscope into the mouth through the esophagus into the stomach then to the duodenum (El Nakeeb et al., 2015). The procedure enables visualization of the GI, including the presence of gallstones in the duodenum. ERCP facilitates removal of gallstones using a balloon attached at the end of the endoscope (El Nakeeb et al., 2015).
- The nurse in the same-day surgery unit provides the discharge instructions to the patient and family before the patient goes for surgery, so the patient is fully awake to receive the instructions and ask questions. What written and verbal instructions should the nurse provide?
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The nurse should inform the patient that she will experience some level of discomfort around the port site postoperatively
(Balachandran et al., 2017). Written instruction on postoperative signs and symptoms for complications should be provided, such as fever, extreme pain on port sites, and uncontrolled vomiting (Balachandran et al., 2017). She should be informed to seek immediate care if she notices any of the symptoms. The patient should be informed and given written instructions that she should return for a follow-up visit after one week for postoperative assessment.
Case Study 2
- Blood and urine samples are sent to the lab, and the results indicate that the serum amylase and lipase are markedly elevated. How do these findings correlate to the diagnosis of acute pancreatitis?
Serum amylase and lipase levels are generally elevated in individuals with acute pancreatitis. Amylase and lipase levels at least three-fold above the reference range are considered a diagnostic of Acute Pancreatitis (Meher et al., 2015). The Amylase P levels are more specific for pancreatic pathology.
- Harrison develops hypocalcemia secondary to acute pancreatitis. What nursing interventions should the nurse implement related to this complication?
Calcium plays a crucial function in normal body functioning and is vital in the maintenance of fluid and electrolytes. Nursing interventions for the patient with hypocalcemia should include performing continuous cardiac monitoring to assess for tachycardia, bradycardia, S gallop, or signs of heart failure. There should be close monitoring of the respiratory status for the presence of inspiratory or expiratory wheeze (Schafer & Shoback, 2016).
Assignment: Assessment and Management of Patients with Biliary Disorders
The patient should be assessed for signs of neuromuscular excitability such as tetany, Chvostek’s signs, and Trousseau’s signs (Schafer & Shoback, 2016). The nurse should initiate Calcium replacement, either orally or intravenously. For oral Calcium therapy, the nurse should administer Vitamin D to facilitate absorption (Schafer & Shoback, 2016). For intravenous Calcium, the nurse should closely monitor the patient for the presence of phlebitis. Lastly, the nurse should educate the patient on foods high in Calcium and encourage him to increase consumption of these foods.